Dr. Smith's ECG Blog

JANUARY 2, 2025

By Smith with comments from our electrophysiologist, Rehan Karim. (And of course Ken's comments at the bottom) An elderly obese woman with cardiomyopathy, Left bundle branch block, and chronic hypercapnea presented hypoxic with altered mental status. She was intubated. Bedside cardiac ultrasound showed moderately decreased LV function. CT of the chest showed no pulmonary embolism but bibasilar infiltrates.

EKG/ECG 122

EKG/ECG Sepsis Wellness Documentation/Coding 122

Sensible Medicine

JANUARY 23, 2025

Two health obsessions that I’ve never really understood are the supposed benefits of vitamin D (for every imaginable ill) and harm of seed oils. Dr. Bobby Dubois thinks a lot about the evidence behind health recommendations on his podcast. His research has led him to a pretty clear opinion about the role of seed oils in health and disease. Attentive Sensible Medicine readers will note that his take is a bit different from that expressed in a recent post.

Wellness 113

Wellness Stroke Research 113

St. Emlyn

JANUARY 2, 2025

St.Emlyn's - Emergency Medicine #FOAMed This feasibility study described the delivery of ECMO CPR (ECPR) for the first time in the UK The post Pre Hospital Extracorporeal CPR (ECPR) in the UK: The Sub30 study appeared first on St.Emlyn's.

CPR 141

CPR Hospitals Resuscitation 141

EM Ottawa

JANUARY 9, 2025

In the acute care setting, steroids have various usages and indications, but their usage can often be nuanced. From adrenal crises to septic shock, severe community-acquired pneumonia, and even acute pharyngitis, steroids play a pivotal role in managing a variety of conditions encountered in the Emergency Department (ED). However, their use is far from straightforwardbalancing […] The post These are the ‘Roids you are looking for – Steroids in the ED appeared first on EMOttawa

Shock 120

Shock Emergency Department Infectious Diseases Sepsis 120

Speaker: Dr. Christine Gall, DrPH, MS, BSN, RN

The promise of virtual care is no longer theoretical and is now a critical solution to many of healthcare’s most urgent challenges. Yet many healthcare leaders remain unsure how to build a business case for investment and launching the right program at the right time can be the difference between value and failure. For organizations seeking a financially sound, clinically effective entry point, Virtual Patient Observation (VPO) offers a compelling case to lead with.

Operations

ACEP Now

JANUARY 5, 2025

Its 4 a.m., and youre three hours from the nearest tertiary care center. A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. On exam, you see bright red blood trickling down her left tonsillar fossa. Her vital signs are normal, except for a heart rate of 115 bpm. Its going to take time to get her to a tertiary center.

Airway Management 98

Airway Management Operations Resuscitation Pediatrics 98

Emergency Medicine Cases

JANUARY 7, 2025

Dr. Patricia Lee is an EM physician in Calgary, Alberta and an Assistant Professor at the University of Calgary in the Department of Emergency Medicine. She reached out to me after listening to Episode 200 How EM Experts Think Part 1 as a longtime supporter of EM Cases, to highlight the importance of recognizing challenges that female-identifying EM physicians may face before, during and after ED shifts.

EMS 118

EMS Leadership Resuscitation 118

Sensible Medicine

JANUARY 3, 2025

Doctors of a certain age tend to fetishize the physical exam. I think this is because learning the physical exam is an important part of the socialization of the doctor. It is also a skill that doesn’t really wither with time. Though with every passing day I feel more and more like part of the old guard, I can only give the exam a tepid defense.

Urgent Care 117

Urgent Care Ultrasounds Wellness 117

EMDocs

JANUARY 8, 2025

Authors: Lloyd Tannenbaum, MD (EM Attending Physician, Geisinger Wyoming Valley, PA); Mai Saber, DO (EM Attending Physician, Hackensack University Medical Center, NJ); Rachel Bridwell, MD (EM Attending Physician, Charlotte, NC) // Reviewer: Brit Long, MD (@long_brit) Hello and welcome back to ECG Pointers, a series designed to make you more confident in your ECG interpretations.

EKG/ECG 94

EKG/ECG EMS Academics Emergency Department 94

EM Ottawa

JANUARY 13, 2025

Methodology: 4/5 Usefulness: 4/5 Vallentin MF, et al. N Engl J Med. 2024 Oct 31. doi: 10.1056/NEJMoa2407616. Editorial: The Way to a Patient’s Heart – Vascular Access in Cardiac Arrest Question and Methods: This RCT compared IO vs. IV vascular access in adults with OHCA, using ROSC as a primary outcome. Findings: No significant difference […] The post Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest appeared first on EMOttawa Blog.

Hospitals 117

Hospitals Outcomes Resuscitation 117

Emergency Medicine Journal

JANUARY 21, 2025

Trauma remains a significant cause of mortality and morbidity. Non-compressible torso haemorrhage is one of the key drives of these mortality data. Our contemporary management has focused on damage control resuscitation, with a focus on haemorrhage control, haemostatic resuscitation and permissive hypotension. The evidence for permissive hypotension lacks the robustness as other treatments, such as tranexamic acid.

Resuscitation 91

Resuscitation 91

Speaker: Simran Kaur, Co-founder & CEO at Tattva.Health

AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!

Outcomes

Emergency Medicine Cases

JANUARY 28, 2025

On this month's EM Quick Hits podcast: Anand Swaminathan on optimizing RSI medication timing, Brittany Ellison ED boarding challenges in older patients and solutions to ED crowding and flow, Dave Jeromeon managing prolonged tourniquet application, Nour Khatib and Phil Gillick on a rural peer support case, Jesse McLaren on ECG reciprocal changes in acute coronary occlusion, and Melody Ngon practical nutrition tips for shift workers.

EMS 103

EMS EKG/ECG Resuscitation 103

St. Emlyn

JANUARY 6, 2025

St.Emlyn's - Emergency Medicine #FOAMed How does pre-hospital emergency anaesthesia (PHEA) delivered by Helicopter Emergency Medical Services (HEMS) impacts trauma care timelines compared to emergency department RSI (EDRSI). This retrospective study explores time efficiency, injury severity, and patient outcomes, highlighting the role of HEMS in delivering critical care to severely injured patients in remote locations.

Emergency Department 98

Emergency Department Outcomes Hospitals 98

Sensible Medicine

JANUARY 30, 2025

A limited mask mandate is returning to my state this week. In 2023, the Maryland Department of Health (DOH) adopted a standard for return to universal masking in healthcare facilities when hospitalizations with respiratory viruses (covid, influenza, or RSV) reach a level of 10 cases per 100,000 population. Maryland has a population of 6.3 million and about 10,000 licensed hospital beds, so that works out to about 6% of hospital beds.

CDC 108

CDC Hospitals Academics 108

EMDocs

JANUARY 11, 2025

Author: Christopher Blanton, MD, MBA (EM Resident, UTSW / Dallas, TX); Joslin Gilley-Avramis, MD (EM Attending Physician, UTSW / Parkland Memorial Hospital) // Reviewed by: Sophia Grgens, MD (EM Physician, BIDMC, MA); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics.

EMS 94

EMS Sepsis Shock Fluid Resuscitation 94

EB Medicine

JANUARY 7, 2025

In this episode, Sam Ashoo, MD interviews Nicholas Stark, MD, MBA & Zaid Altawil, MD about the Emergency Medicine Innovation Collaborative 1. Discussion on EMIC - Overview of the collaborative - Background and formation during the pandemic in late 2021 2. Growth of EMIC - Expansion from three members to over 500 - Focus areas: Education, mentorship, opportunity 3.

EMS 87

EMS 87

Emergency Medicine Journal

JANUARY 21, 2025

This month’s update is by the Emergency Department of the University Hospital of Heraklion, Crete, Greece. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlighted each paper’s main findings, key limitations and clinical bottom line.

Emergency Department 98

Emergency Department Hospitals Outcomes 98

ECG Guru

JANUARY 30, 2025

In this 12-lead ECG there is a bradycardic rhythm, which is regular, heart rate about 45 bpm. The QRS complexes are narow. What is this rhythm called? There are no P waves present, and no flutter or fibrillation waves can be seen. There are 2 possibilities: 1. There is a sinus arrest with a junctional escape rhythm. The junctional rhythm either cannot conduct retrograde to the atria (therefore no inverted retrograde P wave can be seen) or the retrograde P wave is hidden in the QRS complex (atria

EKG/ECG 95

EKG/ECG 95

St. Emlyn

JANUARY 7, 2025

St.Emlyn's - Emergency Medicine #FOAMed Mastering likelihood ratios can transform your diagnostic skills. In this podcast with Rick and Greg, discover how likelihood ratios can enhance decision-making and improve patient care. The post Podcast – Likelihood Ratios: Critical Appraisal Nugget 12 appeared first on St.Emlyn's.

Research 117

Research 117

The Bottom Line

JANUARY 30, 2025

Antibiotic Treatment for 7 versus 14 Days in Patients with Bloodstream Infections BALANCE Investigators. NEJM 2024; DOI: 10.1056/NEJMoa2404991 Clinical Question In hospitalised patients with bloodstream infections (BSI), is antibiotic treatment for 7 days, compared to treatment for 14 days, non-inferior with respect to mortality at 90 days?

95

95

EMDocs

JANUARY 25, 2025

Authors: Michael Sperandeo, MD (Assistant Professor, Dept of Emergency Medicine, Long Island Jewish Medical Center, Associate Program Director EMSL Medical Simulation Fellowship, Zucker School of Medicine at Hofstra/Northwell); Sophia Grgens, MD (EM Physician, BIDMC, MA) // Reviewed by: Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Brit Long, MD (@long_brit); Alex Koyfman, MD (@EMHighAK) Welcome to EM@3AM, an emDOCs series designed to foster your wo

EMS 87

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 87

EB Medicine

JANUARY 25, 2025

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the January 2025 Emergency Medicine Practice article, Alkali Exposure: An Evidence-Based Approach to Diagnosis and Treatment Patient Demographics and Case Scenarios: Types of patients prone to alkali exposure Causes and scenarios leading to alkali exposure (e.g., accidental, intentional, social media challenges) Poison control reports and statistics Types and Effects of Exposure: Different types of exposure: ingestion, ocular, dermal Eff

Poisoning 84

Poisoning EKG/ECG Airway Management Resuscitation 84

EM Literature of Note

JANUARY 16, 2025

This little article has made the rounds, primarily by those who critique it for its many flaws. However, the underlying themes can still be valid, even if an article has limitations. This is a “there is variation in emergency physician admitting practices” article. Literally every practicing physician working in a hospital environment knows there is a broad spectrum of skill, approach to acute illness, and level of risk-tolerance.

Outcomes 77

Outcomes Radiology Radiology Emergency Department 77

American Medical Compliance

JANUARY 1, 2025

Restorative nursing is an essential pillar of healthcare, dedicated to helping patients regain and maintain their physical and psychological well-being. With approximately 12.2% of adults in the United States facing mobility challenges, according to the CDC, the demand for effective restorative care has never been greater. For healthcare providers, these programs go beyond improving patient outcomesthey create a holistic and supportive care environment.

CDC 105

CDC Best Practices Wellness Stroke 105

St. Emlyn

JANUARY 6, 2025

St.Emlyn's - Emergency Medicine #FOAMed How does pre-hospital emergency anaesthesia (PHEA) delivered by Helicopter Emergency Medical Services (HEMS) impacts trauma care timelines compared to emergency department RSI (EDRSI). The post Prehospital Emergency Anaesthesia (PHEA) vs. Emergency Department RSI: A Comparative Study on Trauma Care Timelines and Outcomes appeared first on St.Emlyn's.

Emergency Department 100

Emergency Department Outcomes Hospitals 100

Northwestern EM Blog

JANUARY 14, 2025

Written by: Sasha Becker, MD (NUEM 27) Edited by: Mara Bezerko (NUEM 25) Expert Commentary by : Aaron Wibberley, MD Expert Commentary This is a very nice summary by Dr. Becker and Dr. Bezerko of a troublesome-appearing rhythm occasionally encountered in the emergency department. Thankfully, the majority of presentations are benign. Our role as emergency providers is to risk-stratify for, or rule out, dangerous underlying etiologies of AIVR.

Emergency Department 98

Emergency Department Wellness 98

Emergency Medicine Cases

JANUARY 7, 2025

In this Part 2 of our 2-part podcast series on How EM Experts Think with Dr. Reuben Strayer, Dr. Mike Betzner and Dr. Scott Weingart we dive deep into the nuances of practicing smarter, faster, and better in the ED. We answer questions like: How should we employ hypothetico-deductive reasoning in our daily practice of Emergency Medicine? How can we best streamline thorough data gathering for each case so that we don't miss key data points?

Documentation/Coding 102

Documentation/Coding EMS 102

EMDocs

JANUARY 1, 2025

Authors:Brit Long, MD ( @long_brit EM Attending Physician, San Antonio, TX);Manpreet Singh, MD ( @MPrizzleER Assistant Professor of Emergency Medicine / Department of Emergency Medicine Harbor-UCLA Medical Center); andAlex Koyfman, MD ( @EMHighAK EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital) Happy New Year, and thank you for everything you do!

Sepsis 74

Sepsis EMS EKG/ECG Hospitals 74

ALiEM

JANUARY 13, 2025

A 55-year-old female presented with the complaint of my right eye popped out. Symptoms started approximately seven hours prior to arrival and progressive, severe pain eventually prompted her visit to the ED. This happened once 10 years ago, requiring reduction in the ED. The patient denied preceding trauma, rubbing her eyes/eye-lids, or any history of thyroid disease.

Academics 67

Academics Emergency Department 67

American Medical Compliance

JANUARY 8, 2025

Nursing homes should serve as sanctuaries of care, compassion, and safety for the elderly and vulnerable. Yet, abuse within these settings remains a pervasive and often hidden crisis, impacting countless individuals worldwide. Alarmingly, approximately 1 in 6 individuals aged 60 or older have experienced some form of abuse in community settings, including nursing homes, according to the World Health Organization (WHO).

Incident Reporting 105

Incident Reporting Documentation/Coding Dehydration Burns 105

St. Emlyn

JANUARY 14, 2025

St.Emlyn's - Emergency Medicine #FOAMed The monthly update podcast from November 2024, including learning culture, chest drains in haemothorax, arterial lines in cardiac arrest and bad behaviour. The post Podcast – Monthly Round Up November 2024 – Learning culture, chest drains, arterial lines and more appeared first on St.Emlyn's.

Resuscitation 97

Resuscitation 97

Dr. Smith's ECG Blog

JANUARY 21, 2025

I was reading ECGs on the system and saw all of these, from one patient. I read them without clinical context and looked at the clinical context later. A 70-something dialysis patient presented and coronary disease had missed dialysis and then presented with acute onset of shortness of breath. He denied chest pain. There was mild hypoxia prehospital, lowest saturation 90%, On arrival, BP was 140/84, pulse 122, O2sat 100% and the patient had increased work of breathing.

EKG/ECG 66

EKG/ECG Hospitals Wellness 66

Emergency Medicine Journal

JANUARY 21, 2025

A short systematic review was undertaken to assess whether intradermal sterile water injections (ISWI) provide effective pain relief in adult patients presenting to the Emergency Department (ED) with renal colic. MEDLINE, Embase, Cochrane and Google Scholar databases were searched, identifying seven relevant studies. Study information, patient characteristics, key results and methodological weaknesses were tabulated.

Emergency Department 52

Emergency Department Research 52

EMDocs

JANUARY 4, 2025

We always work hard, but we may not have time to read through a bunch of journals. Its time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: PARAMEDIC-3 and IVIO RCTs IO vs IV Epinephrine for OHCA Spoon Feed Two large studies randomizing patients with out-of-hospital-cardiac arrest (OHCA) to either an intraosseous (IO) or intravenous (IV) first approach

Ultrasounds 97

Ultrasounds Shock Pediatrics Administration 97

ALiEM

JANUARY 10, 2025

A 3-month-old male with no past medical history was brought to the emergency department for evaluation of newly asymmetric pupils. The infant appeared to be asymptomatic per parents, without any behavior changes or associated symptoms noted. The patients mother noticed her sons left pupil was dilated and unresponsive to light the morning of presentation.

Pediatrics 64

Pediatrics Academics Documentation/Coding Emergency Department 64

The Evolution & Medicine Review

JANUARY 28, 2025

Oxygen is essential for human life, yet a growing body of preclinical research is demonstrating that chronic continuous hypoxia can be beneficial in models of mitochondrial disease, autoimmunity, ischemia, and aging. This research is revealing exciting new and unexpected facets of oxygen biology, but translating these findings to patients poses major challenges, because hypoxia can be dangerous.

Research 52

Research 52