JEMS

JULY 2, 2025

Then, logroll back to the ED cart and back to the ED they would go, sans spine board. References 1. Berg G, Nyberg S, Harrison P, Baumchen J, Gurss E, Hennes E. 2013 Dec;13(12):1801-8. Epub 2013 Jun 29. Barnhard By Roy Danks, DO It’s time to decommission the long spine board. Prehosp Emerg Care.

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Mobile Integrated Health E-9-1-1 EMT EMT 98

EMDocs

JULY 21, 2025

SCAPE defining features: 1) rapid onset of respiratory distress (<4-6 hours); 2) pulmonary edema with severe dyspnea; 3) abdominal vital signs with SBP > 160 and/or > 120, hypoxic, tachypneic, tachycardic; 4) critically ill, evidence of pulmonary edema. In ED population, diuretics have not demonstrated clear benefit in mortality.

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JEMS

JUNE 12, 2025

1 Many of these approvals represent entirely new drug classes or treatment approaches. 9 Still, some educators worry that reliance on technology could erode hands-on problem-solving. 8-9 The future of medicine will be digital, personalized, and AI-enabled. References 1. Mercier, E., van de Garde, E.

Mobile Integrated Health 98

Mobile Integrated Health E-9-1-1 EMS EMT 98

REBEL EM

FEBRUARY 24, 2025

1 They noticed how spontaneously breathing patients had their IVC collapse with inspiration; and ventilated patients had their IVC dilate during positive pressure ventilation. You need not be sad regarding the lack of Swan Ganz catheters in your ED. Oct 2013; PMID: 24079262 Gohar E, et al. So, what is in your grab bag?

ALS 64

ALS E-9-1-1 Critical Care OR 64

EMDocs

MARCH 24, 2025

The syphilis and trichomonas tests come back negative in the ED, but his rapid HIV test is positive. How should clinicians approach the diagnosis and management of HIV in the ED? 9 Historically, the management of HIV and its complications was primarily the domain of primary care and infectious disease (ID) specialists.

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EMDocs

FEBRUARY 22, 2025

Answer : CSF Leak Epidemiology: CSF leaks are broken into three main causes Craniofacial trauma: approximately 80% of cases 1 3% of blunt head and 9% of penetrating head trauma patients have CSF leaks Basilar skull fractures commonly occur with CSF leaks (up to 30%) Iatrogenic: approximately 16% of cases 1 3.8% Epub 2021 Sep 9.

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EMDocs

MAY 31, 2025

Physical exam: Appears thin with dry mucous membranes Abdomen is soft, nondistended, and mildly tender diffusely Ulcers present on the uvula and soft palate Labs: WBC 21 10 9 /L, HGB 7.1 Vital signs reveal normothermia, normotension, borderline tachycardia, O2 saturation of 100% on RA, normal respiratory rate, and a weight of 48kg.

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Dr. Smith's ECG Blog

JANUARY 16, 2020

A man in his early sixties with palpitations An elderly patient with a fall, QS-waves, and ST E. A 20-something woman with Chest Pain Eric Abrams case A woman in her 50s with dyspnea and bradycardia Where is the focus of this tachycardia? Ventricular Fibrillation, ROSC after perfusion res. This middle-aged patient presented with SOB, weakn.

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Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. Initially tested in Johannesburg, South Africa: 1 month old to 12 years old Broselow predicted within 10% of weight in 63.6% 2020;13(1):9.

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ALiEM

MARCH 7, 2024

Ultrasound probes from left to right: linear (nenoates), phased array (infants/younger children), and curvilinear (older children/adolescents) Pro tips for performing renal/bladder POCUS on a child [1] Addressing potential anxiety leads to a more efficient and comfortable examination. Estimated volume = 39.2

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REBEL EM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

ED 116

ED E-9-1-1 Emergency Department ALS 116

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. Challenge QUESTION: The relative change in T-QRS-D is not the only thing that changes during period of time that passed between recording of the 2 ECGs shown in Figure-1.

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Broome Docs

MAY 31, 2024

Do we need to intubate French drunkards in ED? 2013 Sep;24(9):1848-53. Epub 2013 Jul 17. 2023 Nov 28;27(1):465. 2024 Apr 1:e240167. 2023 Sep 8;9(1):73. 117(1) 36–41 DOI: 10.1177/01410768231207260 This is a fascinating read about the history of the humble placebo in science. Psychol Sci.

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EMDocs

NOVEMBER 21, 2023

In ED, repeat potassium level was 2.6 Epidemiology: Prevalence of hypoPP is approximately 1 per 100,000. Permanent weakness usually affects the proximal lower extremities, happens in older patients, and develops late. Diagnosis: Can be made in the ED based on history, exam, lab testing. Consult neurology in the ED.

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REBEL EM

SEPTEMBER 13, 2023

Features Urticaria and pruritis Rapid onset (1-2 hours) IgE Dependent (Type I Hypersensitivity) Reactions An allergen cross-links two or more IgE molecules on mast cells or basophils and initiates a signal cascade leading to degranulation. J Emerg Med 2013; 44 (4): 764-772. J Allergy Clin Immune Tract 2017; 5(5): 1402-9.

Frozen Plasma 99

Frozen Plasma Allergic Reaction FFP Plasma 99

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

[link] Case continued She arrived in the ED and here is the first ED ECG. IMPRESSION: 1. We know that most type 1 acute MI due to plaque rupture and thrombosis occurs in lesions that are less than 50% (see Libby reference). I don't know if her pain was getting better or not. The Queen no longer thinks it is OMI.

Coronary 114

Coronary E-9-1-1 STEMI ACS 114

EMDocs

OCTOBER 30, 2023

” – Musings of an American ED resident in July 2022 when US healthcare was affected simultaneously by supply chain issues from GE Healthcare (contrast media) and Abbott Laboratories (Similac baby formula). 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013.

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EMDocs

MAY 11, 2024

A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis?

EMS 101

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EMDocs

AUGUST 22, 2024

1 However, we recognize that many patients prefer to speak a language other than English regardless of their English proficiency, and this does not indicate a deficiency. 6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits.

Emergency Department 98

Emergency Department ALS E-9-1-1 ED 98

Dr. Smith's ECG Blog

JUNE 30, 2023

Queen: #1: NOT OMI, HIGH CONFIDENCE Queen: #2: NOT OMI, HIGH CONFIDENCE ECG 1 Interpretation: there is terminal T-wave in V3-V6. LEARNING POINT : 1. For clarity in Figure-1 — I've reproduced and put together the 2 serial ECGs that were texted to Dr. Smith in today's case. in ECG #1 ). Smith: Young thin black male.

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Dr. Smith's ECG Blog

APRIL 22, 2022

But these cases show the potential dangers of delayed recognition and treatment of inferior reperfusion Take away 1. ECG’s can be labeled as ‘normal’ by the computer (and confirmed by cardiology) even with diagnostic signs of occlusion or reperfusion References 1. Int J Cardiol 2013 2. JAMA Intern Med 2019 9.

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REBEL EM

JULY 18, 2022

TXA has become the standard practice in the ED based on small RCTs, though larger trials have not demonstrated the same benefit ( REBEL EM review ). 2013 Sep;31(9):1389-92. Epub 2013 Jul 30. Medications and cotton pledgets for each arm were packed in blinded boxes by a research nurse outside the ED. Am J Emerg Med.

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E-9-1-1 Epinephrine ED ALS 52

Dr. Smith's ECG Blog

FEBRUARY 16, 2019

Posterior STEMI" may not even technically exist according to the current (2013) ACC/AHA STEMI guidelines, as it is not described as a "STEMI equivalent" and the only relevant statement in the guidelines is: "In addition, ST depression in 2 precordial leads (V1-V4) may indicate transmural posterior injury."

STEMI 52

STEMI E-9-1-1 ACS OR 52

REBEL EM

JANUARY 19, 2023

Previous studies regarding ambulatory management included randomized trials that lacked adequate power, and recently, a 2013 systematic review that, although showed promise in the ambulatory approach, had poor data quality with a high risk of bias. Patients followed up every 1-2 days till day 4.

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Dr. Smith's ECG Blog

AUGUST 3, 2017

There are two main etiologies of ischemic ST-depression: 1) subendocardial ischemia 2) reciprocal to ST-elevation in an opposite wall Here there are distinct R-waves with marked ST-depression throughout most of the precordium. Tips for recognizing Acute Posterior STEMI: 1. References: 1. This can help in confirmation.

STEMI 52

STEMI E-9-1-1 Coronary ALS 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Right atrial diastolic collapse is the earliest sign, but the patient needs to have right atrial collapse for at least 1/3 of the cardiac cycle which can be difficult to identify with ultrasound. Beck’s triad only happens all 3 together in approximately 1/3rd of patients. 2013 Sep;26(9):965-1012.e15. Her pulse is 125.

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Pediatric EM Morsels

AUGUST 9, 2024

Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306. Usually in 1st week of lif e Copious, white-ish drainage Teeming with spirochetes! gross ) Rash Occurs 1-2 weeks after rhinitis. 2024 Jan 16;17(1):e257694.

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Dr. Smith's ECG Blog

JULY 22, 2023

An ECG was performed in the ED at 1554: Original image unavailable, this is the only recorded scanned ECG available. A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. per year incidence of SCD in this cohort [1].

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EMDocs

APRIL 13, 2024

A 24-year-old male presents to the ED from a mixed marital arts competition after being struck on the side of the right head by a fist earlier today. 1] In a survey of college wrestlers, the incidence of auricular hematoma was found to be 52% for those who do not wear headgear versus 26% who wore ear protection.[2]

EMS 98

EMS E-9-1-1 OR ED 98

Don't Forget the Bubbles

NOVEMBER 29, 2023

Intensive Care Research , 1 (3-4), pp.60-64. Even though sedation after endotracheal intubation (ETI) reduces the risk of self-extubation, uncontrolled pain, and awakening awareness, several small single-centre studies demonstrate low rates of sedative drug administration after ETI in the emergency department (ED). Epub 2014 Sep 9.

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Don't Forget the Bubbles

JULY 22, 2024

Pre-school wheezers remain a poorly understood cohort of children despite seeing them every day in paediatric EDs. However, there was no difference in LOS (83 minutes for placebo vs 79 minutes for prednisolone) in participants who were discharged straight from the ED ( 32% ). study from 200 9. What does it mean to our patients?

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Don't Forget the Bubbles

JUNE 30, 2023

The nanny hailed the nearest black cab, and they set straight to our ED. E – Temp 37.2 CRASH 2 , published in 2013 – was huge. When patients were separated into those with a GCS <9, or GCS 9-12, giving TXA to those with a lower GCS didn’t make any difference to survival. Polly’s GCS is not great.

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EMDocs

SEPTEMBER 23, 2023

A 36-year-old female presents to the ED after experiencing an episode of sudden syncope. Answer : Brugada Syndrome Epidemiology and Etiology Rare genetic disorder that affects approximately 1 in 5,000 individuals worldwide 1. More common in males than females, with a male-to-female ratio of approximately 8:1 1.

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E-9-1-1 EMS ALS Defibrillator 99

REBEL EM

MAY 15, 2024

Pathogens ( Gudiol 2013 ) : The pathogens responsible for neutropenic fever have changed over time. 2011 Jun;153(6):773-9. Neutropenic Fever: Fever (one reading of 38.3C Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Warnick, J., Stretton, K., Littlewood, T. doi: 10.1111/j.1365-2141.2011.08693.x.

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Don't Forget the Bubbles

OCTOBER 19, 2023

You, however, are working an ED shift, and when you see the name “Barbie Junior” on your computer screen, your heart does a flutter. It can be in started in the ED, and many of us are already using it. Soon, she was too breathless to feed, and Barbie and Ken were panic-stricken at how pale and lethargic she looked. days compared to 1.50

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E-9-1-1 ED OR Emergency Department 80

This Podcast Will Kill You

OCTOBER 24, 2023

2005): 1-6. Bulletin of Science, Technology & Society , 25 (1), pp.37-45. “Insecticide toxicology, mammalian toxicity of 1-naphthyl-N-methylcarbamate (Sevin insecticide).” Stewart, Nelson E., “Acute toxicity of the insecticide Sevin® and its hydrolytic product 1-naphthol to some marine organisms.”

E-9-1-1 52

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Dr. Smith's ECG Blog

JANUARY 30, 2019

The pattern of STE and STD reminded us of Brugada Type 1 morphology. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% per year incidence of SCD in this cohort [1].

E-9-1-1 52

E-9-1-1 CAD STEMI Defibrillator 52