REBEL EM

NOVEMBER 11, 2024

What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. Comorbidity Index : Higher in the cefepime group (median 2 vs. 1). 9 Instrumental Variable Analysis? vs. 52.2%). vs. 15.3%). vs. 22.3%).

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EMDocs

JANUARY 6, 2025

ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. g/dL, thrombocytopenia of 96 10 9 /L, prothrombin time (PT) of 16.1 1 By the end of 2023, 117.3 million people had been forcibly displaced, representing 1 in 69 individuals or 1.5% seconds (normal 30-40 seconds), creatinine of 3.11

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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. Evaluate for ≥ 3 B lines in two bilateral lung zones. What about diuretics?

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Broome Docs

DECEMBER 22, 2024

2024 Oct 9. There were no differences in survival (12% with IO vs 10% with IV) or neurologically intact survival (9% vs 8%). 2024 Nov 1. 2018 Nov 22;379(21):2002-2014. Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial. doi: 10.1001/jama.2024.20424.

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EMDocs

JULY 2, 2025

Background: Tianeptine is an atypical tricyclic antidepressant (Image 1 displays the structure of Tianeptine) primarily used in some European, Asian, and Latin American countries for the treatment of major depressive disorder, and is sold under the name; Coaxil TM or Tatinol TM. Only 11 of these exposures occurred between 2000-2014.

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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. May 2014; PMID: 24495437. Oct 2013; PMID: 24079262 Gohar E, et al. Ultrasound Med Biol. Sanfilippo F, et al. Nov 2020; PMID: 33140173 Hanson J, et al.

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Dr. Smith's ECG Blog

NOVEMBER 23, 2017

Repost this one A 30-something with 8 hours of chest pain and an e. Computer says. huge inf right lateral RV afib block vfib What is lurking underneath this new right bundle b. QT Correction Formulas Compared to The Rule of Thu. A 30-something with It is not a STEMI; it is an opportunity to save my. A male in his 50s with chest pain.

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Dr. Smith's ECG Blog

NOVEMBER 25, 2017

Repost this one A 30-something with 8 hours of chest pain and an e. Computer says. huge inf right lateral RV afib block vfib What is lurking underneath this new right bundle b. QT Correction Formulas Compared to The Rule of Thu. A 30-something with It is not a STEMI; it is an opportunity to save my. A male in his 50s with chest pain.

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EMDocs

JUNE 2, 2025

age last updated: January 28, 2014., 2021;12(1):885-901. link] Jain S, Khaiboullina S, Martynova E, et al. Role of contact tracing in containing the 2014 Ebola outbreak: a review. Role of contact tracing in containing the 2014 Ebola outbreak: a review. 2017;17(1):225. 2019;6(1):435-458. 2016;77:9-14.

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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. And have you ever. great EKG of heart block, RBBB, TIMI-3 flow in LAD A 40-something with sharp chest pain, worse with l. Viral symptoms, then acute chest pain and this ECG. A young woman with epigastric pain. ECG Crochetag. Atrial fibrillation?

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ALiEM

NOVEMBER 1, 2023

Iron toxicity treated with deferoxamine Background Deferoxamine is the treatment for severe iron toxicity [1]. Deferoxamine 1] Initial dosing starts at 5 mg/kg/hr intravenously. 1, 3, 4] Hypotension is generally the rate-limiting factor for the infusion rate. McGraw-Hill Education; 2019 Madiwale T, Liebelt E. 2023 May 22.

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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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ALiEM

MAY 13, 2024

Her symptoms started 1 week ago as a scratch which progressively got more red and painful. Pediatric Soft Tissue POCUS Ultrasound Technique Figure 1. Cellulitis with cobblestoning Video 1. Abscess with irregular borders and surrounding cellulitis E. Superficial abscess with well-circumscribed borders Table 1.

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Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Here is lead I from ECGs 1 and 2 shown side-by-side to highlight the change in axis from borderline right to completely normal. Consider the following: We become attuned to looking for acute coronary occlusion in patients who present with acute symptoms to the ED ( E mergency D epartment ).

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Pediatric EM Morsels

AUGUST 18, 2023

Rose 2014) They are the most frequently prescribed class of medications in adults; however, in children they are the least frequently prescribed class , <2% of antibiotics. Hersh 2014) Fluoroquinolone Use in Children: Indications for use Let’s keep this simple, Pseudomonas ! Which is a risk of 1 event for 62.5

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Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. ECG 1 What do you think? Grines, C.

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This Podcast Will Kill You

JULY 23, 2024

2014): 6-7. Official journal of the American College of Gastroenterology| ACG , 118 (1), pp.59-76. Annals of internal medicine , 172 (1), pp.ITC1-ITC16. ” BMC medicine 17 (2019): 1-20. Gastroenterology , 160 (1), pp.63-75. ” Internal and emergency medicine 9 (2014): 249-256. Kelly, C.P.,

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REBEL EM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. The first evaluation of the patient was to be done within 1 hour of arrival to ED (Including the first POCUS). to −0.66) and −1.66 (95% CI −2.09

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

Don't Forget the Bubbles

MAY 29, 2023

A study of teams over a 1-year period highlights that people witnessing incivility are also affected, which could lead to individuals feeling unsupported in their teams. 2021:36:1–2, NP448–NP473 Available at. Review of Cultivating Communities of Practice: A Guide to Managing Knowledge, by Wenger E, McDermott R, Snyder WM].

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REBEL EM

AUGUST 30, 2023

Epidemiology 1 to 2.4 cases per 100,000 people ( Zimmerli 2010 ) More common in males with M:F of 3:1 Rate is also increasing due to increased number of spinal procedures Typically affects adults, with most cases occurring in patients over 50 years old. Other pathogens include: E. 2009 Aug; 39(1):10-7. In: Sherman SC eds.

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EMDocs

AUGUST 3, 2023

2014 Sep-Oct;52(8):856-67. Epub 2014 Aug 18. PMID: 25133498 Ghannoum M, Kazim S, Grunbaum AM, Villeneuve E, Gosselin S. 2004;20(9):649-650. Extracorporeal treatment for acetaminophen poisoning: recommendations from the EXTRIP workgroup. Clin Toxicol (Phila). doi: 10.3109/15563650.2014.946994. Clin Toxicol (Phila).

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Don't Forget the Bubbles

JUNE 17, 2024

Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J. 2014 Jun 26;23(12):653-9. 2020 Jan 1;35(1):70-6. 2023 Oct 31;21(1):403. Roche E, Jones A, Plunkett A. cognitive rehearsal techniques ). Organizational dynamics. 2020 Aug 20.

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FOAMfrat

MAY 19, 2024

While transporting to the emergency department, the patient’s mother informed me that PDCD affects less than 1 in 50,000 individuals and is more common in males than females. The patient will thank you for it; we are only human. References 1. Ostergaard E, Moller LB, Kalkanoglu-Sivri HS, et al. 2014 Feb.

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This Podcast Will Kill You

JANUARY 2, 2024

2002): 1-7. Nature Reviews Endocrinology , 7 (9), pp.540-557. Endocrine reviews , 43 (1), pp.61-90. Molecular and Cellular Pediatrics , 7 (1), pp.1-9. Academic Press, 2014. Sochett, E. Annual review of biochemistry , 78 , pp.929-958. ” Annals of Anatomy-Anatomischer Anzeiger 184.1 and Glorieux, F.H.,

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EMDocs

AUGUST 7, 2023

1 A D-dimer level can, therefore, be used as a non-specific and indirect biomarker for the presence of intravascular clotting, which may be useful in the diagnosis of VTE. 1-3 In this patient population, the NPV of a negative D-dimer level is high, such that a negative test makes further evaluation for VTE unnecessary.

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REBEL EM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Recurrence of pneumothorax within 1 year. Pneumothorax recurrence within 1 year: 20% for aspirations, 27% for chest tubes. Panacek, E. PMID: 20696690 Baumann, M.

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This Podcast Will Kill You

SEPTEMBER 10, 2024

Perantoni, E., Kaimakamis, E., Elsevier, 2014. JMIR Medical Informatics, 9(1), p.e22753. . “Laennec, the Man—1781–1826.” ” The Boston Medical and Surgical Journal 195.5 1926): 208-211. Lung sounds recordings: Rocha, B.M., Vogiatzis, I., Natsiavas, P., Oliveira, A., Marques, A. and Paiva, R.P.,

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NAEMSP

APRIL 19, 2023

However, evidence emerged in the 1980’s demonstrating that calcium chloride had no effect on return of spontaneous circulation (ROSC) rates, and in fact could be detrimental (Landry, Foran, & Koyfman, 2014). References: 1. Current AHA guidelines do not recommend routine use of calcium in cardiac arrest (Panchal, et al., Ramazan, K.,

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Dr. Smith's ECG Blog

SEPTEMBER 9, 2020

== MY Arrhythmia Case by K EN G RAUER, MD ( 9/9/2020 ): == PREFACE: Recognition of the presence ( or absence ) of AV block is a common problem in emergency medicine. The ECG that is shown in Figure-1 was obtained from an elderly patient, who was admitted to the hospital for a fall. Is there AV block?

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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. Case Rep Emerg Med 2014 7. JAMA Intern Med 2019 9.

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Dr. Smith's ECG Blog

JANUARY 10, 2020

I was relieved to see this MRI result: MRI IMPRESSION 1) Mildly decreased LV function with no focal wall motion abnormalities. Learning Points: 1. Pericarditis" strikes again == MY Comment by K EN G RAUER, MD ( 1/10/2020 ): == I like this case because it proves what we know = Medicine is not 100%. Pericarditis?

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ACEP Now

NOVEMBER 7, 2023

1 Overall, survival is poor following cardiac arrest, and is affected by factors including age, comorbidities, witnessed arrest, early CPR, early defibrillation, and return of spontaneous circulation (ROSC). Heart disease and stroke statistics—2014 update: a report from the American Heart Association. 2018;13(9):e0204169.

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AAEM RSA

NOVEMBER 23, 2020

9 While these flexible tracks may help women remain in the workforce during the demanding child-rearing years, getting off track can be detrimental to career advancement and promotion, especially in comparison to men who usually start and remain in full-time service. References Bismark M, Morris J, Thomas L, Loh E, Phelps G, Dickinson H.

OR 52

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REBEL EM

JULY 18, 2022

2013 Sep;31(9):1389-92. The NoPAC trial, which was published in 2021,(1) compared TXA to placebo in a large multicenter randomized control trial in the UK which looked at data from 26 emergency departments. PMID: 33612282 Janapala RN, Tran QK, Patel J, Mehta E, Pourmand A. Am J Emerg Med. Epub 2013 Jul 30. PMID: 23911102.

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REBEL EM

DECEMBER 10, 2023

Though the initial focus of the FAST exam was for detection of abdominal free fluid, the eFAST (Extended FAST) is more commonly used and adds thoracic windows helping to identify pneumothorax ( Musthafa 2014 ). 2022 Jan 1;92(1):44-48. 2015 Jan;39(1):172-8. 2005 Sep;12(9):844-9. 2022 Jan 1;92(1):44-48.

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EM Didactic

DECEMBER 19, 2018

Ketamine undergoes extensive hepatic metabolism (via cytochrome P450 enzymes) with norketamine being an active metabolite with 1/3 of the potency of ketamine. 2015 Mar;22(3):251-7 Goltser A, Soleyman-Zomalan E, Kresch F, Motov S. 2015 Jul;16(7):1402-9. 2014 Jun;26(3):237-42 Motov S, Mai M, Pushkar I, Likourezos A, et al.

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Dr. Smith's ECG Blog

DECEMBER 11, 2023

Moreover , the patient has ongoing symptoms and has an unexplained elevated troponin, so she is having an MI and the only question is whether it is type 1 or type 2 due to hypertension. Case continued She was loaded with aspirin 325 mg, and repeat troponin drawn around the time of EKG 1 resulted at 267 ng/L. Peterson, E.

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