ACEP Now

DECEMBER 7, 2024

1 The reason is understandablethrombolytics in stroke is a high-risk, higher-reward treatment. Acceptance of thrombolytics in stroke is exemplified in the results from a survey of EDs participating in ACEPs Emergency Quality Network (E-QUAL) Stroke Collaborative. Click to enlarge. Click to enlarge.

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JEMS

JULY 7, 2025

Perkins ZB, Greenhalgh R, Avest E, et al. International Prehospital Medicine Institute Literature Review, June 2025 1. Perkins ZB, Greenhalgh R, Avest E, et al. The authors classified repeat encounters into one of four categories; medical (61%), trauma (29%), lift assist only (9%) and cardiac arrest (1%).

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Don't Forget the Bubbles

JUNE 10, 2025

The SWAST Feedback Project uses REDCap ( R esearch E lectronic D ata CAP ture) as its data collection platform. Other prehospital clinicians included Emergency care assistants ( 7% ) and student paramedics ( 8% ) (see Figure 1 ). 2021 May 29;6(1):15–22. 2018 [cited 2025 Mar 17];15(1). Br Paramed J.

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JEMS

JUNE 23, 2025

1 EMS has always been described as the canary in the coal mine and the tip of the spear simultaneously. 1 Yet, despite its critical function, EMS remains an underfunded outlier in the Medicaid landscape, excluded from mandatory federal benefits, inconsistently reimbursed, and perennially subject to the whims of state fiscal policy.

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Don't Forget the Bubbles

JUNE 10, 2025

Follow our step-by-step guide below:   1) Build your project group and delegate roles Assembling your project group The project group should have a range of emergency medicine clinicians, including: Senior clinicians (minimum of 2) Consultants. Tier 1 doctors (minimum of 2) Junior grade resident doctors. e.g., ST3 + (UK equivalent).

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Emergency Department E-9-1-1 Ambulance Paramedic 86

JEMS

JULY 23, 2025

2 Only 1% of those studied actively attempted to solicit information from the patient with a suspected Autism Spectrum Disorder (ASD), instead electing to question bystanders. The DSM-5 splits Autism Spectrum Disorder into three levels on this basis: Level 1. References 1. & Stuart, E. World Health Organization (WHO).

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E-9-1-1 EMT EMT Public Safety 98

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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ED E-9-1-1 ALS Frozen Plasma 74

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. Epub 2022 Apr 1. Evaluate for ≥ 3 B lines in two bilateral lung zones.

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JEMS

JULY 9, 2025

1 Obviously, this is an extreme case; however, it illustrates that field amputations can be successful even in the most primitive conditions. The Gigli saw technique had an instrument malfunction on 3/9 trials which was distinct from the other techniques. 1996 Jan-Mar;11(1):63-6. 2018 Jan;54(1):90-95. J Emerg Med.

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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. Shaikh, S., & Keller, E. Jackson, E.

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REBEL EM

JULY 14, 2025

About 1 in 10 patients will have an occult fracture, and roughly 1 in 10 scaphoid fractures result in nonunion. 1,2 However, the risk of nonunion among patients with MRI-confirmed occult fractures is much lower—around 1 in 30. 2025;26(1):14. 7 🧾 Paper Cohen A, Reijman M, Kraan GA, et al. J Orthop Traumatol.

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Dr. Smith's ECG Blog

JUNE 10, 2025

Patient initially presented at 9 PM to a referring facility with hsTnI 13 (ref: < 34 ng/L) then 30, then 60. EKG 1 What do you think? EKG 1 interpretation: Normal sinus rhythm, heart rate 60, normal axis, Q waves in III, aVF, with STE and TWI in lead III. EKG 2 Subtle changes but overall pretty similar to EKG 1.

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STEMI E-9-1-1 CAD ALS 70

EMDocs

MAY 17, 2025

1 These values can be difficult to quickly assess and measure in a fast-paced clinical scenario. See Figure 1. 9 Current best practice suggests a 1:1:1 administration of PRBC, Platelets, and FFP. Provide 1-2 grams calcium chloride or 3-6 grams calcium gluconate should be administered per MTP round.

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Don't Forget the Bubbles

APRIL 7, 2025

This small but mighty gland, roughly 1 cm in diameter, sits at the base of the brain, just below the hypothalamus. The likelihood of a pituitary adenoma increases with age, accounting for 1% of all intracranial tumours before 15 years but rising to 18% in adolescents aged 1524. The most commonly used stimulation tests include: 1.

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EMDocs

MARCH 18, 2025

Episode 116: Massive Hemoptysis Definition: Hemoptysis is expectoration of blood from the respiratory tract; ranges from mild with small streaks of blood to cardiopulmonary compromise (1-5). Massive hemoptysis: no clear definition, ranges from 50 mL in a single expectoration to 100 mL in 24 hours to over 1 L in 48 hours. microg/kg IV.

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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. J Invest Surg Sept 2018; PMID: 28952826 Robb J. Oct 2013; PMID: 24079262 Gohar E, et al. Intensive Crit Care Nurs. Dec 1997; PMID: 9564354.

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

This Podcast Will Kill You

JUNE 16, 2025

New York University Press, 2018. The Lancet Infectious Diseases, 19(9), pp.e313-e321. The Lancet infectious diseases, 9(5), pp.281-290. ” New England Journal of Medicine Atchade, E., ” New England Journal of Medicine Atchade, E., Antibiotics, 13(1), p.96. . “ Toxic shock: A social history.

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Dr. Smith's ECG Blog

JANUARY 13, 2025

When I saw this (presented at a conference), I immediately thought it looked like Thype 1 Brugada phenocopy (in other words, Type 1 Brugada ECG pattern ). If the QRS is prolonged, then the differential includes: 1. Criteria for Type 1 Morphology: 1. A flat ST segment will have a Corrado index greater than 1.

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ACEP Now

MARCH 10, 2025

1 If you enter the Isegahama stable today, you might find Satonofuji diligently training, but you will also find him performing lower-ranked sumo duties such as simmering chanko nabe or sumo stew for others, sweeping the communal living areas, cleaning the bathrooms, or carrying the higher ranked sekitori sumos belongings during tournament days.

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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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E-9-1-1 EMS Plasma OR 63

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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E-9-1-1 STEMI Coronary CPR 52

EMDocs

APRIL 12, 2025

Typically begin after development of the pincer grip (9 months). 1 ADHD is considered an important risk factor for auricular foreign bodies due to increased impulsivity and inatentiveness. 1 Typically presents in ages 9 months – 8 years. 1-3 More common in boys (1.48 to 1 ratio). to 1 ratio).

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E-9-1-1 EMS Emergency Department ED 79

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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E-9-1-1 STEMI Coronary CPR 52

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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E-9-1-1 STEMI Coronary CPR 52

This Podcast Will Kill You

JULY 8, 2025

Human reproduction, 33(9), pp.1602-1618. Stener-Victorin, E., The lancet Diabetes & endocrinology, 10(9), pp.668-680. BMJ medicine, 2(1), p.e000548. Ricardo Azziz, and Sharon E. Frontiers in endocrinology, 9, p.452. Journal of endocrinological investigation, 41(1), pp.49-57. Chicano-Gálvez, E.,

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Pediatric EM Morsels

SEPTEMBER 22, 2023

Negative E-FAST and no signs of long bone injuries should raise concern for neurogenic shock in the hypotensive trauma patient with suspected spinal injury. Alpha 1 agonists are necessary to maintain appropriate blood pressure. 2018 Oct;14(2):47-54. Epub 2018 Oct 31. 2011;46(9):1771. Available from: [link] Ko HY.

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Pediatric EM Morsels

OCTOBER 27, 2023

Initially tested in Johannesburg, South Africa: 1 month old to 12 years old Broselow predicted within 10% of weight in 63.6% 2007-2902 Wells M, Coovadia A, Kramer E, Goldstein L. 2020;13(1):9. 2016;23(1):21-28. 2019 Jan;22(1):147-156. 2019 Jan;22(1):147-156. Epub 2018 Oct 18. Broselow does not.

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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. 22 Aug 2018.

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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

AUGUST 9, 2023

Technique Positioning and Probe Figure 1: Younger children can sit in their parent’s lap and give a hug for lateral and posterior lung scanning. The patient should be in a position of comfort: supine, sitting, or in parent’s lap (Figure 1). Identify anatomical landmarks on ultrasound (Figure 3, Video 1). Balk et al.,

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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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Pediatric EM Morsels

NOVEMBER 17, 2023

Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. 1994 Jul;125(1):57-62. 2018 Mar;28(3):210-217. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Paediatr Anaesth. PMID: 8021785.

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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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Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Which is a risk of 1 event for 62.5 Wirth 2018) One study including 4.4 Meesters 2018) Resistance is growing (likely from inappropriate / overuse)! Arthropathy was seen in 13.7%

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Pediatric EM Morsels

MAY 5, 2023

2018 Dec 20;11(1):5. Hovinen T, Korkalo L, Freese R, Skaffari E, Isohanni P, Niemi M, Nevalainen J, Gylling H, Zamboni N, Erkkola M, Suomalainen A. Lemale J, Mas E, Jung C, Bellaiche M, Tounian P; French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP). J Am Diet Assoc 2001;101:661–9.

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