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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JEMS

JULY 3, 2025

1 The author’s employer, a Michigan-based life support agency, further represents clinician shortages, experiencing only a 70% retention rate of EMTs and a 77% retention rate of paramedics. Here’s a closer look at each topic: 1. References 1. Journal of Taibah University Medical Sciences , 10 (1), 12–15. Teteris, E.,

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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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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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Don't Forget the Bubbles

DECEMBER 16, 2024

Similarly, the global vaccine coverage of children who received a first dose of measles vaccine was 83% in 2023, compared to pre-pandemic levels of 86% in 2019. Coverage of the 6-in-1 vaccine measured at 12 months of age in England for Q4 2023 to 2024 Source: ONS under the Open Government License v3.0

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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? 2019 Jul;3(7):520-531. 2017 Sep;279(1):70-89.

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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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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. Ralston, Aron.

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EMDocs

NOVEMBER 25, 2024

1 Life Cycle and Pathophysiology Life Cycle Humans are the only hosts for O. 1 The parasite has a 5-stage life cycle in which the blackfly acts as an obligate intermediate host. The worms can live as long as 15 years, and female worms may produce microfilariae (early-stage larvae) for up to 9 of those years. 13 Figure 1.

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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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EMDocs

DECEMBER 6, 2024

1 The incidence of iron overdose and iron ingestion related deaths has significantly decreased over time, likely attributable to federal regulation. 1 Commercially available formulations of iron have varying elemental components. 1 Table 1: Iron content of various preparations. 1 Obtain a single view abdominal x-ray.

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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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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. Jan 2019; PMID: 30138573. Oct 2013; PMID: 24079262 Gohar E, et al. Intensive care medicine. Sep 2010; PMID: 20502865 Teboul JL, et al. Castro R, et al.

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This Podcast Will Kill You

JUNE 16, 2025

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. New York University Press, 2018. Wasmuth, S.,

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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

JUNE 14, 2025

A) Cirrhosis B) Portal vein thrombosis C) Splenic abscess D) Splenic hematoma E) Splenic infarction Correct answer: B The spleen resides intraperitoneally within the posterior portion of the left upper quadrant, behind the stomach and adjacent to the lower ribs (9–12). Question: What is the diagnosis?

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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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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 2002;15(1):79-94. 2019;2019:1-16. doi:10.1155/2019/7247238 Shan Y, Lee M, Chang EB. mg/L, Na 132 mEq/L, K 2.7 mEq/L, Cr 0.5

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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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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

This Podcast Will Kill You

JULY 1, 2025

Scientific Opinion on the re‐evaluation of Sunset Yellow FCF (E 110) as a food additive. Scientific Opinion on the re‐evaluation of Allura Red AC (E 129) as a food additive. Scientific Opinion on the re‐evaluation Tartrazine (E 102). Refined exposure assessment for Allura Red AC (E 129). EFSA Journal, 9(1), p.1854.

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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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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. There are other systems that account for body habitus. x exp[0.02

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Core EM

JANUARY 25, 2024

REFERENCES: Castleberg E, Jenson N, Dinh VA. 2014;15(1):111-113. 2020;12(1). link] Published October 28, 2019. Accessed March 9, 2022. Diagnosis of necrotizing faciitis with bedside ultrasound: The staff exam. Western Journal of Emergency Medicine. Clark ML, Fisher KL. Journal of Diagnostic Medical Sonography.

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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. McGraw Hill Education; 2019:104-109 Dave S, DAHLSTROM JJ. 2011;46(9):1771. 5 th Edition.

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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.

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ALiEM

APRIL 12, 2024

Traditionally large-bore tube thoracostomy has been the standard of care for treating many acute intrathoracic pathologies [1]. Pigtails provide a less invasive and often better tolerated alternative to traditional chest tubes and allow for adequate treatment of pneumothoraces and uncomplicated pleural effusions [1-5]. 1999;3(1):57-61.

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ALiEM

MAY 19, 2023

The SB tube was created in 1950 in order to help tamponade variceal bleeds [1]. Apply traction to the tube by tying a roller bandage to the end of it and then the other end to a 1 L bag of IV fluids. Pearl 1: Check the units of pressure being used. The conversion rate is: 1 cmH2O = 0.74 1950 May;131(5):781-9.

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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

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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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. 2019 Sep;74(9):1186-1190. Epub 2019 Jul 16. 2016 Feb;30(1):3-11. Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Paediatr Anaesth. Anaesthesia.

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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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ALiEM

AUGUST 16, 2023

Common agents include local anesthetics, dapsone, quinones, sulfonamides, phenazopyridine, and nitrites [1, 2]. Treatment for methemoglobinemia in G6PD deficiency may consist of ascorbic acid, exchange transfusion, and hyperbaric oxygen [7, 9]. PMID 23953868 Mack E. 2019, McGraw-Hill Education: New York. 1971;75(1):83-86.

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Dr. Smith's ECG Blog

OCTOBER 3, 2024

I agree, however: 1) I don't think you can get a good enough ech o without bubble contrast. 3) E cho is another step that takes time. I had only 9 false positives but I missed 2 OMI. The rhythm for the ECG in Figure-1 is sinus — with normal intervals and axis ( mean QRS axis about +80 degrees ). Time is myocardium.

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Don't Forget the Bubbles

AUGUST 30, 2023

The parents of 9-month-old Josie bring her into the Emergency Department with coryzal symptoms and difficulty breathing. Among those who do not always obtain a CXR, one-fifth still routinely obtained them under a certain age (2 weeks to 12 years, median of 1 year). doi: 10.1590/s1516-31802007000300005 Beyyumi, E., AlDhanhani, H.,

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