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This clinical image depicts erythema migrans (EM), the classic rash seen in 70- 80% of early localized Lyme disease infections. This stage is characterized by the EM rash as well as fatigue, low-grade fevers, malaise, myalgias, and lymphadenopathy. link] www.cdc.gov/lyme/ Steere AC. Platelets : 223 Sodium : 139 Creatinine : 0.8
PMID: 32644703 Robinson PM, Griffiths E, Watts AC. PMID: 27227986 Glover NM, Black AC, Murphy PB. PMID: 31082090 Post Peer Reviewed By: Anand Swaminathan MD, MPH (Insta @EMSwami) The post Elbow Dislocations appeared first on REBEL EM - Emergency Medicine Blog. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. 2023 Nov 5.
Case A patient arrives via EMS from the bus station complaining of fever, vomiting, and back pain. Our experience: It was not long ago that we instructed our staff that: ‘COWS >8, give ’em 8 (mg of buprenorphine).’ DOI: Papudesi BN, Malayala SV, Regina AC. They report insufflating ‘a bundle’ of tranq dope per day.
This scarcity means that EMS clinicians have limited real-world exposure to critically ill infants and children, yet when these cases do arise, the stakes are high. For those working in EMS and community healthcare, ongoing education and professional development in paediatric emergency care are often insufficient.
This was written by one of our fine residents, who will soon be an EMS fellow: Michael Perlmutter Case A mid-50s male came to the ED with a burning sensation that was acutely worse while at home. This dynamic change is diagnostic of ACS. This was also non-diagnostic for OMI, although the dynamic changes are diagnostic of ACS.
Paper: Alwang AK, Law AC, Klings ES, Cohen RT, Bosch NA. PMID: 28106307 Alwang AK, Law AC, Klings ES, Cohen RT, Bosch NA. appeared first on REBEL EM - Emergency Medicine Blog. To assess the clinical impact and relevance of these concerns, Alwang et al. performed the retrospective cohort study below ( Alwang 2024 ).
link] Hummell AC, Cummings M. Accessed October 5, 2024. link] Centers for Disease Control and Prevention (U.S.). History and Physical: Refugee Health Domestic Guidance.; Accessed October 5, 2024. Role of the nutrition-focused physical examination in identifying malnutrition and its effectiveness. 2022;37(1):41-49. doi:10.1002/ncp.10797
ESO’s annual WAVE conference brings together hospitals, fire departments, and EMS agencies for four days of sharing and practical learning. Brooke Burton, Quality Improvement Manager at Unified Fire Authority, led Mistake or Murder: What Can EMS and Hospitals Learn from the Vanderbilt Case? shared key takeaways. .”
Blood sampled from existing peripheral IV cannulae yields results equivalent to venepuncture: a systematic review [ 10.1177/2054270419894817 ] Second Line 18 G Should we be placing in the AC? Future Show: Upping your IV Game Fluids Get dinged for 4, rectal temps on elderly, etc.
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Instead, EMS providers should focus on restoring ventilation and oxygenation: Use bag-valve-mask ventilation or airway adjuncts Provide supplemental oxygen Titrate naloxone only until respiratory effort resumes, not full arousal This “breathe, don’t wake” strategy is safer and more appropriate when sedatives like medetomidine may be involved.
25 AC = Anterior chamber, ELISA = enzyme-linked immunosorbent assay, NS = normal saline, PCR = polymerase chain reaction Management Oral Ivermectin 26 150 mcg/kg given once or twice yearly for 10 to 15 years to match the lifespan of the adult worm is the standard treatment. 0000000000000483 Opoku NO, Bakajika DK, Kanza EM, et al.
PARAMEDIC 3 randomized 6,000 (but they were supposed to get to 15,000) patients with out of hospital arrest from multiple EMS agencies in the UK to either an IO or IV to start. PMID: 39480221 We have 2 studies looking at the same question published in the same edition of the NEJM, so I will tackle them together. ( of the IO group and 5.1%
We’ll keep it short, while you keep that EM brain sharp. 0318502 Lorenzi-Filho G, Genta PR, Figueiredo AC, Inoue D. 0000000000001856 The post EM@3AM: Bradypnea appeared first on emDocs. He states he is very fatigued and feels as though he cannot get a deep breath. 2025;20(3):e0318502. doi:10.1371/journal.pone.0318502
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Well keep it short, while you keep that EM brain sharp. 10 g/dL in patients with acute coronary syndrome (ACS). The post EM@3AM: Systematic Approach to Massive Hemorrhage and Nuances in Special Patient Populations appeared first on emDocs. Case: A 32-year-old female presents to the ED with chief complaint of abdominal pain.
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Per EMS reportedly could not tolerate neb. The ED physicians were of course worried about ACS, and they obtained these POCUS echos: Apical 4 chamber Overall LV function is moderately decreased Parasternal short axis: Is there an anterior wall motion abnormality? He was febrile in the ED. Unable to obtain further history from patient.
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Controversies and Consensus in EM. Post the new article about coronary occlusion Great dynamic BTWI case dunbar extreme subtle inferior MI Aug 13 iMessage, Sudden weakness with bradycardia and bizarre T-waves 1304490 old vs. new anterior MI, with video, lead. Beware Automated Interpretations of Atrial Fibrill. Sept 20-22 Nor.
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
However, with the global evolution of emergency medicine (EM), more HIV patients now engage with EDs, often presenting with acute complications or in an undifferentiated state before receiving a formal diagnosis. link] Jung AC, Paauw DS. J Clin Invest. 2004;113(7):937-945. doi:10.1172/JCI21540 HIV.gov. The Stages of HIV Infection.
A man in his 40s with chest pain and T wave inversion Written by Pendell Meyers Which ACS had more myocardial damage? In syncope, what ar. Acute aphasia. What is the likely etiology? The one that. Acute respiratory distress: Correct interpretation. Would your radiologist make this diagnosis, or sho.
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
EDACS is broader—captures symptoms suspicious for ACS, not just chest pain, and performs well in low-risk patients. Clinical Bottom Line Both HEART and EDACS are best utilized for identifying patients with suspected ACS who are at low risk for MACE. Cardiovascular Read More REBEL Cast Ep114: High Flow O2, Suspected ACS, and Mortality?
Simple ACS? Repost this one A 30-something with 8 hours of chest pain and an e. A 30-something with It is not a STEMI; it is an opportunity to save my. A male in his 50s with chest pain. What is your in. Is this acute coronary occlusion? cardiac arrest followed by shock in PSVT -- in PSV.
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Hyperkalemia paper from West J EM Great V FIb Arrest Case type II STEMI, hypoK 3.3 A 50-something with chest pain and minimal precord. Chest pain and precordial ST depression which reso. Wide Complex Tachycardia: is the patient stable or. The risk of myocardial rupture 15 hours of chest pain. Too late for thrombolytics.
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
Wang (21) Dressler's syndrome (2) Drug Effect (2) Dual AV nodal pathways (6) Dynamic T-waves (10) ECG Radiologist (1) ECG misdiagnosis (2) ECLS -- Extracorporeal Life Support (1) ECMO -- Extracorporeal Membrane Oxygenation (3) EMS voltage cutoff (2) EP study (1) ESRD (1) Early Intervention for NonSTEMI (3) Early Repol Inferior and Lateral (1) Early (..)
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