ACEP Now

DECEMBER 7, 2024

1 The reason is understandablethrombolytics in stroke is a high-risk, higher-reward treatment. When we care for eligible patients with ischemic stroke in the emergency department (ED), there is no debate: We administer thrombolytics when the opportunity presents. Click to enlarge. Click to enlarge.

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

EMDocs

NOVEMBER 13, 2024

Commonly a monomicrobial infection with gram-negative bacteria like E. Major takeaway: Consider SBP in any patient who comes into the ED with ascites. Paracentesis is a safe procedure with a low complication rate (< 1%). g/kg of 20% albumin IV at the time of diagnosis and 1 g/kg IV 48 hours later. Dosing is 1.5

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EMDocs

NOVEMBER 16, 2024

1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 10% of patient’s have an ED visit within 30 or 90 days following THA. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 2020 Sep 30;5(9):558-567.

EMS 96

EMS E-9-1-1 Operating Room Emergency Department 96

JEMS

JULY 7, 2025

Perkins ZB, Greenhalgh R, Avest E, et al. Sutori D, Erdelyi LS, Uri I, et al. Dorsett M, Allen H, Garbacz H, et al. Baker PO, Karim SR, Smith SW, et al. International Prehospital Medicine Institute Literature Review, June 2025 1. International Prehospital Medicine Institute Literature Review, June 2025 1.

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

Don't Forget the Bubbles

NOVEMBER 29, 2024

It’s a busy day in the paediatric ED. Step 1: Conversion to Formaldehyde Methanol is broken down in the liver by an enzyme called alcohol dehydrogenase at a fixed rate. This zero-order elimination occurs at about ~8–9 mg/dL/hour. Back to our toddler in the ED. References Brent J, McMartin K, Phillips S, et al.

Plasma 62

Plasma E-9-1-1 OR ALS 62

Don't Forget the Bubbles

JUNE 10, 2025

Options include feedback on the final diagnosis, inpatient progress, prehospital and ED management, and general paediatric learning points. The SWAST Feedback Project uses REDCap ( R esearch E lectronic D ata CAP ture) as its data collection platform. 2021 May 29;6(1):15–22. 2018 [cited 2025 Mar 17];15(1). Br Paramed J.

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E-9-1-1 Emergency Department Paramedic Ambulance 62

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.

EMS 116

EMS E-9-1-1 Community Paramedicine Emergency Medical Services 116

Don't Forget the Bubbles

DECEMBER 16, 2024

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 Young infants and immunosuppressed individuals are particularly at risk of severe disease, resulting in significant morbidity and associated mortality rates of 1-3 per 1,000 cases.

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E-9-1-1 OR ALS Emergency Department 57

EMDocs

MAY 19, 2025

Medications (most common cause): allopurinol, anticonvulsants (phenytoin, phenobarbital, carbamazepine, lamotrigine), antimicrobials (Sulfa meds, quinolones, PCN, HIV meds), steroids, NSAIDs, immunizations (Table 1). Acute: lasts 7-9 days. ED Evaluation: Clinical diagnosis in the ED based on history and exam. 1 mL/kg/hr.

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E-9-1-1 ALS ED Critical Care 78

REBEL EM

NOVEMBER 11, 2024

Article: Chanderraj R, Admon AJ, He Y, et al. 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). In 2021, Buckley et. JAMA Intern Med.

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E-9-1-1 ICU ALS Critical Care 93

EMDocs

JANUARY 6, 2025

ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. Labs Laboratory workup in the ED is notable for a leukocytosis of 41,000/L, hemoglobin of 6.5 g/dL, thrombocytopenia of 96 10 9 /L, prothrombin time (PT) of 16.1 1 By the end of 2023, 117.3 of the global population.

ED 74

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. In ED population, diuretics have not demonstrated clear benefit in mortality.

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E-9-1-1 ALS Emergency Department OR 88

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 EMS E-9-1-1 EMT 98

Pediatric EM Morsels

MARCH 7, 2025

TXA has been mentioned previously on PEM Morsels in the following contexts: Post Tonsillectomy Hemorrhage , Hemophilia in the ED , Von Willebrand Disease , Epistaxis in Children , Hereditary Angioedema , Hemoptysis in Children , Hyphema , and even in Neonatal Subgaleal Hemorrhage. 2012 Feb;147(2):113-9. 2020;2(1):e0075.

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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. Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial. doi: 10.1001/jama.2024.20424. 2024.20424. Shorter courses of antibiotics.

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E-9-1-1 ACS Paramedic Emergency Department 52

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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E-9-1-1 ALS Emergency Department OR 71

ACEP Now

JANUARY 5, 2025

The PREOXI trial compared oxygen mask pre-oxygenation versus noninvasive positive-pressure ventilation (NIPPV) in patients requiring intubation in emergency departments (EDs) and intensive care units. 1 The primary outcome was the frequency of observed hypoxemia, defined as any pulse oximetry reading below 85 percent.

ALS 40

ALS E-9-1-1 ED Emergency Department 40

REBEL EM

JULY 14, 2025

🤕 Case A 26-year-old woman presents to the ED after falling onto her outstretched right hand while rollerblading. About 1 in 10 patients will have an occult fracture, and roughly 1 in 10 scaphoid fractures result in nonunion. 7 🧾 Paper Cohen A, Reijman M, Kraan GA, et al. 2025;26(1):14.

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EMDocs

JULY 26, 2025

He had a similar episode three months prior which resolved quickly during his ED visit. 1 Hypokalemic paralysis can further be divided into primary and secondary causes: Primary cause: genetic calcium channelopathy. 5 Epidemiology: Hypokalemic Paralysis: 1 Prevalence: 1 in 100,000 individuals worldwide.

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E-9-1-1 EMS ALS ED 75

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. Transient STEMI was studied by Lemkes et al.

STEMI 70

STEMI E-9-1-1 CAD ALS 70

EMDocs

JUNE 28, 2025

Vital signs revealed a BP of 136/76, HR of 88, RR of 9, SpO2 of 94% on room air, and a temperature of 97.6 Answer : Bradypnea Background: Bradypnea is defined as a decreased respiratory rate and varies by age (Table 1) 1 Hypopnea is shallow breathing that occurs during sleep 2 Etiology: Secondary to a number of causes.

EMS 78

EMS E-9-1-1 Overdose ALS 78

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. Jan 2015; PMID: 25559473 Airapetian N, et al. Di Nicol P, et al.

ALS 64

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

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.

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E-9-1-1 FFP ALS Critical Care 70

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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E-9-1-1 ALS ED OR 81

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

EMDocs

JUNE 14, 2025

A 23-year-old female presents to the ED with slurred speech, left lower leg weakness, and confusion. We’ll keep it short, while you keep that EM brain sharp. A friend is with her and states that the patient does not take any medications, has no past medical history, but has been complaining of various symptoms over the past year.

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E-9-1-1 EMS ALS ED 99

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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E-9-1-1 EMS ALS Emergency Department 74

EMDocs

JUNE 2, 2025

Adapted from: Chavez S, Koyfman A, Gottlieb M, et al. link] Batra S, Ochani RK, Diwan MN, et al. 2021;12(1):885-901. link] Jain S, Khaiboullina S, Martynova E, et al. 2017;17(1):225. 2019;6(1):435-458. Velsquez GE, Aibana O, Ling EJ, et al. Velsquez GE, Aibana O, Ling EJ, et al.

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E-9-1-1 ALS EMS OR 100

Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Initially tested in Johannesburg, South Africa: 1 month old to 12 years old Broselow predicted within 10% of weight in 63.6% link] Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. x exp[0.02

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E-9-1-1 Emergency Medical Services Life Support ALS 274

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. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. 2011;46(9):1771. 5 th Edition.

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E-9-1-1 Epinephrine ALS ED 307

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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E-9-1-1 ALS Critical Care Emergency Department 184

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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E-9-1-1 ALS ED OR 161

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.

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E-9-1-1 Emergency Department ALS ED 177

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.,

E-9-1-1 246

E-9-1-1 ALS Emergency Department OR 246

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. Article: Arvig MD, Lassen AT, Gæde PH, et al. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.

ED 116

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

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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E-9-1-1 ALS Emergency Department OR 161

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. 2) To be presented at AHA conference in Chicago in 2 weeks: Sharkey SW et al. 2) You need to be just as expert at echo as I am at the ECG.

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E-9-1-1 Coronary ALS ED 130