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Date: November 10, 2024 Reference: Couper et al. Reference: Couper et al. The Paramedic 3 Trial: A randomized clinical trial of drug route in out-of-hospital cardiac arrest. October 31, 2024 NEJM Access to the SGEM Podcast episode at this LINK.
Reference: Muldowney et al. A Comparison of Ketamine to Midazolam for the Management of Acute Behavioral Disturbance in the Out-of-Hospital Setting. Ann Emerg Med. 2025 Date: April 24, 2025 Guest Skeptic: Dr. Howie Mell received his Medical Doctorate (MD) from the University of Illinois at Chicago, College of Medicine at Rockford.
Reference: Arnold CG, et al. Performance of individual criteria of the Pediatric Emergency Care Applied Research Network (PECARN) intraabdominal injury prediction rule. Acad Emerg Med. Imaging modalities like computed tomography (CT) are the gold standard for diagnosis, but CT use must be balanced against the risks of ionizing radiation.
The biggest change has been the gradual replacement of diacetylmorphine (heroin) by fentanyl and other synthetic opioids. Along the same time, a veterinary sedative, xylazine , became popular in Puerto Rico in individuals who used injection drugs [3]. We treat with wound care and reserve surgical management only for limbs that are no longer viable.
Pecha JD, Yen KG, Moisiuc A, et al. Chabicovsky M, Winkler S, Soeberdt M, et al. Pashaei-Marandi A, Assam JH, Arnold A, et al. A 3-month-old male with no past medical history was brought to the emergency department for evaluation of newly asymmetric pupils. Abdominal : Soft, nontender, nondistended. Neurological : Alert.
Her vital signs are normal, except for a heart rate of 115 bpm. Its going to take time to get her to a tertiary center. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. A patient’s mouth packed with gauze after tonsillectomy surgery. CREDIT: Dr. P.
Some conceptual models envision fully autonomous ambulances that transport stabilized patients without needing onboard medical staff. 2 Robotics and AI also play a growing role in autonomous EMS. 3 Benefits of Autonomous EMS Systems Autonomous EMS delivery systems offer numerous advantages. Cost efficiency is another significant benefit. Fredman, D.,
Symptoms started approximately seven hours prior to arrival and progressive, severe pain eventually prompted her visit to the ED. This happened once 10 years ago, requiring reduction in the ED. The patient denied preceding trauma, rubbing her eyes/eye-lids, or any history of thyroid disease. She endorsed right eye blurred vision and severe pain.
Methodology: 4/5 Usefulness: 4/5 Vallentin MF, et al. N Engl J Med. 2024 Oct 31. doi: 10.1056/NEJMoa2407616. Editorial: The Way to a Patient’s Heart – Vascular Access in Cardiac Arrest Question and Methods: This RCT compared IO vs. IV vascular access in adults with OHCA, using ROSC as a primary outcome.
This results in less protection for underlying structures, and more force is transmitted to the underlying organs. A high index of suspicion is essential—even in the absence of bruising, deformity, or wounds. What you don’t see can still be life-threatening. Children can compensate well—until they can’t. Hypotension is a pre-terminal sign.
Benger JR, Kirby K, Black S, et al. Wang HE, Schmicker RH, Daya MR, et al. Ramaiah R, Das D, Bhananker SM, et al. Agro F, Frass M, Benumof JL, et al. Shin WJ, Cheong YS, Yang HS, et al. 6 Because LMAs require inflation to function appropriately, they are at risk of balloon rupture or loss of seal pressure.
Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)
Medicare Ambulance Extender Bill Introduced in House Yesterday, March 18, Representatives Claudia Tenney (R-NY), Terry Sewell (D-AL), Cliff Bentz (R-OR), Paul Tonko (D-NY), Mike Carey (R-OH), Danny Davis (D-IL), Carol […] The post House Reintroduces Vital Medicare Extender and EMS Workforce Bills appeared first on American Ambulance Association. (..)
Bogossian et al. (1) Bogossian H, Frommeyer G, Ninios I, Hasan F, Nguyen QS, Karosiene Z, Mijic D, Kloppe A, Suleiman H, Bandorski D, et al. T-waves are quite tall and possibly peaked (HyperK?), but potassium returned normal. What is the QT interval? In LBBB, the QT interval is partly prolonged by the wide QRS. Heart Rhythm [Internet].
But what exactly are neurodivergence and neurodiversity? Neurodivergence refers to the unique way in which an individual’s brain processes and responds to certain information, differing from the typical or average brain. 12 Each person has their unique approach to learning and understanding, and we adapt and use techniques that suit us best.
Date: October 29, 2024 Reference: Galili et al. Reference: Galili et al. Low dose ketamine as an adjunct to morphine: a randomized controlled trial among patients with and without current opioid use. AEM Oct 2024. Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. AEM Oct 2024.
Now lets walk through them quickly: Ho et al (4) looked at termination of VT in 15 min or hemodynamic deterioration. Gorgels et al (5) looked at procainamide vs lidocaine and again and primary outcome was VTach termination. Manz et al (6) looked at ajmaline vs lidocaine for the termination of VT. Coolest part of this trial?
References Evans L, Rhodes A, Alhazzani W, et al. link] Meyhoff TS, Hjortrup PB, Jørn Wetterslev, et al. Both studies demonstrated no difference in their primary outcome of mortality before discharge home by day 90 when employing a ‘liberal’ or ‘restrictive’ approach to fluid resuscitation for patients in septic shock. Crit Care Med.
Coming into triage, I see a young man—Georgian-speaking—bracing himself with a hand against the wall and holding his lower abdomen. With what I can only describe as a “grimace” by a singular word, his face conveyed so much more. Without talking or touching the patient, the triage nurse picked up on a deep pain.
Date: December 26, 2024 Reference: Steinhauser S et al. Reference: Steinhauser S et al. Emergency department staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder. AEM December 2024 Guest Skeptic:Dr. Suchismita Datta.
Poorly healing wounds are primarily the result of chronic venous insufficiency, peripheral (arterial) vascular disease, prolonged pressure-point skin injury, or neuropathy secondary to vascular disease or diabetes. Once identified, they must protect the skin from further injury. Examples include Adaptic, Xeroform, Telfa, and Dermagen.
Back in 2020, Holmberg et al. Despite these clear findings, the recommendation persisted—until O’Halloran et al. References: Holmberg MJ, Ross CE, Yankama T, et al. 2019.12.032 O’Halloran AJ, Reeder RW, Berg RA, et al. Scholefield BR, Acworth J, Ng K-C, et al. And the evidence has spoken—again and again.
Isenhour JL, Craig S, Gibbs M, et al. These are very commonly encountered in the emergency department, so being able to correctly identify the rhythm is extremely important. Lets dive in! When you are presented with a tachycardic ECG, we want you to focus on two major factors right away. It could be VTach or SVT with aberrancy. Vereckei A.
Date: October 28, 2024 Reference: Verma et al. Reference: Verma et al. Clinical evaluation of a machine learning–based early warning system for patient deterioration. CMAJ September 2024 Guest Skeptic: Michael Page is currently the Director of Artificial Intelligence (AI) Commercialization at Unity Health Toronto.
Hershey Medical Center Editors : Alex Blau, DO; Michael DeFilippo, DO, Assistant Professor of EM & EMS, WashU School of Medicine Clinical Case The day after a snowstorm you are working for a rural, advanced life support (ALS) agency and you are called to a 62-year-old gentleman with chest pain.
To assess the clinical impact and relevance of these concerns, Alwang et al. performed the retrospective cohort study below ( Alwang 2024 ). Paper: Alwang AK, Law AC, Klings ES, Cohen RT, Bosch NA. Lactated Ringer vs Normal Saline Solution During Sickle Cell Vaso-Occlusive Episodes.
The Bottom Line: HEAT Trial Acetaminophen for Fever in critically Ill Patients with Suspected Infection The SGEM: SGEM #146 The Heat is On IV Acetaminophen for Fever in the ICU References Young, P et al. PMID: 26436473 Schortgen F et al. PMID: 22366046 Sunden-Culberg J et al. Vitals are BP 114/42, HR 138, T 102.1,
Understanding the Study The research, published in Shock (Penn et al., For paramedics, this could mean a shelf-stable, easy-to-use solution that saves more lives in the toughest conditions, revolutionizing prehospital care as we know it. The findings were promising.
fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold
The dose is 25 mg- 100 mg for adults and 0.5 mg/kg-1 mg/kg with maximum dose of 50 mg in children. 1 Whole-bowel irrigation can be considered; however, it is not recommended in unstable patients or those at risk for aspiration. Fluid resuscitation is the initial management of hypotension.
1 A significant number of patients present to the ED with concerns related to traumatic experiences. 1 A significant number of patients present to the ED with concerns related to traumatic experiences. These concerns may be a direct result of trauma (e.g., injuries following an assault), or an indirect result of trauma (e.g.,
References Dyson K, Bray JE, Smith K, et al. Wang HE, Schmicker RH, Daya MR, et al. Benger JR, Kirby K, Black S, et al. Benger JR, Lazaroo MJ, Crout M, et al. 3,4 Which is Best? Practitioners must consider ROSC. Without ROSC, there really is no 72-hour or 30-day outcome at all. Ann Emerg Med. 2017;70(3):382-390.e1.
Rosenbaum SB, Gupta V, Patel P, et al. However, this theory has not been shown to be true in the literature and Ketamine can be an excellent form of anesthesia for combative patients such as in this case. Ketamine is thought to work as an antagonist at the NMDA receptor and has a dose dependent response [1]. CNS Neurosci Ther.
My goal in this column is to share tips, tricks, and emerging concepts from the intensive care unit (ICU) that you can use on your next shift in the emergency department (ED). If there are topics that you want me to cover, don’t hesitate to reach out. Known hypotension, as a bridge to a continuous infusion of a pressor. Unanticipated hypotension.
al in 2008, and is eponymously named after the main author. From the original description by deWinter et al ( N Engl J Med 359:2071-2073, 2008 ) There is a new ECG pattern without ST elevation that signifies acute occlusion of the proximal LAD ( L eft A nterior D escending ) coronary artery.
Now imagine that your tongue suddenly shriveled up and fell off and that in its place is a tongue-sized isopod aka rollie pollie aka pillbug. Just there, hanging out, forever. How are you feeling? Hey, we get it. But at least youll never be alone again. Believe it or not, this is not some bad creative writing exercise. This is a very real parasite.
Munawar K, Nayak G, Fatterpekar GM, et al. He also endorsed left-sided facial weakness and diplopia for the last eight days. He denied fevers, chills, nausea, vomiting, ear pain, tinnitus, hearing changes, blurry vision, photophobia, history of malignancy or HIV, history of stroke. Additional Images Physical Exam Vitals : Temp 36.8°C;
Having paramedics stuck on ambulances not only limits career growth and fuels burnout but also hampers ALS care efficiency, with ambulances frequently tied up at hospitals. Instead, they spread paramedics across all apparatus, acknowledging the blend of firefighting and EMS skills required today.
mm (presumably in 2 consecutive leads, but this important study by Wung et al in 2001 is vague on that). Then numerous angiographic studies refuted this and showed that it is almost always due to posterior STEMI. It may also occur in inferior STEMI because the RCA supplies the sinoatrial nodal artery.
Up to 1/3 of adults over 60 suffer from chronic constipation. Evaluation: A good history and a high index of clinical suspicion is paramount, especially in high-risk patient populations 4 CT of the abdomen and pelvis with contrast is the best choice for diagnosis. Enemas (some studies show this may be associated with perforation risk).
Kochanek et al. explored the evidence in a 2019 systematic review, which forms part of the Brain Trauma Foundation Guidelines, as did Utsumi et al. The guidelines by Kochanek et al. Should we aim to prevent fever, or should we cool patients? At the scene, his lowest GCS was 5 (E1V2M2). Fever is common among patients with TBI.
Methodology: 4/5 Usefulness: 2/5 McMullan JT, et al. Ann Emerg Med. 2024 Oct;84(4):363-373. doi: 10.1016/j.annemergmed.2024.04.018. 2024.04.018. Question and Methods: This out of hospital, placebo-controlled, blinded, parallel group RCT compared reduction in pain scores between Fentanyl + IN Placebo and Fentanyl with IN Ketamine.
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