JEMS

JULY 31, 2025

1 While there is recent data still being combed through by researchers, the tentative report is that numbers continue to go up. References 1. 2022 May;85(1):23-37. Hopper, E. Journal of Clinical Psychiatry, 68(1), 37-46. You have to appreciate that first responders are a different breed and have unique challenges.

E-9-1-1

REBEL EM

NOVEMBER 11, 2024

found no difference in mortality in critical care patients treated with vancomycin and piperacillin- tazobactam compared to vancomycin and cefepime or meropenem. 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.

E-9-1-1

JEMS

JUNE 12, 2025

1 Many of these approvals represent entirely new drug classes or treatment approaches. For EMS clinicians and educators, this relentless pace of innovation demands a constant recalibration of knowledge and skills to address the shifting realities of prehospital care. References 1. Mercier, E., 2010 , 87 , 1348.

E-9-1-1

JEMS

AUGUST 7, 2025

1-6 They were strictly designed to reimburse services for the cost associated with transport to a medical facility. The Economic and Clinical Infrastructure of EMS Is Under Siege These proposed reforms, if implemented, would have devastating, systemic consequences for emergency care in the United States. Prehosp Emerg Care.

EMS

REBEL EM

MAY 19, 2025

Margin: Allowed up to 1 in 25 more deathsthough stricter than past trials. of patients in the 7-day group received antibiotics for longer than 9 days, while 5.8% REBEL Rundown Key Points Generalizability: Mostly Canadian patients with gram-negative UTIs or abdominal infections. Gram-Positive? Lets break it down.

E-9-1-1

JEMS

AUGUST 6, 2025

1 The city had ordered mandatory evacuations, but many medical personnel, such as those at Memorial Medical Center, were caught by the hurricane’s sudden arrival. All EMS personnel, whether they are an emergency medical technician, paramedic, critical care nurse, or any other role – have a duty to patients. References 1.

EMS

Don't Forget the Bubbles

JULY 28, 2025

Several factors explain reliance on adult research: Paediatric critical care, or intensive care, is a relatively new speciality, with the first collaborative research group founded in the 1990s. Figure 1: Impact of implementation science for children and families, staff, and wider health and care services.

E-9-1-1

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. Crit Care Med. Critical Care Medicine. Oct 2013; PMID: 24079262 Gohar E, et al. Mar 2004; PMID: 15090949. Marik P, et al.

ALS

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.

E-9-1-1

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% Prehosp Emerg Care. Patient safety in the pediatric emergency care setting. 2007-2902 Wells M, Coovadia A, Kramer E, Goldstein L. 2020;13(1):9. 2016;23(1):21-28. x exp[0.02

E-9-1-1

Pediatric EM Morsels

JULY 19, 2024

Since the original morsel ( way back in 2012 ), the literature has shown that there are a few extra ingredients that we can add to our morsel recipe when we care for children with post-tonsillectomy hemorrhage. Tranexamic Acid (TXA) IV TXA 15 mg/kg for a child 1 g for adult (that’s right…this isn’t just a presentation seen in children.

E-9-1-1

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].

E-9-1-1

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. 2011;46(9):1771. McGraw Hill Education; 2019:125-138 Ziu E, Mesfin FB. J Pediatr Surg.

E-9-1-1

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.

E-9-1-1

Don't Forget the Bubbles

MAY 29, 2023

A study of teams over a 1-year period highlights that people witnessing incivility are also affected, which could lead to individuals feeling unsupported in their teams. 2021:36:1–2, NP448–NP473 Available at. Review of Cultivating Communities of Practice: A Guide to Managing Knowledge, by Wenger E, McDermott R, Snyder WM].

Critical Care

EMDocs

JANUARY 11, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association (AHA) and Neurocritical Care Society (NCS) released their 2023 Scientific Statement on the critical care management of post ROSC patients. Neurocrit Care. 2023 Dec 1. Treat seizures if present.

Critical Care

Pediatric EM Morsels

NOVEMBER 17, 2023

Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. Cuffed endotracheal tubes in pediatric intensive care. 1994 Jul;125(1):57-62. 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.

E-9-1-1

Don't Forget the Bubbles

NOVEMBER 22, 2023

Of these signs, mortality in children is associated with hepatomegaly and fever; meanwhile, mortality in adults is associated with hyperkalaemia, traumatic brain injury, propofol infusion rates >5mg kg -1 h -1 and ECG changes. 1998;8(6):491-9. Critical care (London, England). Why does PRIS occur? Folino, T.B.

E-9-1-1

Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. However, education and training for healthcare professionals traditionally prioritise ‘hard skills’, particularly critical care resuscitation. Here are ten things to think about: 1.

E-9-1-1

Broome Docs

MAY 31, 2024

Freund Y, Viglino D, Cachanado M, Cassard C, Montassier E, Douay B, Guenezan J, Le Borgne P, Yordanov Y, Severin A, Roussel M, Daniel M, Marteau A, Peschanski N, Teissandier D, Macrez R, Morere J, Chouihed T, Roux D, Adnet F, Bloom B, Chauvin A, Simon T. PMID: 37019501 Pulmonary primatology is harder than you may think Drew T, Võ ML, Wolfe JM.

E-9-1-1

Don't Forget the Bubbles

AUGUST 28, 2023

The median age at diagnosis was 47 months (range 1-173 months). About PICSTAR PICSTAR is a trainee-led research network open to all doctors, nurses and allied health trainees within Paediatric Intensive Care. 2014;9(9):S102-S109. 2019;43(1):98-103.doi:10.1097/RCT.0000000000000782 2019;19(1):2126.doi:10.1016/j.bjae.2018.10.001

Emergency Manager

Don't Forget the Bubbles

FEBRUARY 26, 2024

About PICSTAR PICSTAR is a trainee-led research network open to all doctors, nurses and allied health trainees within Paediatric Intensive Care. We are the trainee arm of the Paediatric Critical Care Society – Study Group (PCCS-SG) and work with them on research, audit and service evaluation. 2007 Jan 1;25(1):6-9.

E-9-1-1

FOAMfrat

APRIL 22, 2024

This kid had sticks go through his cheek from running with a lollipop, hit by a car, almost kidnapped, attacked by a dog, and almost burnt his house down by throwing a 9-volt battery in the trash. Prehosp Emerg Care. 2024 Mar 15:1-9. Robichaud L, Ross D, Proulx MH, Légaré S, Vacon C, Xue X, Segal E.

E-9-1-1

ACEP Now

OCTOBER 11, 2024

1 Pediatric rapid sequence intubation (RSI) in the ED is associated with a higher frequency of failed first attempts and adverse effects than in adult patients. Paralytic agents include rocuronium at 1 mg/kg IV and succinylcholine at 1-2 mg/kg IV. References Long E, Sabato S, Babl FE. mg/kg IV, ketamine at 1.5–2

E-9-1-1

Broome Docs

OCTOBER 31, 2022

Intensive Care Med. 2022 Jan;48(1):78-91. 2022 Sep;21(9):781-791. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Preventing radial arterial catheter failure in critical care – Factoring updated clinical strategies and techniques.

E-9-1-1

Dr. Smith's ECG Blog

SEPTEMBER 11, 2018

I activated the cath lab and brought her to the critical care area. My comments address a few additional differences between the 3 ECGs that were done in this case — with focus on how to put the subtleties I describe in perspective in view of the overall picture ( Figure-1 ). The presence of artifact should be noted in ECG #1.

E-9-1-1

Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Clinical Course of Children 1 to 24 Months Old With Positive Urine Cultures Without Pyuria. 2024;24(1):111-118. Giannoni, E., Pediatric Critical Care Medicine , 25 (3), pp.e117-e128. Acad Pediatr. doi:10.1016/j.acap.2023.06.023

E-9-1-1

NAEMSP

APRIL 19, 2023

This CI does include 1; and further and further analysis of the data showed that the likelihood that calcium has a beneficial effect (e.g. The overall conclusion was that as less than 1% of cardiac arrest etiologies fall into a group that would potentially benefit from calcium, that routine use should be avoided (Padrao, et.

E-9-1-1

Paramedic Training Spot

DECEMBER 8, 2021

Basic Combat Training Basic Combat Training , or BCT, is approximately 10 weeks and will take place at 1 of the 4 locations available. In more than 40 after-action reports, or AARs, from actual combat situations, the key issue with treating critically ill or severely injured casualties was lack of flight paramedics.

Paramedic

REBEL EM

MAY 8, 2023

Paper: Smith JA, Secombe P, Aromataris E. J Trauma Acute Care Surg. Only 1 RCT and 1 cohort study had only mechanically ventilated patients. References: Smith JA, Secombe P, Aromataris E. J Trauma Acute Care Surg. The pendulum is swinging towards conservative management for occult pneumothoraces.

E-9-1-1

ACEP Now

NOVEMBER 7, 2023

1 Overall, survival is poor following cardiac arrest, and is affected by factors including age, comorbidities, witnessed arrest, early CPR, early defibrillation, and return of spontaneous circulation (ROSC). 2018;13(9):e0204169. Margey R, Browne L, Murphy E, et al. Cortez E, Krebs W, Davis J, et al. Resuscitation.

Defibrillator

Dr. Smith's ECG Blog

JULY 12, 2020

While calling for some help and arranging to have her transported to our critical care zone, I got this quick ultrasound which confirmed my suspicion: This quick view was all I was able to obtain in the circumstances. Figure-1: The 1st, 3rd, 4th, 5th and 6th ECGs shown above in this case ( See Text ). mm STE depression in aVL.

E-9-1-1

Pediatric EM Morsels

JULY 28, 2023

Rates of type 1 diabetes have increased since the COVID-19 pandemic. A critical MORSEL is that every child you treat for DKA needs to have an initial thorough neuro exam including cranial nerves and then frequent neuro reassessments … and document it ( so your colleagues who take over care for the kid can know if there has been a change )!

E-9-1-1

REBEL EM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 5 Onset of VAP has been repeatedly shown to increase the number of ventilator days, intensive care length of stay, use of antimicrobials, medical costs, and mortality risk. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis [published online ahead of print, 2023 Aug 9]. References: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM.

E-9-1-1

REBEL EM

OCTOBER 5, 2023

1-6 We now have the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial. Patients enrolled from 31 Intensive Care Units in France. Patients admitted to the ICU with severe community-acquired pneumonia were randomized in a 1:1 ratio to receive hydrocortisone or a placebo.

Critical Care

REBEL EM

AUGUST 21, 2023

Figure 2 : Extended Glasgow Outcome Scale (GOS-E) (credit: Doc_HG ) Secondary Modified Rankin Score Secondary outcomes included death within 6 months. Monitoring cerebral pressures is crucial in assessing the impact of interventions, especially in critical care scenarios.

E-9-1-1