ACEP Now

JULY 3, 2025

1 In the ED, the most important consideration in management of these toxicities involves decontamination, evaluating for airway protection, and managing any hemodynamic instability. mg/kg-1 mg/kg with maximum dose of 50 mg in children. 9 Vasopressor of choice should include norepinephrine or epinephrine.

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JEMS

JULY 8, 2025

1 Notably, these statistics don’t include the substantial increase in behavioral health visits to pediatric emergency departments since the COVID-19 pandemic occurred. 2 E -Eyeball the patient: View this method as a scene size up. E -Establish expectations and set boundaries: Boundaries and expectations must be set. of visits.

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ACEP Now

JUNE 29, 2025

1 Push-dose pressors can come in handy in three situations: Anticipated transient hypotension. A pure a 1 – agonist, phenylephrine gives you peripheral vasoconstriction but no increase in cardiac output. However, because of the b 1 effect, tachydysrhythmias are a common side effect. What is a Push-Dose Pressor?

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This Podcast Will Kill You

FEBRUARY 11, 2025

Journal of Zoological Systematics and Evolutionary Research, 46(1), pp.19-23. Anais da Academia Brasileira de Cincias, 96(1), p.e20230706. Gompper, Matthew E., Diseases of Aquatic Organisms, 66(1), pp.87-90. Pathogens, 9(3), p.230. Carlson, Colin J., ” Science advances 3.9 2017): e1602422. and Okamura, B.,

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ACEP Now

JUNE 17, 2025

1 According to the ACEP Code of Ethics: The physician-patient relationship is the moral center of medicine and the defining element in clinical ethics. 2018;13(9):e0204113. 2017;17(1):136. 2020;20(1):52. 2023;23(1):270. Winter R, Issa E, Roberts N, et al. 2020;10(9):e036471. 2020;103(9):1866-1867.

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EMDocs

DECEMBER 18, 2024

Initial vital signs: HR 136 BPM, BP 172/82 mmHg, RR 24, T 37.2C, SpO2 97% RA Physical examination: General: restless, mildly agitated CV: tachycardic, regularly regular, diaphoretic, Abdomen: Soft, NT, ND, intermittently dry heaving Neuro: tremulous in bilateral arms and hands, tongue fasciculations What do you suspect as the diagnosis?

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FOAMfrat

JANUARY 7, 2025

His wife tells us he's a long-term alcoholic who drinks several pints of vodka every day, and 3 days ago tried to start weaning himself off by drinking less than 1 pint. Journal of Clinical Medicine , 9 (6), 1901. 2023, October 1). Ben-Menachem, E., Brodtkorb, E., Acta Neurologica Scandinavica , 135 (1), 416.

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Dr. Smith's ECG Blog

NOVEMBER 11, 2024

The ECG shows sinus rhythm with a rate of about 78 and 2:1 AV conduction along with right bundle branch block and left anterior fascicular block. 2:1 block is a special case, because the tracing lacks successive PR intervals. I have labeled the P waves below for ease of reference: P waves 8 and 9 both conduct to the ventricles.

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EMDocs

NOVEMBER 13, 2024

Commonly a monomicrobial infection with gram-negative bacteria like E. Paracentesis is a safe procedure with a low complication rate (< 1%). For the remaining fluid inject 1 mL into a purple top EDTA blood tube for cell count; send 2-3 mL for Gram stain in a red-top tube or sterile urine container. coli (50-90% of cases).

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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. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 2020 Sep 30;5(9):558-567. 2021 Mar;33(1):11-17.

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This Podcast Will Kill You

DECEMBER 10, 2024

Nature Reviews Gastroenterology & Hepatology , 20 (9), pp.615-624. 2016): 1-9. Conficconi, E., BioMed research international , 2017 (1), p.9784565. Thieme, E. JAMA network open , 4 (8), pp.e2122248-e2122248. Fitz, Reginald H. Ponsky, T.A., Huang, Z.J., Eichelberger, M.R., Gilbert, J.C., and Newman, K.D.,

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JEMS

JULY 7, 2025

Perkins ZB, Greenhalgh R, Avest E, et al. International Prehospital Medicine Institute Literature Review, June 2025 1. Perkins ZB, Greenhalgh R, Avest E, et al. The authors classified repeat encounters into one of four categories; medical (61%), trauma (29%), lift assist only (9%) and cardiac arrest (1%).

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ACEP Now

DECEMBER 7, 2024

1 A wide spectrum of severity exists in PE presentations, ranging from mild shortness of breath to cardiac arrest. 2023;2(1):100548. Meyer G, Vicaut E, Danays T, et al. 2022;2022(1-2):e202208. Capanegro J, Quinn E, Arndt M, et al. 2019;12(9):859-869. J Soc Cardiovasc Angiogr Interv. Int J Angiol.

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Don't Forget the Bubbles

NOVEMBER 29, 2024

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. Here’s your step-by-step guide: Step 1: Stabilise the Patient Airway, breathing, and circulation (ABCs): Secure and stabilise. 2024;14(1).

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Don't Forget the Bubbles

JUNE 10, 2025

The SWAST Feedback Project uses REDCap ( R esearch E lectronic D ata CAP ture) as its data collection platform. Other prehospital clinicians included Emergency care assistants ( 7% ) and student paramedics ( 8% ) (see Figure 1 ). 2021 May 29;6(1):15–22. 2018 [cited 2025 Mar 17];15(1). 2019 May 9 [doi: 10.1016/j.jbi.2019.103208]

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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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ACEP Now

DECEMBER 7, 2024

1 The reason is understandablethrombolytics in stroke is a high-risk, higher-reward treatment. Acceptance of thrombolytics in stroke is exemplified in the results from a survey of EDs participating in ACEPs Emergency Quality Network (E-QUAL) Stroke Collaborative. Click to enlarge. Click to enlarge.

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JEMS

JUNE 23, 2025

Patients can lose up to 2 million brain cells every minute of a stroke; every hour without treatment, the brain ages 3 1/2 years. Remember B-E F-A-S-T, the stroke acronym, which stands for Balance, Eyes, Face, Arms, Speech and Time — as in, time to call 9-1-1. 21—It was just after 2 p.m. on Monday, Sept.

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JEMS

JUNE 19, 2025

In 2025, some systems are running 1 EMS call every 45 seconds in urban centers, with the majority of those calls for non-life-threatening issues. 1 Yet the industry response has been predictable; “We need more medics.” Delbridge, TR, Davis, CD, Atkins, DL, Castillo, EM, Clawson, J, Goralnick, E, … & Swor, R.

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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. Pediatrics.

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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? 2017 Sep;279(1):70-89. vs. 52.2%). vs. 15.3%).

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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

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. 1 mL/kg/hr. 2021;57(9):895. 2010;88(1):60-68. 2010;31(1):100-4.

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Dr. Smith's ECG Blog

DECEMBER 29, 2024

The Queen of Hearts also knows which large T-waves are hyperacute and which are not: She knows that it is not OMI (Unfortunately, most providers no longer have access to the Queen of Hearts because 1) it is not yet FDA approved and 2) thus a provider can only use it in the context of research.) Here are 9 cases that involve re-occlusion.

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JEMS

JULY 2, 2025

References 1. Berg G, Nyberg S, Harrison P, Baumchen J, Gurss E, Hennes E. Barnhard By Roy Danks, DO It’s time to decommission the long spine board. These may be fighting words to the hardcore EMS provider who has seen the decades-old spine splint go through its many iterations. Prehosp Emerg Care. 2010 Oct-Dec;14(4):419-24.

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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.

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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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Pediatric EM Morsels

MARCH 7, 2025

Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H,Gogichaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA,Meja-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR,Yutthakasemsunt S. 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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ACEP Now

JANUARY 5, 2025

1 The primary outcome was the frequency of observed hypoxemia, defined as any pulse oximetry reading below 85 percent. Theodorou A, Melanis K, Bakola E, et al. The obvious winner was NIPPV, whose 9.1 percent incidence of hypoxemia was half that of the oxygen mask cohort. 2024;332(19):1623-1633. 2024;103(7):e209862.

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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% PMID: 34605781 Yahav D, Franceschini E, Koppel F, et al. PMID: 30535100 von Dach E, Albrich WC, Brunel AS, et al. Gram-Positive? Crit Care Med. Clin Infect Dis.

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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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ACEP Now

DECEMBER 17, 2024

1 His tragic loss underscores the urgent need for mental health support for residents and fellows. Accessed December 9, 2024. Accessed 9 December 2024. Other demands included increased time for parental leave and childcare, clean resident call rooms, reimbursement for board exam fees, and improved medical benefits coverage.

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Don't Forget the Bubbles

NOVEMBER 27, 2024

Umana E, Mills C Norman-Bruce H, Mitchell H, McFetridge L, Lynn F, McKeeman G, Foster S, Barrett MJ, Roland D, Lyttle MD, Watson C, Waterfield T, on behalf of Paediatric Emergency Research in the UK and Ireland (PERUKI), Lancet eClinical, 2024 Who were the patients? An additional 1 ml of blood was taken for PCT from some infants.

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