ACEP Now

NOVEMBER 7, 2024

About three percent of emergency department (ED) visits are due to skin and soft tissue infections, but data are lacking on the contribution of chronic wounds to this number. Wound management in the ED is only a starting point, and appropriate referral and follow-up are key to an improved outcome.

ED 97

ED OR Emergency Department Ambulance 97

ACEP Now

NOVEMBER 8, 2024

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.

Emergency Department 52

Emergency Department ED OR ALS 52

EMDocs

DECEMBER 1, 2024

A 52-year-old male with a history of essential hypertension presents to your South Texas ED for his second visit this week complaining of indolent fever, shortness of breath, pleuritic chest pain, and a rash on his trunk and extremities. We’ll keep it short, while you keep that EM brain sharp.

E-9-1-1 98

E-9-1-1 EMS OR ED 98

EM Board Bombs

JUNE 26, 2025

-Case- A 52-year-old woman with a history of heavy menstrual bleeding presents to the ED with progressive fatigue, dizziness, and dyspnea on exertion. Evaluation: Anemia is a common ED finding and can range from an incidental lab result to a life… Source She denies chest pain or syncope.

ED 52

ED OR 52

The Skeptics' Guide to EM

DECEMBER 28, 2024

Emergency departments (EDs) are often the first point of contact for patients experiencing opioid-related crises, ranging from overdose to withdrawal. This positions EDs as critical spaces for intervention, offering a chance to initiate treatment, provide education, and connect patients with long-term resources.

Emergency Department 223

Emergency Department Overdose ED ALS 223

ACEP Now

NOVEMBER 8, 2024

In: Cone DC, Brice JH, Delbridge TR, Myers B, eds. 6 Because LMAs require inflation to function appropriately, they are at risk of balloon rupture or loss of seal pressure. While not unique to LMAs, the potential risk of airway occlusion is higher than it is for other EGAs. 2018;320(8):769-778. Guyette FX, Wang HE. 3rd Edition.

E-9-1-1 40

E-9-1-1 Emergency Medical Services Emergency Medical Technician AEMT 40

EMDocs

JANUARY 8, 2025

Remember, from the ED point of view, if you are confronted with a wide complex regular tachydysrhythmia, assume VTach until proven otherwise! These are very commonly encountered in the emergency department, so being able to correctly identify the rhythm is extremely important. Lets dive in! It could be VTach or SVT with aberrancy.

CAD 96

CAD EMS Emergency Department ED 96

Medic Mindset

NOVEMBER 13, 2024

As an EM physician, he shares how he decides to care for his own patients in the ED who present with rapid atrial fibrillation. Casey Patrick is the EMS medical director of Montgomery County Hospital District (Texas). He shares with listeners how he came to the decision to remove Diltiazem from his service.

Paramedic 98

Paramedic Emergency Department EMS ED 98

EMDocs

JULY 9, 2025

Clinical Application in the ED Incorporating VTI into sepsis management requires minimal additional equipment beyond the ultrasound already present in many emergency departments. She reports worsening fatigue and decreased oral intake over the past few days. On arrival, her vital signs are BP 85/50 mm Hg, HR 115 bpm, RR 22, temperature 101.6°F,

Emergency Department 85

Emergency Department ALS ICU Critical Care 85

ACEP Now

DECEMBER 7, 2024

A 28-year-old female is brought to the emergency department (ED) by police after a sexual assault. 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.

Mental Health Services 52

Mental Health Services Emergency Department ED ALS 52

ACEP Now

JUNE 11, 2025

A 55-year-old woman with medical history of well-controlled hypertension and renal cell carcinoma, status post-partial nephrectomy, presented to the emergency department (ED) with sudden-onset, 10-out-of-10 chest pain and pressure. Screening, evaluation, and early management of acute aortic dissection in the ED. Curr Cardiol Rev.

Operating Room 59

Operating Room Emergency Medical Services Emergency Department ED 59

ALiEM

NOVEMBER 22, 2024

Although this patient had a formal ultrasound, POCUS can be a useful tool in the ED to identify and expedite intussusception treatment. Case Question: What is the treatment for intussusception? Air or hydrostatic enemas have a 70-85% success rate in current literature. These are often done under either fluoroscopic or ultrasound guidance.

ED 183

ED OR 183

International Journal of Paramedicine

JANUARY 15, 2025

ED-based protocols have already been created to aid in the treatment of patients with this condition. Existing protocols for delirium in the pre-hospital setting were designed for younger adults, who have different etiologies and different levels of tolerance for medications than most older adults.

Ambulance 52

Ambulance ED EMS OR 52

Dr. Smith's ECG Blog

MAY 20, 2025

interesting spontaneous reperfusion case 1413140 prehospital STEMI first ED ECG is here, with 3/10 pain: But this is the same patient just 10 minutes before, with 7/10 pain Isn't it ridiculous to say that the patient has both a STEMI and an NSTEMI? ACS is dynamic. It can't be given one static name. Now the patient has one disease: OMI.

STEMI 59

STEMI OR ACS ED 59

ALiEM

DECEMBER 20, 2024

On the day of presentation, he woke up with a new rash over his face and hands which prompted the ED visit. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. A 3-year-old male with a history of severe atopic dermatitis presented for facial rash and hand pain. Mom had been applying Aquaphor and Vaseline several times a day.

Emergency Department 161

Emergency Department ED OR 161

ACEP Now

DECEMBER 7, 2024

As emergency departments (EDs) have become the focus of bottlenecks in the entire health care systemfrom insufficient inpatient beds leading to hospital boarding to dwindling access to primary carea siege atmosphere has developed. The majority do not require any additional resources on the part of the ED.

Ambulance 98

Ambulance EMT EMT ED 98

ACEP Now

JUNE 29, 2025

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). For this inaugural column, I wanted to start with a topic near and dear to my heart: push-dose vasopressors in the ED. This column is for you!

Emergency Department 59

Emergency Department E-9-1-1 Epinephrine Critical Care 59

EMDocs

DECEMBER 18, 2024

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

E-9-1-1 100

E-9-1-1 Emergency Department ICU ED 100

The Skeptics' Guide to EM

NOVEMBER 16, 2024

With emergency department (ED) volumes rising, administrators are eager to explore AI-driven solutions to improve patient safety and reduce staff burnout. They want to know how CHARTWatch integrates with electronic health records (EHRs), whether it can adapt to their patient ED population, and how clinicians respond to using the tool.

ICU 274

ICU Emergency Department ALS ED 274

ACEP Now

JULY 3, 2025

Acute toxic ingestions are a common reason for presentation to the emergency department (ED) and clinical scenarios range from benign accidental ingestions to large overdoses resulting in hemodynamic instability. 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.

E-9-1-1 52

E-9-1-1 Overdose Epinephrine Naloxone 52

REBEL EM

DECEMBER 23, 2024

The heterogeneity of treatment effects was also assessed among different hemoglobin SS genotypes, levels of care, volumes of fluid resuscitation, and diagnosis of acute kidney dysfunction on admission. Outcomes: Primary and secondary outcomes were objective and patient-centered but not optimally measured.

ALS 116

ALS ED ACS EMR 116

ACEP Now

MAY 10, 2025

A Simplified Protocol for Intralipid Administration in the ED Ultrasound-guided nerve blocks (UGNBs) are becoming more common in emergency medicine practice. Recently, numerous Emergency Department (ED) groups have demonstrated the efficacy of UGNBs for pain control with a low rate of complications. Click to enlarge.

ED 87

ED Emergency Department ALS Epinephrine 87

Don't Forget the Bubbles

MAY 19, 2025

These findings raise an important question: if the OFC, in its current form, doesnt meaningfully impact outcomes but does extend ED stays, is it time to rethink how (or if) we use it? The findings suggested that children with iHypoCa were nearly three times more likely to present with hypotension. But did it help?

Emergency Department 62

Emergency Department ACS EMS OR 62

Dr. Smith's ECG Blog

SEPTEMBER 6, 2013

On arrival, here is the ED ECG: No significant change. Then numerous angiographic studies refuted this and showed that it is almost always due to posterior STEMI. Atrial fibrillation in STEMI: Atrial fibrillation is uncommonly an acute and immediate result of STEMI, but is a common pre-existing condition in elderly patients with STEMI.

STEMI 52

STEMI OR ALS ED 52

ALiEM

NOVEMBER 18, 2024

In: Mattu A and Swadron S, ed. 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; CorePendium.

Emergency Department 177

Emergency Department ALS OR ED 177

EM Literature of Note

DECEMBER 4, 2024

Those who work in the ED are acutely aware of this, and it conjures up tremendous cognitive pressures on staff every shift. Every ED clinician knows the most benign-appearing triage complaint may obfuscate lurking catastrophe. If some are to be believed, hundreds of thousands are being killed each year by diagnostic errors in the ED.

Emergency Department 95

Emergency Department ED OR 95

EMDocs

JANUARY 11, 2025

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).

E-9-1-1 96

E-9-1-1 EMS ALS Emergency Department 96

Broome Docs

JANUARY 27, 2025

European Journal of Internal Medicine , [link] You can listen to my 27-minute rant on Youtube here: [link] This multinational trial looked at a three-pronged diagnostic protocol in the ED for adults with suspected acute aortic syndromes. The protocol used the ADD score, a POCUS echo protocol and D-dimer to try and exclude AAS in the ED.

ED 100

ED OR ACS Critical Care 100

ACEP Now

JANUARY 4, 2025

I was about two months into a family practice internship when I went to visit my uncle whose neighbor happened to be an ED resident, Dr. Clarke said. ED attendings Dr. Gerald Whelan and Dr. Shumary Chow supervising a full arrest in C booththe main trauma roomwith an ED tech administering CPR. Click to enlarge.)

ED 52

ED Emergency Department Ambulance CPR 52

Dr. Smith's ECG Blog

JANUARY 15, 2025

Our transport time to the ED was 30 min. Unfortunately, the ED declined as it was viewed as an NSTE. Lake County Ambulance obtained ECG within 9 minutes and transmitted to ED. Pt transported to SMMC ED where Dr. Hansen and team obtained ECG now showing ST Elevation and alert activated. We are hopeful for her recovery.

STEMI 52

STEMI ICU ED Ambulance 52

The Skeptics' Guide to EM

MAY 3, 2025

Case: A 6-week-old boy is brought by his parents to your emergency department (ED) for fever. Unfortunately, its expensive, and not all EDs have access to it or can receive the results promptly to help with decision making. His older sister has been sick with upper respiratory symptoms for the past week but seems to be recovering.

ALS 205

ALS ED Emergency Department OR 205

EM Board Bombs

MAY 22, 2025

-Case- A 41-year-old woman presents to the ED with a sudden onset of left-sided facial droop. She woke up this morning and noticed she couldn’t smile on that side, close her left eye fully, or raise her eyebrow. She denies weakness in her arms or legs, no slurred speech, and has no headache.

ED 52

ED OR 52

Don't Forget the Bubbles

JULY 7, 2025

The crew are 25 minutes away from the ED. Adrenaline, an endogenous catecholamine produced by the adrenal medulla, exerts its effects on both alpha- and beta-adrenergic receptors in a dose-dependent manner, triggering the well-known sympathomimetic ‘fight or flight’ response to stress. mL) Child 6–12 years: 300 micrograms IM (0.3

Emergency Department 109

Emergency Department Epinephrine ED BLS 109

EMDocs

NOVEMBER 13, 2024

Major takeaway: Consider SBP in any patient who comes into the ED with ascites. Literature concerning risk with PPIs is controversial. Presentation: Classic presentation is abdominal pain or tenderness, fever, and altered mental status. Literature suggests 10-33% of patients are asymptomatic or only have mild symptoms. increase in mortality.

E-9-1-1 100

E-9-1-1 ALS OR ED 100

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. 10% of patient’s have an ED visit within 30 or 90 days following THA. of adults over the age of 55).

EMS 96

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

EMDocs

NOVEMBER 19, 2024

His roommate found an empty pill bottle on the floor next to him. Second-generation antipsychotics (see Table 1 below) improve both positive and negative symptoms of schizophrenia and are less likely to be associated with EPS. 1,2 Most second-generation antipsychotics act as D 2 antagonists and inhibit the 5-HT 2A receptor.

Overdose 102

Overdose EMS ALS Emergency Medical Services 102

JEMS

JULY 11, 2025

Nancy Caroline’s Emergency Care in the Streets (9th ed.). The populations from NEMSIS are very different, with cardiac arrests being over 583,000 incidence, and our population with gastric decompression is slightly above 5,000 patients, or less than 1% of the total population. Gastric decompression is an easy skill. What Is NEMSIS.”

Mobile Integrated Health 116

Mobile Integrated Health Overdose CPR Community Paramedicine 116