ALiEM

OCTOBER 30, 2024

‘Dope’ is no longer heroin in an increasing number of our communities. The biggest change has been the gradual replacement of diacetylmorphine (heroin) by fentanyl and other synthetic opioids. Due in large part to the proliferation of anonymous chemical factories able to produce industrial volumes of inexpensive synthetic opioids without opium or other controlled precursors, fentanyl spilled into the United States, Canada, and Europe, heroin soon fell to market forces [1, 2].

E-9-1-1 161

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

Emergency Medicine Cases

OCTOBER 1, 2024

In this ECG Cases blog we look at 5 cases of ECGs falsely labeled 'normal'. Can you spot the critical abnormality? Written by Jesse McLaren; Peer Reviewed and edited by Anton Helman. October 2024 Five patients presented with ECGs labeled ‘normal’. Can you use systematic ECG interpretation to identify the [.] The post ECG Cases 51 – ECGs falsely labeled “normal” appeared first on Emergency Medicine Cases.

EMS 307

EMS 307

American Ambulance Association

OCTOBER 10, 2024

FOR IMMEDIATE RELEASE Contact: Tristan North tnorth@ambulance.org October 10, 2024 Congressman Mike Bost Honored with Legislative Recognition Award from the American Ambulance Association Washington, D.C. — The American Ambulance […] The post Congressman Mike Bost Honored with Legislative Recognition Award appeared first on American Ambulance Association.

Ambulance 263

Ambulance 263

The Skeptics' Guide to EM

OCTOBER 19, 2024

Date: October 7, 2024 Reference: Nguyen et al. Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial. Annals of EM 2024. Guest Skeptic: Dr. Brendan Freeman is an emergency medicine physician, assistant professor of emergency medicine, and medical education fellow at Staten Island University Hospital.

OR 247

OR Emergency Department ED ALS 247

First 10 EM

OCTOBER 28, 2024

As with everything that comes out of the PECARN group, this is a huge study, and is therefore one that everyone needs to know about. That being said, despite working in two very busy community hospitals with a high percentage of pediatrics visits, c-spine injuries are just not an issue I struggle with. I have […] The post The PECARN c-spine rule could cause a lot of harm appeared first on First10EM.

EMS 122

EMS 122

California Casualty

OCTOBER 24, 2024

On National First Responders Day, we honor the brave men and women who selflessly rush into danger when others flee, putting their lives on the line to protect and save. Whether battling fires, responding to medical emergencies, or maintaining order in the face of chaos, first responders serve with unmatched courage and skill.

First Responder 130

First Responder OR Firefighter 130

ALiEM

OCTOBER 28, 2024

A 2-year, 11-month-old female with a history of constipation was brought to the ED by her mother for abdominal pain. The mother noticed that the patient’s abdomen had been enlarging for months. When they visited the pediatrician several months ago, the pediatrician also noticed a mildly enlarged abdomen but the patient was asymptomatic at that time.

ED 161

ED OR 161

American Ambulance Association

OCTOBER 8, 2024

FOR IMMEDIATE RELEASE Contact: Tristan North tnorth@ambulance.org October 8, 2024 Senator Jerry Moran Honored with Legislative Recognition Award from the American Ambulance Association Washington, D.C. — The American Ambulance Association […] The post Senator Jerry Moran Honored with Legislative Recognition Award appeared first on American Ambulance Association.

Ambulance 263

Ambulance 263

Critical Care Scenarios

OCTOBER 16, 2024

We discuss the practical barriers to implementing the A-F ICU liberation bundle, with Kali Dayton, ACNP-BC (@HomeIcu), host of the Walking Home from the ICU podcast, and consultant to ICUs working on these issues. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! We discuss the practical barriers to implementing the A-F ICU liberation bundle, with Kali Dayton, ACNP-BC ( @HomeIcu ), host of the Walking Home from the ICU podcast, and consultant to ICUs working

ICU 208

ICU 208

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% Febrile Non-hemolytic (FNHTR) – 1% Transfusion-associated circulatory overload (TACO) – 1% Transfusion-related acute lung injury (TRALI) – <0.01% Anaphylaxis/ABO incompatibility –

Allergic Reaction 188

Allergic Reaction ED Plasma Epinephrine 188

ACEP Now

OCTOBER 29, 2024

On a busy day shift in the emergency department, our seasoned triage nurse comes to me after I finish caring for a hallway patient, “Hey, can you come see this guy in the triage room? His vitals are fine…”. Seemingly unsure, she pauses, “I’m getting an interpreter, and I think he has belly pain, but something just doesn’t seem right.” Coming into triage, I see a young man—Georgian-speaking—bracing himself with a hand against the wall and holding his lower abdomen.

Emergency Department 59

Emergency Department ALS Emergency Medical Services OR 59

ALiEM

OCTOBER 21, 2024

A 5-year-old generally healthy fully immunized boy presented to the ED with worsening left ear redness, swelling, and tenderness that his family noticed the day before presentation. His family had also recently noticed an abrasion over that ear. The patient was on amoxicillin for strep throat, which was diagnosed a week before the onset of his symptoms and was improving.

ED 169

ED OR 169

Emergency Medicine Cases

OCTOBER 1, 2024

In this EM Cases podcast Anton chats with Dr. Peter Brindley and Dr. Leon Byker who have a deep interest in the Culture of Medicine to explore what culture in medicine is, why culture is so important, and then drive home 10 strategies to improving the culture in our departments emphasizing the importance of human connection, empathy, open communication, and a willingness to learn from mistakes in creating a positive and fulfilling work environment, so that we love our work, we love our departmen

EMS 180

EMS 180

American Ambulance Association

OCTOBER 23, 2024

FOR IMMEDIATE RELEASE Contact: Tristan North tnorth@ambulance.org October 10, 2024 Senator Debbie Stabenow Receives Inaugural EMS Legacy Award from the American Ambulance Association Washington, D.C. — Senator Debbie Stabenow […] The post Senator Stabenow Receives Inaugural EMS Legacy Award appeared first on American Ambulance Association.

EMS 239

EMS Ambulance 239

EMOttawa

OCTOBER 31, 2024

Delirium is a medical emergency. It is characterized by acute disturbance of consciousness, with changes in perceptual disturbances and fluctuation of symptoms. Delirium is often the initial manifestation of an underlying acute illness and can be present before fever, tachypnea, tachycardia, or hypoxia. There is an ED prevalence ranging from 7-24%, with increased mortality rates […] The post Delirium revisited appeared first on EMOttawa Blog.

ED 127

ED OR EMS 127

California Casualty

OCTOBER 31, 2024

Your pet is part of the family, so you want to make sure they’re welcome wherever you rent. From understanding pet policies to preventing your four-legged companion from leaving a lasting pawprint on the property, there are a few key things to keep in mind.

130

130

EMergucate

OCTOBER 29, 2024

The following chest x-ray is from an elderly patient with cough & dyspnoea.

EMS 130

EMS 130

ALiEM

OCTOBER 7, 2024

A 52-year-old female with a past medical history of hypertension and prediabetes presented to the emergency department with double vision that started one day prior to arrival. She stated that her double vision improved when she closed one eye. She denied trauma, headache, neck pain, dizziness, dysphagia, numbness, tingling, weakness, or gait instability.

Emergency Department 161

Emergency Department OR 161

Core EM

OCTOBER 23, 2024

The Case A 24-year-old man with no past medical or surgical history presented to the emergency department with 5 days of progressively worsening bilateral leg cramping, paresthesias, and multiple falls. The following ECG is obtained: EKG Show Details EKG Characteristics Rate 88 Rhythm Sinus Rhythm with PAC's Intervals Normal PR and QRS interval, Prolonged QTc interval (619 ms) Axis Normal ST Segments Normal Additional Features Diffuse, prominent, prolonged T-waves Diagnosis Diagnosis : Hypokalem

Emergency Department 130

Emergency Department ICU Critical Care Ambulance 130

American Ambulance Association

OCTOBER 10, 2024

FOR IMMEDIATE RELEASE Contact: Tristan North tnorth@ambulance.org October 10, 2024 Congressman Ryan Zinke Honored with Legislative Recognition Award from the American Ambulance Association Washington, D.C. — The American Ambulance […] The post Congressman Ryan Zinke Honored with Legislative Recognition Award appeared first on American Ambulance Association.

Ambulance 147

Ambulance 147

EMOttawa

OCTOBER 24, 2024

Precedex (dexmedetomidine) is an alpha-2 adrenergic agonist increasingly used in critical care environments for sedation and anxiolysis. It offers a unique profile of sedation without respiratory depression, making it an attractive option in various clinical scenarios. Historically, it has been used more frequently in the ICU than in Emergency Departments, likely due to provider comfort. […] The post Is there a Precedence for Precedex in the ED?

ED 131

ED ICU Critical Care Emergency Department 131

California Casualty

OCTOBER 8, 2024

In the classroom, every second is an opportunity to learn. That’s where sponge activities come in—quick, engaging learning tasks that soak up spare moments like a sponge, turning downtime into teaching time.

OR 130

OR 130

EMergucate

OCTOBER 29, 2024

17-year-old boy with wrist fracture. This patient became blue during manipulation of the fracture under bier’s block anaesthetic effect.

130

130

ALiEM

OCTOBER 11, 2024

A 76-year-old female presented with a lingering cough and an oral lesion to the left lower cheek. She reported ten days of improving flu-like symptoms but had a persistent cough and nasal congestion. On the day of presentation, she developed a painful, intermittently bleeding “blood blister” to the left lower cheek that had increased in size, as well as new red spots on her arms and legs.

OR 152

OR ALS 152

Core EM

OCTOBER 16, 2024

We discuss migraines with one of the authorities in the field. Hosts: Benjamin Friedman, MD of Montefiore Brian Gilberti, MD [link] Download Leave a Comment Tags: Neurology Show Notes Initial Approach to Diagnosing Migraines: Differentiating between primary headaches (migraine, tension-type, cluster) and secondary causes (e.g., subarachnoid hemorrhage).

ED 130

ED OR 130

American Ambulance Association

OCTOBER 7, 2024

FOR IMMEDIATE RELEASE Contact: Tristan North tnorth@ambulance.org October 7, 2024 Senator Jon Tester Honored with Legislative Recognition Award from the American Ambulance Association Washington, D.C. — The American Ambulance Association […] The post Senator Jon Tester Honored with Legislative Recognition Award appeared first on American Ambulance Association.

Ambulance 147

Ambulance 147

Dr. Smith's ECG Blog

OCTOBER 3, 2024

This was sent to me from Sam Ghali ( @EM_Resus ) with no other information. I assumed it was a patient with acute chest pain. "What do you think, Steve? Real or just fake?" What do YOU think? It has some inferior ST elevation with some reciprocal ST depression and inverted T in aVL. This usually indicates inferior OMI. My answer: "Fake: pretty certain, but not 100% certain.

E-9-1-1 127

E-9-1-1 Coronary ALS ED 127

California Casualty

OCTOBER 11, 2024

Transportation Expense (TE) coverage, often called rental reimbursement is an optional coverage that can be added to your auto insurance policy to help cover the costs associated with renting a car while your vehicle is being repaired due to a covered loss, such as an accident.

130

130

EMergucate

OCTOBER 28, 2024

This VBG was from a young girl with sever gastroenteritis (Vomiting and diarrhoea) for 3 days. PH = 7.52, that is moderate alkalaemia. pCO2 = 21 mmHg. So, we have respiratory alkalosis.

130

130

ALiEM

OCTOBER 23, 2024

Ultrasound-guided procedures are difficult enough just identifying the anatomy. Performing a nerve block with the ultrasound in one hand and the needle in the other hand adds extra challenges. The simplest 1-person approach involves attaching a syringe with local anesthetic directly to the end of the procedural needle. A 2-person approach involves attach the syringe to a custom tubing-needle setup such as below.

Emergency Department 141

Emergency Department OR 141

Core EM

OCTOBER 1, 2024

We discuss migraines with one of the authorities in the field. Hosts: Benjamin Friedman, MD of Montefiore Brian Gilberti, MD [link] Download Leave a Comment Tags: Neurology Show Notes Initial Approach to Diagnosing Migraines: Differentiating between primary headaches (migraine, tension-type, cluster) and secondary causes (e.g., subarachnoid hemorrhage).

ED 130

ED OR 130

American Ambulance Association

OCTOBER 25, 2024

As many of you are aware, OSHA has published the NPRM titled the Emergency Response Rule. This rule will have substantial impacts on EMS and Fire Emergency Service Organizations should […] The post SBA Informational Session on OSHA Emergency Response Rule appeared first on American Ambulance Association.

Emergency Response 130

Emergency Response Ambulance EMS 130

Dr. Smith's ECG Blog

OCTOBER 8, 2024

This was sent to me by a reader who wishes to remain anonymous. A lady in her 60s came to the ER with chest discomfort and shortness of breath. She had a history of previous anterior MI treated by primary PCI to the proximal LAD. The first EKG is from 2:30 PM on the day of presentation to the ER. Smith : To me this is a blatantly obvious acute anterior OMI.

OR 126

OR STEMI ICU Coronary 126

St. Emlyn's

OCTOBER 22, 2024

St.Emlyn's - Emergency Medicine #FOAMed This post accompanies the podcast “Simulation for Elite Team Performance,” which was recorded live at the Tactical Trauma 2024 conference in Sundsvall, Sweden. We are grateful to the organizing team […] The post Podcast – Simulation for Elite Team Performance with Andrew Petrosoniak at Tactical Trauma 2024 appeared first on St.Emlyn's.

Emergency Department 124

Emergency Department 124

EMergucate

OCTOBER 27, 2024

Today’s ECG is a 45yr male who presents to ED with a 12hr history of epigastric pain and diaphoresis. He is an ex smoker, no other cardiac risk factors.

ED 130

ED EMS 130

Critical Care Scenarios

OCTOBER 2, 2024

We chat with Noelia Bischoff, recently off orientation in the medical ICU at Johns Hopkins as a nurse practitioner, about the transition from her role as a bedside ICU nurse. Check out the Intensive Care Academy here! Find us on Patreon here! Buy your merch here! We chat with Noelia Bischoff, recently off orientation in the medical ICU at Johns Hopkins as a nurse practitioner, about the transition from her role as a bedside ICU nurse.

ICU 124

ICU 124

EMCrit Project

OCTOBER 5, 2024

When you need to temporize orbital compartment syndrome, there is markedly easier way than Lateral Cantholysis EMCrit Project by Scott Weingart, MD FCCM.

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