ACEP Now

NOVEMBER 8, 2024

The quick-moving, high-stress practice of emergency medicine means health care professionals need to be prepared for anything. Among emergency physicians’ diverse patient populations, neurodivergent individuals represent a unique group with distinct challenges and requirements. Neurodivergence is an umbrella term that refers to a variety of neurological differences (not deficits), including autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and dyslexia, among other

Emergency Department

REBEL EM

NOVEMBER 6, 2024

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 (80%) Demographics Most commonly affects patients between ages 10-20 years old As age increases, elbow dislocation rates tend to d

E-9-1-1

Dr. Smith's ECG Blog

NOVEMBER 27, 2024

Pendell and I and the geniuses at Powerful Medical (Producers of the PMCardio Queen of Hearts OMI AI app ) are working on an objective, mathematical definition of hyperacute T-waves , based on real OMI outcomes and hyperacute T-wave annotation that has excellent interrater agreement (between me and Pendell), and it will end up being a logistic regression using these 3 variables: 1) area under the curve (AUC) relative to the QRS size 2) increased symmetry , as defined by time from T-wave onset to

STEMI

The Skeptics' Guide to EM

NOVEMBER 30, 2024

Date: November 10, 2024 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. Guest Skeptic: Missy Carter is a PA currently practicing in critical care after having attended the University of Washington's MEDEX program.

Epinephrine

Pulsara

NOVEMBER 7, 2024

Editor's Note: In August 2024, EMS1 and Fitch & Associates released their annual EMS trend survey, What Paramedics Want, proudly sponsored by Pulsara. Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Read, enjoy, share, and take to heart the following information brought to you by the most prestigious thought leaders in EMS.

EMS

Emergency Medicine Cases

NOVEMBER 12, 2024

In this EM Cases main episode podcast, we tackle the complexities of trauma airway management, including direct trauma to the airway. We discuss indications and timing of intubation, penetrating neck trauma, the head injured patient, the agitated patients and the soiled airway. The critical question is: when should we deviate from, delay or modify RSI, and how do we navigate the unique challenges presented by trauma airways and airway trauma?

EMS

ACEP Now

NOVEMBER 8, 2024

Airway management remains a fundamental skill for all emergency physicians. Extraglottic airway devices (EGAs) have become a widely accepted means of airway management along with rescue airway devices. We aim to clarify the role of these devices in the prehospital setting and discuss considerations surrounding the most frequently used devices in current practice.

E-9-1-1

EMDocs

NOVEMBER 13, 2024

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we cover the literature on evaluation and management of primary SBP. Episode 110: Primary Spontaneous Bacterial Peritonitis Background: End-stage liver disease with cirrhosis and ascites is a major cause of death worldwide. Primary spontaneous bacterial peritonitis (SBP) is one of the most common infections in those with cirrhosis and ascites.

E-9-1-1

St. Emlyn's

NOVEMBER 19, 2024

St.Emlyn's - Emergency Medicine #FOAMed Traditionally, large-bore chest tubes have been standard for managing hemothorax, but smaller tubes are now proving just as effective in stable patients, with added benefits like reduced pain and fewer tube days. This review explores outcomes in drainage efficacy, complication rates, and patient comfort, showing that small-bore thoracostomy may be a reliable alternative for non-emergent cases.

OR

Pulsara

NOVEMBER 20, 2024

EDITOR'S NOTE: This article originally appeared on EMS1.com under the title "Everyday use of this care platform helps prepare personnel for the 'big one.'" Special thanks to our guest author, John Erich, for EMS1 BrandFocus Staff. __ MCIs are no time to be learning new tools – this one is suitable for use on every call as well as major incidents In Texas, there’s rarely a dull moment for emergency responders.

Ambulance

Medic Mindset

NOVEMBER 13, 2024

Want CE for listening? Here’s how. Dr. Casey Patrick is the EMS medical director of Montgomery County Hospital District (Texas). As an EM physician, he shares how he decides to care for his own patients in the ED who present with rapid atrial fibrillation. He wants paramedics to ask the same question he asks: Is the rapid A-fib the primary problem or secondary to another critical condition like sepsis, PE, DKA, hypovolemia, etc?

Paramedic

ACEP Now

NOVEMBER 7, 2024

This is the second visit in two weeks for an elderly gentleman who is concerned about his legs being red and swollen. During the first visit, he was diagnosed with cellulitis and placed on cephalexin. Today, he notes worsening swelling and a blister forming near his left ankle. The pain makes it difficult for him to ambulate unassisted through his home.

ED

Don't Forget the Bubbles

NOVEMBER 29, 2024

It’s a busy day in the paediatric ED. A worried parent rushes in carrying a toddler who’s just had a gulp from an unlabelled bottle in the garage. The child looks unsettled but otherwise fine—for now. “It was just a bit of the stuff we use for cleaning the car windscreen,” the parent says. You smell the faint odour of alcohol on the child’s breath A quick mental note: methanol poisoning?

Plasma

EMDocs

NOVEMBER 16, 2024

Authors: Steven Wright, MD (EM Resident Physician, UTSW – Dallas, TX); Samia Farooqi, MD (Assistant Professor of EM/Attending Physician, UTSW – Dallas, TX) // Reviewed by: Sophia Görgens, MD (EM Physician, BIDMC, MA); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited review of clinical basics.

EMS

First Responder Wellness

NOVEMBER 15, 2024

Enhancing Mental Health Support for Public Safety and First Responders Lexipol , the leader in solutions that enhance performance excellence in public safety, is proud to announce a new partnership with First Responder Wellness (FRW). This collaboration aims to enhance mental health support for first responders by integrating Lexipol’s clinician and peer support training with FRW’s residential treatment services for public safety personnel in need of specialized care.

First Responder

REBEL EM

NOVEMBER 11, 2024

Background: Patients with sepsis are routinely treated with empiric broad-spectrum antibiotics while awaiting source identification, as recommended by the surviving sepsis campaign.2 Vancomycin, in combination with either piperacillin-tazobactam or cefepime, is commonly used for empiric treatment in these cases. Literature comparing the two regimens has largely focused on the adverse effects of each medication, rather than on overall efficacy.

E-9-1-1

Pulsara

NOVEMBER 13, 2024

Editor's Note: In August 2024, EMS1 and Fitch & Associates released their annual EMS trend survey, What Paramedics Want, proudly sponsored by Pulsara. Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Read, enjoy, share, and take to heart the following information brought to you by the most prestigious thought leaders in EMS.

Paramedic

First Responders Foundation

NOVEMBER 25, 2024

Service dogs play an invaluable role in supporting Veterans and first responders, offering assistance that ranges from anxiety relief and refocusing in public settings to specialized tasks that help manage daily challenges, such as diabetic or cardiac alerting. Whether it’s helping a firefighter cope with trauma or aiding a police officer with mobility issues, these specially trained dogs provide a level of support that can be life-changing.

First Responder

Don't Forget the Bubbles

NOVEMBER 18, 2024

As you roll into your night shift, getting briefed and handed the urgent pager, you exit the briefing room and go into the hum of the neonatal intensive care unit. The familiar beeps of monitors and the soft cries of a premature infant fill the air, but then—a sharp, unusual beep cuts through. Moments later, a nurse calls, “Doctor, could you check this blood pressure?

OR

EMDocs

NOVEMBER 14, 2024

Authors: Lloyd Tannenbaum, MD (EM Attending Physician, Geisinger Wyoming Valley, PA); Mai Saber, DO (EM Attending Physician, Hackensack University Medical Center, NJ); Rachel Bridwell, MD (EM Attending Physician, Charlotte, NC) // Reviewer: Brit Long, MD (@long_brit) Hello and welcome back to ECG Pointers, a series designed to make you more confident in your ECG interpretations.

EMS

Chicago EMT Training

NOVEMBER 4, 2024

We are ready to begin hosting psychomotor exams for BLS providers that successfully completed their written NREMT requirement. Assessments include: Medical Assessment (Neuro) Trauma Assessment (Head to Toe) Airway Management (with iGel) CPR//AED/choking for adults, pediatrics, and infants Bleeding Control (tourniquet) Penetrating Chest Trauma Spinal Motion Restriction OB Delivery Please schedule an appointment with Victor at info@chicagoemttraining.com To prepare, you can utilize our study guide

BLS

REBEL EM

NOVEMBER 18, 2024

View Course Dates This 2-day course provides an in-depth look at effective surgical airway management techniques that you will actually use in your next emergency airway. There is a unique focus on airway anatomy and imaging combined with one-of-a-kind opportunity to practice the techniques on a large variety of non-embalmed, specially prepared cadavers.

Critical Care

NVFC

NOVEMBER 5, 2024

The National Emergency Response Information System (NERIS) launched on November 4 to modernize incident data collection and provide vital intelligence for local fire departments across the United States. NERIS is a secure, cloud-based platform developed in collaboration with the American fire service to capture all-hazards incident data and provides analytic tools for local fire and emergency service leaders in near-real time.

Emergency Response

ESO

NOVEMBER 5, 2024

We’re excited to announce the launch of our advanced Critical Care functionality within ESO Electronic Health Record (EHR) , designed to meet the unique demands of high-acuity healthcare environments. Developed in close collaboration with our customers, this innovative upgrade helps streamline workflows for emergency medical and critical care professionals, enabling faster and safer decision-making on the ground and in the air.

Critical Care

ALiEM

NOVEMBER 22, 2024

A 13-month-old, full-term male presented due to intermittent emesis over a 3-week period. He and his parents had COVID one week prior to presentation. He had multiple episodes of non-bloody, non-bilious vomit the day before and the day of presentation. Parents noted he had been listless and unable to tolerate food. The mother was also concerned that he was straining to have bowel movements and that a mass was coming out of his bottom on the ride to the hospital.

ED

EMDocs

NOVEMBER 19, 2024

Authors: Bricey Bayonnet, MD ( EM Resident Physician, Atrium Health’s Carolinas Medical Center, Charlotte, NC); Christine Murphy, MD (EM Attending Physician; Medical Toxicologist, Atrium Health’s Carolinas Medical Center, Charlotte, NC) // Reviewed by: James Dazhe Cao, MD (@JamesCaoMD, Associate Professor of EM, Medical Toxicology, UT Southwestern Medical Center, Dallas, TX); Anthony Spadaro MD, (@TSpadaro91, Fellow in Medical Toxicology, Rutgers NJMS); Alex Koyfman, MD (@EMHighAK); Brit Long, M

Overdose

The Skeptics' Guide to EM

NOVEMBER 2, 2024

Date: October 29, 2024 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. He is the Vice Chair of the Emergency Department and Program Director of the EM residency program at Nassau University Medical Center in East Meadow, NY, the safety net hospital for Nassau County.

Emergency Department

REBEL EM

NOVEMBER 25, 2024

Background: In 2018, the BEAM Trial, a small single-center randomized clinical trial, conducted in the emergency department at Hennepin County Medical Center, demonstrated that bougie use significantly increased the first-attempt intubation success rate compared to the endotracheal tube with stylet (98% vs 87% (absolute difference, 11% [95% CI, 7% to 14%]). 1 Conversely, the 2021 BOUGIE trial—a larger, multicenter randomized clinical trial conducted by the same investigators—found no significant

Operating Room

NVFC

NOVEMBER 5, 2024

The end of the year is approaching, and the holiday season can bring many positives. It can also be a difficult time for emergency responders and their families. Juggling commitments at home with responsibilities at work and at the fire department can be stressful, as can responding to a neighbor’s worst day during what is supposed to be a festive, family-oriented time of year.

First Responder

Dr. Smith's ECG Blog

NOVEMBER 11, 2024

Written by Willy Frick A middle aged man presented for elective outpatient surgery. The following ECG was obtained in the preoperative area. What do you think? 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. The PR interval on the conducted beats is prolonged, about 220 ms.

OR

ALiEM

NOVEMBER 18, 2024

A 48-year-old male with no significant past medical history presented to the Emergency Department with a left-sided facial rash and associated burning left eye pain that started four days prior. He was seen at an ophthalmology clinic when his symptoms started and given oral valacyclovir which he took for three days without improvement. He also endorsed left-sided facial weakness and diplopia for the last eight days.

Emergency Department

EMDocs

NOVEMBER 25, 2024

Authors: Kamoga Dickson, MD (EM Resident Physician, Makerere College of Health Sciences, Kampala, Uganda); Jessica Pelletier, DO, MHPE (APD/Assistant Professor of EM/Attending Physician, University of Missouri-Columbia) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case A 42-year-old male from a rural area in northeastern Uganda presents to the tertiary care emergency department with severe itching, skin changes on his legs, and episodes of blurred vision, describing &

E-9-1-1

St. Emlyn's

NOVEMBER 6, 2024

St.Emlyn's - Emergency Medicine #FOAMed Creating a learning culture in the emergency department (ED) fosters psychological safety, open communication, and continuous improvement. This approach supports team resilience, enhances patient care, and reduces burnout. Learn practical steps to build a strong learning culture in your ED, promoting growth and collaborative excellence in emergency medicine.

ED

FOAMfrat

NOVEMBER 14, 2024

We can all remember a call that sticks out in our minds, a crazy, messy, tragic call that has stuck with us over the course of our entire careers. I know I’ve had a few of these, but there’s one in particular I’d like to share that breaks from the norm and has stuck with me every day since. One day, I was running a paramedic fly-car and was dispatched for a sick subject withdrawing from alcohol.

Paramedic

NVFC

NOVEMBER 5, 2024

This year, Crash Responder Safety Week (CRSW) takes place November 18-22 with the important message, “Responders Ahead! Reduce Your Speed as You Proceed.” Every year, law enforcement, fire and rescue, EMS, public works, transportation, towing, and other responders put their lives at risk to clear the 7 million motor vehicle crashes as well as the broader range of roadway incidents such as stalled vehicles or roadway debris.

EMS

Peter Canning

NOVEMBER 9, 2024

The day I thought Donald Trump might really win was several months ago when I attended a gathering of people who had or had had family members in prison and were interested in humane drug policy. One of the leaders of the group, said he wasn’t buying Kamala. “A prosecutor is a prosecutor is a prosecutor,” he said, “She ain’t fooling us,” he said which was greeted by many “Here.

Naloxone

The Skeptics' Guide to EM

NOVEMBER 16, 2024

Date: October 28, 2024 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. He leads an AI team intending to improve patient outcomes and healthcare system efficiency.

ICU