May, 2024

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Transcutaneous Pacing: Part 2

EMS 12-Lead

TCP in the ROSC Patient: False Electrical Capture at 75mA Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the second installment of a blog series showing how transcutaneous pacing (TCP) can be difficult and how you can improve your skills. We will be using redacted information from different cases where paramedics attempted TCP in the field.

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Ep 195 Management of Subarachnoid Hemorrhage

Emergency Medicine Cases

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.

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Optimizing Trauma Resuscitation Education: A Year-Long In-Situ Simulation Curriculum

Core EM

Optimizing Trauma Resuscitation Education: A Year-Long In-Situ Simulation Curriculum Ashika Jain, MD, Nelly Parisot, MD, Michael J. Klein, MD, Janice Shin-Kim, MD, Brian Lin, MD, Julia Paris, MD, Shannon McNamara, MD, Jessica Strauss, MD, Soma Pathak, MD Delivering optimal care in a trauma resuscitation requires a highly coordinated and skilled team.

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Hot off the press: Bridge to EM curriculum (2nd edition) released

ALiEM

It has been 3 years since the 8-week, self-guided Bridge to Emergency Medicine (EM) curriculum was launched to help graduating medical students prepare for EM residency. The curriculum has been viewed over 43,000 times and we have awarded over 5,000 ALiEMU course certificates. It is now a part of many residency programs’ intern boot camp. Launching the 2nd edition of Bridge to EM (2024) We are thrilled to announce that we launching the second edition of the curriculum.

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SGEM#440: I’m Gonna Need Someone To Help Me – GRACE4 AUD and CHS Management in the ED

The Skeptics' Guide to EM

Reference: Borgundvaag et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. AEM May 2024 Date: May 22, 2024 Dr. Bjug Borgundvaag Guest Skeptic: Dr. Bjug Borgundvaag is the Founding Director of the Schwartz/Reisman Emergency Medicine Institute (SREMI), at Sinai Health System.

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EMS.gov | EMS Day at the Museum and National Mall Event

American Ambulance Association

Join Us for “EMS Day at the Museum” and National Mall Event to Commemorate EMS Week It’s the 50th anniversary of EMS Week and to celebrate this momentous occasion, the Smithsonian National […] The post EMS.gov | EMS Day at the Museum and National Mall Event appeared first on American Ambulance Association.

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Lightning rounds 40: Critical care medicine fellowships with Nicholas Ghionni

Critical Care Scenarios

We chat about pulmonary/critical care medicine fellowship with recent graduate Nicholas Ghionni (@pulmtoilet), a first-year attending at the MedStar Baltimore Hospital system. He completed PCCM fellowship at MedStar Washington Hospital Center where he also served as chief fellow. Find us on Patreon here! Buy your merch here! We chat about pulmonary/critical care medicine fellowship with recent graduate Nicholas Ghionni ( @pulmtoilet ), a first-year attending at the MedStar Baltimore Hospital sys

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ECG of the Week – 6th May 2024

EMergucate

The following ECG is from a 46-year-old male with an hour of chest pain. He has a background of hypertension, morbid obesity and is a heavy smoker. Interpret the ECG.

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PEM POCUS Series: Soft Tissue Ultrasound

ALiEM

Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric soft tissue ultrasonography. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU PEM POCUS: Soft Tissue Quiz Case Goals List the indications of performing a pediatric soft tissue point-of-care ultrasound (POCUS).

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SGEM Xtra: Yeah, Might Be All that You Get – How Ted Lasso Made Us Better

The Skeptics' Guide to EM

Date: May 13, 2024 Guest Skeptics: Dr. Rebecca Szabo is an obstetrician/gynecologist and medical educator specializing in simulation from Melbourne, Australia working at The Royal Women’s Hospital and The University of Melbourne. This is her first time as a guest skeptic on the SGEM, she has created FOAMed content through various media, including the MedEd Stuff N Nonsense Podcast.

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AAA Submits Paramedic Expedited Visa Comments in Line with PARA-EMT Act

American Ambulance Association

On May 13, the AAA submitted a Comment Letter to the Department of Labor (DOL) in response to their Request for Information (RFI) on modernizing the process and updating the occupations […] The post AAA Submits Paramedic Expedited Visa Comments in Line with PARA-EMT Act appeared first on American Ambulance Association.

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TIRBO 61: How to use POCUS (our expert consensus)

Critical Care Scenarios

Brandon summarizes his recent publication describing best practices for performing POCUS. Read the paper open access at POCUS Journal. Find us on Patreon here! Buy your merch here! Brandon summarizes his recent publication describing best practices for performing POCUS. Read the paper open access at POCUS Journal. Find us on Patreon here! Buy your merch here!

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WTBS 30 Lessons on Emergency Medicine Leadership: The Role of The Leader

Emergency Medicine Cases

Dr. Howard Ovens reflects on the role of leader in the EM in this 2nd part of a 2-part Waiting to Be Seen blog series on EM leadership. He touches on mentoring, being committed, aligning with patients' interests, being a role model and a few quick takes on some controversial issues in EM. The post WTBS 30 Lessons on Emergency Medicine Leadership: The Role of The Leader appeared first on Emergency Medicine Cases.

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Lab case 445

EMergucate

85 year-old-woman with fracture of right neck of femur. Her blood gases showed the following: PH = 7.51 pCO2 = 59.5 mmHg pO2 = 70 mmHg HCO3 = 47.

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“Tranq Dope”: A New Menace

EMOttawa

The North American opioid crisis is rapidly expanding, resulting in unprecedented levels of harm and strain on the healthcare system. The opioid epidemic is not new to ED providers across the country, but the true extent of harm is quite shocking. In Canada, there has been 40,642 apparent opioid toxicity deaths and 39,435 opioid-related hospitalizations […] The post “Tranq Dope”: A New Menace appeared first on EMOttawa Blog.

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An EPiC mental model. St Emlyn’s

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed The practice of coordinating, consulting and managing an entire acute clinical service in real-time is fairly unique to emergency medicine. Central to this is the EPiC (or emergency physician in charge) role #FOAMed @stemlyns with @codingbrown The post An EPiC mental model. St Emlyn’s appeared first on St.Emlyn's.

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EMS.gov | On-Demand: EMS Harm Reduction and SUD Treatment

American Ambulance Association

Webinar Recap & Materials: EMS Harm Reduction and SUD Treatment Thank you to everyone who attended our recent EMS Focus Webinar on EMS Harm Reduction and SUD Treatment. If you […] The post EMS.gov | On-Demand: EMS Harm Reduction and SUD Treatment appeared first on American Ambulance Association.

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Episode 74: Obstructive shock, with Sarah Lorenzini (Nurses’ Podcrawl 2024)

Critical Care Scenarios

Our collaboration with Sarah Lorenzini of the Rapid Response RN podcast, discussing a case and general principles for diagnosing and managing obstructive shock. Check out the other episodes on shock in the Nurses’ Podcrawl 2024! Find us on Patreon here! Buy your merch here! Our collaboration with Sarah Lorenzini of the Rapid Response RN podcast, discussing a case and general principles for diagnosing and managing obstructive shock.

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Ep 195 ED Management of Spontaneous Subarachnoid Hemorrhage

Emergency Medicine Cases

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.

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insitu sim, a big problem

EMergucate

Simulation report 1/2/24 In situ sim ED JHC Hi everyone, Thank you so much for participating and helping … Continue reading →

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Cardiac Arrest – the 5 C’s

Life in the Fastlane

Kane Guthrie Cardiac Arrest – the 5 C’s Cardiac Arrest - the 5 C's with Cliff Reid. Causes Of Cardiac Arrest You NEVER Thought Of?! Meet The Hs & Ts & Cs!

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An undergraduate who is an EKG tech sees something. The computer calls it completely normal. How about the physicians?

Dr. Smith's ECG Blog

This was sent by an undergraduate (not yet in medical school, but applying now) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly. Edited by Smith He also sent me this great case. A 63 year old man with a history of hypertension, hyperlipidemia, prediabetes, and a family history of CAD developed chest pain, shortness of breath, and diaphoresis after consuming a large meal at noon.

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DOL Announces Final Rule Updating the Hazard Communication Standard

American Ambulance Association

This content is for AAA members only. Please either Log In or Join! The post DOL Announces Final Rule Updating the Hazard Communication Standard appeared first on American Ambulance Association.

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TIRBO 60: They don’t care about you

Critical Care Scenarios

The difference between people and institutions. Find us on Patreon here! Buy your merch here! The difference between people and institutions. Find us on Patreon here! Buy your merch here!

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JC: Serratus Anterior Plane Blocks for rib fractures in the ED. St Emlyn’s

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed JC: Review of an RCT of serratus anterior plane blocks in the emergency department for chest/rib injury. Is this now a standard of care? @stemlyns #FOAMed The post JC: Serratus Anterior Plane Blocks for rib fractures in the ED. St Emlyn’s appeared first on St.Emlyn's.

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ECG of the Week – 15th May 2024

EMergucate

The following ECG is from a 30-year-old female who presents with acute severe chest pain and collapse. She is 5 days post-partum.

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AFG and SAFER Reauthorization Passes the House of Representatives

NVFC

On May 8 the House of Representatives passed an amended version of S. 870, the Fire Grants and Safety Act, by a vote of 393 Yes, 13 No, and 1 present. This bill would reauthorize the Assistance to Firefighters Grants (AFG), Staffing for Adequate Fire and Emergency Response (SAFER) grants, and U.S. Fire Administration (USFA) through the end of Fiscal Year (FY) 2028 and extend the statutory sunset for AFG and SAFER though the end of FY 2030.

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Chest pain: Are these really "Nonspecific ST-T wave abnormalities", as the cardiologist interpretation states?

Dr. Smith's ECG Blog

Written by Jesse McLaren, with a very few edits by Smith A 60-year-old presented with chest pain. The ECG did not meet STEMI criteria, and the final cardiology interpretation was “ST and T wave abnormality, consider anterior ischemia”. But are there any other signs of Occlusion MI? There’s only minimal ST elevation in III, which does not meet STEMI criteria of 1mm in two contiguous leads.

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EMS.gov | Commemorate National EMS Week

American Ambulance Association

NHTSA’s Office of EMS Thanks You for Making Your Communities Healthier The Office of EMS (OEMS) at the National Highway Traffic Safety Administration (NHTSA) is honoring our country’s EMS clinicians […] The post EMS.gov | Commemorate National EMS Week appeared first on American Ambulance Association.

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Andexanet alfa: expensive and harmful?

First 10 EM

We have previously discussed the many pharmaceutical advertisements published by the New England Journal of Medicine, thinly disguised as science, such as the original open label uncontrolled look at andexanet alfa. (Connolly 2019) At that point, I concluded that andexanet alfa should clearly not be used (although our pharmacies didn’t listen and wasted a lot […] The post Andexanet alfa: expensive and harmful?

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PulmCrit: Why the new study associating piptazo with increased mortality is wrong

EMCrit Project

Piperacillin-tazobactam is an antibiotic that a lot of people love to hate. Combine this with the conservatism that often (rightfully) surrounds drug safety, and it creates a lot of volatility. Before going further, we should review some recent history regarding piptazo. In the early 2010's, a series of retrospective correlational studies found that patients treated […] EMCrit Project by Josh Farkas.

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ECG of the Week May 22nd

EMergucate

The following ECG is given to you by your waiting room nurse who has assessed a 50-year-old man in the waiting room.

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Effect of Bougie Use on First-Attempt Success in Tracheal Intubations: A Systematic Review and Meta-Analysis

EMOttawa

Methodology: 4/5 Usefulness: 3/5 von Hellmann R, et al. Ann Emerg Med. 2024 Feb;83(2):132-144. Question and Methods: Systematic review of 18 studies (12 RCT) of adult patients comparing bougie use vs standard of care in tracheal intubations to evaluate first-attempt success. Findings: Bougie was associated with increased first-attempt intubation success overall (RR 1.11 95%CI 1.06 […] The post Effect of Bougie Use on First-Attempt Success in Tracheal Intubations: A Systematic Review and M

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Wide complex tachycardia, resistant to cardioversion. Some fascinating features here.

Dr. Smith's ECG Blog

An elderly dialysis patient presented with chest pain. She has poor LV function. Previous echo 4 months ago (confirmed with ED bedside echo): The estimated left ventricular ejection fraction is 30%. Severely decreased LV function. Regional wall motion abnormality-inferior, inferolateral, septum, anterolateral, anterior and apex, lateral. Here is her ECG: Regular Wide Complex Tachycardia.

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ACE Cost Data Collection Newsletter | May 2024

American Ambulance Association

Submit Your GACDS Data By May 31, 2024 Ground Ambulance Organizations with an NPI identified in the Year 3 and Year 4 CMS GADCS selection lists are expected to submit their data to CMS […] The post ACE Cost Data Collection Newsletter | May 2024 appeared first on American Ambulance Association.

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EMS Week: Honoring Our Past, Forging Our Future

NVFC

May 19-25 marks the 50th anniversary of EMS Week with the theme “Honoring Our Past, Forging Our Future.” The National Volunteer Fire Council (NVFC) recognizes and gives thanks to all EMS providers for the lifesaving work you do every day. As we remember the past, we look forward to a future that builds on what has come before and strives to achieve excellence for the communities we serve.

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What Are the Best AI Detectors?

Life in the Fastlane

Sheralyn Guilleminot and Mike Cadogan What Are the Best AI Detectors? We investigated to see which tools are the best detectors of artificial intelligence in medical writing. One tool was the clear winner, while others clearly struggled with accuracy!

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