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In this ECG Cases blog Dr. Jesse MacLaren guides us through 10 cases of patients who present with generalized weakness or acute neurologic symptoms and discusses how to look for ECG signs of dysrhythmias, electrolyte emergencies, acute coronary occlusion, and demand ischemia in patients with generalized weakness and in patients with neurologic symptoms, to consider predisposing factors like LVH; seizure-like activity from cardiac syncope; TIA/CVA embolic sources like atrial fibrillation or LV th
Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. He is also a fully-fledged ultrasonographer. Casey currently splits his time […] The post SGEM#415: Buckle Down for some Ultrasound to Diagnosis Distal Forearm Fractures first appeared on The Ske
To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Never fear. As our fearless leader likes to say: “children are not aliens, but they are a special population with unique anatomy and physiology.” Children compensate for blood and volume loss very well… until they don’t.
A 49-year-old male was triaged to the Fast Track area with complaints of an abrasion to the neck following an assault. The patient was attending a party with his family when “someone started shooting.” The patient believes some stucco or stone fragment from a brick wall struck him in the neck during the initial incident, but his primary concern was for his more seriously wounded family members.
Transfusion seems like the simplest intervention in medicine. The patient is losing blood, so let’s put some back in. Not much more complicated than an oil change. Sure, you need to use a specific brand, but as long as the system is topped up, everything should run just fine. Therefore, when someone (to be left […] The post Massive hemorrhage: a very deep dive appeared first on First10EM.
In many countries, pulmonary and critical care are commonly bundled together. Consequently, a single person will often be responsible for both inpatient ICU management as well as inpatient pulmonary consultation. Honestly, I have some doubts about whether this is an ideal system. As both pulmonology and critical care medicine become increasingly complex, it's becoming impossible […] EMCrit Project by Josh Farkas.
On this month's EM Quick Hits podcast: Anand Swaminathan on the role of methylene blue in septic shock, Nour Khatib on jaw dislocation reduction techniques, Hans Rosenberg on a phenotypic approach to Crohn's disease emergencies, Gil Yehudaiff on evidence based analgesics in renal colic, Brit Long on the importance of inhaled steroids for asthma, and Andrew Petrosoniak on the "lethal diamond" in polytrauma patients and the current state of hypocalcemia in bleeding trauma patients.
Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. AEM August 2023 Guest Skeptic: Dr. Suchismita Datta. She is an Assistant Professor and Director of Research in the Department of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. This is the last show for […] The post SGEM#414: The SQuID Protocol first appeared on The Skeptics Guide to Emergency Medicine.
Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. AEM August 2023 Guest Skeptic: Dr. Suchismita Datta. She is an Assistant Professor and Director of Research in the Department of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. This is the last show for […] The post SGEM#414: The SQuID Protocol first appeared on The Skeptics Guide to Emergency Medicine.
Life is full of hazards! Chance encounters with life’s hazards seem to increase in the Summer time (ex, Trampolines , Snakes , Lawn Mowers , Water , and Heat ). It is good that continue to raise awareness of such hazards so we can prevent them ! Certainly, the care of pediatric patients is known for its “ Seasonality. ” Now that the long days of summer ( for us in the Northern Hemisphere ) might be behind us, some of those hazards may also be receding, but injuries and illnesse
What well-known adverse reaction results from ingestion of the pictured mushroom? Acute hepatitis Disulfiram-like reaction with ethanol consumption Pneumonitis from inhalation of spores Seizures from glutamate agonist activity [Image from Canstockphoto] Reveal the Answer 2. Disulfiram-like reaction with ethanol consumption Coprinus atramentarius or Ink Cap mushroom is well known to cause a disulfiram-like reaction when it is consumed prior to ethanol.
Introduced to the world by our friend Scott Weingart, delayed sequence intubation (DSI) is often summarized as procedural sedation for the procedure of preoxygenation. (Weingart 2011, Weingart 2015) It is a brilliant concept, makes a ton of sense on paper, and anecdotally has seemed to help a number of my patients. However, any long time […] The post Delayed sequence intubation: An RCT appeared first on First10EM.
I came to work one day and one of my partners said, "Hey, Steve, we had a STEMI this afternoon!" I said, "Cool, can I see the ECG?' Of course he said: "Yes, it was a 60 year old diabetic with Chest pain." So he showed me the ECG recorded in triage: What did I say? "That is not a STEMI. That is Arterial Pulse Tapping Artifact (APTA)." He said: "What?
This talk, from Clare Skinner, on music, medicine and leadership , comes from our 2022 DFTB conference in Brisbane. [link] Years ago, before I became a medical student, I heard Professor Michael Field , Associate Dean of Medical Curriculum at the University of Sydney, nephrologist, and an accomplished flautist, being interviewed about his love of music on ABC Classic FM.
BACKGROUND: intracerebral hemorrhage (ICH) makes up 10-15% of all strokes and significantly contributes to overall stroke-related morbidity and mortality ( Hostettler 2019 ). Levetiracetam is frequently used to prevent seizures in patients with conditions such as ICH, traumatic brain injury (TBI), supratentorial neurosurgery, and subarachnoid hemorrhage (SAH).
Jarlicia Islandriana Scott Paramedic Pafford Emergency Medical Services Clarksdale, MS Share on Instagram | Facebook | Twitter | LinkedIn How did you come to be in EMS? I found myself […] The post EMS Profiles | Meet Jarlicia Islandriana Scott appeared first on American Ambulance Association.
A 65-year-old male presented with chest and abdominal pain for three weeks. He endorsed a poor appetite and a weight loss of 16 kilograms in the last month. He denied fever, vomiting, diarrhea, and tarry stools and described having his usual bowel movements. Additional Images Physical Exam Vitals : BP 172/71; HR 127; T 35.9°C; O2 Sat 100% General : In acute distress Cardiovascular : Regular rate and rhythm; no murmur; bilateral upper extremity and lower extremity pulses palpable Gastrointestin
This is a guest post by Dr. Lanujan Kaneswaran. Lanujan is a second-year Family Medicine resident at the University of Toronto. He has a background in medical health informatics and machine learning. His areas of interest include artificial intelligence and machine learning in medicine, and health equity through advocacy and technology. When managing atrial fibrillation […] The post Can we use D-dimer to assess for left atrial clot in atrial fibrillation?
This was written by Magnus Nossen, from Norway, with comments and additions by Smith A 50 something smoker with no previous medical hx contacted EMS due to acute onset chest pain. Upon EMS arrival the patient appeared acutely ill and complained of chest pain. An ECG was recorded immediately and is shown below. How do you interpret the ECG? ECG#1 There is a regular tachycardia with a ventricular rate of about 180 bpm.
The Choosing Wisely ® campaign is an initiative that promotes collaborative conversations between clinicians and families to safely avoid unnecessary and potentially harmful tests. The American Academy of Paediatrics Section on Emergency Medicine (AAP SOEM) created a list of five key recommendations for Paediatric Emergency Medicine after a structured review process and expert consensus opinion.
We chat with Leon Chen about his work setting up infrastructure for clinical POCUS at Memorial Sloan Kettering. Leon is an Adult/Gerontology Acute Care Nurse Practitioner in the ICU, Clinical Program Manager of Research and Simulated Learning, and an Associate Professor at Columbia University School of Nursing. Find us on Patreon here! Buy your merch … Continue reading "Lightning rounds #32: Creating a POCUS system with Leon Chen" We chat with Leon Chen about his work setting up infrastructure f
This content is for AAA members only. Please either Log In or Join! The post Impact of Partial Government Shutdown on Healthcare appeared first on American Ambulance Association.
66 year-old-male with a history of type 2 diabetes and hypertension presented as a transfer for rapid progression of lower extremity pain, swelling, and blue-purple discoloration of the entire limb with concern for a possible necrotizing infection. His symptoms began earlier in the day and progressed over just a few hours. He had no known thromboembolic risk factors.
This ECG was texted to me with no other information. I assumed the presentation was consistent with acute MI. What did I say? "OMI. Activate the cath lab." The T-waves in V2-V6 are diagnostic. It does, in fact, the STE meets STEMI criteria since there is 1 mm of in V4 and V5. There is also some non-diagnostic STE in inferior leads. There is zero reciprocal ST depression. 50% of LAD OMI have zero reciprocal ST depression!
The Choosing Wisely ® campaign is an initiative that promotes collaborative conversations between clinicians and families to safely avoid unnecessary and potentially harmful tests. The American Academy of Paediatrics Section on Emergency Medicine (AAP SOEM) created a list of five key recommendations for Paediatric Emergency Medicine after a structured review process and expert consensus opinion.
The EM Cases Quiz Vault is now on Anki flashcards to help you solidify knowledge of Emergency Medicine Cases podcasts. Herein lies a guide to optimize EM Cases Anki decks, download links and more. The post EM Cases Quiz Vault on Anki appeared first on Emergency Medicine Cases.
Jameson Fernandez Emergency Medical Technician Cataldo Ambulance Somerville, Massachusetts Share this on Instagram | Facebook | X / Twitter | LinkedIn How did you come to be in EMS? The […] The post EMS Profiles | Meet Jameson Fernandez appeared first on American Ambulance Association.
A 64-year-old Caucasian male with a history of alcohol use disorder and tobacco use disorder presents with painless bilateral hand contractures that have been worsening for the past several months. He denies any recent trauma, fever, chills, or decreased sensation. The patient works as a construction worker. Physical Exam Vitals : BP 143/83 ; HR 94; RR 18; T 98.6°F; O2 saturation 98% on room air Musculoskeletal : He has bilateral palmar contractures proximal to the fourth digits.
Sent by anonymous, written by Pendell Meyers, reviewed by Smith and Grauer A man in his 40s presented to the ED with HTN, DM, and smoking history for evaluation of acute chest pain. He was eating lunch when he had sudden onset chest pressure, 9/10, radiating to his back, with sweating and numbness in both hands. Triage ECG: What do you think? It's a very "fun" ECG, with initial ectopic atrial tachycardia (negative P waves in inferior leads conducting 1:1 with the QRSs), followed by spontaneous r
We discuss the nuts and bolts of urinary infection with an obstructing stone with Ashley Winter (@AshleyGWinter), board certified urologist with a fellowship in male and female sexual medicine, and chief medical officer of Odela Health. Find us on Patreon here! Buy your merch here! Takeaway lessons We discuss the nuts and bolts of urinary infection with an obstructing stone with Ashley Winter ( @AshleyGWinter ), board certified urologist with a fellowship in male and female sexual medicine, and
Press Release from the Prehospital Blood Transfusion Initiative Coalition PREHOSPITAL BLOOD TRANSFUSION INITIATIVE COALITION BEING FORMED Contact: Bill Skillman bskillman@veli.co 781 315 7537 In cities, towns and rural communities across […] The post Prehospital Blood Transfusion Initiative appeared first on American Ambulance Association.
A 29-year-old female with a past medical history of migraine headaches presented to the emergency department (ED) for several hours of bilateral eye pain, redness, and decreased visual acuity. The patient is a contact lens wearer. The night prior to presentation at 18:00, the patient inserted her contacts that she had washed and soaked in a hydrogen peroxide (H2O2) cleaning solution.
Submitted by anonymous, edited by Jesse McLaren The first person "I" and "me" is this anonymous sender. A 50 year old presented to the emergency department of a remote rural community (where the nearest cath lab is a plane ride away) with one hour of mild chest pain radiating to the back and jaw, and an ECG labeled ‘normal’ by the computer interpretation.
This talk, from Joe Brumm, was given at our 2022 DFTB conference. “Bluey” is an iconic Australian children’s animated television series. It follows the adventures of a Blue Heeler puppy named Bluey and her family, including her father, Bandit, her mother, Chilli, and her younger sister, Bingo. [link] There is a profound connection between art and life.
Researchers at the University of Texas at Austin have developed an electroencephalogram (EEG) sensor that is incorporated into a virtual reality headset. The technology can measure brain activity while someone is undergoing an immersive virtual reality experience. The device may assist in enhancing medical virtual reality interventions, such as those used to treat post-traumatic stress disorder or phobias, by revealing brain activity during different tasks or experiences that help clinicians to
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