April, 2024

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Ep 193 The Crashing Asthmatic – Recognition and Management of Life Threatening Asthma

Emergency Medicine Cases

In this part 2 of our 2-part podcast on asthma with Dr. Sameer Mal and Dr. Leeor Sommer, we dig into the recognition and management of life-threatening asthma. We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma? What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic

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SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke

The Skeptics' Guide to EM

Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. NEJM Feb 2024 Date: April 12, 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. He is an assistant professor in Emergency […] The post SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke first appeared on The Skeptics Guid

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Episode 73: POCUS for nephrology, with Abhilash Koratala

Critical Care Scenarios

We discuss the role of point-of-care ultrasound in evaluating the patient with kidney injury and assessing volume status, with Abhilash Koratala (@nephroP), nephrologist, Director of Clinical Imaging for Nephrology at the Medical College of Wisconsin, and champion of nephrology-focused ultrasound. Find us on Patreon here! Buy your merch here! Takeaway lessons References Episode 4 with … Continue reading "Episode 73: POCUS for nephrology, with Abhilash Koratala" We discuss the role of point-of-ca

OR 285
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Elder Male with Syncope

EMS 12-Lead

David Didlake @DidlakeDW EMS personnel responded to the residence of an 81 y/o Male with syncope. His spouse had called 911 after she heard a loud “thud” in the adjacent room. He was found altered, hypotensive, and with a large hematoma to the left periorbital region. No 12 Lead ECG was captured, but telemetry did reveal the following: The spouse offers a pertinent medical history to include HTN and HLD, and furthermore states that he hasn’t previously complained of any chest discomfort, or shor

Coronary 290
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SAEM Clinical Images Series: Red Rash on My Legs

ALiEM

A 23-year-old female with no known past medical history presented with a rash concentrated on her legs, with a few areas on her arms and chest. The rash began the day before presentation when she became overheated while wearing sweatpants in 104°F weather. The rash was mildly pruritic but not painful. She denied any prior reaction to her sweatpants that she has had for several months.

OR 189
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PLEASE UPDATE THE RSS FEED

Core EM

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ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain

Emergency Medicine Cases

In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. They explain complementary diagnostic insights into pericardial effusion and cardiac tamponade, occlusion MI and RV strain. The post ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain appeared first on Emergency Medicine Cases.

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5 Min Sono – Kidney Stones (2024)

Core Ultrasound

We identify the presence of kidney stones using ultrasound with a pretest suspicion of kidney stones then identifying the presence or absence of hydronephrosis.

OR 190
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Traveling Ticks: Tickborne Illnesses and International Travel

Pediatric EM Morsels

Traveling Ticks are more than just ticking off a checklist before you get ready to travel! Climate change and changes in land usage have contributed to an expanded range of ticks (Beard 2016). There are species of ticks found on every continent and carrying a variety of vectors capable of infecting humans. Globally, ticks are the second most common vector to transmit illnesses after mosquitos (Parola 2018).

E-9-1-1 161
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Pigtail catheter for pleural drainage: Tips to minimize complications

ALiEM

Traditionally large-bore tube thoracostomy has been the standard of care for treating many acute intrathoracic pathologies [1]. However, the advent of less invasive small-bore chest tubes, also known as pigtail catheters, has gradually led to a paradigm shift. Pigtails provide a less invasive and often better tolerated alternative to traditional chest tubes and allow for adequate treatment of pneumothoraces and uncomplicated pleural effusions [1-5].

E-9-1-1 183
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FTC Publishes Final Rule Banning Employee Non-Compete Agreements

American Ambulance Association

This content is for AAA members only. Please either Log In or Join! The post FTC Publishes Final Rule Banning Employee Non-Compete Agreements appeared first on American Ambulance Association.

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EM Quick Hits 56 – Nitroglycerin in SCAPE, REBOA, Diverticulitis Imaging, CRAO, Penicillin Allergy, Physician Personality

Emergency Medicine Cases

In this month's EM Quick Hits podcast: Justin Morgenstern on the first RCT of high dose nitroglycerin in SCAPE, Andrew Neill on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) indications and evidence, Brit Long on indications for CT in suspected diverticulitis, Tahara Bhate on Central Retinal Artery Occlusion (CRAO) and diagnostic error, Matthew McArthur on penicillin allergy labels, myths and penicillin challenges, and Susan Lu on how ED physician personality influences patie

EMS 263
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SGEM#437: Don’t Be Fooled by the Meds I Got, I Still Need an ESP Block – For My Rib Fractures

The Skeptics' Guide to EM

Reference: Ramesh S, Ayyan SM, Rath DP, Sadanandan DM. Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial. AEM April 2024 Date: April 19, 2024 Guest Skeptic: Dr. Suchismita Datta. She is an Assistant Professor and Director of […] The post SGEM#437: Don’t Be Fooled by the Meds I Got, I Still Need an ESP Block – For My Rib Fractures first appeared o

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ECG of the Week 24th April 2024

EMergucate

The following ECG is from an 80-year-old man who has been referred by his GP with worsening renal failure. He has a history of atrial fibrillation with bradycardia, for which he has a pacemaker.

EMS 130
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Episode 195: ARDS

Core EM

We review Acute Respiratory Distress Syndrome Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Critical Care , Pulmonary Show Notes Definition of ARDS: Non-cardiogenic pulmonary edema characterized by acute respiratory failure. Berlin criteria for diagnosis include acute onset within 7 days, bilateral pulmonary infiltrates on imaging, not fully explained by cardiac failure or fluid overload, and impaired oxygenation with PaO2/FiO2 ratio <300 mmHg, even wi

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Lightning rounds 39: Understanding flight medicine with Jace Mullen

Critical Care Scenarios

We explore critical care transport medicine from both a clinical and career perspective, including helicopters (HEMS), fixed wing jet, and ground ambulance transports, with Jace Mullen, flight paramedic and airway educator out of Denver. Find us on Patreon here! Buy your merch here! We explore critical care transport medicine from both a clinical and career perspective, including helicopters (HEMS), fixed wing jet, and ground ambulance transports, with Jace Mullen, flight paramedic and airway ed

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U.S. DOL Issues Final Rule to Increasing the FLSA Overtime Exemption Salary Levels

American Ambulance Association

This content is for AAA members only. Please either Log In or Join! The post U.S. DOL Issues Final Rule to Increasing the FLSA Overtime Exemption Salary Levels appeared first on American Ambulance Association.

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Functional Neurologic Disorders

EMOttawa

Patients living with functional neurologic disorders (FND) have been deeply stigmatized by the medical system. In a patient survey by FND Hope (an international organization for the research and advocacy around FND) 82% of patient respondents felt they had been treated poorly due to stigma relating to their FND diagnosis, primarily by emergency physicians [1] […] The post Functional Neurologic Disorders appeared first on EMOttawa Blog.

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SGEM #435: Don’t Stop Believing…A Vaccine can Work for RSV

The Skeptics' Guide to EM

Reference: Drysdale SB et al. Nirsevimab for Prevention of Hospitalizations due to RSV in Infants. N Engl J Med. 2023 Date: March 29, 2024 Guest Skeptic: Dr. Michael Cosimini is a pediatrician in Portland Oregon. He is the designer of Empiric Game, a medical editor and contributor to Pediatrics Reviews and Perspectives (PedsRAP) and the […] The post SGEM #435: Don’t Stop Believing…A Vaccine can Work for RSV first appeared on The Skeptics Guide to Emergency Medicine.

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Lab case 441 interpretation

EMergucate

Answers: PH = 7.15, that is severe acidaemia HCO3 = 6.5 mmol/L, so we have metabolic acidosis. Since we have metabolic acidosis, then we need to calculate compensation and anion gap.

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Are you a perfect diagnostician? No? Then give your patients a break

First 10 EM

Give your patients a break. Nobody is a perfect diagnostician. Not even the best trained physician can determine, with 100% accuracy, which patients have serious pathology. Even with advanced testing, we aren’t close to perfect. However, if you listen to the subtext of breakroom complaints, it seems like we expect patients to be better diagnosticians […] The post Are you a perfect diagnostician?

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TIRBO 59: How we make the podcast

Critical Care Scenarios

The nuts and bolts of how we produce the show. Find us on Patreon here! Buy your merch here! The nuts and bolts of how we produce the show. Find us on Patreon here! Buy your merch here!

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Emergency Medical Products for First Responders Since 1977

American Ambulance Association

What is the Life-Assist Difference? Life-Assist has been serving First Responders with emergency medical products and equipment since 1977. We Offer a Personal Touch in an Automated World Our genuine […] The post Emergency Medical Products for First Responders Since 1977 appeared first on American Ambulance Association.

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Podcast 166 - Transcutaneous Pacing & False Capture

FOAMfrat

In this episode, we discuss a recent paper on false electrical capture and pre-hospital transcutaneous pacing by paramedics. The guests, Tom Boutilet, Josh Kimbrell, and Judah Kreinbrook, discuss their research findings and the implications for paramedics. They conducted a retrospective study and found that paramedics often mistakenly believe they have electrical capture when they do not.

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Comment Period Extended for OSHA’s Updated Emergency Response Standard

NVFC

On February 5, the Occupational Safety and Health Administration (OSHA) published a Notice of Proposed Rulemaking (NPRM) to modernize the agency’s “Fire Brigades” standard with a proposed new “Emergency Response Standard.” This NPRM’s publication triggered the beginning of a public comment period that was initially scheduled to conclude on May 6. Thanks to feedback from the emergency services community, OSHA has extended this public comment period to June 21, 2024.

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Lab case 443

EMergucate

20 year-year-old man brought to ED after a car accident. His blood pressure was 80/41 and he was unconscious. His blood gases showed the following: PH = 6.

ED 130
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EPIC-SR: The negative paxlovid data Pfizer has been sitting on

First 10 EM

As mentioned in my most recent review, publication bias has been a major concern when trying to decide whether to prescribe paxlovid. Pfizer rushed to publish their positive study (EPIC-HR), but refused to release the results of a second simultaneous study (EPIC-SR) that was stopped (due to futility) at the exact same time. With the […] The post EPIC-SR: The negative paxlovid data Pfizer has been sitting on appeared first on First10EM.

EMS 130
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Butterfly iQ3 Unboxing!

Core Ultrasound

I’m so excited to share with you my unboxing of the new Butterfly iQ3. Watch to see my first impressions! I’ve had the pleasure of working with many ultrasound companies over the past 10 years, both as a consumer and as an ultrasound director of a large academic hospital. I’ve enjoyed all of the iterations of the Butterfly ultra-portable ultrasound transducer, but I love their third version (the iQ3), the best!

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Homeland Security | Homeland Threat Assessment 2024

American Ambulance Association

The Department of Homeland Security (DHS) Intelligence Enterprise Homeland Threat Assessment reflects the insights from across the Department, the Intelligence Community, and other critical homeland security stakeholders. It focuses on […] The post Homeland Security | Homeland Threat Assessment 2024 appeared first on American Ambulance Association.

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PTM Journal Club: Blood Product and ACE-CPR use Prehospital

EMOttawa

In this Prehospital Journal Club Recap, let us take a deep dive into the use of blood products, as well as the adjunct use of automated controlled elevation in CPR. Resuscitation with blood products in patients with trauma-related hemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomized, controlled, phase 3 trial Background The use […] The post PTM Journal Club: Blood Product and ACE-CPR use Prehospital appeared first on EMOttawa Blog.

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Serving the Whole Community: Autism Awareness for Emergency Responders

NVFC

By Brian Focht Practical tips for diversity, equity, and inclusion in your community April is Autism Awareness Month, but many people are aware of Autism every day. I became one of those for whom autism isn’t just a word but a reality when my son was diagnosed with autism spectrum disorder (ASD) in 2003. Our family is far from alone – in 2023, the CDC reported that approximately 1 in 36 children in the U.S. is diagnosed with ASD.

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interdisciplinary sim

EMergucate

Simulation report 4/4/24, In situ sim ED JHC Hi everyone, Thank you so much for participating and helping … Continue reading →

ED 130
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Pulmcrit wee: The cutoff razor

EMCrit Project

A razor is a rule of thumb that is helpful, although it isn't always correct. In medicine we're familiar with Occam's razor (the rule of parsimony). The cutoff razor states: if a continuous variable is dichotomized using a cutoff, then values near the cutoff provide little information. A simple illustration of the cutoff razor is […] EMCrit Project by Josh Farkas.

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The Brain Injury Guidelines: Can we avoid talking to neurosurgeons?

First 10 EM

One of the biggest headaches in modern medicine is the apparent requirement to call busy specialists just to confirm what seems like an obvious treatment plan. In emergency medicine, this often happens when a patient needs to be admitted under one service, but with a medical problem related to another speciality. We get stuck in […] The post The Brain Injury Guidelines: Can we avoid talking to neurosurgeons?

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4/11 CMS Ambulance Open Door Forum

American Ambulance Association

The next CMS Ambulance Open Door Forum scheduled for: Date: Thursday, April 11, 2024 Start Time: 2:00pm-3:00pm PM Eastern Time (ET); Please dial-in at least 15 minutes before call start […] The post 4/11 CMS Ambulance Open Door Forum appeared first on American Ambulance Association.

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5 Min Sono – Pericardiocentesis (2024)

Core Ultrasound

Pericardial effusion Old 5MS vid (2016) Pericardial Tamponade Courses The post 5 Min Sono – Pericardiocentesis (2024) first appeared on Core Ultrasound.

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OSHA Needs to Hear from You Regarding Their Proposed Emergency Response Standard

NVFC

On February 5, the Occupational Safety and Health Administration (OSHA) published a Notice of Proposed Rulemaking (NPRM) to modernize the agency’s “Fire Brigades” standard with a proposed new “Emergency Response Standard.” This NPRM’s publication triggered the beginning of a public comment period that is scheduled to conclude June 21, 2024. Anyone, organization or individual, is encouraged to submit comments to OSHA during this this public comment period (ignore the May 6 deadline as it has been