February, 2024

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SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Syndrome in the ED.

The Skeptics' Guide to EM

Reference: McLatchie et al and DAShED investigators. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. EMJ Nov 2023. Date: February 11, 2024 Guest Skeptic: Nirdosh Ashok Kumar, Emergency Medicine Specialist – Aga Khan University Hospital, Karachi, Pakistan. […] The post SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Sy

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ECG Cases 48 – ECG Interpretation in Cardiac Arrest

Emergency Medicine Cases

In this month's ECG Cases blog Dr. Jesse McLaren reviews interpretation of the pre-arrest ECG: identifying high risk ECGs requiring empiric treatment like calcium for hyperkalemia, magnesium for long QT, or reperfusion for Occlusion MI; the intra-arrest ECG: identifying pseudo-PEA; and post-arrest ECG: the importance of serial ECGs to reduce false positive STEMI, role of POCUS to help with the differential of diffuse ST depression with reciprocal ST elevation in aVR, and identifying signs of Occ

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OHSA Notice of Proposed Rule Making (NPRM) Emergency Response Standard

American Ambulance Association

This content is for AAA members only. Please either Log In or Join! The post OHSA Notice of Proposed Rule Making (NPRM) Emergency Response Standard appeared first on American Ambulance Association.

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ALiEM AIR Series | Toxicology Module

ALiEM

Welcome to the AIR Toxicology Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to related to toxicology in the Emergency Department. 8 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board.

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Episode 193: Threatened Abortion

Core EM

We review threatened abortion and the complexities in its care. Hosts: Stacey Frisch, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: OBGYN Show Notes Background Defined as vaginal bleeding during early pregnancy (before 20 weeks) with a closed cervical os, no passage of fetal tissue, and IUP on ultrasound Occurs in 20-25% of all pregnancies.

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Travel-Related Illnesses in Children

Pediatric EM Morsels

There have been many times I have encountered a triage note which states “ patient recently returned from … (insert awesome foreign country) … ” Not only does this leave me daydreaming about my future travel adventures, but has often caused me to take pause. Thoughts of what endemic illnesses could this child potentially have been exposed to in their travels?

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SGEM#341: You Make Me Feel Like a Natural Treatment

The Skeptics' Guide to EM

Reference: Li, T., & Gal, D. (2023). Consumers prefer natural medicines more when treating psychological than physical conditions. Journal of Consumer Psychology 2023, Date: February 23, 2024 Guest Skeptic: Ethan Milne is a Marketing PhD student at the Ivey Business School (Western University). He researches how moral outrage and status-seeking personalities motivate social media aggression, and how […] The post SGEM#341: You Make Me Feel Like a Natural Treatment first appeared on The Skeptics G

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ECG of the Week – Feb 28th 2024

EMergucate

The following ECG is from a 40-year-old man who presents overnight with left sided sharp chest pain which has woken him from sleep. He describes the pain as radiating into his left arm.

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SAEM Clinical Images Series: Neonatal Rash

ALiEM

An 18-day-old male presented for a rash on his face for two days. The patient was born via spontaneous vaginal delivery full term without complications to a mom who has a history of genital HSV but without active lesions at delivery and on acyclovir. The patient presented with a vesicular rash on his face including around his eyes. He had conjunctival discharge noted by mom.

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CMS Ambulance Open Door Forum: Rescheduled

American Ambulance Association

The Ambulance Open Door Forum has been rescheduled from March 14th to NEW DATE date, April 11th at the same time of 2:00pm-3:00pm ET. Thank you. Register Here Overview: The […] The post CMS Ambulance Open Door Forum: Rescheduled appeared first on American Ambulance Association.

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Better Watch Your Back… Finding the Needle in the Haystack.

Core EM

The Case A 71-year-old male with a history of chronic obstructive pulmonary disease, hyperlipidemia, and peptic ulcer disease presents to the emergency department with substernal chest pain radiating down the right arm and dyspnea that began acutely while “running” up the stairs from the subway. The following ECG is obtained upon arrival to the emergency department.

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SGEM #429: It’s CT Angio, Hi. I’m the Problem. It’s Me. For Pediatric Oropharyngeal Trauma

The Skeptics' Guide to EM

Reference: Curry SD, et al. Systematic Review of CT Angiography in Guiding Management in Pediatric Oropharyngeal Trauma. Laryngoscope. March 2023 Date: January 30, 2024 Guest Skeptic: Dr. Alexandra (Ali) Espinel is an Associate professor of pediatrics and otolaryngology at Children’s National Hospital and George Washington University. She is also the director of the Pediatric Otolaryngology […] The post SGEM #429: It’s CT Angio, Hi.

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Ep 191 The Future of EM – Systems Thinking

Emergency Medicine Cases

In order fix EM, each of us needs to understand systems issues and systems thinking, and advocate for a better system based on sound systems principles and specific solutions. In this main episode EM Cases podcast Anton is joined by Dr. Alecs Chochinov and Dr. Davie Petrie, two systems thinkers and leaders in EM. They discuss solutions for how to fix EM in 5 spheres: having a coordinated mission, optimizing access points, accountability, disaster preparedness and adaptation/evolution.

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Proton Pump Inhibitor Use and Risk of Serious Infections in Young Children

EMergucate

Proton Pump Inhibitor Use and Risk of Serious Infections in Young Children Marion Lassalle, PharmD, PhD1; Mahmoud Zureik, MD, PhD1,2; Rosemary Dray-Spira, MD, PhD1 August 14, 2023 doi:10.1001/jamapediatrics.2023.

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ACMT Toxicology Visual Pearl: Salt, not Shock

ALiEM

What agent would most likely be responsible for these ECG findings? Cyclobenzaprine Digoxin Flecainide Sotalol Reveal the Answer 3. Flecainide Background [1-3] Flecainide is a class IC antiarrhythmic that binds to the voltage-gated sodium channel of the myocardium, slowing depolarization and prolonging phase 0 of the action potential. In toxicity, bradydysrhythmias, AV nodal blockade, ventricular tachycardia, and rate-dependent QRS widening occur.

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EMS Gives Life | EMT Dave and Wife Kelly Need Your Help

American Ambulance Association

Dave and Kelly’s Inspiring Journey Meet Dave Raymond, a dedicated firefighter EMT, and his wife, Kelly, who has been on a courageous four-year quest to find a kidney donor. In […] The post EMS Gives Life | EMT Dave and Wife Kelly Need Your Help appeared first on American Ambulance Association.

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Lightning rounds 37: Weaning the deliriosedated patient (SCCM roundup)

Critical Care Scenarios

A roundup of opinions from attendees at SCCM’s 2024 Critical Care Congress in Phoenix on strategies for rescuing the patient stuck in a loop of deep sedation and agitation. Thanks to Pat Posa, Martha Roberts, Juliana Barr, Kelly Drumright, and Ben Lassow for their input. Resources A roundup of opinions from attendees at SCCM’s 2024 Critical Care Congress in Phoenix on strategies for rescuing the patient stuck in a loop of deep sedation and agitation.

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OSHA’s Emergency Response Standard Update Threatens Volunteer Fire Departments

NVFC

On December 21, the Occupational Safety and Health Administration (OSHA) announced that it will issue a Notice of Proposed Rulemaking (NPRM) to modernize the agency’s “Fire Brigades” standard. This standard was first published and last updated in 1980. This proposed updated standard would issue several new requirements that would be very burdensome, and in many cases impossible, for volunteer fire departments to comply with.

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Update on February 22 Network Outage

FirstNet Authority

Update on February 22 Network Outage Blog joseph.rey@fir… Thu, 02/29/2024 - 13:49 By Joe Wassel, Executive Director and CEO, First Responder Network Authority Learn more about how FirstNet is transforming public safety communications — contact your local FirstNet Authority Public Safety Advisor and sign up for our discipline newsletters. Follow us on Twitter , Facebook , Instagram , and LinkedIn for the latest FirstNet Authority updates.

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ECG of the Week – 21st February 2024

EMergucate

The following ECG is from a 60 year old lady with chest pain and dyspnoea a few hours after finishing a triathlon. At the scene she was hypothermic at 32 degrees.

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SAEM Clinical Images Series: Back Lesion

ALiEM

An 18-year-old-female with no known past medical history presented with a lesion on her back that had been present and enlarging for five months. It was not painful unless she touched it, and then only mildly tender. She denied any known cause, wound, prior rash, or other lesions. Her review of systems and past medical history were negative. Additional Images Physical Exam Vitals : Normal Skin : An erythematous lenticular, or biconvex, lesion with distinct borders is noted at the left posterior

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GoAERO Competition + Informational Webinar Details

American Ambulance Association

From GoAEROprize.com Heroes who look past danger to help people in need, Heroes to step in to be the difference between triumph and tragedy, And Heroes who use their minds to […] The post GoAERO Competition + Informational Webinar Details appeared first on American Ambulance Association.

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TIRBO 54: Documenting POCUS studies

Critical Care Scenarios

How to document your ultrasound findings. Find us on Patreon here! Buy your merch here! How to document your ultrasound findings. Find us on Patreon here! Buy your merch here!

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Ketamine and Etimodate: Into the Void

EMOttawa

We’re increasingly cognizant of the physiological importance of maintaining specific hemodynamics during resuscitation. Practice patterns vary broadly, so we’ve done a deep dive into the various evidence around the use of ketamine and etomidate in specific clinical scenarios. Physiology of the rapid sequence intubation Rapid sequence intubation (RSI) is the nearly simultaneous administration […] The post Ketamine and Etimodate: Into the Void appeared first on EMOttawa Blog.

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Classic EM: Early adjunctive methylene blue in patients with septic shock: a randomized controlled trial.

Core EM

Early adjunctive methylene blue in patients with septic shock: a randomized controlled trial. PubMed, 2023 Background Methylene blue is a potential last-line treatment for patients experiencing refractory septic shock. Limited evidence is available regarding its use as a supplementary treatment in early septic shock, the most effective timing for administration, the ideal dosage, and its safety profile.

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Lab case 437

EMergucate

A police recruit doing a 20 km pack hike. Collapsed. GCS on arrival was 7. His temperature was 39.2 on arrival. His venous blood gases showed the following: PH = 7.

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SAEM Clinical Images Series: An Ultrasonographic Rabbit Hole

ALiEM

An 86-year-old man with a past medical history of coronary artery disease, hypertension, hyperlipidemia, chronic kidney disease, COPD, choledocholithiasis requiring ERCP and sphincterotomy 2 years ago presented with five days of feeling unwell. History was limited due to cognitive impairment. His daughter had reported to staff he had been feeling unwell for five days, intermittently having nausea and generalized abdominal pain, subjective fevers, chest pain, and shortness of breath.

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CMS Releases New GADCS Tip Sheet for Rural, Super Rural Services

American Ambulance Association

The Centers for Medicare & Medicaid Services (CMS) released a new “Reporting for Rural and Super-Rural Organizations Tip Sheet” on February 16, 2024. This guide assists ground ambulance organizations in […] The post CMS Releases New GADCS Tip Sheet for Rural, Super Rural Services appeared first on American Ambulance Association.

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TIRBO 55: Bowel regimens

Critical Care Scenarios

How I make patients poop. Find us on Patreon here! Buy your merch here! How I make patients poop. Find us on Patreon here! Buy your merch here!

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Top resus papers for TBS. St Emlyn’s

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed This week I am in Zermatt, Switzerland for ‘The Big Sick’ conference. This is something I have been looking forward to years, but major heart surgery (valves not pipes) and […] The post Top resus papers for TBS. St Emlyn’s appeared first on St.Emlyn's.

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Apply for an Assistance to Firefighters Grant to Support Department Necessities

NVFC

The application period for the FY 2023 Assistance to Firefighters Grant (AFG) is now open. These grants provide funding to fire departments for needed resources such as equipment, gear, vehicles, and training. The Notice of Funding Opportunity, guidance documents, and other materials are available on the AFG web site. In addition, FEMA is hosting a series of Q&A sessions over the next month to provide applicants an opportunity to interact with AFG staff and ask questions about the program, t

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Lab case 438

EMergucate

Answers: PH = 7.39, that is within normal range/ pCO2 = 48 mmHg, that is slightly elevated (Can be considered normal for venous blood) HCO3 = 29 mmol/L.

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How to Cite Videos, Podcasts, Apps, Media, and Blogs in a Publication or CV (AMA style 11th edition)

ALiEM

As medical education podcasts, videos, and blogs continue to grow in popularity it is crucial that we cite them correctly, both in publications and on our CVs. We also must recognize the important contributions of media such as clinical photographs, radiology images, and ECGs. The American Medical Association (AMA) Manual of Style released its 11th edition in 2020.

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EMS.gov | HHS Announces New Performance Goals to Enhance Cybersecurity

American Ambulance Association

HHS Announces New Cybersecurity Performance Goals to Enhance Cybersecurity The U.S. Department of Health and Human Services (HHS), through the Administration for Strategic Preparedness and Response (ASPR), announced on January […] The post EMS.gov | HHS Announces New Performance Goals to Enhance Cybersecurity appeared first on American Ambulance Association.

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Episode 71: Transplant medications with Olivia Philippart

Critical Care Scenarios

We discuss the medications typically used after organ transplant, their impact on critical illness, and how to manage them when these patients show up sick—with Olivia Philippart, transplant clinical pharmacist specializing in liver and kidney transplant at University of Kentucky HealthCare. Find us on Patreon here! Buy your merch here! Takeaway lessons References From: Fishman … Continue reading "Episode 71: Transplant medications with Olivia Philippart" Photo by Tim Webb We discuss the medicat

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The AcT Trial: Tenecteplase vs Alteplase for Acute Ischemic Stroke

REBEL EM

Background : Alteplase, a class of medication that converts plasminogen to plasmin leading to fibrin degradation and subsequent clot lysis, has been the standard of care for acute ischemic stroke (AIS) patients that meet eligibility criteria. Tenecteplase, a modified version of alteplase, is being increasingly utilized for AIS due to its favorable pharmacological profile, ease of administration, and cost effectiveness.

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How will you save this critically ill patient? A fundamental and lifesaving ECG interpretation that everyone must recognize instantly.

Dr. Smith's ECG Blog

Written by Pendell Meyers A woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed: What do you think? Extremely wide complex monomorphic rhythm just over 100 bpm. The QRS is so wide and sinusoidal that the only real possibilities left are hyperkalemia or Na channel blockade.

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