November, 2023

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SGEM#421: I Think I’d Have a Heart Attack – Maybe Not in a Rural Area?

The Skeptics' Guide to EM

Date: November 22, 2023 Reference: Stopyra et al. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. AEM November 2023. Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is the cofounder of FOAMcast and a […] The post SGEM#421: I Think I’d Have a Heart Attack – Maybe Not in a Rural Area?

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EM Quick Hits 53 Postpartum Hemorrhage, Serotonin Syndrome, TBI Herniation Syndromes, Ulcerative Colitis, Pediatric C-Spine Immobilization, Global EM

Emergency Medicine Cases

On this month's EM Quick Hits podcast: Anand Swaminathan on update to ED management of postpartum hemorrhage, Nour Khatib on serotonin syndrome and its mimics, Katie Lin on an approach to recognition and management of severe TBI and brain herniation syndromes, Hans Rosenberg on the ED management of ulcerative colitis, Heather Cary on pediatric c-spine immobilization controversies and techniques, Navpreet Sahsi on the difference between humanitarian and development work The post EM Quick Hits 53

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ACMT Toxicology Visual Pearl: Poison Dart Frog

ALiEM

The toxin from the golden poison dart frog most resembles which of the following in its mechanism of action? Botulinum toxin Bufotoxin Grayanotoxin Palytoxin Tetrodotoxin Photo adapted from Wilfried Berns (Wikimedia Commons) Reveal the Answer 3. Grayanotoxin – a sodium channel opener Background The golden poison dart frog ( Phyllobates terribilis ), often considered one of the most poisonous animals on the planet, secretes onto its skin the lipophilic alkaloid batrachotoxin , which irreversibly

ALS 284
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Cuffed Endotracheal Tubes for Children: ReBaked Morsel

Pediatric EM Morsels

While doing literature review for my scholarly project it dawned on me that it might be time to dust off a classic morsel from the bottom of the cookie jar. On this 10 year anniversary, we chose to throw this one back in the oven to include some even more delicious data on cuffed endotracheal tube (ETT) use. No matter whether you have the wisdom of many years of practice ( old doc like Dr.

E-9-1-1 190
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A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

Don't Forget the Bubbles

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. He presented tachycardic and hypotensive with a capillary refill time of 5 seconds. After 40ml/kg of IV 0.9% NaCl, his HR came down a little, but the effect was short-lived. He has an HR of 190/min, and his BP is 85/35 mmHg. The CRT is unchanged.

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EMCrit 361 – Life Threatening Tox and Toxicologic Cardiac Arrests from the AHA

EMCrit Project

AHA Guidelines on Critical Care Toxicology EMCrit Project by Scott Weingart, MD FCCM.

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SGEM#420: I get knocked down, but I get up again – do I have a scaphoid fracture?

The Skeptics' Guide to EM

Date: November 2, 2023 Reference: Coventry et al. Which clinical features best predict occult scaphoid fractures? A systematic review of diagnostic test accuracy studies. Emerg Med J. Aug 2023 Guest Skeptic: Dr. Matt Schmitz is an Orthopaedic Surgeon who sub-specializes in adolescent sports and hip preservation. He will soon be transitioning out of the US military after […] The post SGEM#420: I get knocked down, but I get up again – do I have a scaphoid fracture?

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SAEM Clinical Images Series: Pediatric Genitourinary Bleeding

ALiEM

A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. The grandmother first noted blood in the patient’s underwear the previous morning when she was helping the patient wipe and she noticed it again prior to arrival, this time saturating the patient’s underwear.

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INTERACT3: Management of intracranial hemorrhage

First 10 EM

Evidentiary amnesia is a term I use to describe the phenomenon I frequently encounter in which evidence seems to be forgotten over time. When I hear people lecture about the management of intracranial hemorrhage, and even when I invite incredibly smart people to write about neurologic emergencies, blood pressure management is always recommended. But why?

EMS 134
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Massive Haemorrhage: Science and Practice

Broome Docs

This is another lecture by the always amazing Dr Justin Morgenstern from the series of talks he delivered on his tour of Perth in September 2023. In this talk I challenged Justin to go on a very deep dive into the literature around the modern management of the massively bleeding trauma patient. What is the best way to resuscitate and replace all those blood products in these severely unwell people?

FFP 130
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CMS Announces 2024 Ambulance Inflation Factor

American Ambulance Association

This content is for AAA members only. Please either Log In or Join! The post CMS Announces 2024 Ambulance Inflation Factor appeared first on American Ambulance Association.

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SGEM Xtra: Say What You Need to Say…but Don’t Say “Sepsis Screening”

The Skeptics' Guide to EM

Reference: Roland D, Munro A. Time for paediatrics to screen out sepsis “screening.” BMJ. June 2023 Date: Sept 12, 2023 Guest Skeptic: Dr. Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Professor for the University of Leicester’s SAPPHIRE group. He specializes in Paediatric Emergency Medicine and is a passionate […] The post SGEM Xtra: Say What You Need to Say…but Don’t Say “Sepsis Screening” first appeared on The Skeptics Guide to Emergency Medicine.

OR 135
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Ep 188 Hemoptysis – ED Approach and Management

Emergency Medicine Cases

Key principles and approach to management of both non-massive and massive hemoptysis with Dr. Scott Weingart and Dr. Bourke Tillmann, who answer questions such as: What are the factors to consider in the decision to intubate patients with massive hemoptysis? How can one reliably distinguish hemoptysis from pseudohemoptysis? What is the evidence for tranexamic acid in patients with hemoptysis?

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ALiEM AIR Series | Trauma 2023 Module

ALiEM

Welcome to the AIR Trauma 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 trauma 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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Diagnostic imaging during pregnancy and lactation

First 10 EM

When caring for pregnant women, I frequently find myself searching for information on radiation risks from diagnostic imaging, to help guide our shared decision making process, so I decided to create a summary in a spot I would always know where to find it. I have ranted in the past about the many problems with […] The post Diagnostic imaging during pregnancy and lactation appeared first on First10EM.

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Imaging Case of the Week 574

EMergucate

The facial x-rays are from an adult with right cheek swelling, bruising & cough.

EMS 130
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EMS.gov | Input Requested: EMS Education Agenda 2050

American Ambulance Association

Input Requested: EMS Education Agenda 2050 NHTSA plans community-lead revision of 1996 Education Agenda, tackling education to clinicians The National Highway Traffic Safety Administration (NHTSA) is seeking public comment regarding the upcoming revision […] The post EMS.gov | Input Requested: EMS Education Agenda 2050 appeared first on American Ambulance Association.

EMS 130
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Acute Chest Pain? Spill the “T”

Core EM

The Case A 62-year-old male with a history of Hypertension, Hyperlipidemia, Coronary Artery Disease with stents, Pulmonary Embolism on Eliquis, presents with sudden onset, severe, mid-sternal chest pain that started 15 minutes prior to arrival. He arrived initially with diaphoresis and pallor which have self-resolved following arrival to the ED. EKG Show Details EKG Characteristics Rate 95 BPM Rhythm Normal Sinus Rhythm Intervals PR 164, QRS 82, QT/QTc 360/452 (normal) Axis Normal Additional Fea

Coronary 130
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Global EM 5 Is it Ethical? 5 Core Principles When Choosing a Global Health Project

Emergency Medicine Cases

Dr. Navpreet Sahsi outlines 5 core ethical principles in choosing and participating a global health project on EM Cases' Global EM blog. The post Global EM 5 Is it Ethical? 5 Core Principles When Choosing a Global Health Project appeared first on Emergency Medicine Cases.

EMS 137
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SAEM Clinical Images Series: More Than Skin Deep

ALiEM

A 57-year-old female college counselor living in the northeastern United States with no PMH presented for evaluation of rash, joint pain, and dyspnea for the past three weeks. The patient first noticed the rash on her upper back, describing it as being itchy. The rash then spread to her face, scalp, and thighs. Two weeks ago, she noticed swelling in her hands and had a gradual onset of dyspnea on exertion.

OR 200
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"I Need a Medic!"

Chicago EMT Training

We occasionally get an inquiry asking to become a paramedic. It's encouraging to hear that there is still interest in becoming first responders! A quick breakdown on the differences between an EMT-B(asic) and an EMT-P(aramedic) Basic Life Support (BLS) vs Advanced Life Support (ALS) So there it is. The two main levels of care you would probably see in the prehospital setting.

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Lab case 429

EMergucate

70 year old man presented with reduced level of consciousness. His venous blood gas showed the following: PH = 7.

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NCSL Podcast | Emergency Medicine in Rural America

American Ambulance Association

Emergency Medicine in Rural America | OAS Episode 198 NOVEMBER 19TH, 2023 | 36:56 | E198 SHARE EMBED RECAST SUBSCRIBE DOWNLOAD MP3 EPISODE SUMMARY Two experts in emergency medical services joined the podcast […] The post NCSL Podcast | Emergency Medicine in Rural America appeared first on American Ambulance Association.

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The Primary Survey in Trauma

Core EM

The primary survey in trauma management is a critical initial assessment to identify and address life-threatening conditions. It follows the ABCDE approach: Airway maintenance with cervical spine protection, Breathing and ventilation, Circulation with hemorrhage control, Disability (neurological status), and Exposure/Environmental control. This systematic method ensures prompt identification and immediate treatment of urgent medical issues, enhancing the chances of survival and recovery in traum

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Quiz post: 2 similar patients with similar ECGs. Which, if any, or both, are OMI? Will you outperform the Queen of Hearts?

Dr. Smith's ECG Blog

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both were awake and alert with normal vital signs. Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" What do you think? Here they are: Patient 1, ECG1: Zoll computer algorithm stated: " STEMI , Anterior Infarct" Patient 2, ECG1: Zoll computer algorithm stated: "ST elevation, probably benign early repolarization.

OR 126
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SAEM Clinical Images Series: Wolf in Sheep’s Clothing

ALiEM

A 55-year-old female with a history of hyperlipidemia presents after a syncopal episode. She had mild nausea and diarrhea on the morning of presentation but otherwise had no prodromal symptoms before suddenly losing consciousness in a grocery store. Of note, she recalls a similar syncopal episode in the remote past, also preceded by gastrointestinal symptoms at that time.

OR 195
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The Difficulty of an EMT class

Chicago EMT Training

The class usually starts out optimistic and hopeful with how the rest of the semester will play out. Not unlike when I applied to Malcolm X College years ago, we try to forewarn the amount of time it takes to truly understand the material in this class. It's not inherently difficult but rather the volume of content that is overwhelming. We all have something going in outside of the EMT class.

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Lab case 428 interpretation

EMergucate

Answers: PH = 7.479, that is mild acidaemia. HCO3 = 30 mmol/L (that is high). So, we have metabolic alkalosis. Next we check the respiratory compensation for metabolic alkalosis.

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National Biodefense Science Board (NBSB) Public Meeting on November 30, 2023

American Ambulance Association

The next public meeting of the National Biodefense Science Board (NBSB) will be held virtually on Thursday, November 30, 2023, from 12:30 to 4:00 p.m. ET. Advanced registration is required. To register […] The post National Biodefense Science Board (NBSB) Public Meeting on November 30, 2023 appeared first on American Ambulance Association.

Ambulance 130
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Episode 190: Electrical Storm

Core EM

We discuss Electrical Storm (VT storm) and how to care for the very irritable heart. Hosts: Brian Gilberti, MD Reed Colling, MD [link] Download Leave a Comment Tags: Cardiology Show Notes Background/Overview of VT: Definition: What makes it a storm Three or more sustained episodes of VF, VT, or appropriate ICD shocks in a 24-hour period Pathophysiology: Understanding the origin and mechanism Sympathetic drive/adrenergic surge Underlying pathology: Sodium channelopathies, infiltrative disease li

OR 130
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Acute Dyspnea and Right Bundle Branch Block

Dr. Smith's ECG Blog

I was texted this ECG just as I was getting into bed. It is of an elderly woman who complained of shortness of breath and had a recent stent placed. I was told that the Queen of Hearts had called it OMI with high confidence. What do you think? Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema.

OR 125
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SAEM Clinical Images Series: Utility of Bedside Ultrasonography

ALiEM

A 24-year-old G1P0010 female with a PMHx of ovarian cyst (unknown laterality) and emergency contraceptive use 3 months prior presented with sudden onset abdominal pain (upper > lower) that awoke her from sleep four hours prior to presentation with associated nausea and mild lower back pain. The pain is 10/10, sharp, stabbing, and diffuse. Additionally, she reported trace white vaginal discharge at baseline.

OR 161
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Propofol-related Infusion Syndrome

Don't Forget the Bubbles

One-liner… Although commonly used, Propofol can have severe adverse effects. Propofol Infusion Syndrome (PRIS) can lead to significant morbidity and mortality in children. What is Propofol? Commonly referred to as “the milk of amnesia”, propofol is a drug used for induction and maintenance of general anaesthesia and for procedural sedation. Propofol is prepared in a lipid emulsion, giving it a characteristic milky white appearance, and due to its ability to dissolve in fats, it is rapidly redist

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Lab case 428

EMergucate

28 days old boy brought by his parents for multiple vomiting episodes. His venous gases showed the following: PH = 7.

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California Human Resources | Changes to CA Paid Sick Leave Law

American Ambulance Association

This content is for AAA members only. Please either Log In or Join! The post California Human Resources | Changes to CA Paid Sick Leave Law appeared first on American Ambulance Association.

Ambulance 130
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2023 AHA Update on Management Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning

EMDocs

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. This post will focus on the key parts of the guideline that affect ED evaluation and management. Top 10 Take Home Pearls 1. Treatment of cardiac arrest and life-threatening toxicity due to poisoning often requires specialized treatments that most clinicians do not use frequentl

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Infection and DKA, then sudden dyspnea while in the ED

Dr. Smith's ECG Blog

To learn more about Occlusion MI, join us in this Free Webinar on November 27 12 noon US Central Time: Sign up at this link: [link] Infection and DKA, then sudden dyspnea while in the ED A 63 year old male with a PMH of CAD and peripheral vascular disease from type 1 DM presented to clinic and was found to have a very high blood sugar and so was sent to the emergency department.

ED 120