December, 2024

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SGEM Xtra: The 12 Days of Christmas the SGEM Gave to Me

The Skeptics' Guide to EM

Date: December 15, 2024 Guest Skeptics: Dr. Chris Carpenter, Vice Chair of Emergency Medicine at Mayo Clinic. Today, were sleighing through the holiday season with a special episode filled with statistical cheer, a dash of skepticism, and a hint of eggnog-flavoured nerdiness. This is an SGEM Xtra like the one we did on What I Learned from Top Gun. Its fun to mix it up and not do a structured critical appraisal of a recent publication and have a more philosophical chat.

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ECG Cases 52 – The Art of Occlusion MI, part 1: Mirror Image

Emergency Medicine Cases

In this month's ECG Cases Jesse McLaren takes us through 6 cases highlighting important mirror concepts in ECG interpretation including: which leads are reciprocal to each other, how to identify which is the main ST/T change and which is the mirror, reciprocal changes highlighting subtle inferior, lateral and posterior OMI, ST elevation in aVR as a mirror to widespread ST depression and more.

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SAEM Clinical Images Series: An On-Target Diagnosis

ALiEM

A 25-year-old female with no pertinent past medical history presented to an emergency department in Massachusetts with four days of generalized malaise, myalgias, congestion, low-grade fever, and a rash behind her left knee. The patient denied cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, and diarrhea. She lives with three roommates, none of whom were sick, and she denied any other known sick contacts.

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Communic8: Eight Universal Leadership Lessons from the Children’s Emergency Department

Don't Forget the Bubbles

The Childrens Emergency Department is a busy, challenging, and dynamic environment. The skills needed to deliver the best possible outcomes for children and young people are multifaceted and constantly evolving. They involve a mixture of clinical, communication, and leadership traits. Having recently moved from a leadership position within the Childrens Emergency Department to a more system-based role involving children of all ages, its apparent to me how transferable my experiences on the shop

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What can you find with continuous ST monitoring in the ED?

Dr. Smith's ECG Blog

This was written by one of our fine residents, who will soon be an EMS fellow: Michael Perlmutter Case A mid-50s male came to the ED with a burning sensation that was acutely worse while at home. He had recently returned from overseas travel where these symptoms had been intermittently bothersome over the preceding weeks and had been attributed to heartburn.

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Rethinking Fluid Resuscitation in Vaso-Occlusive Crisis: Is Lactated Ringer’s the Superior Choice?

REBEL EM

Background: Sickle cell disease (SCD) affects an estimated 300,000 infants born worldwide each year and has a total estimated prevalence of 100,000 in the United States alone ( Piel 2017 ). Within this population, over 90% of healthcare encounters are due to painful vaso-occlusive episodes (VOE) ( Kidwell 2021 ). VOE is often complicated by hypovolemia, making fluid administration a common intervention ( Lovett 2017 ).

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SGEM#464: I Can Do It with A Broken Heart – Compassion for Patients with OUD

The Skeptics' Guide to EM

Date: December 26, 2024 Reference: Steinhauser S et al. Emergency department staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder. AEM December 2024 Guest Skeptic:Dr. Suchismita Datta. She is anAssistant Professor and Director of Research in theDepartment of Emergency Medicine at the NYU Grossman Long Island Hospital Campus.

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SAEM Clinical Images Series: This Rash Came Out of No Where

ALiEM

A 26-year-old male with a past medical history of eczema presented to the Emergency Department with a rash for two days. The patient stated he first noticed a rash on his right arm that rapidly spread to his face, chest, and left arm. He reported having similar rashes before but never to this extent. The patient stated he was given Bactrim and amoxicillin about one month ago for another rash, though he was unsure of the diagnosis.

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Out-of-Hospital Intranasal Ketamine as an Adjunct to Fentanyl for the Treatment of Acute Traumatic Pain: A Randomized Clinical Trial

EMOttawa

Methodology: 4/5 Usefulness: 2/5 McMullan JT, et al. Ann Emerg Med. 2024 Oct;84(4):363-373. doi: 10.1016/j.annemergmed.2024.04.018. Question and Methods: This out of hospital, placebo-controlled, blinded, parallel group RCT compared reduction in pain scores between Fentanyl + IN Placebo and Fentanyl with IN Ketamine. Findings: There was no significant difference in reduction of pain scores or adverse […] The post Out-of-Hospital Intranasal Ketamine as an Adjunct to Fentanyl for the Treatme

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Work-Life Balance During the Holidays

California Casualty

Balancing work and personal life during the holidays can feel like a juggling act. That’s especially true for shift workers on the front line—EMTs, nurses, police officers, and firefighters. While others are wrapping gifts or planning holiday feasts, you’re often working long shifts, answering urgent calls, or preparing for the next day’s challenges.

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Imaging decisions in paediatric trauma. RCR update 2024

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed The blog highlights the updated 2024 guidelines from the Royal College of Radiologists (RCR) on imaging in pediatric trauma. It emphasizes critical changes from the previous 2014 guidelines, focusing on the judicious use of imaging to minimize ionizing radiation exposure in children. Key updates include algorithms for blunt trauma, penetrating trauma, and blast injuries.

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Cardiac Arrest Update 2024 (Part 1)

Core Ultrasound

Ultrasound is a powerful tool that can significantly enhance patient care during cardiac arrest. In Part 1 of this lecture, we break down how ultrasound can be effectively utilized in three key areas: identifying reversible causes, assisting in critical procedures, and guiding resuscitation. RUSH exam Courses The post Cardiac Arrest Update 2024 (Part 1) first appeared on Core Ultrasound.

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Strategies to Reduce Ambulance Patient Offload Delays

ACEP Now

As emergency departments (EDs) have become the focus of bottlenecks in the entire health care systemfrom insufficient inpatient beds leading to hospital boarding to dwindling access to primary carea siege atmosphere has developed. Although EDs offer around-the-clock access to highly trained physicians and a full suite of imaging and laboratory services, their very success has led to tremendous overcrowding and enormous strains on staff.

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SAEM Clinical Images Series: Not Your Average Eczema

ALiEM

A 3-year-old male with a history of severe atopic dermatitis presented for facial rash and hand pain. Mom had been applying Aquaphor and Vaseline several times a day. On the day of presentation, he woke up with a new rash over his face and hands which prompted the ED visit. He is up to date on childhood immunizations and is not prescribed any oral medications.

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Getting Triggered By Errors in the Emergency Department

EM Literature of Note

The emergency department is a place of risk and errors. Those who work in the ED are acutely aware of this, and it conjures up tremendous cognitive pressures on staff every shift. Every ED clinician knows the most benign-appearing triage complaint may obfuscate lurking catastrophe. The vision changes that are actually an acute aortic dissection. A sore shoulder that is necrotizing fasciitis.

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Are there hyperacute T-waves? And how can we know?

Dr. Smith's ECG Blog

A 50-something man presented with worsening severe exertional chest pain which was just resolving as he had an ECG recorded in triage. Time zero. Are the T-waves in leads I and II hyperacute? Hard to tell. How can we know? By the evolution of the ECG! Watch what happends as the heart recovers from its episode of ischemia. The T-waves deflate, demonstrating that the first one was indeed hyperacute. 2 hours T-waves in lead II are significant smaller In lead I not much difference Troponins returned

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Toxic alcohol poisoning: What do we know about fomepizole, methanol and ethylene glycol?

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed Uncover the truth about alcohol poisoning. Find out how toxic alcohols can be ingested accidentally or intentionally and the serious consequences they can have with a focus on Emergency medicine management. #FOAMed @stemlyns The post Toxic alcohol poisoning: What do we know about fomepizole, methanol and ethylene glycol?

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Cardiac Arrest Update 2024 (Part 2)

Core Ultrasound

In part two of this series on using ultrasound during cardiac arrest, we dive into advanced strategies to further optimize your resuscitation care. Building on the foundation from part one, this video focuses on actionable tips to take your ultrasound skills to the next level during cardiac arrest scenarios. Cardiac Arrest Part 1 RUSH exam Courses The post Cardiac Arrest Update 2024 (Part 2) first appeared on Core Ultrasound.

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Year in Review: Product Innovation and Progress from 2024

ESO

At ESO, we are a mission-centric company, which is why it is vital that each step that we take ties back to our commitment to transform community health and safety through the power of data, whether thats through product innovation or our research. The EMS, fire services, and hospital organizations that use our platform arent just our customers, but our partners in working towards that mission through their own achievements.

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SAEM Clinical Images Series: Pediatric Forehead Swelling

ALiEM

A 12-year-old male with a history of autism spectrum disorder and chronic sinusitis presented for forehead swelling. His mother reported that she noticed progressive forehead swelling for about one month. She had followed up with the patients pediatrician and ENT and was given oral cephalexin and fluticasone nasal spray which did not make any changes in his symptoms.

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HHS OIG Issues Favorable Advisory Opinion on Ambulance Treatment-in-Place

American Ambulance Association

On November 21, 2024, the HHS Office of the Inspector General (OIG) issued Advisory Opinion 24-09. The opinion relates to a proposal by a municipal ambulance service to begin billing […] The post HHS OIG Issues Favorable Advisory Opinion on Ambulance Treatment-in-Place appeared first on American Ambulance Association.

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Chest pain and rapid pacing followed by an unexplained wide complex tachycardia. Time for cardioversion?

Dr. Smith's ECG Blog

Written by Willy Frick with edits by Ken Grauer An older man with a history of non-ischemic HFrEF s/p CRT and mild coronary artery disease presented with chest pain. He said he had had three episodes of chest pain that day while urinating. The following ECG was obtained in the emergency department during active chest pain. ECG 1 What do you think? There is a lot going on in this ECG.

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What’s the long term complication rate of IO access?

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed Intraosseous (IO) access is essential in prehospital emergency care when intravenous access is challenging. A Danish retrospective cohort study of over 5,000 patients found fewer than five cases of osteomyelitis, no osteonecrosis or compartment syndrome, and no complications in children. Despite a high mortality rate (60% at 180 days) potentially underestimating long-term risks, the study's robust design supports IO access as a generally safe and effe

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Does the literature support medications for stable, monomorphic ventricular tachycardia?

EMDocs

Authors: Molly Rinkevich, PharmD, PGY2 EM Pharm Resident (Geisinger Wyoming Valley, Wilkes Barre, PA); Howard Rainey, DO (Geisinger Medical Center, Danville, PA); Drew Schmucker, PharmD (Geisinger Wyoming Valley, Wilkes Barre, PA); Lloyd Tannenbaum, MD (APD, Geisinger Wyoming Valley, Wilkes Barre, PA) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case: Its 3 am on a busy shift and EMS rolls in with a 67-year-old male coming in from home with a history of ischemic card

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Thrombolytics in Stroke: Moving Beyond Controversy to Comprehensive Care

ACEP Now

The use of thrombolytics for acute ischemic stroke may be one of the most controversial topics in emergency medicine during the last several decades. This debate recurs in multiple forums including many previous pieces in ACEP Now. 1 The reason is understandablethrombolytics in stroke is a high-risk, higher-reward treatment. If the potential for harm were absent, or if the benefit of thrombolytics was only marginal, there would be no controversy.

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Clinical Conundrum: Should We Always Treat Fever in Patients with Sepsis?

REBEL EM

Bottom Line Up Top: There doesnt appear to be a morbidity or mortality benefit to treating fever in sepsis and fever may have a protective effect. Only treat fever if it causes the patient distress. Clinical Scenario: A 45-year-old woman presents with cough and shortness of breath. Vitals are BP 114/42, HR 138, T 102.1, Sat 93% on RA. The patient is alert and oriented and has no other complaints.

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Implementing Ultrasound w/ Allen Wolfe

FOAMfrat

The integration of point-of-care ultrasound (POCUS) is transforming emergency medical services (EMS) by enhancing diagnostic capabilities and improving accuracy in answering important clinical questions. Recently, I had the opportunity to discuss this topic extensively with Allen Wolfe, the Senior Director of Education at Life Link III. Breaking Barriers to Adoption A significant challenge in incorporating ultrasound technology within EMS has been overcoming initial barriers to adoption.

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Which patient needs a CT scan?

Dr. Smith's ECG Blog

Which patient needs a CT Scan? Case 1: 20-something woman with chest pain Case 2: 50-something man with chest pain Case 1 A 20-something yo woman presented in the middle of the night with severe crushing chest pain. It had begun 4 hours before arrival and was initially dull, but became severe and "unbearable" 2 hours prior to arrival. She was a walk-in at triage.

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Difficult Airway Society Meeting 2024

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed Explore key takeaways from the DAS 2024 meeting, including airway management in obstetrics, ethics of training, challenges in critical care, and international practices. Insights tailored for emergency and anaesthesia professionals. The post Difficult Airway Society Meeting 2024 appeared first on St.Emlyn's.

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Drunk Driving Prevention

California Casualty

Every day, lives are lost, and families are affected by drunk driving. Yet, these tragedies are entirely preventable. By raising awareness and taking action, we can help ensure safer roads for everyone.

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Mastering Ultrasound-Guided Nerve Blocks Basics, Part 2

Core Ultrasound

Expand your expertise in ultrasound-guided nerve blocks with Part 2 of this comprehensive tutorial series. In this video, we delve into advanced techniques, exploring brachial plexus blocks, fascia iliaca compartment blocks, and the erector spinae plane block (both in the thoracic and lumbar regions). Nerve Blocks, Pt 1 Courses The post Mastering Ultrasound-Guided Nerve Blocks Basics, Part 2 first appeared on Core Ultrasound.

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Killer antibiotic stewardship strategy? (The ADAPT-Sepsis trial)

First 10 EM

Antibiotic resistance is an existential problem. Optimizing sepsis care, including the appropriate length of antibiotic therapy, is an important goal. So should we be willing to allow an increase in mortality to reduce total antibiotic use, as the ADAPT-Sepsis non-inferiority design seems to imply? The paper Dark P, Hossain A, McAuley DF, Brealey D, Carlson […] The post Killer antibiotic stewardship strategy?

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Lifting Buddy - The Left Ventricular Assist Device

FOAMfrat

Anyone who has tried a little resistance training knows that a lifting buddy can really help lighten the load and ensure you have enough strength to prevent yourself from getting smothered by the bar. They may have to pick up the slack even more on days you are feeling weak, but a good lifting buddy helps you build strength and improve performance. The LVAD is a device for the weak heart that still requires some cardiac effort, but takes some the majority of burden off the LV.

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How Long Does It Take to Become an EMT?

Unitek EMT

Explore the Path to Becoming an EMT: Timeline, Training Requirements, and What to Expect Along the Way. Emergency Medical Technicians (EMTs) are vital members of the healthcare and emergency response system. They are often the first healthcare providers on the scene of accidents, medical emergencies, and disasters, delivering life-saving care and ensuring patients are transported […] The post How Long Does It Take to Become an EMT?

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Dizziness in a 40-something with recent stent for inferior OMI

Dr. Smith's ECG Blog

Dizziness is so unlikely to be OMI without an obvious ECG, that I am going to pretend that this patient presented with chest pain. The PMCardio Queen of Hearts app asks you, before giving an interpretation of OMI ("STEMI-Equivalent"), whether the patient's clinical presentation is high risk for OMI. If no, then she will tell you that the case is outside of the intended use group.

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What to Do if Your Vehicle Gets Stuck in the Snow

California Casualty

You’re ready to hit the road, but your car has other plans—stuck in a snowbank with tires spinning. Before your frustration gets out of hand, take a deep breath. With the right techniques and a little patience, you can free your vehicle and get back on track.

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EMCrit 389 – Massive Transfusion Update and Hemostatic Resuscitation

EMCrit Project

John Holcomb, author of the PROPPR trial, on massive transfusion in 2024 EMCrit Project by Scott Weingart, MD FCCM.

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