March, 2024

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Transcutaneous Pacing: Part I

EMS 12-Lead

TCP In Transit: A case reviewing transcutaneous pacing, false electrical capture, and re-arrest. Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the first installment of a blog series showing how transcutaneous pacing (TCP) can be difficult, and how you can improve your skills. We will be using redacted information from different cases where paramedics attempted TCP in the field.

CPR 312
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SAEM Clinical Images Series: Purple Finger

ALiEM

A 30-year-old female with a past medical history of Crohn’s Disease presented to the ED for evaluation of an acutely bruised right 4th finger. She stated she was typing on a computer keyboard approximately 10 minutes prior to presentation and she noticed a sudden popping sensation at the base of her right ring finger. After the popping sensation, she noticed a cool sensation of the finger and numbness to the entire finger.

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SGEM#432: SPEED, Give Me What I Need – To Diagnose Acute Aortic Dissections

The Skeptics' Guide to EM

Reference: Gibbons et al. The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol): A multicenter, prospective, observational study. AEM February 2024. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. He is the Vice Chair of the Emergency Department at Nassau University […] The post SGEM#432: SPEED, Give Me What I Need – To Diagnose Acute Aortic Dissections first appeared on Th

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Decision Engines to Improve Performance

High Performance EMS

There is plenty of data in the world, the key to improving performance is to discover the right information and make an appropriate decision, based on facts, in time to change outcomes for the better. Computers are quite useful in aggregating and processing data to distill information in support of the decision-making process, but artificial intelligence and machine-learning has increased our expectations of cyber assistance.

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Ep 192 ED Adult Asthma Management Strategies For Improved Prognosis – A Stepwise Approach

Emergency Medicine Cases

In this part 1 of our 2-part podcast series on Asthma Management we explore a systematic approach to managing patients presenting to the ED with asthma exacerbations. Our discussion will emphasize the critical role of a thorough history and physical examination in effectively stratifying patient risk and guiding treatment/disposition decisions. Additionally, we'll examine the importance of providing comprehensive discharge medications and instructions to mitigate both mortality and morbidity ass

ED 269
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Rebaked: Inborn Errors of Metabolism presenting in the ED

Pediatric EM Morsels

Often our job requires us to consider the presence of needles of significant illness in the haystack of nonspecific symptoms. With the help of our favorite geneticist , Dr. Liz Baker, we will dive into the haystack headfirst and find those needles. Hopefully, without getting poked. Let’s consider Inborn Errors of Metabolism Presenting in the ED : Inborn Errors of Metabolism: Basics Common Presentations, Uncommon Kiddos For the child with lethargy, vomiting, acidosis, hypoglycemia , organom

ED 253
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2024 Vanguard Award Winners Announced

American Ambulance Association

FOR IMMEDIATE RELEASE Contact: Samantha Hilker Director of Strategic Initiatives shilker@ambulance.org American Ambulance Association Announces 2024 Vanguard Award Winners Washington D.C. – The American Ambulance Association (AAA) is proud to […] The post 2024 Vanguard Award Winners Announced appeared first on American Ambulance Association.

Ambulance 246

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SGEM Xtra: A Philosophy of Emergency Medicine

The Skeptics' Guide to EM

Date: March 6, 2024 This is an SGEM Xtra created from a lecture I gave for the Rural Ontario Medical Program (ROMP) ICE Camp Retreat in Collingwood, Ontario last month. ROMP helps Ontario medical students & residents arrange core & elective rotations in rural Ontario. An old friend, Dr. Matt De Stefano invited me to […] The post SGEM Xtra: A Philosophy of Emergency Medicine first appeared on The Skeptics Guide to Emergency Medicine.

EMS 185
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5 Min Sono – IVC (2024)

Core Ultrasound

Old IVC Vid (2021) TEE VTI Here are Dr. Spiegel’s Notes: 1. The discussion of what an IVC tells you is a fairly nuanced discussion but essentially it is telling you the difference in the RA pressure compared to the intra-abdominal pressure. It is our job as clinicians to interpret what that means. I find if you teach IVC US from that perspective than all the variability in techniques make a whole lot of sense.

ICU 246
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WTBS 29 Four Key Learnings from a Career in Emergency Medicine Leadership

Emergency Medicine Cases

In this Waiting to Be Seen blog Dr. Howard Ovens outlines 4 key learnings from his extensive career in EM leadership: Be a good clinician, get substantial real-world experience, take a long-term view of benefits and risks and get along with your counterparts in the leadership dyad. The post WTBS 29 Four Key Learnings from a Career in Emergency Medicine Leadership appeared first on Emergency Medicine Cases.

EMS 201
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Gelastic Seizures: No Laughing Matter

Pediatric EM Morsels

We encounter seizures commonly in the Emergency Department. While they can be dramatic and devastating, we have learned to become comfortable with the wide variety that may present in children. From the simple febrile seizure to the complex seizure, we know how to stabilize and how to evaluate. While fortunately most seizure activity is short lived, we also know that status epilepticus can be difficult to manage, and persistent seizures should make us consider specific etiologies (ex.

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Lightning rounds 38: Working in APP leadership, with Jason Wieland

Critical Care Scenarios

We talk about working in critical care APP leadership positions, with Jason Wieland, PA, Lead Pulmonary & Critical Care APP at WakeMed Health System in Raleigh, NC. Find us on Patreon here! Buy your merch here! We talk about working in critical care APP leadership positions, with Jason Wieland, PA, Lead Pulmonary & Critical Care APP at WakeMed Health System in Raleigh, NC.

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SAEM Clinical Images Series: Seeing Double

ALiEM

A 53-year-old woman with no significant past medical history presented to the emergency department with a 3-day history of double vision on leftward gaze. She initially presented to urgent care with a chief complaint of chest heaviness and concern that her blood pressure was too high, but was sent to the emergency department for further cardiac and neurological evaluation after her urgent care provider noticed abnormal eye movement.

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Episode 194: Nitrous Oxide Toxicity

Core EM

We review Nitrous Oxide Toxicity: Symptoms, diagnosis, and treatment overview Hosts: Stefanie Biondi, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Toxicology Show Notes Patient Case Illustration Hypothetical case: 21-year-old male with no previous medical history, experiencing a month of progressively worsening numbness, tingling, and weakness.

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EMS.gov | New Resources Address Important EMS Issues

American Ambulance Association

New Resources Address Important EMS Issues The Latest Updates on Highway Safety Regulations, Rural EMS Education and Special Pathogens Updating the Highway Safety Improvement Program The Federal Highway Administration has […] The post EMS.gov | New Resources Address Important EMS Issues appeared first on American Ambulance Association.

EMS 130
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ECG of the Week March 20th

EMergucate

The following ECG is from a 65 year old lady who has presented with two hours of central chest pain. She has a history of hypertension and is a current smoker. What are the key features on her ECG?

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Lung Abscess in Children

Pediatric EM Morsels

We have digested many Morsels regarding various pulmonary complaints. While some are very rare (ex, Pulmonary Embolism , Pulmonary Hypertensive Crisis , Negative Pressure Pulmonary Edema , CPAM ) others are commonly encountered (ex, Croup , Bronchiolitis , Sinusitis ). It is pneumonia , however, that often generates the most conversations. When should I consider a CXR ?

EMS 169
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SGEM#433: Breathe – Simple Aspiration vs. Drainage for Complete Pneumothorax

The Skeptics' Guide to EM

Reference: Marx et al. Simple Aspiration versus Drainage for Complete Pneumothorax: A Randomized Noninferiority Trial. Am J Respir Crit Care Med. 2023 Date: March 22, 2024 Guest Skeptic: Dr. Richard Malthaner holds the prestigious position of Chair/Head of the Division of Thoracic Surgery and serves as the Director of the Thoracic Robotic Program at Western […] The post SGEM#433: Breathe – Simple Aspiration vs.

ALS 134
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SAEM Clinical Images Series: Workout Gone Wrong

ALiEM

A 28-year-old male presented to the ED for evaluation of an injury to his right eye. While working out with an exercise band, it snapped back, hitting the patient in the right eye. He experienced blurry vision and excess eye tearing immediately after the incident occurred. The patient also developed gross blood over the front of the eye. Physical Exam Vitals : Temp 98°F, HR 73, BP (135/77), RR 16, SpO2 99% HEENT : Gross blood in the anterior portion of the right eye (grade I).

ED 161
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Acute Radiation Exposure

Core EM

Author: Mallika Singh, MD Editor: Jonathan Kobles, MD Background Unintentional or intentional exposure to radiological material represents a potential threat to human health on the individual to mass-casualty scale. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. Due to their availability, iridium-192, Cesium-137, and Cobalt-60 are often viewed as the substances posing the greatest threat for intentional radiation exposure.

ALS 130
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EMS.gov | New Resources Address Important EMS Issues

American Ambulance Association

New Resources Address Important EMS Issues The Latest Updates on Highway Safety Regulations, Rural EMS Education and Special Pathogens Updating the Highway Safety Improvement Program The Federal Highway Administration has […] The post EMS.gov | New Resources Address Important EMS Issues appeared first on American Ambulance Association.

EMS 130
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Imaging Case of the Week 586 Answer

EMergucate

The chest x-ray shows features highly suggestive of thoracic aortic dissection. Mediastinal widening. Indistinct aortic knuckle. Right paratracheal density.

EMS 130
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Episode 72: CPR-induced consciousness with Jack Howard

Critical Care Scenarios

Find us on Patreon here! Buy your merch here! We discuss the phenomenon of CPR-induced consciousness (i.e. patients demonstrating awakeness during resuscitation) with Jack Howard, Intensive Care Paramedic at Ambulance Victoria in the northern suburbs of Melbourne, Australia, and first author on a recent literature review and Delphi-derived expert guideline on CPRIC management.

CPR 124
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SGEM Xtra: The Matrix – Social Media for Knowledge Translation

The Skeptics' Guide to EM

Date: March 16, 2024 This is an SGEM Xtra episode. Yes, that is two back-to-back SGEM Xtra episodes. The critical appraisal that was lined up for this week’s episode got delayed due to some scheduling problems with clinical responsibilities. You can access all the slides for this episode from this LINK and see the presentation […] The post SGEM Xtra: The Matrix – Social Media for Knowledge Translation first appeared on The Skeptics Guide to Emergency Medicine.

OR 132
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SAEM Clinical Images Series: Two Pupils for the Price of One

ALiEM

A 24-year-old female with no pertinent PMHx presents to the ED with a chief complaint of eye pain. She reported a 10-day history of worsening right eye pain following being punched in that eye. She had been managing her pain with ice and had not taken any OTC medications. Her mom convinced her to go to the ED and she first went to an outside hospital, but was referred to come to our institution.

ED 152
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Posterior Circulation Strokes

EMOttawa

Posterior circulation ischemia accounts for approximately 20-25% of all ischemic strokes and is a significant cause of patient disability. The diagnosis can be extremely challenging as findings are often not typically focal. Posterior strokes are misdiagnosed more than 3x more often than anterior circulation strokes.1 Similar to anterior circulation strokes, posterior strokes are most commonly […] The post Posterior Circulation Strokes appeared first on EMOttawa Blog.

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EMS Testifies at House Ways & Means Field Hearing

American Ambulance Association

Yesterday was a proud day for EMS! Yesterday, Dr. @ed_racht of @AMR_social and former @NAEMT_ President @mattzavadsky provided testimony at a House Ways & Means field hearing on the challenges […] The post EMS Testifies at House Ways & Means Field Hearing appeared first on American Ambulance Association.

EMS 130
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Lab case 441

EMergucate

An unconscious young girl, was brought to ED by ambulance. Apparently she ingested an unknown substance during a party.

Ambulance 130
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TIRBO 57: Volume vs pressure control

Critical Care Scenarios

Should you use volume or pressure control ventilation? Find us on Patreon here! Buy your merch here! Should you use volume or pressure control ventilation? Find us on Patreon here! Buy your merch here!

OR 124
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Overdiagnosis: Would we better better off not looking?

First 10 EM

There is little doubt that the use of testing has increased dramatically in emergency medicine during my career. Between 2001 and 2010 the use of CT in emergency departments increased 3-fold (and the use of MRI increased 9-fold, but for some reason it is still almost impossible for me to get one done.) (Carpenter 2015) […] The post Overdiagnosis: Would we better better off not looking?

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SAEM Clinical Images Series: Not Your Usual Irritated Eye

ALiEM

In July 2022, a 32-year-old male with a past medical history of HIV (on antiretroviral therapy, CD4 390, viral load undetectable) presented to the emergency department with constitutional symptoms and a rash for 4-5 days. His symptoms included malaise, body aches, subjective fevers, a sore throat, tender, swollen neck glands, body rash, and irritation of his left eye.

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PulmCrit Wee: Propofol induced eyelid opening apraxia – the struggle is real

EMCrit Project

Eyelid opening apraxia refers to a specific inability to open the eyelids. This may result from non-dominant hemispheric strokes. On superficial examination it will mimic unconsciousness, but upon further examination the patient is awake and able to respond to stimuli with their extremities. I've seen a similar phenomena of eyelid opening apraxia a few times […] EMCrit Project by Josh Farkas.

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JEMS | Remembering Mike Touchstone

American Ambulance Association

Jonathon Feit eulogizes Mike Touchstone for making significant contributions to advance EMS and fire leadership. Mike Touchstone’s Joie de Vivre: Obituary to Everyone’s Friend, Mentor and Muse by Jonathon S. […] The post JEMS | Remembering Mike Touchstone appeared first on American Ambulance Association.

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Lab case 440 interpretation

EMergucate

Answers: PH = 7.396, that is within normal range, very slightly to the acidaemic side/ pCO2 = 52 mmHg, that is high.

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TIRBO 56: Transfixing vessels

Critical Care Scenarios

You poked through the deep wall of a vessel. Now what? Find us on Patreon here! Buy your merch here! You poked through the deep wall of a vessel. Now what? Find us on Patreon here! Buy your merch here!

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Classic EM: High risk and low prevalence diseases: Blast injuries

Core EM

High risk and low prevalence diseases: Blast injuries American Journal of Emergency Medicine, 2023 Background Blast injuries stem from the instantaneous transformation of a substance from solid or liquid to gas, releasing energy in the form of heat, light, pressure, and sound. While rare, blast injuries carry a high rate of morbidity and mortality. Blast injuries commonly have a mixed presentation of blunt and penetrating trauma.

EMS 100
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Serving the Whole Community: Celebrating Women’s History Month with Women in Fire

NVFC

Practical tips for diversity, equity, and inclusion in your community March is recognized nationally as Women’s History Month, which provides an opportunity for the fire service to recognize the positive impact female members have on fire and rescue departments. It is also a time to consider how to enhance efforts to recruit and retain women and update policies that help keep the entire community safe.