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Reference: Remick KE, et al. National Assessment of Pediatric Readiness of US Emergency Departments during the Covid-19 Pandemic. JAMA Netw Open. July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC. Her research focuses on prehospital care of children with anaphylaxis. […] The post SGEM #425: Are You Ready for This?
Olivia Ostrow on the management of button battery ingestions, Brit Long on C difficile infection, Jesse McLaren on an approach to ECG's in the tox patient, Joe Mullally on the identification and treatment of bed bug bites, Andrew Petrosoniak on fibrinogen replacement in bleeding trauma patients, Justin Morganstern on Cold Air for Croup. The post EM Quick Hits 54 Button Battery Ingestion, C. difficile, ECG in Tox, Bed Bugs, Fibrinogen in Trauma, Cold Air for Croup appeared first on Emergency Medi
We discuss assessing patients prior to intubation or other airway management, including both elective and emergent circumstances, with Dr. Jed Wolpaw, anesthesiologist and intensivist from Johns Hopkins, anesthesiology residency program director, and host of the ACCRAC podcast. Find us on Patreon here! Buy your merch here! Takeaway lessons References We discuss assessing patients prior to intubation or other airway management, including both elective and emergent circumstances, with Dr.
Prehospital Narrow Pulse Pressure Predicts Need for Resuscitative Thoracotomy and Emergent Intervention After Trauma J Surg Res., 2021 Background Prehospital trauma team activation criteria allow for prompt mobilization of personnel and resources. Prehospital hypotension is one of those criteria. Pulse pressure is the difference between systolic and diastolic blood pressure.
An 88-year-old female presented to the ER with a chief complaint of cough, vague abdominal pain, and a rash. The patient stated that she was started on Cipro eyedrops 1 or 2 days prior to presentation for a possible eye infection. A day prior to presentation she developed a purple purpuric rash on her lower extremities that gradually progressed up her legs, and was present on her buttocks thighs, and lower legs.
Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.
Reference: Wilkinson-Stokes M, Betson J, Sawyer S. Adverse events from nitrate administration during right ventricular myocardial infarction: a systematic review and meta-analysis. Emerg Med J. February 2023 Date: January 24, 2024 Guest Skeptic: Dr. Rupinder Sahsi is a fellow EBM enthusiast with academic appointments at McMaster University and Wright State University who works as an emergency physician […] The post SGEM#428: Don’t Worry, Be Happy – The Safety of Nitroglycerin Administration in R
Based on a blend of number of listens, feedback from listeners, website visits and personal faves, EM Cases Best of 2023 Top 10. The post EM Cases Best of 2023 Top 10 appeared first on Emergency Medicine Cases.
Based on a blend of number of listens, feedback from listeners, website visits and personal faves, EM Cases Best of 2023 Top 10. The post EM Cases Best of 2023 Top 10 appeared first on Emergency Medicine Cases.
We are once again buried in a wave of viral respiratory illnesses, and much of the burden of illness is still COVID. I did a pretty thorough review of all COVID antiviral therapies in 2022, both on First10EM and on the EMCases Journal Jam, but that was 2 years ago. I think most of us […] The post Paxlovid evidence: still very little reason to prescribe appeared first on First10EM.
How and when to reverse anticoagulation in the bleeding EM patient. Hosts: Joe Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: Anticoagulation , Critical Care , Resuscitation Show Notes Coagulation Cascade: Algorithm for Anticoagulated Bleeding Patient in the ED: Indications for Anticoagulation Reversal: References: Baugh CW, Levine M, Cornutt D, et al.
Dr. Sara Krzyzaniak (podcast host and Stanford University PD) and Dr. Michelle Lin (ALiEM Founder/UCSF) are joined by Dr. Aaron Kraut (University of Wisconsin PD) in this insightful, rapid-fire, practical episode through the lens of experienced residency program directors. What does the Electronic Residency Application Service (ERAS) preliminary data show just far for the 2024 residency application season?
background: ANTHARTIC trial Prophylaxis against VAP (ventilator associated pneumonia) has is already supported by a few studies in the literature, perhaps most notably the ANTHARTIC trial. That was a multi-center RCT evaluating 48 hours of therapy with ampicillin-sulbactam for patients intubated following cardiac arrest. Antibiotic therapy reduced early-onset VAP, with a trend towards more ventilator-free […] EMCrit Project by Josh Farkas.
Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. Resuscitation 2023. Date: January 11, 2024 Guest Skeptic: Dr. Chris Root is an EMS fellow in the Department of Emergency Medicine at the University of New Mexico Health […] The post SGEM#426: All the Small Things – Small Bag Ventilation Masks in Out of Hospital Cardiac Arrest first appeared on The Skeptics Guide to Emergency Me
Background: Sepsis remains one of the leading causes of morbidity and mortality. It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Time to antibiotic therapy (from triage, not from onset of infection) has become a quality metric to improve the time to administration of these medications. In an effort to administer antibiotics earlier, many studies have attempted to give antibiotics in the prehospital setting but the benefit of this int
I love when people use science to investigate the many simple assumptions we make about the world. Not every trial needs to look novel (mostly read “me too”) drugs or fancy procedures. I also have a child in the age range for croup, and we are in our winter viral season in Canada, so this […] The post Cold air for croup (An RCT) appeared first on First10EM.
Background & Pathophysiology: An inflammatory colitis caused by fecal impaction Marked distension and increased intraluminal pressure leads to ischemic pressure necrosis of the colonic wall and compromise of vascular supply and mucosal perfusion Risk of progression to colonic perforation and peritonitis Multiple areas of ulceration occur adjacent to the fecaloma; most commonly in the rectosigmoid colon Diagnosis: Lab findings are non-specific – may reveal increased WBC and/or acute phase rea
A 59-year-old male with no known past medical history other than an incidental abdominal aortic aneurysm presented with sudden onset, painless vision loss in his left eye. The patient was watching TV two days prior when he saw a “brightness” in his left eye and then progressive blurriness until his vision faded away, all occurring within the span of a minute.
Reference: Zaoutis T, et al. Short-course Therapy for Urinary Tract Infections in Children: the SCOUT randomized clinical trial. JAMA Pediatr. Aug 2023 Date: October 30, 2023 Guest Skeptic: Dr. Ellie Hill is a pediatric emergency medicine physician at Children’s National Hospital in Washington, DC and Assistant Professor of Pediatrics and Emergency Medicine at George Washington University […] The post SGEM #427: I Want a Treatment with a Short Course…for Pediatric Urinary Tract Infections first
Triquetrum chip fractures, scapholunate injuries, hook of the hamate fractures, and of course, scaphoid fractures can be easily missed with serious consequences for our patients. In this part 2 of our 2-part podcast series on wrist injuries we highlight the "Big 4" most commonly missed and mismanaged carpal bone injuries, elucidating the key historical, physical exam and x-ray findings, as well as management strategies.
St.Emlyn's - Emergency Medicine #FOAMed Virchester (the home of St Emlyn’s) is a large conurbation that suffers from many of the issues that affect large urban populations in the western world. One part of that […] The post JC: Intubation for the low GCS tox patient. St Emlyn’s appeared first on St.Emlyn's.
Background: The lumbar puncture (LP or spinal tap) is a procedure that has been in the medical arsenal since first described in 1891 by German physician Heinrich Quincke. It can be both diagnostic and therapeutic, utilized in the diagnosis (meningitis, Guillain-Barre syndrome, subarachnoid hemorrhage) and symptomatic treatment (idiopathic intracranial hypertension, normal pressure hydrocephalus) of diseases of the central nervous system, respectively.
A 40-year-old male, tailor by occupation, was brought to the Emergency Department with complaints of high-grade fever for the past 11 days. Fever was documented to be 102°F and was not associated with any chills or rigors. The patient also complained of shortness of breath for one week associated with a dry cough, as well as an altered sensorium for one day.
background and general concept My research project in fellowship was the construction of a mathematical model to convert VBG values into ABG values. The fundamental concept for the model was pretty simple: we can approximate the respiratory quotient (RQ) of tissue in the hand as being constant. This indicates that changes in oxygen content and […] EMCrit Project by Josh Farkas.
From EMS.gov on January 24, 2024 Recent Announcements TODAY: Rural Emergency Medical Service (EMS) Training Grant Pre-Application Webinar The Substance Abuse and Mental Health Services Administration (SAMHSA) is hosting a webinar […] The post Recent Announcements and New Resources on EMS.gov appeared first on American Ambulance Association.
Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. It can be used to distinguish between various conditions, including chronic obstructive pulmonary disease (COPD) exacerbation, acute heart failure (AHF), pleural effusion, pulmonary edema, pericardial effusion, pneumothorax, and pneumonia [2,3].
A quick primer on hypocalcemia in the ED. Hosts: Joseph Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: calcium , Critical Care , Endocrine Show Notes Swami’s CoreEM Post Hypocalcemia Repletion: IV calcium supplementation with 100-300 mg Ca2+ raises serum Ca2+ by 0.5 – 1.5 mEq For acute but mild symptomatic hypocalcemia: 200-1000mg calcium chloride IV or 1-2g IV calcium gluconate over 2 hours For severe hypocalcemia: 1g calcium chloride IV or 1-2g IV calcium gluc
A 49-year-old female with a past medical history of recurrent diverticulitis initially presented with one month of shortness of breath and a minor nonproductive cough for which she was started on doxycycline by her primary care provider. She then developed a rash on her chest, upper back, and face. Antibiotics were switched to amoxicillin and azithromycin.
Statement from Global Medical Response Air Evac Lifeteam is heartbroken to report that three crew members have perished in an incident that occurred on Saturday, January 20. At 11:23 pm […] The post In Memory of the Crew of Air Evac Lifeteam N295AE appeared first on American Ambulance Association.
We discuss head and neck surgery with Dr. Alexandra Kejner, otolaryngologist at the Medical University of South Carolina specializing in transoral robotic surgery, reconstructive surgery including microvascular free tissue transfer, salivary neoplasms, and sialoendoscopic procedures. Find us on Patreon here! Buy your merch here! Takeaway lessons References We discuss head and neck surgery with Dr.
BACKGROUND: Necrotizing soft tissue infections are a rare but potentially lethal condition that can quickly lead to severe morbidity and mortality if not identified by clinical history and physical exam. It is a rapidly progressing infection that moves along fascial planes, often evading the immune system. This is a tricky diagnosis that can often be inconspicuous, so clinical gestalt is key.
A 42-year old Bengali man with a history of hyperlipidemia presented to the Emergency Department with facial swelling, diffuse rash, renal insufficiency and proteinuria after receiving his COVID-19 vaccine (Moderna) booster dose. There were no adverse events with the first two doses of the vaccine except for mild transient sore throat and cough after the 2nd dose.
Sheralyn Guilleminot and Mike Cadogan Real-World Applications of Artificial Intelligence in Medicine Interview with critical care clinician, and AI enthusiast, Dr Sameer Shaikh on the many ways to use AI to save time and increase efficiency in healthcare
January 17, 2024 – Irving, TX We didn’t need emergency warning devices to get where we were going – a motor vehicle crash without serious injuries. We tried to change […] The post Enhancing EMS Safety: Outcomes of the Lights and Siren Collaborative appeared first on American Ambulance Association.
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