January, 2024

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SGEM #425: Are You Ready for This? Pediatric Readiness of Emergency Departments

The Skeptics' Guide to EM

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?

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EM Quick Hits 54 Button Battery Ingestion, C. difficile, ECG in Tox, Bed Bugs, Fibrinogen in Trauma, Cold Air for Croup

Emergency Medicine Cases

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

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Ultrasound Guided Lower Extremity Nerve Blocks

Core EM

Written by: Sadakat Chowdhury MD Edited by: Mak Sarich MD, Jay Lin MD, Jonathan Kobles MD Background: Ultrasound (US) guided nerve blocks offer an applicable option for achieving analgesia in the emergency department. As an alternative to parenteral or oral analgesia, nerve blocks have the potential for improved pain control, decreased risk of harm (hypoventilation, compromised airway or perfusion, potential for addiction), and decreased length of hospital stay. 1 2 3 4 This article will focus o

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SAEM Clinical Images Series: A Rare Case of Purpura

ALiEM

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.

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Recent Announcements and New Resources on EMS.gov

American Ambulance Association

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.

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DKA gone wrong

EMergucate

Simulation report 1/2/24 In situ sim ED JHC Hi everyone, Thank you so much for participating and helping … Continue reading →

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SGEM#426: All the Small Things – Small Bag Ventilation Masks in Out of Hospital Cardiac Arrest

The Skeptics' Guide to EM

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

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Podcast 186.0: Hypocalcemia

Core EM

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

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EM Match Advice 42: Mid Interview Season Check-In

ALiEM

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?

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In Memory of the Crew of Air Evac Lifeteam N295AE

American Ambulance Association

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.

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Imaging Case of the Week 580 Answer

EMergucate

The abdominal x-ray shows Dilated central small bowel loops. Branching gas pattern over the liver indicating the presence of pneumobilia.

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SGEM #427: I Want a Treatment with a Short Course…for Pediatric Urinary Tract Infections

The Skeptics' Guide to EM

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

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Mechanical Ventilation Basics

EMOttawa

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.

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Post-Intubation Sedation and Analgesia

Core EM

Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. While physical adjuncts like securing the tube, in line suctioning, and head positioning are part of general post intubation management, a better understanding of analgesics and sedatives have offered newer approaches and improved outcomes down the line during the patient’s hospital stay.

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SAEM Clinical Images Series: Fever with Rash

ALiEM

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.

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Enhancing EMS Safety: Outcomes of the Lights and Siren Collaborative

American Ambulance Association

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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Answers for ECG case for the 17th of January 2024

EMergucate

This ECG represents fever induced Brugada syndrome. Needs aggressive treatment of the fever and Cardiology referral for ICD.

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Real-World Applications of Artificial Intelligence in Medicine

Life in the Fastlane

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

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Paxlovid evidence: still very little reason to prescribe

First 10 EM

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.

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Wide Complex Tachycardia

Core EM

The Case A 41-year-old male presents to the ED with constant palpitations for one day. The patient's medical history is notable for a congenital bicuspid aortic valve, four months post aortic valve replacement with a post-surgical ejection fraction of 30%. The following ECG is obtained: EKG Show Details EKG Characteristics Rate Fast Rhythm Wide complex tachycardia Intervals Wide complex QRS (146 ms) Axis Left axis deviation ST Segments Non-specific Additional Features Right bundle branch block m

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SAEM Clinical Images Series: A Lethal Combination of Skin and Lung Findings

ALiEM

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.

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EMS.gov | National Engagement Open Now for NERIS Draft Data Framework

American Ambulance Association

The US Fire Administration (USFA) and Fire Safety Research Institute (FSRI) have announced the commencement of a national engagement period for the National Emergency Response Information System (NERIS) Draft Data Framework. This period will end on January […] The post EMS.gov | National Engagement Open Now for NERIS Draft Data Framework appeared first on American Ambulance Association.

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Imaging Case of the Week 582

EMergucate

The following shoulder x-ray is from an adult who is complaining of shoulder pain following MVA. What can be seen?

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PulmCrit hot take: VAP prophylaxis (PROPHY-VAP trial)

EMCrit Project

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.

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Cannabidiol in refractory status epilepticus

Don't Forget the Bubbles

A UK-based study found that 4% of admissions to a tertiary paediatric intensive care unit (PICU) over a 10-year period were due to refractory status epilepticus (RSE) – seizures which fail to terminate despite appropriate first and second-line treatments. Of those patients admitted with RSE, a subset will go on to develop super-refractory status epilepticus (SRSE).

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Stercoral Colitis

Core EM

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

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SAEM Clinical Images Series: Post-Vaccination Rash

ALiEM

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.

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Final Rule Governing the Classification of Independent Contractors

American Ambulance Association

This content is for AAA members only. Please either Log In or Join! The post Final Rule Governing the Classification of Independent Contractors appeared first on American Ambulance Association.

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ECG case for the 10th of January 2024

EMergucate

61-year-old non-English speaking lady from India. Presented with chest pain for few hours. What is the spot diagnosis?

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Year in Review: NVFC Hazmat PIT Crew Program

NVFC

The National Volunteer Fire Council (NVFC), in cooperation with the U.S. Department of Transportation Pipeline and Hazardous Materials Safety Administration, launched a new hazmat train-the-trainer program, Partners in Training (PIT) Crew, in early 2023. This program provided in-person courses to hundreds of first responders across the country in its first year.

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Pre-Hospital Antibiotics in Sepsis?

REBEL EM

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

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Ultrasound Diagnosis of Necrotizing Soft Tissue Infections

Core EM

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.

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FirstNet Authority Board Approves Investment for Network Evolution

FirstNet Authority

FirstNet Authority Board Approves Investment for Network Evolution Press Releases michelle.fordi… Mon, 01/29/2024 - 13:53 The First Responder Network Authority (FirstNet Authority) is an independent authority within the U.S. Department of Commerce. Created in 2012, its mission is to ensure the building, deployment, and operation of the nationwide broadband network that equips first responders to save lives and protect U.S. communities.

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Medicare Ground Ambulance Data Collection System Overview Webinar – January 18

American Ambulance Association

Dear ground ambulance providers and suppliers, Starting January 1, 2024, selected ground ambulance organizations in Year 3 and Year 4 are required to report cost, utilization, revenue, and other information to CMS. Organizations that […] The post Medicare Ground Ambulance Data Collection System Overview Webinar – January 18 appeared first on American Ambulance Association.

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Lab case 436

EMergucate

58-year-old lady with history of COPD presented with fever. Her venous blood gases showed the following: PH = 7.

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PulmCrit – Validation of my model for converting VBGs to ABGs

EMCrit Project

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.

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NVFC Launches Online Tool to Connect Responders with Mental Health Professionals

NVFC

The National Volunteer Fire Council (NVFC) has launched an online, searchable directory of behavioral health professionals ready and able to help firefighters, EMS providers, rescue workers, and their families. This new tool replaces the previous PDF directory and will make it easier for responders and their families to find the assistance they need.