The Skeptics' Guide to EM

JANUARY 6, 2024

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?

Emergency Department 320

Emergency Department Emergency Medical Services ALS ED 320

Emergency Medicine Cases

JANUARY 23, 2024

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

EMS 251

EMS 251

Core EM

JANUARY 25, 2024

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

Epinephrine 188

Epinephrine ED OR Emergency Department 188

ALiEM

JANUARY 26, 2024

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.

OR 183

OR EMS 183

American Ambulance Association

JANUARY 24, 2024

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.

Mental Health Services 130

Mental Health Services Emergency Medical Services Ambulance EMS 130

EMergucate

JANUARY 31, 2024

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

ED 130

ED 130

The Skeptics' Guide to EM

JANUARY 13, 2024

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

Defibrillator 260

Defibrillator CPR First Responder Life Support 260

Core EM

JANUARY 25, 2024

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

Critical Care 188

Critical Care ED ALS OR 188

ALiEM

JANUARY 5, 2024

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?

EMS 177

EMS ALS OR 177

American Ambulance Association

JANUARY 22, 2024

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.

Ambulance 130

Ambulance 130

EMergucate

JANUARY 20, 2024

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

EMS 130

EMS 130

The Skeptics' Guide to EM

JANUARY 20, 2024

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

Emergency Department 169

Emergency Department ALS ICU OR 169

EMOttawa

JANUARY 25, 2024

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.

ICU 142

ICU ED OR Critical Care 142

Core EM

JANUARY 25, 2024

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.

Emergency Department 188

Emergency Department ICU Critical Care ALS 188

ALiEM

JANUARY 22, 2024

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.

Emergency Department 161

Emergency Department OR 161

American Ambulance Association

JANUARY 17, 2024

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.

EMS 130

EMS Ambulance 130

EMergucate

JANUARY 23, 2024

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

130

130

First 10 EM

JANUARY 15, 2024

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.

129

129

Life in the Fastlane

JANUARY 15, 2024

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

Critical Care 126

Critical Care 126

Core EM

JANUARY 25, 2024

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

Coronary 188

Coronary Emergency Department ED OR 188

ALiEM

JANUARY 8, 2024

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.

ED 152

ED OR 152

American Ambulance Association

JANUARY 15, 2024

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.

Emergency Response 130

Emergency Response Ambulance 130

EMergucate

JANUARY 10, 2024

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

130

130

EMCrit Project

JANUARY 22, 2024

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.

123

123

Don't Forget the Bubbles

JANUARY 29, 2024

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).

ALS 122

ALS Critical Care OR 122

Core EM

JANUARY 25, 2024

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

E-9-1-1 188

E-9-1-1 OR 188

ALiEM

JANUARY 12, 2024

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.

Emergency Department 130

Emergency Department EMS ED 130

American Ambulance Association

JANUARY 12, 2024

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.

Ambulance 130

Ambulance OR 130

EMergucate

JANUARY 29, 2024

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

EMS 130

EMS 130

NVFC

JANUARY 30, 2024

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.

First Responder 119

First Responder Firefighter Emergency Response EMS 119

EMCrit Project

JANUARY 1, 2024

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.

121

121

Core EM

JANUARY 25, 2024

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.

E-9-1-1 188

E-9-1-1 Emergency Department OR 188

REBEL EM

JANUARY 18, 2024

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

ICU 119

ICU ALS EMS 119

American Ambulance Association

JANUARY 10, 2024

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.

Ambulance 130

Ambulance 130

EMergucate

JANUARY 23, 2024

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

130

130

FirstNet Authority

JANUARY 29, 2024

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.

First Responder 118

First Responder 118

Don't Forget the Bubbles

JANUARY 17, 2024

Orbeez, those colourful, water-absorbent polymer beads, have become increasingly popular among children for play and craft activities. However, their small size and appealing appearance can pose significant health risks to young children. What are Orbeez made of? Orbeez are made from a superabsorbent polymer (SAP), primarily composed of cross-linked polyacrylate.

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111