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Most EMS providers are choosing the proximal tibial as their go-to IO access. The current evidence has not given a definitive answer as to which type of access is best for OHCAs. Clinical Question: Should we use an IV first or an IO first approach to deliver epinephrine to adult patients with an OHCA? Reference: Couper et al.
Agitation can stem from various underlying conditions, including psychiatric disorders, substance intoxication, metabolic disturbances, traumatic brain injury, or postictal states. If not managed appropriately, severe agitation can escalate, leading to self-harm, harm to others, or interference with necessary medical care.
Comparison: Infants positioned in a sitting position or prone position. Outcome: Primary Outcome(s): Successful lumbar puncture on the first attempt, with < 500 red blood cells/mm3. Total number of lumbar puncture attempts (successful or unsuccessful).
His allergies to acetaminophen, non-steroidal anti-inflammatories (NSAIDs), and opioids limit your pain management options. A bedside sonogram shows no significant hydronephrosis. You’re considering ketamine for pain relief but wonder if you should choose IV sub-dissociative ketamine or nebulized ketamine? mg/kg nebulized or 0.3 mg/kg intravenously?
Editorial: The Way to a Patient’s Heart – Vascular Access in Cardiac Arrest Question and Methods: This RCT compared IO vs. IV vascular access in adults with OHCA, using ROSC as a primary outcome.
His parents tell you, His sister was diagnosed with appendicitis during the Covid pandemic. At that time, she was admitted to the hospital but just treated with antibiotics. She was able to go home and has done well since that time. Do you think he needs surgery, or can he be treated with antibiotics as well? Reference: St Peter, et al.
In EMT and paramedic school, we receive a brief introduction to how consent applies in EMS. We learn that informed consent occurs when a patient is awake, alert, able to […]
We discuss indications and timing of intubation, penetrating neck trauma, the head injured patient, the agitated patients and the soiled airway. The critical question is: when should we deviate from, delay or modify RSI, and how do we navigate the unique challenges presented by trauma airways and airway trauma? and many more.
It can be seen in other forms of heart block as well (such as complete heart block). See Ken Grauer 's comment below for more on this. As this patient is scheduled for imminent elective surgery, it is important to determine whether this is Mobitz I (benign) or Mobitz II (requires pacing). So.Which is it? History is often helpful.
If theyre too wide, its like a holiday sweater thats too looseunflattering and not very useful. Reconsider that sample size or effect size to get clinically impactful intervals you would want to share with Santa Claus. And remember, CIs dont mean certainty! Day 3: Three Missing Values Missing data is the Grinch of research.
I could do this every day, all day, 24/7 and it wouldn’t be enough,” she said from behind the wheel of her county-issued Ford Fusion one cool spring morning. Since the county health department program launched in October, Breunig has provided direct medical care or medical case management to more than 110 people. They’re not going to dissolve.”
Whether defusing a bomb or managing a crashing patient, calm execution under pressure saves lives. The Team is Everything: Hunt may be the face, but he’s nothing without Luther, Benji, and the crew. Good clinicians plan for failure just as much as success — that’s what keeps patients (and careers) safe.
interesting spontaneous reperfusion case 1413140 prehospital STEMI first ED ECG is here, with 3/10 pain: But this is the same patient just 10 minutes before, with 7/10 pain Isn't it ridiculous to say that the patient has both a STEMI and an NSTEMI? ACS is dynamic. It can't be given one static name.
She denied rash, allergies, fever, URI symptoms, urinary symptoms, or new medications. Additional Images Physical Exam General : No acute distress. HEENT : Significant bilateral periorbital edema with an otherwise normal eye exam. 2+ bilateral tonsillar swelling and erythema, no exudates. No uvula swelling or deviation. No oral mucosal lesions.
We review a phase II randomised controlled trial exploring intravenous salbutamol as an adjunct analgesic in the emergency department. The post JC: Salbutamol for Analgesia in Renal Colic – Worth a Puff or a Painful Disappointment? appeared first on St.Emlyn's.
Medicare Ambulance Extender Bill Introduced in House Yesterday, March 18, Representatives Claudia Tenney (R-NY), Terry Sewell (D-AL), Cliff Bentz (R-OR), Paul Tonko (D-NY), Mike Carey (R-OH), Danny Davis (D-IL), Carol […] The post House Reintroduces Vital Medicare Extender and EMS Workforce Bills appeared first on American Ambulance Association. (..)
The patient stated he was given Bactrim and amoxicillin about one month ago for another rash, though he was unsure of the diagnosis. He denied any known allergies or exposures to new foods or hygiene products. He had no chest pain, SOB, nausea, or diarrhea. He lives in a correctional facility and does not know of anyone with any rashes.
The biggest change has been the gradual replacement of diacetylmorphine (heroin) by fentanyl and other synthetic opioids. Along the same time, a veterinary sedative, xylazine , became popular in Puerto Rico in individuals who used injection drugs [3]. We treat with wound care and reserve surgical management only for limbs that are no longer viable.
Case Question: What is the treatment for intussusception? Air or hydrostatic enemas have a 70-85% success rate in current literature. These are often done under either fluoroscopic or ultrasound guidance. A delayed repeat enema can be done in cases where the initial enema resolved some of the intussusception.
She lives with three roommates, none of whom were sick, and she denied any other known sick contacts. She also denied any occupational exposures or recent travel, although did endorse some recent hiking in the area. Platelets : 223 Sodium : 139 Creatinine : 0.8 Over the next several days, the rash will expand and may develop a central clearing.
The boy has otherwise been feeding and acting normally. You examine the baby with an astute medical trainee. As you discuss the next steps in management, she asks you, I know theres a bunch of guidelines or decision tools to help risk stratify which babies are low risk for bacterial infections, but I can never keep them straight.
Symptoms started approximately seven hours prior to arrival and progressive, severe pain eventually prompted her visit to the ED. This happened once 10 years ago, requiring reduction in the ED. The patient denied preceding trauma, rubbing her eyes/eye-lids, or any history of thyroid disease. She endorsed right eye blurred vision and severe pain.
Types of Necrotizing Fasciitis Type I (Polymicrobial) Involves aerobic and anaerobic organisms (e.g., Bacteroides, Clostridium, Peptostreptococcus). Common in immunocompromised patients or those with comorbidities (e.g., diabetes, peripheral vascular disease). Can occur in otherwise healthy individuals. Immunosuppression (e.g.,
A 3-month-old male with no past medical history was brought to the emergency department for evaluation of newly asymmetric pupils. The infant appeared to be asymptomatic per parents, without any behavior changes or associated symptoms noted. Abdominal : Soft, nontender, nondistended. Neurological : Alert. Moving all 4 extremities spontaneously.
He also endorsed left-sided facial weakness and diplopia for the last eight days. He denied fevers, chills, nausea, vomiting, ear pain, tinnitus, hearing changes, blurry vision, photophobia, history of malignancy or HIV, history of stroke. Additional Images Physical Exam Vitals : Temp 36.8°C;
WJEM December 2023 Population: Transgender and gender-diverse populations of any age, in any setting, region, or nation. It included both medical and paramedical care within these groups. The study looked at implementing clinical practice guidelines (CPG) and best practice statements (BPS) for the care of TGD individuals in ED.
Jesse McLaren illustrates the paradigm shift from STEMI to Occlusion MI (OMI) through 9 cases, and drives home the points that if there is STEMI criteria, consider false positives (eg. secondary and proportional to LVH or BER); if there is no STEMI criteria, consider false negatives and look for other signs of occlusion (eg.
Patients frequently come to the ED because they are in pain, and our ability to relieve that pain is central to the patient experience. Alternatives to opiate pain medications have significant limitations with analgesic ceilings (NSAIDs) as well as side effects or toxicity potential that limit their use and efficacy.
Communication is as Visual as it is Verbal Communication is not just about speaking words; its about connecting, understanding, and being understood. Whether interacting with children, young people, or even colleagues, the nuances of communication turn exchanges into meaningful dialogue. The tone of their voice, even when the words seem neutral.
Emergency medical services(EMS) has historically been a punitive system, resulting in people being unforthcoming about issues or concealing minor infractions in hopes of evading discipline. In a profession as noble as ours, is this what we want? When investigating an incident, identifying the root cause is essential.
T-waves are quite tall and possibly peaked (HyperK?), but potassium returned normal. I do not see OMI here and all trops were only minimally elevated, consistent with either chronic injury from cardiomyopathy or with acute injury from sepsis. What is the QT interval? In LBBB, the QT interval is partly prolonged by the wide QRS. Bogossian et al. (1)
Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. He is also a fully-fledged ultrasonographer.
The patient had been tolerating oral intake well, passing adequate urine, having normal bowel movements, and behaving at baseline. No associated fever, diarrhea, bloody stool, dysuria, hematuria, or weight loss. fusion_text] Additional Images Physical Exam Vitals : Temp 97.9 °F HEENT : Normocephalic and atraumatic. No scleral icterus.
You run toward danger, answer the call in the toughest moments, and shoulder the weight of other people’s emergencies. But who looks out for you? For first responders, the toll of constant stress, trauma, and long shifts can quietly accumulate—until it erupts as burnout, anxiety, or worse. That’s why taking a mental health day isn’t […]
Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)
A promising application of AI is the development of early warning systems to detect patient deterioration. These systems use real-time data from electronic health records (EHRs) and other sources to predict which patients are at risk of adverse outcomes, such as cardiac arrest or transfer to an intensive care unit (ICU) [1.2].
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! Find us on Patreon here!
Only one in 246 patients who screen positive for an eating disorder at triage have a chief complaint suggesting it. These patients dont always fit the stereotypemany appear healthy, have normal BMI, or present with vague GI, cardiac, or neurological symptoms. Missing the diagnosis has important consequences.
Emergency physicians often face the challenge of deciding whether to proceed with imaging, given the potential risks associated with ionizing radiation from CT scans. High Risk (>12.1% sensitivity and 99.9% High Risk (>12.1% sensitivity and 99.9%
It does NOT have structural brain damage visible on standard neuroimaging. In the research setting, abnormalities can be found via functional, blood flow, or metabolic imaging. Mild traumatic brain injury also includes a larger group of injuries that may have evidence of structural injury.
When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago. A code stroke is activated, and the initial CT head shows no signs of hemorrhage or early ischemic changes. A CT angiogram shows a proximal middle cerebral artery occlusion. CT perfusion showed a 10 mL core and 189 mL penumbra.
Grouped vesicles/pustules on an erythematous base and tenderness to palpation should prompt the physician to suspect herpetic skin infection. Eczema herpeticum may be potentially life-threatening if it has spread to multi-system involvement such as HSV keratitis or encephalitis. References American Academy of Pediatrics: Herpes simplex.
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