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SGEM#462: Spooky Scary Access – IV or IO for OHCA

The Skeptics' Guide to EM

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.

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SGEM#473: Did You Ever Have To Make Up Your Mind – Midazolam or Ketamine for Acute Agitation in the Pre-Hospital Setting

The Skeptics' Guide to EM

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.

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SGEM #470: Here We Go Up Up Up or Lateral for Infant Lumbar Punctures

The Skeptics' Guide to EM

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).

OR 177
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SGEM#457: Inhale – Nebulized or IV Ketamine for Acute Pain?

The Skeptics' Guide to EM

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?

OR 247
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Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest

EMOttawa

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.

OR 117
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SGEM#476: Cuts like a Knife or Antibiotics for Pediatric Appendicitis

The Skeptics' Guide to EM

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.

OR 151
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Go to the Hospital or Go to Jail

JEMS

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 […]

OR 98