ALiEM

JANUARY 13, 2025

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.

Emergency Department 169

Emergency Department ED ALS OR 169

Emergency Medicine Cases

JUNE 18, 2024

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.

STEMI 337

STEMI OR EMS 337

The Skeptics' Guide to EM

JUNE 8, 2024

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.

Emergency Department 356

Emergency Department ED ALS Paramedic 356

Core EM

JANUARY 1, 2025

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.,

Critical Care 130

Critical Care ICU OR 130

Emergency Medicine Cases

SEPTEMBER 12, 2023

The post ECG Cases 45 ECG in Weakness and Neurological Symptoms appeared first on Emergency Medicine Cases.

Coronary 340

Coronary OR EMS 340

ALiEM

JUNE 10, 2024

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%

Emergency Department 317

Emergency Department ED OR 317

Don't Forget the Bubbles

DECEMBER 31, 2024

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 Department 140

Emergency Department OR 140

REBEL EM

NOVEMBER 6, 2024

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 (..)

E-9-1-1 115

E-9-1-1 ACS OR Emergency Department 115

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

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.

Critical Care 340

Critical Care ALS ED Emergency Department 340

American Ambulance Association

MAY 6, 2025

This content is for AAA members only. Please either Log In or Join! The post AAA Advocates for Student Loan Forgiveness for All EMS Personnel appeared first on American Ambulance Association.

EMS 130

EMS Ambulance OR 130

Dr. Smith's ECG Blog

JANUARY 2, 2025

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)

Coronary 116

Coronary OR Defibrillator ALS 116

Critical Care Scenarios

JANUARY 31, 2024

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!

OR 286

OR 286

Pediatric EM Morsels

AUGUST 23, 2024

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.

Emergency Department 284

Emergency Department OR ED EMS 284

Core EM

MAY 1, 2025

Defined by: >20% blasts in peripheral blood or bone marrow. May include extramedullary blast proliferation. Without treatment, median survival is only 36 months.

Emergency Department 130

Emergency Department OR 130

The Skeptics' Guide to EM

NOVEMBER 16, 2024

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].

ICU 272

ICU Emergency Department ALS EMS 272

The Skeptics' Guide to EM

APRIL 13, 2024

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.

ALS 337

ALS Emergency Department OR EMS 337

ALiEM

OCTOBER 27, 2023

He denied vomiting, dizziness, diplopia, loss of consciousness, or seizures. Nothing made it better or worse. Additional Images Physical Exam Vitals : BP 101/63; HR 76; RR 14; T 36.7°C Most cases of MCM are found during prenatal ultrasonography. Adults with isolated MCM are typically asymptomatic and found incidentally on radiographic imaging.

OR 278

OR ED 278

EMS 12-Lead

APRIL 9, 2024

No 12 Lead ECG was captured, but telemetry did reveal the following: The spouse offers a pertinent medical history to include HTN and HLD, and furthermore states that he hasn’t previously complained of any chest discomfort, or shortness of breath. He awoke earlier that morning in his usual state of health. The CXR demonstrated no pulmonary edema.

Coronary 290

Coronary ACS CAD ED 290

Emergency Medicine Cases

APRIL 2, 2024

In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. They explain complementary diagnostic insights into pericardial effusion and cardiac tamponade, occlusion MI and RV strain.

Emergency Department 341

Emergency Department OR STEMI EMS 341

EMDocs

NOVEMBER 19, 2024

Second-generation antipsychotics (see Table 1 below) improve both positive and negative symptoms of schizophrenia and are less likely to be associated with EPS. 1,2 Most second-generation antipsychotics act as D 2 antagonists and inhibit the 5-HT 2A receptor. Atypical antipsychotics come in daily and long-acting forms.

Overdose 110

Overdose EMS Emergency Medical Services OR 110

Pediatric EM Morsels

JULY 26, 2024

While it is important for us to maintain a safe work environment for our patients and our team, managing the agitated patient requires more of us than administering Droperidol or Ketamine. Make sure to consult your friendly neighborhood pediatric neurologist and/or rheumatologist! The prevalence ranges from 12.5%-61%

Plasma 274

Plasma OR ED Critical Care 274

EMDocs

DECEMBER 1, 2024

typhi infection if treatment is refractory to supportive measures or conventional community-acquired pneumonia antibiotics Treat with atypical bacterial coverage (doxycycline, azithromycin, chloramphenicol, or fluoroquinolones) A 32-year-old woman presents to the ED with a fever and rash after returning from a trip to Southeast Asia. .:

EMS 104

EMS E-9-1-1 OR ED 104

ACEP Now

JANUARY 5, 2025

Her vital signs are normal, except for a heart rate of 115 bpm. Its going to take time to get her to a tertiary center. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. A patient’s mouth packed with gauze after tonsillectomy surgery. CREDIT: Dr. P.

Operating Room 98

Operating Room Epinephrine ALS ED 98

ACEP Now

NOVEMBER 7, 2024

Poorly healing wounds are primarily the result of chronic venous insufficiency, peripheral (arterial) vascular disease, prolonged pressure-point skin injury, or neuropathy secondary to vascular disease or diabetes. Once identified, they must protect the skin from further injury. Examples include Adaptic, Xeroform, Telfa, and Dermagen.

ED 97

ED OR Emergency Department Ambulance 97

Medic Mindset

NOVEMBER 13, 2024

He wants paramedics to ask the same question he asks: Is the rapid A-fib the primary problem or secondary to another critical condition like sepsis, PE, DKA, hypovolemia, etc? He shares with listeners how he came to the decision to remove Diltiazem from his service. “ – Dr. Casey Patrick Thank you, iSimulate.

Paramedic 98

Paramedic Emergency Department EMS ED 98

Emergency Medicine Cases

AUGUST 19, 2024

ECG artifact and lead reversal can mimic tachy-arrhythmia, infarct or Brugada. Learn how to identify these errors to prevent misdiagnosis on this month's ECG Cases with Dr. Jesse McLaren. The post ECG Cases 51 – Artifact and Lead Misplacement appeared first on Emergency Medicine Cases.

OR 286

OR EMS 286

Pediatric EM Morsels

MARCH 29, 2024

Let’s consider Inborn Errors of Metabolism Presenting in the ED : Inborn Errors of Metabolism: Basics Common Presentations, Uncommon Kiddos For the child with lethargy, vomiting, acidosis, hypoglycemia , organomegaly, or cardiopulmonary arrest remember to consider Inborn Errors of Metabolism (IEM) on your DDx. Kid with Known diagnosis?

ED 300

ED Plasma OR EMS 300

Pediatric EM Morsels

APRIL 19, 2024

Pediatric Buckle and Greenstick Forearm Fractures: Basics The junction of the metaphysis and diaphysis in pediatric long bones is an area of biomechanical transition (Light, 1984) Thin metaphyseal cortex meets the thick cortex of the diaphysis Or in Emergency Medicine terms, “ Thick bone meet thin bone.”

ALS 293

ALS ACS Emergency Department ED 293

The Skeptics' Guide to EM

DECEMBER 16, 2023

Background: Patient experiences of care are associated with health outcomes and may impact perspectives of ED care and the patient recovery process.(1-5) 1-5) Perceptions of discrimination in healthcare are linked to delays in seeking medical treatment, nonadherence to clinician recommendations, and mistrust of clinicians and the healthcare system.(6-7)

Emergency Department 313

Emergency Department ED ALS OR 313

Pediatric EM Morsels

JULY 19, 2024

Your support staff…depending on the amount of bleeding, you are about to have your hands full and may need IV access, medications, airway management, etc. Get a hold of ENT early as OR management and/or admission are common. Set up suction x2 in the room! Using a Mac Laryngoscope as a tongue blade can be helpful! Headlamps can also be helpful!

E-9-1-1 293

E-9-1-1 Epinephrine OR Emergency Department 293

The Skeptics' Guide to EM

AUGUST 31, 2024

This can be defined as a "modest or self-deprecating statement whose actual purpose is to draw attention to something of which one is proud." It was interesting to hear his response. WARNING: There may be some things discussed on the podcast or blog that could be upsetting.

OR 310

OR 310

First Responders Foundation

NOVEMBER 25, 2024

Service dogs play an invaluable role in supporting Veterans and first responders, offering assistance that ranges from anxiety relief and refocusing in public settings to specialized tasks that help manage daily challenges, such as diabetic or cardiac alerting. The retired first responder or Veteran participates in the training of the dog.

First Responder 90

First Responder Public Safety Firefighter OR 90

ALiEM

AUGUST 7, 2023

The patient is reluctant to abduct the right arm secondary to pain. Neuro : No gross motor or sensory deficits were appreciated Laboratory Data Non-contributory Case Question: What is the diagnosis? Sternoclavicular (SC) joint dislocation SC joint dislocation can occur with anterior or posterior displacement of the medial clavicular head.

Emergency Department 246

Emergency Department OR EMS ED 246

ALiEM

NOVEMBER 17, 2023

The grandmother first noted blood in the patient’s underwear the previous morning when she was helping the patient wipe and she noticed it again prior to arrival, this time saturating the patient’s underwear. Urethral prolapse is a rare condition occurring in prepubertal female pediatric patients.

Emergency Department 250

Emergency Department OR 250

Emergency Medicine Cases

FEBRUARY 13, 2024

In this month's ECG Cases blog Dr. Jesse McLaren reviews interpretation of the pre-arrest ECG: identifying high risk ECGs requiring empiric treatment like calcium for hyperkalemia, magnesium for long QT, or reperfusion for Occlusion MI; the intra-arrest ECG: identifying pseudo-PEA; and post-arrest ECG: the importance of serial ECGs to reduce false (..)

STEMI 320

STEMI OR EMS 320

Core EM

JANUARY 25, 2024

Treat aggressively with IVF, antibiotics (covering gram negative and anaerobic organisms), and rapid transfer to the OR to resect the affected colon A 32-60% mortality rate has been reported when stercoral colitis is associated with perforation! Stercoral Colitis.

E-9-1-1 246

E-9-1-1 OR 246

Emergency Medicine Cases

JULY 9, 2024

The decision of whether or not to order a CT head for an older patient who falls is one I need to make on almost every shift. The Canadian CT Head Rule does not apply to older patients. Does the recently derived Falls Decision Rule give us an answer to the question of which older patients can safely forego a CT head after a fall?

EMS 290

EMS OR 290