High Performance EMS

JANUARY 20, 2022

Not to give any details of the factual-based story away, I see many parallels between the implementation of sabermetrics in baseball and system status management in EMS. There must be buy-in, or at the very least a willing curious acceptance , throughout the organization before significant change can be successful.

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OR Emergency Medical Services EMS 130

NVFC

MARCH 12, 2024

However, departments that protect fewer than 2,500 people, which are almost all volunteer, have the highest percentage of firefighters over the age of 50 (34%). In many rural areas it is not uncommon to find volunteers in their 60s or 70s. The post Is Volunteerism Dying Or Has Your Marketing Flatlined?

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Emergency Medicine Cases

JULY 18, 2023

He lives with autism spectrum disorder and is uncomfortable in X-ray rooms, and you wonder if there is a role for PoCUS to help exclude a fracture. With expert clinical commentary by Dr. Arun Sayal and Research Methodology Hot Take by Dr. Shelley Mcleod.

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First 10 EM

DECEMBER 25, 2023

Throughout the length of my career, we have consistently heard that less is more when it comes to blood transfusions (outside of the critically ill requiring massive transfusion, where the message, correct or not, has been the exact opposite).

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OR Coronary EMS 95

EMOttawa

MAY 6, 2024

Question and Methods: This multi-centre, triple-blind, double dummy RCT in China aimed to evaluate the functional outcomes and safety of intravenous tirofiban as compared to aspirin in moderate to severe strokes […] The post Tirofiban for Stroke without Large or Medium-Sized Vessel Occlusion appeared first on EMOttawa Blog.

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ALiEM

FEBRUARY 28, 2024

Clinical photograph for: Ludwig Angina. CorePendium. For Media Without an Associated Publication: This type of citation may be helpful if the image is used in multiple places within a publication, or if it is not tied to a particular publication. In the example below, there is no specified date of publication for the image. Last Name First Initial.

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Critical Care Scenarios

MAY 31, 2023

A brief overview and call to arms around the key concepts of ICU liberation. A brief overview and call to arms around the key concepts of ICU liberation.

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OR ICU 100

Medgadget

SEPTEMBER 14, 2023

Researchers at the National University of Singapore have developed a highly sensitive pressure sensor that can provide haptic feedback for surgeons using laparoscopic tools or for use in robotic grippers as part of robotic surgical systems.

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OR 94

NAEMSP

APRIL 15, 2024

Article Summary by Sarah Fabiano, MD, FACEP, FAAEM Kupas DF, Wydro GC, Tan DK, Kamin R, Harrell AJ 4th, Wang A. Clinical care and restraint of agitated or combative patients by emergency medical services practitioners. Prehosp Emerg Care 2021 Sep-Oct;25(5):721-3. doi: 10.1080/10903127.2021.1917736. Epub 2021 Jun 7. PMID: 33877949.

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OR Emergency Medical Technician Emergency Medical Services EMS 52

The Skeptics' Guide to EM

FEBRUARY 11, 2023

first appeared on The Skeptics Guide to Emergency Medicine. Date: February 7, 2023 Reference: Cheskes et al. One issue that has not been covered on the SGEM is pad placement and double sequential external defibrillation. Reference: Cheskes et al. Defibrillation Strategies for Refractory Ventricular Fibrillation.

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Defibrillator Medical Transportation OR CPR 137

EMDocs

NOVEMBER 6, 2023

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. This post will focus on the key parts of the guideline that affect ED evaluation and management. Top 10 Take Home Pearls 1.

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Naloxone OR Overdose BLS 92

Paramedics World

JANUARY 3, 2024

Feeling tired, weary, or exhausted? These sensations of fatigue seem to be an inevitable part of modern life. We blame fatigue on lack of sleep, overwork, stress, not enough exercise,… The post Fatigue: Is It Simple Tiredness or an Underlying Illness? appeared first on Paramedics World.

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Emergency Medicine Cases

DECEMBER 16, 2019

In this ECG Cases blog we look at seven patients with potentially ischemic symptoms and subtle ECG changes in the lateral leads. Which had acute coronary occlusion? Introducing the concept of Occlusion MI - a paradigm shift in ECG diagnosis of MI. The post ECG Cases 4: Lateral STEMI or Occlusion MI? appeared first on Emergency Medicine Cases.

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Emergency Medicine Cases

OCTOBER 22, 2019

In this ECG Cases blog we present ECGs from 7 patients who presented with chest pain and mild anterior ST elevation. Can you identify which were early repolarization and which were anterior STEMI? The post ECG Cases 2: Early Repolarization or Anterior STEMI? appeared first on Emergency Medicine Cases.

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Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

This is diagnostic of full reperfusion.] An old ECG was found: As you can see, this patient has zero baseline STE, and normal T-waves. You never know if a patient's baseline has normal large STE or complete absence of STE, or somewhere in between. 90% of normals have some STE in V2 and V3. I focus my comment on this initial ECG in today's case.

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OR STEMI Coronary 112

The Skeptics' Guide to EM

MAY 23, 2020

Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at St. Joseph’s Regional Medical Center in Paterson, NJ. Managing editor of EM:RAP and Associate Editor at REBEL EM. Date: May 19th, 2020 Reference: Yang P et al.

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The Skeptics' Guide to EM

DECEMBER 21, 2019

Mathew Reeves is a Professor and Interim Chair of the Department of Epidemiology and Biostatistics at the College of Human Medicine at MSU. Dr. Joshua Reynolds is […] The post SGEM Xtra: NNT – WET or DRI first appeared on The Skeptics Guide to Emergency Medicine. Date: December 17th, 2019 Reference: Reeves and Reynolds.

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OR ALS ED 100

NCOAE

DECEMBER 11, 2023

Spinal immobilization involves the use of various devices, including a long spine board (LSB) and a cervical collar to stabilize the spine and prevent further injury. However, recent research has called this practice into question. For this reason, the term “spinal motion restriction (SMR)” has gained favor over “spinal immobilization.”

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OR Emergency Medical Technician Emergency Department Emergency Medical Services 52

EMergucate

AUGUST 15, 2023

Comparison of intravenous paracetamol (acetaminophen) to intravenously or intramuscularly administered non-steroidal anti-inflammatory drugs( NSAIDs) or opioids for patients presenting with … Continue reading →

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OR ED 130

University of Maryland Department of Emergency Med

JUNE 3, 2023

Bottom Line: Lack of pericardial fluid or cardiac motion on FAST exam leads to no intact survivors for ED RT for trauma. Zone 1 REBOA. Click to view the rest

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ED OR 74

The Skeptics' Guide to EM

JANUARY 30, 2021

Steve is currently an Assistant Professor in the Department of Family Medicine at Western University (London, Ontario) […] The post SGEM#317: Dese Bones Gonna Heal Again – With or Without a Non-Selective NSAID first appeared on The Skeptics Guide to Emergency Medicine. Date: January 22nd, 2021 Guest Skeptic: Dr. Steve Joseph. J Bone Joint Surg Am.

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Dr. Smith's ECG Blog

OCTOBER 1, 2023

Elevated troponin" After hours of misdiagnosis and ongoing pain, the patient finally gets to go to the cath lab 6 hours after arrival ( could have been an immediate ECG diagnosis of LAD OMI using human expertise OR the Queen ), where they of course find a complete 100% thrombotic occlusion of the mid LAD, at the site of his prior LAD stent.

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OR STEMI Coronary CAD 117

EMS 20/20

DECEMBER 1, 2021

A crew has to make a hard choice. stay and play or load and go? With a rapidly closing window to make a hard decision does the crew make the right choice? Spence and Chris give their opinions and ask for yours in this weeks episode! LISTENER FEEDBACK WANTED! A crew has to make a hard choice. stay and play or load and go?

OR 40

OR 40

University of Maryland Department of Emergency Med

SEPTEMBER 30, 2023

"The main findings were the following: (1) there was no evidence of an effect of HTS compared with other agents (mainly mannitol) on long-term n. Click to view the rest

OR 71

OR 71

Emergency Medicine Cases

FEBRUARY 11, 2020

What is the preferred first line reduction technique for posterior shoulder dislocation? What are the most common and consequential pitfalls in the management of anterior shoulder dislocations? and many more.

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OR EMS 130

Dr. Smith's ECG Blog

DECEMBER 12, 2022

Here is the OMI progression of ECG findings for review: You can see that OMI ECG findings must "deflate" and pass through normal or near-normal in order to get to reperfusion findings. In other words, to get from hyperacute T waves and STE to terminal T wave inversion, the ST and T wave must pass transiently through a state of near-normal.

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OR ACS STEMI Coronary 52

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Smith : this ECG is definitely not OMI, but could be mistaken for Swirl pattern, which is a septal OMI with STE in V1 and STD in V6. See these cases: Precordial Swirl -- 20 cases of Swirl or Look-Alikes Subsequent serial high sensitivity troponin I measurements were all below the level of detection. AMI was ruled out altogether.

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OR STEMI EMS ED 104

Dr. Smith's ECG Blog

AUGUST 6, 2023

NOTE: There are 2 reasons to watch this video while stopping to freeze the screen each time that a new tracing is shown: i ) To hone your skill in making a “quick read” — in which you force yourself to commit to a diagnosis of OMI or no - OMI; — and — ii ) To give yourself an extra moment to look at all 12 leads of each ECG — so that you can practice (..)

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OR STEMI Coronary 91

Dr. Smith's ECG Blog

JUNE 17, 2023

But these T waves are asymmetric and not "fat" enough. I believe there is not quite enough STE for formal STEMI criteria, but some might measure 1.0 Physician accuracy in interpreting potential ST-segment elevation myocardial infarction electrocardiograms.

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Emergency Medicine Education

MARCH 7, 2024

In November 2023, JAMA published an article on noninvasive airway management among patients with depressed consciousness. The watch-and-wait approach, involving close monitoring for individuals with traditional GCS scores <9 and suspected acute poisoning, demonstrated positive outcomes. Link to article

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OR 40

EMDocs

AUGUST 10, 2023

Today we look at the DIRECT MT trial. Inclusion criteria: Enrolled patients over the age of 18 with acute ischemic stroke with CTA confirmed occlusion of ICA, or M1 or M2 segment of MCA Within 4.5 1.40) No statistically significant difference in secondary outcomes No significant difference in safety outcomes Death 18% vs. 19%, RR 0.94 (0.68-1.30)

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OR Critical Care ALS 66

CanadiEM

MARCH 12, 2024

In this issue, we collaborated with the CJEM team to present “Hypotension and respiratory events related to electrical cardioversion for atrial fibrillation or atrial flutter in the emergency department” in a visual abstract format​1​. These patients are often treated with beta- or calcium-channel blockers, both at home and in the ED.

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Emergency Department OR ED 52

Critical Care Scenarios

JUNE 26, 2022

Some musings in response to people who are impressed by the work we do. Some musings in response to people who are impressed by the work we do.

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Critical Care OR 100

The Skeptics' Guide to EM

DECEMBER 15, 2018

Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Associate Professor for the University of Leicester’s SAPPHIRE group. He specialises in Paediatric Emergency Medicine and is a passionate […] The post SGEM#239: Febrile Seizure Recurrence – With or Without You Acetaminophen?

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Handtevy

MARCH 28, 2019

The amazing part of this story is that it took more than 20 years for the scientific community to prove this theory to be correct and for other doctors to accept it as standard practice. This interesting piece of history defines the term neophobia, or the fear of something new. Are there are evolutionary reasons for neophobia?

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EMT Training Station

APRIL 5, 2023

With this in mind, it’s essential to show our appreciation and support for these incredible individuals. From practical tools and gadgets to thoughtful tokens of appreciation, these carefully-selected gifts are guaranteed to bring a smile to the face of the life-saving professional in your life.

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Dr. Smith's ECG Blog

OCTOBER 15, 2022

Here is the visual explanation for the term we have coined, as this LAD occlusion pattern causes upward STT shifts in V1-2 and downward STT shifts in V5-V6: It is easy to mistake if for LVH (or vice versa) because LVH often shows STE in V1-V3 and STD in V5, 6. I like to focus on the ST-T wave appearance in leads V1 and V6.

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OR E-9-1-1 STEMI 52