June, 2024

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SGEM#442: I’m on the Right Track Baby I Was Born This Way

The Skeptics' Guide to EM

Reference: Kruse et al. Systematic Review, Quality Assessment, and Synthesis of Guidelines for Emergency Department Care of Transgender and Gender-diverse People Recommendations for Immediate Action to Improve Care. WJEM December 2023 Date: May 30, 2024 Guest Skeptic: Dr. Kay Dingwell is a rural emergency physician working in Prince County, PEI with a special interest in gender-affirming care and improving the care of trans and gender-diverse patients.

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Running Toward Disaster

High Performance EMS

Sadly, this is not an adventure story of heroic first responder actions on the scene of an emergency incident but rather about how current EMS operations are failing us and their missions. Across the country, a quarter of positions in the dispatch center , the folks we rely on to keep resources coordinated, are going unfilled. Recent annual surveys also show that over 10% of EMS clinicians will leave the field entirely each year.

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From Collision to Clarity: PECARN cervical spine injury prediction rule for injured children

ALiEM

For years, adult literature has provided clear guidelines for cervical spine imaging through the NEXUS and Canadian C-spine Rule (CCR) tools. These have been invaluable in helping clinicians decide when to image the neck in trauma patients. Similarly, the Pediatric Emergency Care Applied Research Network (PECARN) has developed robust tools for assessing blunt head trauma in children.

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ECG Cases 50 – STEMI: A Failed Paradigm, Enter Occlusion MI

Emergency Medicine Cases

Dr. 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. acute Q waves or loss of R waves, hyperacute T waves, or reciprocal STD/TWI) and if the ECG is nondiagnostic, consider other OMI signs including clinical (refractory isc

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Topical Therapies for Pediatric Burns

Pediatric EM Morsels

The management of pediatric thermal burns always seems to be a hot topic , whether we are caring for a little future chef who splashed a scalding microwaved noodle cup on himself, or a toddling youngster who pulled a pot of boiling water on herself. Or maybe you have the adventurous adolescent who was a little too aggressive with the lighter fluid before igniting the campfire.

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CMS GADCS: Public Safety Webinar Recording

American Ambulance Association

CMS recently posted an updated Medicare Ground Ambulance Data Collection System (GADCS) webinar on Public Safety Organizations on their Ambulance Events webpage. The post CMS GADCS: Public Safety Webinar Recording appeared first on American Ambulance Association.

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SGEM#443: Don’t Stop Me Now – REBOA for Hemorrhage Control in Trauma Patients?

The Skeptics' Guide to EM

Reference: Jansen et al. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. JAMA. 2023 Date: June 10, 2024 Guest Skeptic: Dr. Rob Leeper is an intensivist, trauma surgeon, and general surgeon at Western University where he also serves as the director of the Royal College Surgical Foundations program.

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New Podcast Alert!

Chicago EMT Training

Marty and I created a new show. We hope to catch with up with old friends, discuss current events and policies, and cultivate discussions with healthcare adjacent professionals. Thanks for being here.

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EM Quick Hits 57 – HIV Diagnosis, Failed Paradigm of STEMI Criteria, Poisoned Patient Airway Management, Spontaneous Bacterial Peritonitis, DIY Investments

Emergency Medicine Cases

In this month's EM Quick Hits podcast: Megan Landes on the importance of diagnosing HIV in the ED, Jesse McLaren on the failed paradigm of STEMI criteria and ECG tips to identify acute coronary occlusion, Anand Swaminathan on evidence for non-invasive airway management in the poisoned patient, Brit Long and Hans Rosenberg on the identification, workup and management of spontaneous bacterial peritonitis, Matt Pointer on the most lucrative side-gig, DIY investing.

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Acute Transverse Myelitis in Children

Pediatric EM Morsels

Ooooo the infamous chief complaint of “ weakness ” ……. We just love those don’t we? Although neurological complaints may not be a crowd’s favorite, it is one we must become comfortable with. Timely recognition and treatment can be life-improving and life-saving! So, with that goal in mind, let us digest another delicious morsel on weakness – Acute Transverse Myelitis in Children : Acute Transverse Myelitis in Children: Basics Rare, non-compressive, inflammatory condition of the spinal cord

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CMS GADCS: Labor Costs Webinar Recording

American Ambulance Association

CMS recently posted an updated Medicare Ground Ambulance Data Collection System (GADCS) webinar on Labor Costs on their Ambulance Events webpage. The post CMS GADCS: Labor Costs Webinar Recording appeared first on American Ambulance Association.

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SGEM#441: Searching Searching for the best Clinical Decision Rule to Detect Pediatric C-Spine Injury

The Skeptics' Guide to EM

Reference: Tavender E, et al. Triage tools for detecting cervical spine injury in paediatric trauma patients. Cochrane Database Syst Rev. 2024 Date: May 29, 2024 Guest Skeptic: Dr. Caleb Ward is a pediatric emergency medicine attending and Associate Professor of Pediatrics and Emergency Medicine at Children’s National Hospital and The George Washington School of Medicine and Health Sciences in Washington, DC.

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Lightning rounds 41: Respiratory therapy with Keith Lamb

Critical Care Scenarios

We explore the profession of respiratory therapy in the US, including their role and training and how to optimize our clinical relationships, with Keith Lamb (@kdlamb1), RRT, RRT-ACCS, FAARC, FCCM. Keith is an RT at the University of Virginia in Charlottesville, working clinically in neuro/surgical/trauma critical care, who has been active in research and has … Continue reading "Lightning rounds 41: Respiratory therapy with Keith Lamb" We explore the profession of respiratory therapy in the US,

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PulmCrit: Bilevel Sequence Intubation (BSI) – The new standard

EMCrit Project

introduction Bilevel Sequence Intubation (BSI) refers to initiation of noninvasive bilevel positive pressure ventilation with a backup rate prior to intubation (either using a BiPAP machine or a full-featured mechanical ventilator). BSI is distinct from traditional rapid sequence intubation (RSI), since BSI involves the delivery of machine-initiated, pressure-controlled breaths following administration of sedation and paralytics. […] EMCrit Project by Josh Farkas.

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Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think? If this EKG were handed to you to screen from triage without any clinical information, what would you think?

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BiPAP for preoxygenation (the PREOXI trial)

First 10 EM

Preparation for intubation, appropriate preoxygenation, and preventing peri-intubation arrests has been one of my core topics for conference talks. My initial airway series emphasized “optimizing the basics” and carefully considering “is this patient ready for intubation?”. My “RSI and then they die” lecture is by far my most watched video on YouTube.

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EMS.gov | State EMS Bill Tracking Database Updated with Key Enacted Legislation

American Ambulance Association

State EMS Bill Tracking Database Updated with Key Enacted Legislation NCSL.org features a searchable database of all state EMS legislation. The National Highway Traffic Safety Administration (NHTSA) and the National Conference […] The post EMS.gov | State EMS Bill Tracking Database Updated with Key Enacted Legislation appeared first on American Ambulance Association.

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SGEM#444: I Need Oxygen…But How Much Oxygen for Critically Ill Children

The Skeptics' Guide to EM

Reference: Peters MJ, et al. Conservative versus liberal oxygenation targets in critically ill children (Oxy-picu): a UK multicentre, open, parallel-group, randomised clinical trial. Lancet. December 2023 Guest Skeptic: Dr. Anireddy Reddy is a pediatric intensive care attending physician in the Department of Anesthesiology and Critical Care Medicine at Children’s Hospital of Philadelphia.

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TIRBO 62: The sweet spot for learning

Critical Care Scenarios

Responsible self-directed learning occurs in a zone between comfort and novelty. Find us on Patreon here! Buy your merch here! Responsible self-directed learning occurs in a zone between comfort and novelty. Find us on Patreon here! Buy your merch here!

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EMCrit 377 – Breaking News – The PREOXI Trial changes everything about Preoxygenation for Intubations in the Critically Ill

EMCrit Project

the PREOXI trial validates what I have been saying for 15 years about preoxygenation for the critically ill patient EMCrit Project by Scott Weingart, MD FCCM.

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The Andexxa Showpiece

EM Literature of Note

Every so often a masterclass performance arises in the medical literature. A performance transcending the boundaries of what was once thought possible. A shining exemplar of human achievement. This is a trial, published in the New England Journal of Medicine , with the following features: Conducted by an institute sponsored by pharma. Designed by the first author, a consultant for pharma, and two employees of pharma.

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Ten Tips for Better Presentations – Part 1

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed Presentation skills - what are they and why do we need to have them? This post covers the things to consider before you even open any presentation software. The post Ten Tips for Better Presentations – Part 1 appeared first on St.Emlyn's.

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Updates on the VA Final Rule and NDAA Workforce Amendment

American Ambulance Association

House Passes Language to Stop FY2025 Start of VA Final Rule On June 5, the U.S. House of Representatives passed the FY2025 MilCon-VA-Related Agencies Appropriations bill. Included in the bill […] The post Updates on the VA Final Rule and NDAA Workforce Amendment appeared first on American Ambulance Association.

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Mental Health Resources for First Responders

NVFC

June is PTSD Awareness Month, and first responders may experience post-traumatic stress due to the traumatic events they are exposed to on the job. Use this opportunity to familiarize yourself and your department members of the signs and symptoms to watch for and the resources that are available if someone needs help. The NVFC offers the following: Webinar: Moral Injury – Peeling Back the Layers of PTSD – Register for this webinar, taking place June 11 and sponsored by ESO, to learn how moral di

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Podcast 169 - EVD Transport Logistics w/ Alaina Martini

FOAMfrat

Alaina Martini, a flight nurse at Allegheny Life Flight, shares her expertise in transporting patients with external ventricular drains (EVDs). She explains the indications for EVD insertion, such as aneurysmal subarachnoid hemorrhage and obstructive hydrocephalus. Alaina discusses the importance of assessing the color and texture of the cerebrospinal fluid (CSF) to detect changes and potential rebleeding.

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EMCrit Wee – Controlled Automated Reperfusion of the Whole Body (CARL) ECPR / ECLS Yields Amazing Results

EMCrit Project

Today, we talk about a paper that showed impressive neurologically intact survival for all-rhythms presenting in cardiac arrest, both OHCA and IHCA. It uses a new set of strategies and technologies called CARL. The Paper Treatment of Refractory Cardiac Arrest by Controlled Reperfusion of the Whole Body: A Multicenter, Prospective Observational Study Supplemental Material […] EMCrit Project by Scott Weingart, MD FCCM.

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The MATE ACT Mandate

Life in the Fastlane

Sunayana Samantaray and Mike Cadogan The MATE ACT Mandate The Medication Access and Training Expansion (MATE) Act went into effect late 2023.

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Noninvasive Ventilation for Preoxygenation during Emergency Intubation

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed Does the use of non invasive ventilation prior to intubation of critically ill patients improve outcomes? The post Noninvasive Ventilation for Preoxygenation during Emergency Intubation appeared first on St.Emlyn's.

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Share Your Message of Support for Families of Fallen EMS Heroes

American Ambulance Association

The all-volunteer National EMS Memorial Service honors EMS professionals who have died in the line of duty. Write your message of sympathy for the families of the 2024 honorees below, […] The post Share Your Message of Support for Families of Fallen EMS Heroes appeared first on American Ambulance Association.

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Second Entry Period Open: MSA Cairns® 1836 Fire Helmet Giveaway

NVFC

The second entry period is now open for the MSA Cairns® 1836 Fire Helmet Giveaway. Volunteer firefighters who are members of the National Volunteer Fire Council (NVFC) can enter to win one of the helmets, which showcase the iconic traditional design with innovative features that address today’s fire service needs. This is the second of four opportunities to win a Cairns® 1836 Fire Helmet in 2024.

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Chocolate, Chaos, and Cops

FOAMfrat

It’s a Fall night in the middle of nowhere, you’re staffing a Paramedic Ambulance in a combination system. You’re on a 24hr shift and getting ready for bed, already drowsy and ready for a nap. Right as you’re making your bunk you get dispatched for a reported overdose with police enroute, no further information. We’ve all had this call before, right?

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PulmCrit: PPIs are safe and effective for GI prophylaxis… the end.

EMCrit Project

REVISE is the latest multicenter RCT on the use of PPIs for GI prophylaxis in critical illness. I would view this as the triquel following SUP-ICU and PEPTIC. In order to understand REVISE in context, let's briefly review SUP-ICU and PEPTIC trials, before discussing REVISE. Part I: SUP-ICU (2018) This was a large multicenter RCT […] EMCrit Project by Josh Farkas.

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Streamlining Crisis Response: A Deep Dive Into MCIs and Large Events

Pulsara

Patient tracking during MCIs and pre-planned events is a complex operation with many moving parts. Every incident is different and requires different resources, making planning for and preparing for incidents challenging. To set ourselves up for success, we need to practice the same way we respond. That's why a panel of experts from California, Colorado, and Texas believe that the answer lies in using the same tools to manage and track patients during a crisis as you do for everyday response.

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Paediatric Emergency Medicine – Premier Conference – Day 1

St. Emlyn's

St.Emlyn's - Emergency Medicine #FOAMed Discover the highlights of Day 1 at the Premier conference on Paediatric Emergency Medicine. The post Paediatric Emergency Medicine – Premier Conference – Day 1 appeared first on St.Emlyn's.

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Rest in Peace, Richard Zuschlag

American Ambulance Association

It is with profound sorrow that the American Ambulance Association extends our heartfelt condolences to the Acadian family on the passing of Richard Zuschlag. As a cherished friend and esteemed […] The post Rest in Peace, Richard Zuschlag appeared first on American Ambulance Association.

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NVFC Testifies to Congress Regarding OSHA’s Emergency Response Standard and Develops One-Pager to Assist with Public Comments

NVFC

On June 4, the National Volunteer Fire Council (NVFC) testified before the House of Representatives Homeland Security Committee’s Subcommittee on Emergency Management and Technology regarding the impact that the Occupational Safety and Health Administration’s (OSHA) proposed Emergency Response Standard will have on volunteer fire departments. OSHA published a Notice of Proposed Rulemaking on February 5 to replace their Fire Brigade Standard with the proposed Emergency Response Standard.

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How to Hyperoxygenate Before Suctioning

SSCOR

Hypoxia is one of the most common suctioning complications. It’s also preventable in most scenarios. Hyperoxygenate a patient before suctioning to reduce the risk of hypoxia as well as other suctioning complications. Here’s what you need to know about the process.

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