The Skeptics' Guide to EM

JUNE 8, 2024

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.

Emergency Department 345

Emergency Department ED ALS Paramedic 345

Emergency Medicine Cases

APRIL 2, 2024

In this part 2 of our 2-part podcast on asthma with Dr. Sameer Mal and Dr. Leeor Sommer, we dig into the recognition and management of life-threatening asthma. We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma? What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic

Epinephrine 340

Epinephrine EMS 340

EMS 12-Lead

MAY 15, 2024

TCP in the ROSC Patient: False Electrical Capture at 75mA Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the second installment of a blog series showing how transcutaneous pacing (TCP) can be difficult and how you can improve your skills. We will be using redacted information from different cases where paramedics attempted TCP in the field.

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Epinephrine Paramedic CPR ED 331

ALiEM

JUNE 10, 2024

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.

Emergency Department 317

Emergency Department ED OR 317

American Ambulance Association

JULY 23, 2024

To the Editor of The Guardian, On July 21, The Guardian published Jessica Glenza’s “Plan to end exorbitant ‘surprise’ ambulance bills heads to Congress.” The inflammatory title and lack of […] The post What The Guardian Missed About US Ambulance Balance Billing appeared first on American Ambulance Association.

Ambulance 278

Ambulance 278

Critical Care Scenarios

APRIL 24, 2024

We discuss the role of point-of-care ultrasound in evaluating the patient with kidney injury and assessing volume status, with Abhilash Koratala (@nephroP), nephrologist, Director of Clinical Imaging for Nephrology at the Medical College of Wisconsin, and champion of nephrology-focused ultrasound. Find us on Patreon here! Buy your merch here! Takeaway lessons References Episode 4 with … Continue reading "Episode 73: POCUS for nephrology, with Abhilash Koratala" We discuss the role of point-of-ca

OR 285

OR 285

Pediatric EM Morsels

JULY 19, 2024

Previously, we covered Post-Tonsillectomy Hemorrhage and how we hope that “all bleeding eventually stops: ideally, by means that we have imposed rather than by exhaustion of the patient’s RBC resources.” Since the original morsel ( way back in 2012 ), the literature has shown that there are a few extra ingredients that we can add to our morsel recipe when we care for children with post-tonsillectomy hemorrhage.

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E-9-1-1 Epinephrine OR Emergency Department 247

Core EM

APRIL 25, 2024

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Dr. Smith's ECG Blog

JUNE 17, 2024

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?

E-9-1-1 139

E-9-1-1 ACS Emergency Department Coronary 139

St. Emlyn's

JULY 9, 2024

St.Emlyn's - Emergency Medicine #FOAMed A podcast with Steve Smith ECG educator extraordinaire where we discuss occlusive myocardial infarction and the future of AI and ECG interpretation. The post Podcast – Occlusive Myocardial Infarction, ECGs and Artificial Intelligence with Steve Smith appeared first on St.Emlyn's.

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The Skeptics' Guide to EM

APRIL 13, 2024

Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. NEJM Feb 2024 Date: April 12, 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. He is an assistant professor in Emergency […] The post SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke first appeared on The Skeptics Guid

Emergency Department 322

Emergency Department ALS OR EMS 322

Emergency Medicine Cases

MAY 28, 2024

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.

ED 304

ED EMS 304

EMS 12-Lead

MARCH 30, 2024

TCP In Transit: A case reviewing transcutaneous pacing, false electrical capture, and re-arrest. Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the first installment of a blog series showing how transcutaneous pacing (TCP) can be difficult, and how you can improve your skills. We will be using redacted information from different cases where paramedics attempted TCP in the field.

CPR 312

CPR Paramedic Ambulance Defibrillator 312

ALiEM

MARCH 18, 2024

A 30-year-old female with a past medical history of Crohn’s Disease presented to the ED for evaluation of an acutely bruised right 4th finger. She stated she was typing on a computer keyboard approximately 10 minutes prior to presentation and she noticed a sudden popping sensation at the base of her right ring finger. After the popping sensation, she noticed a cool sensation of the finger and numbness to the entire finger.

Emergency Department 306

Emergency Department ED OR 306

American Ambulance Association

JULY 18, 2024

This content is for AAA members only. Please either Log In or Join! The post OSHA Proposed Emergency Response Rule Comment Deadline This Monday appeared first on American Ambulance Association.

Emergency Response 246

Emergency Response Ambulance OR 246

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! Takeaway lessons References We discuss assessing patients prior to intubation or other airway management, including both elective and emergent circumstances, with Dr.

OR 286

OR 286

EMOttawa

MAY 23, 2024

The North American opioid crisis is rapidly expanding, resulting in unprecedented levels of harm and strain on the healthcare system. The opioid epidemic is not new to ED providers across the country, but the true extent of harm is quite shocking. In Canada, there has been 40,642 apparent opioid toxicity deaths and 39,435 opioid-related hospitalizations […] The post “Tranq Dope”: A New Menace appeared first on EMOttawa Blog.

ED 136

ED Overdose 136

First 10 EM

JUNE 24, 2024

A can’t intubate can’t oxygenate scenario will always be scary, but after years of mental rehearsal and some real world experience, the idea of surgical front of neck access in an adult doesn’t bother me much. (I think that is an important mental space for emergency physicians to find if you want to be able […] The post The pediatric can’t intubate can’t oxygenate scenario (Use a knife) appeared first on First10EM.

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EMCrit Project

JUNE 17, 2024

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.

OR 129

OR 129

Dr. Smith's ECG Blog

JULY 21, 2024

Written By Magnus Nossen — with edits by Ken Grauer and Smith. The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The pain was 10/10 in intensity radiating bilaterally to the shoulders and also to the left arm and neck. The below ECG was recorded. The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion.

Defibrillator 121

Defibrillator Coronary ALS STEMI 121

St. Emlyn's

JULY 14, 2024

St.Emlyn's - Emergency Medicine #FOAMed Background – What do we already know about REBOA? In 2023, Dr Zaf Qasim reviewed the UK REBOA trial for us on St Emlyn’s (The UK-REBOA trial – Has the […] The post JC: Prehospital Partial Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for Exsanguinating Subdiaphragmatic Hemorrhage appeared first on St.Emlyn's.

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Critical Care 127

The Skeptics' Guide to EM

MARCH 2, 2024

Reference: Gibbons et al. The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol): A multicenter, prospective, observational study. AEM February 2024. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. He is the Vice Chair of the Emergency Department at Nassau University […] The post SGEM#432: SPEED, Give Me What I Need – To Diagnose Acute Aortic Dissections first appeared on Th

Operating Room 308

Operating Room Emergency Department ALS ED 308

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. The post ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain appeared first on Emergency Medicine Cases.

Emergency Department 299

Emergency Department OR STEMI EMS 299

EMS 12-Lead

APRIL 9, 2024

David Didlake @DidlakeDW EMS personnel responded to the residence of an 81 y/o Male with syncope. His spouse had called 911 after she heard a loud “thud” in the adjacent room. He was found altered, hypotensive, and with a large hematoma to the left periorbital region. 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 shor

Coronary 290

Coronary ACS CAD ED 290

ALiEM

MARCH 5, 2024

Which medication can be derived from the bark of the pictured tree? Aspirin Atropine Colchicine Quinine Reveal the Answer 1. Aspirin Background The photo shows a weeping willow, a member of the Salix genus of trees. Willow tree bark contains salicin from which aspirin (acetylsalicylic acid) can be derived. For over 3500 years, willow bark has been used as a traditional medicine to treat fevers and pain [1].

OR 286

OR 286

The Bottom Line

JULY 19, 2024

In critically ill patients undergoing tracheal intubation does pre-oxygenation with non-invasive ventilation compared with pre-oxygenation with an oxygen mask reduce the incidence of hypoxemia during intubation?

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EM Literature of Note

JUNE 5, 2024

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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EMOttawa

JANUARY 25, 2024

Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.

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ICU ED OR Critical Care 143

First 10 EM

APRIL 2, 2024

Give your patients a break. Nobody is a perfect diagnostician. Not even the best trained physician can determine, with 100% accuracy, which patients have serious pathology. Even with advanced testing, we aren’t close to perfect. However, if you listen to the subtext of breakroom complaints, it seems like we expect patients to be better diagnosticians […] The post Are you a perfect diagnostician?

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EMCrit Project

JUNE 13, 2024

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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Dr. Smith's ECG Blog

FEBRUARY 22, 2024

Written by Pendell Meyers A woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed: What do you think? Extremely wide complex monomorphic rhythm just over 100 bpm. The QRS is so wide and sinusoidal that the only real possibilities left are hyperkalemia or Na channel blockade.

EMS 140

EMS STEMI ED OR 140

St. Emlyn's

JULY 11, 2024

St.Emlyn's - Emergency Medicine #FOAMed The Faculty of Forensic & Legal Medicine's guidelines for managing non-fatal strangulation (NFS). These guidelines advocate a trauma-informed, multidisciplinary approach to improve outcomes for patients who have experienced NFS. @stemlyns #FOAMed The post Non-fatal strangulation appeared first on St.Emlyn's.

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The Skeptics' Guide to EM

JANUARY 6, 2024

Reference: Remick KE, et al. National Assessment of Pediatric Readiness of US Emergency Departments during the Covid-19 Pandemic. JAMA Netw Open. July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC. Her research focuses on prehospital care of children with anaphylaxis. […] The post SGEM #425: Are You Ready for This?

Emergency Department 310

Emergency Department Emergency Medical Services ALS ED 310

Emergency Medicine Cases

JUNE 18, 2024

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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STEMI OR EMS 280

FOAMfrat

MARCH 19, 2024

The Hamilton T1 is quickly becoming one of the most prominent ventilators in the transport environment. While initially, all the bells and whistles can be intimidating, some high points make the learning curve slightly less steep. My goal for this blog is to highlight some "hacks" that are actually just strategies you should know and common misconceptions.

OR 131

OR 131

Life in the Fastlane

MAY 18, 2024

Kane Guthrie Cardiac Arrest – the 5 C’s Cardiac Arrest - the 5 C's with Cliff Reid. Causes Of Cardiac Arrest You NEVER Thought Of?! Meet The Hs & Ts & Cs!

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NVFC

FEBRUARY 13, 2024

On December 21, the Occupational Safety and Health Administration (OSHA) announced that it will issue a Notice of Proposed Rulemaking (NPRM) to modernize the agency’s “Fire Brigades” standard. This standard was first published and last updated in 1980. This proposed updated standard would issue several new requirements that would be very burdensome, and in many cases impossible, for volunteer fire departments to comply with.

Emergency Response 131

Emergency Response 131