REBEL EM

AUGUST 30, 2023

Epidemiology 1 to 2.4 cases per 100,000 people ( Zimmerli 2010 ) More common in males with M:F of 3:1 Rate is also increasing due to increased number of spinal procedures Typically affects adults, with most cases occurring in patients over 50 years old. Other pathogens include: E. Often used interchangeably with osteomyelitis.

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Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

To me, it was clearly atrial flutter with 1:1 conduction. Continue Eliquis 5mg BID, should be continued for 3 months == MY Comment , by K EN G RAUER, MD ( 9/18 /2024 ): == I found the following aspects of today's case of special interest. Why did Dr. Smith immediately say the rhythm was AFlutter with 1:1 AV conduction?

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Don't Forget the Bubbles

JANUARY 17, 2024

Around 80% of those reported pass spontaneously, with another 10-20% requiring endoscopic removal and only 1% requiring surgical intervention. Mirza and Sheikh reported perhaps the first unfortunate case in 2012. In 2012, one brand of SAP beads – Water Balz – was recalled by the U.S. Image adapted from Mullens et al.,

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EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). What alternative testing can be done in these circumstances?

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Emergency Department E-9-1-1 ED ICU 94

EMDocs

SEPTEMBER 23, 2023

Answer : Brugada Syndrome Epidemiology and Etiology Rare genetic disorder that affects approximately 1 in 5,000 individuals worldwide 1. More common in males than females, with a male-to-female ratio of approximately 8:1 1. Type 1 “Brugada sign” The only type that is considered diagnostic.

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EMDocs

JANUARY 17, 2024

1) There are a limited number of antitussives on the US market which include benzonatate, codeine, dextromethorphan, diphenhydramine, and hydrocodone. 9) The safety announcement highlighted the mortality risk of exploratory ingestions in children under 10 years. 5) From 2012 to 2019, pediatric benzonatate prescribing soared by 62%. (9)

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FOAMfrat

MAY 19, 2024

While transporting to the emergency department, the patient’s mother informed me that PDCD affects less than 1 in 50,000 individuals and is more common in males than females. The patient will thank you for it; we are only human. References 1. Ostergaard E, Moller LB, Kalkanoglu-Sivri HS, et al. Knowledge is power.

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EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? On exam, the patient opens eyes to voice, has extraocular movements intact, is unable to speak, and has 0/5 strength in all extremities. The patient was intubated for acute hypercapnic and hypoxic respiratory failure and airway protection.

EMS 89

EMS E-9-1-1 ALS OR 89

EMDocs

FEBRUARY 7, 2024

Despite a plateau in overall union membership of around 10% in 2023 1 , major labor actions shook the U.S. 2023 October 9. 2012 Feb 1;4(1):127-57. Author: Ryan Leone, MSc, Medical Student at Columbia University // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) What’s the issue? January 23, 2024.

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EMDocs

JULY 3, 2023

Presentation Traumatic SAH occurs following a direct or indirect traumatic mechanism leading to TBI that allows for bleeding into the subarachnoid space. 3 Common associated injuries may include skull fractures, intracerebral contusion, cervical spine injuries, and vascular injuries of the head and neck.

ED 86

ED E-9-1-1 ALS OR 86

This Podcast Will Kill You

NOVEMBER 7, 2023

New England Journal of Medicine, 355(1), pp.51-65. Nature reviews Disease primers, 1(1), pp.1-20. Craythorne, E. 2012): 114. International journal of dermatology, 49(9), pp.978-986. Drissi, Madeeha, Emily Carr, and Chad Housewright. “Sunscreen: a brief walk through history.” Miller, A.J.

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EMDocs

AUGUST 22, 2024

1 However, we recognize that many patients prefer to speak a language other than English regardless of their English proficiency, and this does not indicate a deficiency. 9 Less likely to be satisfied with their care and have a lower understanding of their discharge instructions. 11 Unlikely to receive language assistance.

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Emergency Department ALS E-9-1-1 ED 82

Don't Forget the Bubbles

MARCH 11, 2024

Terminology Plagios is ancient Greek for oblique or slanting Cephal is Latin for head or skull. When put together as ‘plagiocephaly’, the term broadly means cranial asymmetry. Deformational plagiocephaly is due to external forces causing constraint or twisting. Possible causes include twin pregnancy, intra-uterine constraint, or sleeping position.

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Don't Forget the Bubbles

MAY 29, 2023

A study of teams over a 1-year period highlights that people witnessing incivility are also affected, which could lead to individuals feeling unsupported in their teams. link] Isn’t it just ‘part of the job?’ Unfortunately, incivility may be familiar in your workplace. Incivility doesn’t just affect the person on the receiving end of it.

Critical Care 98

Critical Care E-9-1-1 Paramedicine Paramedicine 98

NAEMSP

JANUARY 5, 2023

1] The Adult Cardiac Arrest ACLS algorithm currently includes epinephrine and either amiodarone or lidocaine as recommended pharmacologic therapies. 1] Table from Hamam et al. 9] Figure from Clemency et al. Or in other words, is IO access inferior to IV access? Below, we will examine the current literature.

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ECG & Echo Learning

OCTOBER 2, 2022

Most agents exhibit both vasopressor and inotropic effects (Figure 1). μg/kg/min Bolus : 1 mg IV every 3 to 5 min (max 0.2 mg/kg) IM: (1:1000): 0.1 mg (max 1 mg) Safe for peripheral use ++ + N/A Beta-effect more pronounced at low doses. μg/kg/min Bolus : 1 mg IV every 3 to 5 min (max 0.2 mg/kg) IM: (1:1000): 0.1

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E-9-1-1 ALS Coronary Epinephrine 52

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. ECG 1 What do you think? Grines, C.

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ACEP Now

OCTOBER 9, 2023

Clinical Case Your next patient is a Spanish-speaking 24-year-old female who begins by telling you that she is embarazada. Census Bureau, 60.6 million Americans (approximately 20.8 1,2 Medical interpreters (as opposed to translators who work with the written word), are essential to bridging the language gap. emergencies, patient’s request).

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Emergency Department E-9-1-1 ALS OR 64

AAEM RSA

AUGUST 27, 2020

1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. Kirkegaard H, Soreide E, de Haas, I et al. De Fazio C, Skrifvars MB, Soreide E et al. 2019;23(1):1–9.

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Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

ECG #1 Interpretation: ECG #1 shows sinus rhythm at a heart rate of 77 bpm. Following more detailed questioning — it turned out the patient had started taking 9 different herbal remedies to ease lethargy and unspecific neurological symptoms. For clarity in Figure-1 — I've reproduced the initial ECG in today's case.

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E-9-1-1 ALS Defibrillator OR 98

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al.

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E-9-1-1 Plasma ALS OR 145

Dr. Smith's ECG Blog

AUGUST 3, 2017

There are two main etiologies of ischemic ST-depression: 1) subendocardial ischemia 2) reciprocal to ST-elevation in an opposite wall Here there are distinct R-waves with marked ST-depression throughout most of the precordium. Tips for recognizing Acute Posterior STEMI: 1. References: 1. This can help in confirmation.

STEMI 52

STEMI E-9-1-1 Coronary ALS 52

Dr. Smith's ECG Blog

JULY 22, 2023

A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% He denied chest pain or shortness of breath.

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ECG Medical Training

DECEMBER 4, 2016

Cardiac Care Show – Episode #1: Mechanical CPR Hello, and welcome to the Cardiac Care Show. I’m your host Tom Bouthillet. In today’s episode I’d like to talk about mechanical CPR, which is a frequent topic of conversation in the Resuscitation group on Facebook and the #FOAMed community on Twitter.

CPR 52

CPR E-9-1-1 Defibrillator Ambulance 52

REBEL EM

SEPTEMBER 13, 2023

Features Urticaria and pruritis Rapid onset (1-2 hours) IgE Dependent (Type I Hypersensitivity) Reactions An allergen cross-links two or more IgE molecules on mast cells or basophils and initiates a signal cascade leading to degranulation. Both conditions can range in severity from benign to life threatening (Wilkerson 2012).

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Frozen Plasma Allergic Reaction FFP Plasma 104

EMDocs

JULY 13, 2024

Evaluate for retained products of conception as etiology Diagnosis Diagnosis of endometritis with at least two of the following: 8 Fever >100.4F Evaluate for retained products of conception as etiology Diagnosis Diagnosis of endometritis with at least two of the following: 8 Fever >100.4F

EMS 64

EMS E-9-1-1 Plasma OR 64

Don't Forget the Bubbles

NOVEMBER 29, 2023

Intensive Care Research , 1 (3-4), pp.60-64. A 2012 study on paediatric patients showed that approximately 42% were intubated without medications, and 2% were intubated with paralysis only in the ED. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. Burgart, A.M. and Kanaris, C.,

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Don't Forget the Bubbles

SEPTEMBER 18, 2023

However, symptoms may also be non-specific, including irritability, headache, poor feeding, vomiting, or diarrhoea. The diagnosis is clinical and can be made by directly visualising erythema or bulging of the tympanic membrane. Treatment is mainly symptomatic with analgesia. A throat culture is the gold standard for confirming a bacterial infection.

Emergency Department 143

Emergency Department E-9-1-1 ALS OR 143

FOAMfrat

OCTOBER 20, 2023

As reported within the 6th edition Manual of Emergency Airway Management, there are cardiac arrest rates between 1% and 4%, with other complications (mostly hypoxemia and hypotension) as high as 30% in patients with first-pass success [1, pg 29; 4-10]. Why is Physiologic Optimization Important? Up to 44% per other sources [12].

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E-9-1-1 ALS ACS OR 52

NAEMSP

APRIL 19, 2023

This CI does include 1; and further and further analysis of the data showed that the likelihood that calcium has a beneficial effect (e.g. The overall conclusion was that as less than 1% of cardiac arrest etiologies fall into a group that would potentially benefit from calcium, that routine use should be avoided (Padrao, et.

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E-9-1-1 Advanced Life Support Overdose CPR 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

The pattern of STE and STD reminded us of Brugada Type 1 morphology. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% The article is edited by Smith. F (rectal).

E-9-1-1 52

E-9-1-1 CAD STEMI OR 52

REBEL EM

JANUARY 19, 2023

Patients were randomly assigned 1:1 to treatment with either an ambulatory device or standard guideline-based management (aspiration, standard chest tube insertion, or both). Patients were observed for 1-2 hours for clinical stability, and placement was confirmed with a chest x-ray.

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E-9-1-1 OR ALS EMS 52

This Podcast Will Kill You

MAY 21, 2024

” Neurol Asia 9 (2004): 59-63. Berlin, Heidelberg: Springer Berlin Heidelberg, 2012. and De Wit, E., Bertherat, E., Epidemiology and Infection 147, e95, 1–6. Animals , 13 (1), p.159. Rota, and Pierre E. What does it take to make the WHO’s list of high priority pathogens of pandemic potential?

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REBEL EM

MARCH 13, 2023

The search contained terms for (1) prehospital cardiac arrest or prehospital advanced life support, and (2) injuries and trauma. Grasner 2011; Zwingmann 2012) Their data pools overlap considerably with previous studies; it would have been concerning if the data differed significantly. Discussion: Dead On Scene: The 96.2%

Advanced Life Support 52

Advanced Life Support Life Support E-9-1-1 EMS 52

REBEL EM

DECEMBER 28, 2022

Conducted at 2 US Veterans Affairs medical centers from 2012–2019. Approx 1 in 4 (23%) patients with a urine culture had no bacterial growth, which may dilute any effect of treatment duration or choice of agent. What They Did Prospective, randomized, double-blinded, placebo-controlled, non-inferiority study.

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EMDocs

NOVEMBER 13, 2023

1 One study found that CTA head and neck was ordered for 2.5% 8 The VAN (vision, aphasia, neglect) score ( Figure 1 ), first proposed by Teleb et al. 9 A later assessment of the VAN score in Beume et al. 8 The VAN (vision, aphasia, neglect) score ( Figure 1 ), first proposed by Teleb et al.

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E-9-1-1 ALS Emergency Department ED 87

EMDocs

JANUARY 20, 2024

She describes the pain as left-sided, non-radiating, and 9/10 in severity. Answer: Takotsubo Cardiomyopathy 1-18 Background: Also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, stress cardiomyopathy, Gebrochenes-Herz syndrome, and broken-heart syndrome.

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E-9-1-1 EMS Coronary ACS 74