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-9-1-1 114

E-9-1-1 ACS OR Emergency Department 114

Pediatric EM Morsels

APRIL 7, 2023

Observation, interaction with patient, as well as parent information is key to bring the whole picture together!

ALS 130

ALS OR EMS Critical Care 130

The Skeptics' Guide to EM

FEBRUARY 18, 2023

Date: February 17, 2023 Reference: Gettel et al. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. Date: February 17, 2023 Reference: Gettel et al. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019.

Emergency Department 130

Emergency Department ALS ED EMS 130

Pediatric EM Morsels

OCTOBER 27, 2023

PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. link] Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Krug 2007] What If the Child is Obese or Emaciated? There are other systems that account for body habitus.

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

NAEMSP

APRIL 18, 2025

2013 Jun;19(6):370-80. Epub 2013 Apr 10. Rosenbaum SB, Gupta V, Patel P, et al. However, this theory has not been shown to be true in the literature and Ketamine can be an excellent form of anesthesia for combative patients such as in this case. Ketamine can also be used at a lower dose (0.1-0.3mg/kg CNS Neurosci Ther.

Ambulance 52

Ambulance EMS EMT EMT 52

The Skeptics' Guide to EM

AUGUST 19, 2023

I responded by posting the 2013 SGEM episode on INTERACT-2 ( SGEM#73 ) which showed no statistical difference between intensive (<140 mmHg) and guideline directed (<180 mmHg). Date: August 14, 2023 Reference: Ma et. Date: August 14, 2023 Reference: Ma et. Most EM physicians shared the frustration and made positive comments.

EMS 186

EMS ALS Emergency Department OR 186

EMDocs

JANUARY 11, 2025

Up to 1/3 of adults over 60 suffer from chronic constipation. Evaluation: A good history and a high index of clinical suspicion is paramount, especially in high-risk patient populations 4 CT of the abdomen and pelvis with contrast is the best choice for diagnosis. Enemas (some studies show this may be associated with perforation risk).

E-9-1-1 98

E-9-1-1 EMS Emergency Department OR 98

The Skeptics' Guide to EM

MAY 14, 2022

Date: May 13th, 2022 Reference: Abril et al. Date: May 13th, 2022 Reference: Abril et al. These include: acetaminophen ( Williams et al Lancet 2014), steroids ( Balakrishnamoorthy et al Emerg Med J 2014) and benzodiazepines ( Friedman et al Ann Emerg Med 2017). An Analysis of Data From Randomized Studies.

ALS 130

ALS Emergency Department ED OR 130

The Skeptics' Guide to EM

OCTOBER 28, 2017

[display_podcast] Date: October 24th, 2017 Reference: Harrison et al. display_podcast] Date: October 24th, 2017 Reference: Harrison et al. That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015. Reference: Harrison et al.

ALS 130

ALS Emergency Department OR ED 130

The Skeptics' Guide to EM

AUGUST 28, 2021

Date: August 27th, 2021 Reference: Gagnon et al. Date: August 27th, 2021 Reference: Gagnon et al. Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial. first appeared on The Skeptics Guide to Emergency Medicine.

ED 130

ED Emergency Department ALS OR 130

The Skeptics' Guide to EM

DECEMBER 7, 2019

Date: October 2nd, 2019 Reference: Ramgopal et al. Date: October 2nd, 2019 Reference: Ramgopal et al. The Journal of Pediatrics published a systematic review of literature regarding the Management of ALTE in 2013 and one of the findings was that there was very little agreement in the literature on how to apply the definition.

CPR 130

CPR ALS OR 130

REBEL EM

SEPTEMBER 13, 2023

of people who take NSAIDs ( Nzeako 2010 ). patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 of people who take NSAIDs ( Nzeako 2010 ). Typically involves the mouth, larynx, pharynx, and subglottic tissue ( Kostis 2005 ).

Frozen Plasma 104

Frozen Plasma Allergic Reaction FFP Plasma 104

Don't Forget the Bubbles

OCTOBER 25, 2023

Image adapted by Holland JA et al. Image adapted by Holland JA et al. Strabismus alone is a rare sign of a brain tumour in this age group; however, the associated papilloedema is concerning. The fact that fundoscopy has been carried out on this child is a feat. It is often difficult to do this in an ED setting. How is IIH diagnosed?

ALS 124

ALS OR ED 124

ALiEM

MARCH 7, 2024

Transvere ultrasound views of the bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.) The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Lay the patient supine when possible.

E-9-1-1 177

E-9-1-1 Emergency Department ALS ED 177

The Skeptics' Guide to EM

JULY 3, 2021

Reference: Dankiewicz et al: TTM2 Trial Investigators. Reference: Dankiewicz et al: TTM2 Trial Investigators. This is the original Target Temperature Management (TTM) trial by Nielson et al NEJM 2013. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. This gives a NNT of 4.

Paramedic 130

Paramedic Defibrillator ALS OR 130

The Skeptics' Guide to EM

APRIL 24, 2021

Reference: Martel et al. Way back in 2013 we looked at haloperidol for agitation due to psychosis ( SGEM#45 ) and concluded that it was an effective treatment but had common side effects. Reference: Martel et al. Kirsty is also the creator of the wonderful infographics called #PaperinaPic.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

REBEL EM

MAY 29, 2024

EMRAP HD: Epistaxis Posterior Pack References Cassisi NJ et al. PMID: 5569677 Zeyyan E et al. PMID: 20938948 Loftus BC et al. PMID: 8170679 Viducich RA et al. Take Home Points: Posterior epistaxis is a rare, life-threatning presentation. Literature doesn’t defend this approach but, the lit is pretty sparse.

ICU 102

ICU ALS ACS EMS 102

EMDocs

AUGUST 22, 2024

You may be more familiar with the term “limited English proficiency” (LEP), defined as: someone who does not speak English as their primary language and has a limited ability to read, speak, write, or understand English. For instance, displaying posters in multiple languages that explain the language services patients are entitled to.

Emergency Department 105

Emergency Department ALS E-9-1-1 ED 105

The Skeptics' Guide to EM

JUNE 24, 2017

[display_podcast] Date: June 20th, 2017 Reference: Bernard et al. display_podcast] Date: June 20th, 2017 Reference: Bernard et al. Then came the Targeted Temperature Management (TTM) Trial ( Nielsen et al NEJM 2013 ). Reference: Bernard et al. Circulation 2016. Circulation 2016.

CPR 100

CPR Epinephrine ALS Paramedic 100

EMDocs

NOVEMBER 21, 2023

Denied weakness of his upper extremities, paresthesias, vision changes, trouble swallowing or speaking, and drug or alcohol use. Exam: 2/5 strength when attempting to flex his bilateral thighs. Could not ambulate. Otherwise normal CN’s, sensation, upper extremity motor exam. HypoPP only impacts skeletal muscles, NOT smooth or cardiac muscle.

E-9-1-1 95

E-9-1-1 ALS ED OR 95

This Podcast Will Kill You

JULY 23, 2024

Caio, Giacomo, et al. Cenit, María Carmen, et al. Al-Dulaimi, D., Gasbarrini, Giovanni, et al. Gasbarrini, Giovanni Battista, et al. Kerner, Gaspard, et al. Newberry, Carolyn, et al. Suddenly, grocery stores were filled with gluten-free crackers, cookies, buns, you name it. 2019): 100. Rubin, J.E.

E-9-1-1 98

E-9-1-1 ALS OR 98

The Skeptics' Guide to EM

MARCH 10, 2018

[display_podcast] Date: March 6th, 2018 Reference: Zahed et al. display_podcast] Date: March 6th, 2018 Reference: Zahed et al. Zahed et al did a randomized control trial (RCT) in 2013 on using TXA for the treatment of anterior epistaxis [2]. Reference: Zahed et al. AEM March 2018. AEM March 2018. AEM March 2018.

Emergency Department 100

Emergency Department ALS Coronary OR 100

EMDocs

MAY 11, 2024

A) Basilar artery stroke B) Cavernous sinus syndrome C) Lateral medullary infarction D) Multiple sclerosis Answer: C Vertigo , or the internal sensation of motion when no motion exists, is often classified as either peripheral or central depending on the origin of the pathology. loss of pain and temperature sensation).

EMS 111

EMS E-9-1-1 ALS OR 111

EMDocs

JANUARY 29, 2024

The American Heart Association/American Stroke Association (AHA/ASA) recommends maintaining BP below 185/110 mmHg in eligible patients undergoing thrombolytic therapy or endovascular intervention [1]. Following thrombolysis or endovascular therapy, the recommended blood pressure goal is below 180/105 mmHg to prevent hemorrhagic complications [1].

ALS 99

ALS Critical Care OR EMS 99

Pediatric EM Morsels

JUNE 16, 2023

Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Overdose 154

Overdose OR Critical Care ALS 154

The Skeptics' Guide to EM

MARCH 13, 2021

Reference: Post et al. Reference: Post et al. Jeff was actually on the SGEM as the guest skeptic discussing this clinical decision instrument way back in 2013 ( SGEM#48 ). Robert Edmonds is an emergency physician in the US Air Force in Ohio. Robert Edmonds is an emergency physician in the US Air Force in Ohio.

ALS 100

ALS Emergency Department ED OR 100

FOAMfrat

JULY 3, 2024

If they are not already there, get ALS-level care to the patient as soon as possible. I personally know of 2 ALS providers who were exposed to chlorine gas in a pool incident on the job and both ended up retiring from their service and still have lifelong breathing problems as a result. Be prepared to take an advanced airway early.

Life Support 105

Life Support ALS Emergency Response OR 105

Don't Forget the Bubbles

JUNE 26, 2023

In this case-based article, we’ll talk about single ventricle defects and their management (both medical and surgical), then look at the two main shunt options during Stage 1 reconstruction. Single ventricle defects Many complex congenital heart defects have single ventricle physiology. Usually, though, they will proceed to surgery.

Critical Care 128

Critical Care ALS OR CPR 128

Don't Forget the Bubbles

AUGUST 7, 2023

The controversy around what is ‘normal’ in infants’ and children’s vitals was demonstrated in a 2011 systematic review by Fleming et al. and two cohort studies, one performed in Australia by O’Leary et al. and one in the US by Bonafide et al. and two cohort studies, one performed in Australia by O’Leary et al.

Life Support 98

Life Support Advanced Life Support ALS Emergency Department 98

EMDocs

OCTOBER 9, 2023

References 1) Liu D, Ahmet A, Ward L, et al. Published 2013 Aug 15. Activation of the glucocorticoid receptor has an inhibitory effect on the enzyme phospholipase A2, with subsequent decreases in pro-inflammatory cytokines, prostaglandins, and at higher doses, B-cell and T-cell production. and cardiovascular disease (OR 1.2-2.56).

ED 108

ED Life Support Advanced Life Support CPR 108

EMDocs

FEBRUARY 22, 2024

2013; 7362. He reports onset of his symptoms while mowing his lawn just prior to arrival and reports that he was not wearing eye protection. The man does not use glasses or contact lenses. He denies known ocular trauma or ocular surgical history. Triage VS: BP 136/86 mm Hg, HR 110 bpm, T 98.6 F oral, RR 14 bpm, SpO2 98% on room air.

ALS 98

ALS ED EMS OR 98

Don't Forget the Bubbles

OCTOBER 2, 2023

mmol/L) with acute illness between 2013 and 2018. Selman C, Mainzer R, Lee K, et al. O Sullivan MP, Livingstone V, Korotchikova I, et al Reference centiles for infant sleep parameters from 4 to 16 weeks of age: findings from an Irish cohort Archives of Disease in Childhood 2023; 108: 481-485. What’s it about?

ALS 138

ALS OR ED Emergency Department 138

EMS 12-Lead

APRIL 2, 2022

Upon arrival he was found alert and oriented, and without gross distress. He denied difficulty breathing, epigastric pain, or chest discomfort. BP 110/67 HR 68 RR 14 (non-labored) SpO2 95 RA Physical exam revealed slight pallor and diaphoresis. Auscultation of breath sounds did not yield any evidence of wheezing, crackles, or diminished fields.

ALS 130

ALS STEMI Coronary OR 130

This Podcast Will Kill You

OCTOBER 22, 2024

Schieppati, Arrigo, et al. Stiff person syndrome, like many rare diseases, does not get nearly the same amount of screen time or name recognition that other, more common diseases do. For many people, Celine Dion’s announcement of her diagnosis with the condition in 2022 marked the first time they had heard of it. Cohen, Louis. 1966): 222-224.

ALS 98

ALS OR 98

Don't Forget the Bubbles

SEPTEMBER 30, 2024

Simpson et al. A 2011-2012 Australian study by Blake et al. There was a disproportionate number of DNWs on Sundays, and if they presented between 4 pm and midnight, A 2002 Canadian study by Goldman et al., Gaucher et al. Gaucher et al. Similarly, a study by Suastegui et al., What is happening locally?

Emergency Department 89

Emergency Department ALS ED OR 89

Don't Forget the Bubbles

AUGUST 9, 2023

References Cerbone M, Capalbo D, Wasniewska M, Mattace Raso G, Alfano S, Meli R, et al. We’ll use some cases to think about the different causes of subacute hypothyroidism, but first, let’s explore what it is. Hypothyroidism can be classified by lab values. A TSH between 4.5 It is soft, cystic, and not tender. Source: Salerno, M. Endocrinol.

ALS 98

ALS OR 98

FOAMfrat

MARCH 4, 2025

Avoidant/Restrictive Food Intake Disorder (ARFID ) is more unique and was not added to the DSM-5 until 2013. Lets do a little review of the differences in these disorders. Anorexia Nervosa Anorexia is a condition where the individual obsesses about food and weight. Purging may consist of vomiting or the intake of laxatives or diuretics.

ALS 95

ALS Ambulance OR EMS 95