EMDocs

DECEMBER 1, 2024

typhi infection if treatment is refractory to supportive measures or conventional community-acquired pneumonia antibiotics Treat with atypical bacterial coverage (doxycycline, azithromycin, chloramphenicol, or fluoroquinolones) A 32-year-old woman presents to the ED with a fever and rash after returning from a trip to Southeast Asia. .:

EMS 103

EMS E-9-1-1 OR ED 103

This Podcast Will Kill You

FEBRUARY 11, 2025

” International Journal for Parasitology: Parasites and Wildlife 2 (2013): 222-227. Now imagine that your tongue suddenly shriveled up and fell off and that in its place is a tongue-sized isopod aka rollie pollie aka pillbug. Just there, hanging out, forever. How are you feeling? Hey, we get it. But at least youll never be alone again.

E-9-1-1 97

E-9-1-1 ALS OR 97

The Skeptics' Guide to EM

DECEMBER 15, 2018

Eur J Paediatr Neurol 2013) that concluded antipyretics were ineffective in reducing the recurrence of febrile seizures in children. Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Associate Professor for the University of Leicester’s SAPPHIRE group. Date: December 13th , 2018 Reference: Murata et al.

OR 130

OR Emergency Department ALS 130

Pediatric EM Morsels

MAY 10, 2024

2013 Oct;132(4):e1010-7. Ask about suicidal ideation : Let’s not miss a caustic ingestion… Ask about birth control : Teens may be on OCPs and at increased risk for PE and their parents don’t know it Ask about drugs : Does your patient smoke, vape, or use cocaine? Have you ever had chest pain or shortness of breath in exercise? Equal pulses?

E-9-1-1 271

E-9-1-1 OR EMS 271

EMDocs

NOVEMBER 13, 2024

Literature concerning risk with PPIs is controversial. Presentation: Classic presentation is abdominal pain or tenderness, fever, and altered mental status. Literature suggests 10-33% of patients are asymptomatic or only have mild symptoms. Clinician sensitivity for SBP based on bedside assessment is between 40-75%. increase in mortality.

E-9-1-1 105

E-9-1-1 ALS OR ED 105

Pediatric EM Morsels

JULY 26, 2024

Epub 2013 Dec 18. While it is important for us to maintain a safe work environment for our patients and our team, managing the agitated patient requires more of us than administering Droperidol or Ketamine. Make sure to consult your friendly neighborhood pediatric neurologist and/or rheumatologist! The prevalence ranges from 12.5%-61%

Plasma 271

Plasma OR ED Critical Care 271

EMDocs

DECEMBER 18, 2024

fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold

E-9-1-1 105

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

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-9-1-1 107

E-9-1-1 ACS OR Emergency Department 107

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

ALiEM

NOVEMBER 10, 2023

2013 Apr;168(4):726-32. Epub 2013 Feb 16. Management of FDE anchors on identification and discontinuation of the causative agent. Topical or systemic steroids are common adjuncts and there is limited evidence suggesting the utility of systemic cyclosporine for severe cases [1]. Br J Dermatol. doi: 10.1111/bjd.12133. PMID: 23413807.

Emergency Department 161

Emergency Department OR 161

FOAMfrat

DECEMBER 26, 2024

These showed that with 22 incidents between 2011 and 2013, 43 people were harmed. TRIGGER WARNING: TOPICS OF SUICIDE MAY BE HARD FOR SOME PEOPLE TO READ ABOUT. THIS ARTICLE IS COVERING THE MEDICAL ASPECTS OF CHEMICAL SUICIDES. IF YOU OR A LOVED ONE NEEDS HELP, CALL 988 OR SEEK CARE AT A LOCAL EMERGENCY DEPARTMENT.

Epinephrine 116

Epinephrine First Responder OR CAD 116

Pediatric EM Morsels

AUGUST 9, 2024

Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306. Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal? Is this bloody stool concerning? Are this odd movements part of normal development? Is that umbilical area ok or concerning? May be on soles of feet !

E-9-1-1 154

E-9-1-1 Plasma Emergency Department OR 154

Core EM

JANUARY 25, 2024

Definition: Catatonia: A behavioral motor dysregulation syndrome marked by an inability to move normally despite full physical capacity, which can occur in the context of many underlying psychiatric and general medical disorders [4]. Epidemiology : Who typically suffers from catatonia? Who typically suffers from malignant catatonia?

MICU 246

MICU Emergency Department ED OR 246

The Skeptics' Guide to EM

FEBRUARY 18, 2023

Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. 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

NOVEMBER 3, 2023

2013 Sep 4; 89(3): 527–530. Additionally in a head-to-head study, there was improved mortality with IV artesunate (Forgie 2022) IV artesunate is extremely expensive to stock and may not be available at every hospital in non-endemic regions. It appears after an asymptomatic period. Treating malaria is an ART! vivax or P. Am J Trop Med Hyg.

ALS 281

ALS EMS Critical Care OR 281

Pediatric EM Morsels

MAY 24, 2024

Low Risk Intra-Abdominal (IAI) Trauma – Derivation of the Rule The PECARN Group first released their derivation of a pediatric prediction rule for intra-abdominal injury in 2013. 2013 Aug 1;167(8):700-707. Only 6 patients classified as very low risk were found to have IAI requiring intervention. Lancet Child Adolesc Health.

ALS 164

ALS EMS Emergency Department OR 164

Core EM

JANUARY 25, 2024

Background: The lumbar puncture (LP or spinal tap) is a procedure that has been in the medical arsenal since first described in 1891 by German physician Heinrich Quincke. Technique: Probe selection: The linear probe is more ideal for pediatric patients and adults with a leaner body habitus. High-quality images obtained in <1 minute in 87.9%

ALS 246

ALS Critical Care OR 246

Pediatric EM Morsels

JULY 28, 2023

Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 or serum bicarbonate between 11-17 mmol/L Moderate : venous pH < 7.2 or serum bicarbonate between 5-10 mmol/ L Severe : venous pH < 7.1 Neuroimaging is NOT required. GCS score is not sensitive enough.

E-9-1-1 246

E-9-1-1 ALS OR Critical Care 246

The Skeptics' Guide to EM

OCTOBER 20, 2018

Background: There has been a huge increase in the number of CT scans performed with more than 75 million CT scans performed in the US in 2013. Her GFR is 50 and you are wondering if the contrast needed for the CT will cause an acute kidney injury (AKI) and if so, can you do anything to mitigate causing an AKI? mg/dL within 3 days.

Coronary 181

Coronary Emergency Department ALS OR 181

Emergency Medicine Cases

NOVEMBER 7, 2017

Yet according to a 2013 Medscape survey, 40% of physicians reported burnout in U.S. Burnout – it’s the elephant in the room that we all know about but prefer not to discuss. They explain why wellness matters, how you can strive to achieve it and how to recognize when you or a colleague are unwell so that you can get the help you need.

OR 130

OR EMS 130

ALiEM

DECEMBER 18, 2023

2013 Jun;6(6):31-7. The patient specifically denied mucous membrane involvement (mouth, eyes, genitalia), vomiting, diarrhea, dysuria, hematuria, neck stiffness, cough, dyspnea, chest pain, or exposure to ticks or exotic animals. Additional Images Physical Exam Vitals : T 39.6°C; Additional Images Physical Exam Vitals : T 39.6°C;

Emergency Department 177

Emergency Department OR 177

ALiEM

AUGUST 30, 2024

2013 Mar;34(3):115-24; quiz 125. The patient had no significant past medical history. She also endorsed three weeks of cough and congestion, and one day of muffled voice. She denied difficulty swallowing, fatigue, cold intolerance, or hair and nail changes. Physical Exam Vitals : BP 87/62; Pulse 80; Temp 36°C (96.8°F); Abdominal : Soft.

ACS 161

ACS Emergency Department ED OR 161

Core EM

JANUARY 25, 2024

Int J Emerg Med 2013; 6:12. More than 1/3 of geriatric trauma patients presenting to the ED after a fall return to the ED or die within one year of initial evaluation. 4 Elderly patients, who comprise only 8-12% of total ED major trauma cases, represent a disproportionate 15-30% of trauma mortalities and costs. Heffernan &al. 2010;69:813.

ALS 246

ALS ED ICU OR 246

Pediatric EM Morsels

MAY 5, 2023

2013 Aug;110(4):755-73. Epub 2013 Jan 14. Supplementation is key! Key nutrients and vitamins are not always found in specialized diets (or picky children) and adherence to multivitamins is a must! Look out for nutritional deficiencies ! References: Alexy U, Fischer M, Weder S, Längler A, Michalsen A, Sputtek A, Keller M.

E-9-1-1 130

E-9-1-1 OR EMS 130

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 97

E-9-1-1 EMS Emergency Department ALS 97

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). Most EM physicians shared the frustration and made positive comments. Some neurologists disagreed with the premise of the tweet and challenged it.

EMS 186

EMS ALS Emergency Department OR 186

Pediatric EM Morsels

OCTOBER 27, 2023

PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. Krug 2007] What If the Child is Obese or Emaciated? x exp[0.02

E-9-1-1 271

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

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

The Skeptics' Guide to EM

JUNE 11, 2017

The reversal of antiplatelet medications in intracerebral hemorrhage was covered in a Best Available Evidence ( Martin and Conlon Ann Emerg Med 2013 ). Robert Edmonds is an Emergency Medicine staff physician in Newport News, VA and a recent graduate of the University of Missouri-Kansas City EM residency. Lancet 2016.

ALS 130

ALS OR EMS 130

EMOttawa

FEBRUARY 22, 2024

In 2013, in the United States there were 7 million visits to the emergency department (ED) for lacerations making up a total of 5.2% Lacerations are a common presenting complaint to emergency department. of ED visits(1).

Emergency Department 93

Emergency Department ED OR 93

The Skeptics' Guide to EM

DECEMBER 7, 2019

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. It is a diagnosis of exclusion that applies to infants under the age of 12 months. . *

CPR 130

CPR ALS OR 130

The Skeptics' Guide to EM

APRIL 24, 2021

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. Droperidol has been used widely, particularly in Australasia, for acute severe agitation. Reference: Martel et al.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

The Skeptics' Guide to EM

OCTOBER 28, 2017

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. There is a RANThony on pediatric pain control and one of the interesting treatments was sucrose. Sweet Solutions to Reduce Procedural Pain in Neonates: A Meta-analysis.

ALS 130

ALS Emergency Department OR ED 130

EMDocs

APRIL 6, 2024

Source Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013-2020). We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Pediatr Crit Care Med. 2024 Feb 1;25(2):147-158.

OR 97

OR 97

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 101

Frozen Plasma Allergic Reaction FFP Plasma 101

The Skeptics' Guide to EM

MAY 14, 2022

They include: CBT and mindfulness ( Cherkin et al JAMA 2016), chiropractic ( Paige et al JAMA 2017), physical therapy ( Paolucci et al J Pain Research 2018) and acupuncture (Colquhoun and Novella Anesthesia and Analgesia 2013 ). The pain is 10/10 in intensity, gets worse with bending, turning, and prolonged walking.

ALS 130

ALS Emergency Department ED OR 130

Don't Forget the Bubbles

OCTOBER 25, 2023

2013 Sep 24;81(13):1159-65. Epub 2013 Aug 21. 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? Manometer three-way tap.

ALS 124

ALS OR ED 124