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?

Emergency Department 94

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

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.

E-9-1-1 103

E-9-1-1 ALS ED OR 103

EMDocs

JUNE 27, 2024

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? Other lung fields unremarkable. C or 100.4 mg/kg, max 0.4

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

EMDocs

JUNE 14, 2023

Patellar reflexes are 1+. 1, 2, 4, 9 Organophosphates are one of many types of insecticide and are used worldwide to manage crops. 1, 2, 4, 9 Organophosphates are one of many types of insecticide and are used worldwide to manage crops. 1, 2 Sensory > Motor neurons with predilection for long axons.

E-9-1-1 70

E-9-1-1 Emergency Department Plasma ED 70

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 97

Critical Care E-9-1-1 Paramedicine Paramedicine 97

Don't Forget the Bubbles

MARCH 18, 2024

The Royal Children’s Hospital in Melbourne summarises them in an easy-to-follow flow diagram (figure 1). Typical HUS has a diarrheal prodrome, usually caused by an infection with a Shiga-toxin-producing E. Typical HUS has a diarrheal prodrome, usually caused by an infection with a Shiga-toxin-producing E. What is typical HUS?

E-9-1-1 59

E-9-1-1 ALS OR 59

EMDocs

JUNE 7, 2023

1-5 Farmers also treat sheep for parasites using OPs and may become symptomatic after exposure, an illness called Dipper’s Flu. 8 Intermediate syndrome Occurs 1 to 5 days after acute exposure in up to 40% on individuals. 7, 9 Often have absence of excessive cholinergic stimulation. 7 May lead to respiratory failure.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

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.

E-9-1-1 98

E-9-1-1 ALS Emergency Department EMT 98

EMDocs

SEPTEMBER 7, 2023

1 Clinical Questions: When should a clinician suspect diethylene glycol (DEG) toxicity? Toxicity typically evolves through three phases: 2,3,7,8,9 Phase 1: Gastrointestinal symptoms (e.g., Upon review of the history, several of the patients had been exposed to a liquid acetaminophen-based teething medication.

E-9-1-1 66

E-9-1-1 ALS Emergency Department Plasma 66

Don't Forget the Bubbles

JUNE 30, 2023

E – Temp 37.2 Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7% Pupils are equal and reactive. This is not good. This is not good. This is not good.

E-9-1-1 145

E-9-1-1 OR ALS Critical Care 145

This Podcast Will Kill You

NOVEMBER 7, 2023

New England Journal of Medicine, 355(1), pp.51-65. 2014): 415-435. Nature reviews Disease primers, 1(1), pp.1-20. Craythorne, E. International journal of dermatology, 49(9), pp.978-986. Public Health Research & Practice, 32(1). ” Baylor University Medical Center Proceedings. Miller, A.J.

E-9-1-1 52

E-9-1-1 ALS ED OR 52

AAEM RSA

NOVEMBER 23, 2020

9 While these flexible tracks may help women remain in the workforce during the demanding child-rearing years, getting off track can be detrimental to career advancement and promotion, especially in comparison to men who usually start and remain in full-time service. Shollen et al. 6 Jolly et al. hours more per week on domestic activities.

OR 52

OR E-9-1-1 ALS 52

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.

E-9-1-1 59

E-9-1-1 OR ED 59

EMDocs

AUGUST 7, 2023

1 A D-dimer level can, therefore, be used as a non-specific and indirect biomarker for the presence of intravascular clotting, which may be useful in the diagnosis of VTE. 1-3 In this patient population, the NPV of a negative D-dimer level is high, such that a negative test makes further evaluation for VTE unnecessary.

E-9-1-1 69

E-9-1-1 ALS Plasma OR 69

Don't Forget the Bubbles

JANUARY 10, 2024

The study asked TWO questions: 1. 3,950 children were recruited between September 2014 to May 2017. Transfusion guidelines in LMICs in sub-Saharan Africa differ significantly from the Western world. However, these recommendations are only based on expert opinion and have not been systematically evaluated.

E-9-1-1 78

E-9-1-1 ALS OR Critical Care 78

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.

E-9-1-1 120

E-9-1-1 OR Coronary ACS 120

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

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

Dr. Smith's ECG Blog

JANUARY 10, 2020

I was relieved to see this MRI result: MRI IMPRESSION 1) Mildly decreased LV function with no focal wall motion abnormalities. Learning Points: 1. Pericarditis" strikes again == MY Comment by K EN G RAUER, MD ( 1/10/2020 ): == I like this case because it proves what we know = Medicine is not 100%. There is no effusion.

E-9-1-1 52

E-9-1-1 OR STEMI Emergency Department 52

ALiEM

MARCH 7, 2024

Ultrasound probes from left to right: linear (nenoates), phased array (infants/younger children), and curvilinear (older children/adolescents) Pro tips for performing renal/bladder POCUS on a child [1] Addressing potential anxiety leads to a more efficient and comfortable examination. Pre-warmed ultrasound gel is helpful when available.

E-9-1-1 177

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

Dr. Smith's ECG Blog

SEPTEMBER 9, 2020

== MY Arrhythmia Case by K EN G RAUER, MD ( 9/9/2020 ): == PREFACE: Recognition of the presence ( or absence ) of AV block is a common problem in emergency medicine. The ECG that is shown in Figure-1 was obtained from an elderly patient, who was admitted to the hospital for a fall. Is there AV block?

E-9-1-1 52

E-9-1-1 OR 52

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.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

A 40-something male presented with dyspnea and left arm numbness, and perhaps some chest tightness, for 1 1/2 hours. Here is his triage ECG: There is massive STE in V3-V6, and also STE in II, III, aVF. This is all but diagnostic of STEMI, probably due to wraparound LAD The cath lab was activated. Suppose you had used the formula?

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 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.

E-9-1-1 70

E-9-1-1 CAD OR STEMI 70

Don't Forget the Bubbles

NOVEMBER 29, 2023

Intensive Care Research , 1 (3-4), pp.60-64. 2014 May;32(5):452-6. Epub 2014 Jan 15. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. This article is based on: Mayberry, H., Burgart, A.M. and Kanaris, C., Intubated, awake, and paralysed: a never event. DOI: 10.1097/PEC.0b013e3182713316

E-9-1-1 135

E-9-1-1 Emergency Department ED CPR 135

Don't Forget the Bubbles

JUNE 17, 2024

Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J. 2014 Jun 26;23(12):653-9. Clinicians have reported similar rates, with non-consultant doctors particularly affected. cognitive rehearsal techniques ). Organizational dynamics. 2020 Aug 20.

E-9-1-1 105

E-9-1-1 Critical Care CPR ICU 105

Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. She calls out her findings: A – OK B – 1 puncture mark to the anterior left chest wall, covered with a three-sided dressing. RR 25-30. Actively oozing.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

This Podcast Will Kill You

JANUARY 2, 2024

2002): 1-7. Nature Reviews Endocrinology , 7 (9), pp.540-557. Endocrine reviews , 43 (1), pp.61-90. Molecular and Cellular Pediatrics , 7 (1), pp.1-9. Academic Press, 2014. Sochett, E. Annual review of biochemistry , 78 , pp.929-958. ” Annals of Anatomy-Anatomischer Anzeiger 184.1 and Glorieux, F.H.,

E-9-1-1 52

E-9-1-1 ALS OR 52

REBEL EM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 1, 4, 6 The overall incidence of VAP is somewhere around 5%-40% of all intubated patients, depending on the study and country from which it is reported. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 124

E-9-1-1 ICU OR ALS 124

REBEL EM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Recurrence of pneumothorax within 1 year. They concluded that more research of higher quality is needed to strengthen the evidence in favor of one technique over the other.

E-9-1-1 104

E-9-1-1 ALS Emergency Department OR 104

Don't Forget the Bubbles

JULY 17, 2023

You will find the list is broken down into four sections: 1.Reviews 2023 Jun 1. 2023 Jun 1 Adverse Effects of α-2 Adrenergic Agonists and Stimulants in Preschool-age Attention-deficit/Hyperactivity Disorder: A Developmental-Behavioral Pediatrics Research Network Study. 2023 Jun 9. 2023 Jun 6:1-11. 2023 Jun 9.

E-9-1-1 98

E-9-1-1 ALS Emergency Department Emergency Medical Services 98

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 142

Emergency Department E-9-1-1 ALS OR 142

NAEMSP

APRIL 19, 2023

However, evidence emerged in the 1980’s demonstrating that calcium chloride had no effect on return of spontaneous circulation (ROSC) rates, and in fact could be detrimental (Landry, Foran, & Koyfman, 2014). Current AHA guidelines do not recommend routine use of calcium in cardiac arrest (Panchal, et al.,

E-9-1-1 52

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

EMDocs

JULY 15, 2023

aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. Vital signs are unremarkable. pneumoniae , S.

E-9-1-1 66

E-9-1-1 EMS OR ED 66

REBEL EM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Patients : Compared standard of care to serial US plus stand care in patients with dyspnea. to −0.66) and −1.66 (95% CI −2.09 to −0.78) and -1.97 (95% CI −2.70

ED 128

ED E-9-1-1 Emergency Department ALS 128

REBEL EM

DECEMBER 10, 2023

Though the initial focus of the FAST exam was for detection of abdominal free fluid, the eFAST (Extended FAST) is more commonly used and adds thoracic windows helping to identify pneumothorax ( Musthafa 2014 ). 2022 Jan 1;92(1):44-48. Not so FAST- Chest ultrasound underdiagnoses traumatic pneumothorax. J Trauma Acute Care Surg.

E-9-1-1 40

E-9-1-1 Emergency Department OR ALS 40

AAEM RSA

APRIL 1, 2021

1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 in the 1:1:1 group vs. 17.0%

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

Dr. Smith's ECG Blog

APRIL 22, 2022

But these cases show the potential dangers of delayed recognition and treatment of inferior reperfusion Take away 1. ECG’s can be labeled as ‘normal’ by the computer (and confirmed by cardiology) even with diagnostic signs of occlusion or reperfusion References 1. Case Rep Emerg Med 2014 7. JAMA Intern Med 2019 9.

E-9-1-1 52

E-9-1-1 STEMI ALS ED 52