ALiEM

MAY 13, 2024

Her symptoms started 1 week ago as a scratch which progressively got more red and painful. Pediatric Soft Tissue POCUS Ultrasound Technique Figure 1. Cellulitis with cobblestoning Video 1. Abscess with irregular borders and surrounding cellulitis E. Superficial abscess with well-circumscribed borders Table 1.

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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.,

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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

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Dr. Smith's ECG Blog

DECEMBER 11, 2023

Moreover , the patient has ongoing symptoms and has an unexplained elevated troponin, so she is having an MI and the only question is whether it is type 1 or type 2 due to hypertension. Case continued She was loaded with aspirin 325 mg, and repeat troponin drawn around the time of EKG 1 resulted at 267 ng/L. At midnight. At midnight.

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Pediatric EM Morsels

AUGUST 18, 2023

Rose 2014) They are the most frequently prescribed class of medications in adults; however, in children they are the least frequently prescribed class , <2% of antibiotics. Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children.

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This Podcast Will Kill You

JULY 23, 2024

2014): 6-7. Official journal of the American College of Gastroenterology| ACG , 118 (1), pp.59-76. Annals of internal medicine , 172 (1), pp.ITC1-ITC16. ” BMC medicine 17 (2019): 1-20. Gastroenterology , 160 (1), pp.63-75. ” New England Journal of Medicine 371.1 Rubio-Tapia, A., Kelly, C.P., Greer, K.B.,

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Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Here is lead I from ECGs 1 and 2 shown side-by-side to highlight the change in axis from borderline right to completely normal. Consider the following: We become attuned to looking for acute coronary occlusion in patients who present with acute symptoms to the ED ( E mergency D epartment ). Answer : Bedside ultrasound!

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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.

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Broome Docs

DECEMBER 22, 2024

2024 Oct 9. There were no differences in survival (12% with IO vs 10% with IV) or neurologically intact survival (9% vs 8%). There is a bunch more – so have a listen or watch us on Youtube feed below. You can read all the papers on the links in the show notes right here. doi: 10.1001/jama.2024.20424. 2024.20424. of the IV group).

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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 129

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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

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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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.

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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.

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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.

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EMDocs

AUGUST 3, 2023

These local protocols vary from the labeled dosing; contacting and using your local poison center’s protocol is recommended. These local protocols vary from the labeled dosing; contacting and using your local poison center’s protocol is recommended. It does not preclude the continuation of NAC.

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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.

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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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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.

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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.

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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.,

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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

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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?

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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.

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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.,

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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%

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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?

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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.

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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.

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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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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.

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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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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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ACEP Now

NOVEMBER 7, 2023

1 Overall, survival is poor following cardiac arrest, and is affected by factors including age, comorbidities, witnessed arrest, early CPR, early defibrillation, and return of spontaneous circulation (ROSC). Heart disease and stroke statistics—2014 update: a report from the American Heart Association. 2018;13(9):e0204169.

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REBEL EM

JULY 18, 2022

2013 Sep;31(9):1389-92. The NoPAC trial, which was published in 2021,(1) compared TXA to placebo in a large multicenter randomized control trial in the UK which looked at data from 26 emergency departments. Initial interventions include local pressure, ice, and forward head positioning for persistent bleeds. Am J Emerg Med.

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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?

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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.

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