ALiEM

AUGUST 9, 2023

Technique Positioning and Probe Figure 1: Younger children can sit in their parent’s lap and give a hug for lateral and posterior lung scanning. The patient should be in a position of comfort: supine, sitting, or in parent’s lap (Figure 1). Identify anatomical landmarks on ultrasound (Figure 3, Video 1). Tsou et al.,

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Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. Challenge QUESTION: The relative change in T-QRS-D is not the only thing that changes during period of time that passed between recording of the 2 ECGs shown in Figure-1.

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EMDocs

MARCH 2, 2024

A 58-year-old female with a history of diabetes, hypertension, and chronic back pain presents to the ED with severe headache and nausea. Answer : Pneumocephalus 1-21 Background: Pneumocephalus is defined by the presence of air within the cranial cavity.  2017 Jan-Mar;7(1):58-64.  An Pediatr (Engl Ed). 2019

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EMDocs

JUNE 27, 2024

An 8-year old male with a history of sickle cell anemia presents to the ED for evaluation of fever for 2 days and “feeling like I can’t get a full breath”. 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 2022 Jul 5;328(1):57-68. C or 100.4 mg/kg, max 0.4 C or 100.4

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EMDocs

MAY 11, 2024

A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis?

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Don't Forget the Bubbles

JANUARY 17, 2024

” ( Ed. 2015 But we all know that what happens in the lab does not always mirror what happens in real life. Around 80% of those reported pass spontaneously, with another 10-20% requiring endoscopic removal and only 1% requiring surgical intervention. BMC Pediatrics , 21 (1), Jackson, J., 2012 Jan;3(1):6.

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This Podcast Will Kill You

NOVEMBER 7, 2023

Manne, eds. New England Journal of Medicine, 355(1), pp.51-65. Nature reviews Disease primers, 1(1), pp.1-20. 2015): 83-92. Craythorne, E. International journal of dermatology, 49(9), pp.978-986. Public Health Research & Practice, 32(1). History Biology Heckman, Carolyn J., and Sharon L.

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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. have limited English proficiency according to the 2015 U.S. One cohort study in a public ED found that 84.5% Over 25 million individuals in the U.S.

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Broome Docs

JANUARY 30, 2023

PMID: 33933300 Khan A, Saleem MS, Willner KD, Sullivan L, Yu E, Mahmoud O, Alsaid A, Matsumura ME. 2022 Sep 1;5(9):e2235575. 2015 Apr;72(4):668-73. Epub 2015 Jan 23. doi: 10.1007/s00381-022-05455-1. 2015 Dec;21(6):1244-6. Epub 2015 Dec 29. JAMA Netw Open. 2022 Aug 1;5(8):e2226809. 2022.26809.

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Don't Forget the Bubbles

FEBRUARY 26, 2024

A 6-year-old known asthmatic presents to ED with a two-day history of cough and coryza, worsening wheeze and work of breathing over the last day. In 2015, Silva et al. 2007 Jan 1;25(1):6-9. He is usually managed with beclomethasone twice daily and salbutamol as needed. reviewed the two published randomised control trials.

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Dr. Smith's ECG Blog

NOVEMBER 14, 2019

I’ve taken th e l ead V 3 examples in Figure-1 from previous cases posted on Dr. Smith’s ECG Blog : T OP in Figure-1 — Despite marked ST elevation in this lead V3 — this is not T-QRS-D, because there is well-defined J-point notching ( BLUE arrow ). This patient had a repolarization variant as the reason for ST elevation.

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Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Clinical Course of Children 1 to 24 Months Old With Positive Urine Cultures Without Pyuria. 2024;24(1):111-118. Arch Dis Child Fetal Neonatal Ed. Giannoni, E., Acad Pediatr. doi:10.1016/j.acap.2023.06.023 Epub ahead of print.

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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. Estimated volume = 39.2

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Don't Forget the Bubbles

MARCH 11, 2024

A 4-month-old boy presents to the paediatric ED. New York, USA: The International Society for Pediatric Neurosurgery, 2024 (Accessed January 9, 2024). link] Mitchell, E. Pediatric Annals, 52(1), e10–e17. His parents are concerned about the appearance and shape of his head. They ask how this can be fixed. Vladusic, S.

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Dr. Smith's ECG Blog

MARCH 9, 2023

He had episodes of chest pain off and on all night, until about 1 hour prior to arrival when the pain became constant, crushing, 10/10 chest pain that radiated to both arms. Proven STEMI has an open artery in 19% to 36% of cases, depending on whether it is TIMI −1, −2, or −3 flow. 25] Stone et al found that 72% have TIMI 0 or 1 flow.

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Pediatric EM Morsels

AUGUST 4, 2023

Let’s take a take a minute to review Superior Mesenteric Artery Syndrome presenting in the ED so we will be prepared when you see it! Record, 2015) Normal aortomesenteric angle ranges from 28 o to 65 o and the normal distance from 10 to 34 mm. Record, 2015) Nausea and pain are typically post-prandial. Record, 2015).

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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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REBEL EM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

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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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Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. Riskin (2015) showed that rudeness accounted for a 12% reduction in diagnostic and procedural performance in a simulated resuscitation. Here are ten things to think about: 1. 2014 Jun 26;23(12):653-9.

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REBEL EM

MAY 27, 2024

Background: The REVERT Randomized Controlled Trial demonstrated the superiority of the modified valsalva maneuver (MVM) over the standard valsalva maneuver (VM) in re-establishing normal sinus rhythm (NSR) in patients with PSVT (Appelboam 2015). Duration of Antiarrhythmic Effect: MVM group: 35.44 seconds (SD = 7.73) Adenosine group: 24.24

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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.

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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. All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. A PEM Adventure Ranulf is a 14-year-old explorer.

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EMDocs

MAY 29, 2023

Louis); Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 54-year-old female with a past medical history of rheumatoid arthritis presents to the emergency department (ED) with generalized fatigue. In the ED her vitals are T 99.6°F, What Are ESR and CRP?

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EMDocs

JULY 13, 2024

A 37-year-old G2P2 female with no other past medical history presents to the ED with a 2-day history of intermittent fever and foul-smelling vaginal discharge. 1997 Mar;11(1):203-22. 1985 Dec 1;153(7):737-9. Kankuri E, Kurki T, Carlson P, Hiilesmaa V. We’ll keep it short, while you keep that EM brain sharp. PMID: 9067792.

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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. 2015; 372(5):418-25. J Allergy Clin Immune Tract 2017; 5(5): 1402-9. N Engl J Med.

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Broome Docs

MARCH 28, 2024

PMID: 34890894 Myth 1: Kayexalate is safe and useful. 2024 Jan 2;53(1):afad255. Yerke JR, Mireles-Cabodevila E, Chen AY, Bass SN, Reddy AJ, Bauer SR, Kokoczka L, Dugar S, Moghekar A. Casey wrote a protocol for peripheral noradrenaline 9 years ago… in 2015! Am J Emerg Med. 2022 Feb;52:85-91. 2021.11.030.

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EMDocs

JULY 15, 2023

A 65-year-old female with a history of diabetes, hypertension, obesity, chronic lymphedema and venous insufficiency presents to the ED with redness to her right leg noted 2 days ago but worsening since yesterday. aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. pneumoniae , S. pneumoniae , S. pneumoniae , S.

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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. Lancet 2015 6. JAMA Intern Med 2019 9. Am J Med 2021 5.

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Dr. Smith's ECG Blog

MAY 19, 2022

Written by Pendell Meyers, edits by Smith and Grauer A man in his late 20s with history of asthma presented to the ED with a transient episode of chest pain and shortness of breath after finishing a 4-mile run. At the time of evaluation in the ED, his symptoms were resolved. He typically runs 4 to 8 miles per day.

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EMDocs

FEBRUARY 17, 2024

1 Dissolvable illicit substances such as heroin are commonly strained through cotton or cigarette filters. Duration of opioid use greater than 1 year and type of opioids used are contributing factors. 137 129/47 2,000 5 Table 1. In: Baum GL, Wolinsky E (eds). Wolters Kluwer; 2015. Harrison DW, Walls RM.

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EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. 1 One study found that CTA head and neck was ordered for 2.5% of all patients in the ED for over 800 different stated indications. In a study of 17,903 CTAs ordered in the ED, Tu et al.

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EM Didactic

DECEMBER 19, 2018

Introduction Pain is one the most common presentation to the emergency department (ED) and therefore, we should be aware of novel treatments options, adjuncts that can be used in addition to conventional therapies. Opioids are among the most commonly used analgesics in ED. 2015 Apr;33(4):601.e5-7. 2015 Jul;16(7):1402-9.

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Don't Forget the Bubbles

JULY 5, 2023

Figure 1: Clinical manifestations and long-term consequences of sickle cell disease Training and education on sickle cell disease: Training and education are crucial to improve morbidity and mortality. with thanks A 15-month-old Kenyan boy presents to ED with right hand swelling. Blood culture is pending.

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REBEL EM

MAY 15, 2024

2011 Jun;153(6):773-9. Neutropenic Fever: Fever (one reading of 38.3C Neutropenic Fever: Fever (one reading of 38.3C Warnick, J., Stretton, K., Littlewood, T. Improving the immediate management of neutropenic sepsis in the UK: Lessons from a national audit. British Journal of Haematology. doi: 10.1111/j.1365-2141.2011.08693.x.

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FOAMfrat

JULY 1, 2023

In fact, Herbstritt 2012, identified that there was "no significant difference to time to intubate, intubating conditions, or intubating success rate when using 1 to 1.2 mg/kg Rocuronium versus 1 to 1.5 mg/kg of Succinylcholine during RSI in an ED setting." [1] mg/kg Rocuronium versus 1 to 1.5 Updated 2021 Oct 1].

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Dr. Smith's ECG Blog

APRIL 8, 2015

Summary of ED Approach to Syncope Please excuse the formatting problems, which I have not been able to fix! Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. Palpitations preceding syncope (highest value on EGSYS score) 9. Abnormal ECG – looks for cardiac syncope.

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