Paramedics Unlimited

MARCH 28, 2017

At Paramedics Unlimited we’ve had our three RT130 Arduous Pack Tests and Physical Assessment classes in preparation for Wildland Season 2017. We are ready for fire season 2017. Our paramedics and EMT’s have learned so much, they are highly motivated and skilled, incredibly fit, and work together to build a strong team.

Paramedic 52

Paramedic 52

Core EM

JANUARY 25, 2024

Annual incidence of approximately 2-4 cases/million/year (Kappler, 2017), with 90% of cases occurring in adulthood. Joly, 2017) Risk factors include: Female, 2:1 female to male predominance (Terrell, 2010) Black race Obesity TTP is a life-threatening condition with mortality of 10-20% despite targeted therapies.

Plasma 246

Plasma Frozen Plasma Emergency Department FFP 246

Pediatric EM Morsels

OCTOBER 6, 2023

Let us take a moment to review Typhoid Fever in children : Typhoid Fever: Basics Salmonella enterica serotype Typhi is the causative bacteria and represents 75% of cases of enteric fever (GBD 2017) Salmonella enterica serotypes Paratyphi A, B and C cause Paratyphoid fever which has clinically indistinguishable features.

OR 161

OR EMS ED 161

Pediatric EM Morsels

JUNE 2, 2023

2017 Jun 27;10:197-207. Michelet M, Schluckebier D, Petit LM, Caubet JC. Food protein-induced enterocolitis syndrome – a review of the literature with focus on clinical management. J Asthma Allergy. doi: 10.2147/JAA.S100379. PMID: 28721077; PMCID: PMC5499953.

Emergency Department 189

Emergency Department ALS EMS OR 189

Pediatric EM Morsels

NOVEMBER 15, 2024

There are associated co-morbiditiested [Lee 2017, Steinrueke 2023] BECTS Seizures / Benign Rolandic Epilepsy- Moral of the Morsel It’s not a stroke, it’s a seizure. 2017 Jun 30;7(1):1-6. Symptoms can be unilateral and involve the face and tongue, but it’s not a stroke! Available from: [link] Lee YJ, Hwang SK, Kwon S. J Epilepsy Res.

ALS 152

ALS OR EMS 152

The Skeptics' Guide to EM

OCTOBER 28, 2023

. * Acetaminophen ( Williams et al Lancet 2014) * Muscle relaxants ( Friedman et al JAMA 2015) * NSAIDs ( Machado et al Ann Rheum Dis 2017) * Steroids ( Balakrishnamoorthy et al Emerg Med J 2014) * Benzodiazepines ( Friedman et al Ann Emerg Med 2017) Many non-pharmacologic therapies have also been tried with limited efficacy.

ALS 221

ALS Emergency Department ED OR 221

Core EM

JANUARY 25, 2024

mEq/L Effect starts 10-20 mins after administration and can last 4-6 hours Albuterol 10-20 mg over 10 mins (NB: higher dose than for asthma) Peak effect at 90 mins Decreases by 0.5 – 1.0 mEq/L alone With insulin, ~1.2 mEq/L, additive effect Bicarbonate Controversy.

Epinephrine 246

Epinephrine OR ED 246

The Skeptics' Guide to EM

MAY 14, 2022

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). Unfortunately, none of these other treatment modalities has high-quality evidence supporting their use.

ALS 130

ALS Emergency Department ED OR 130

Pediatric EM Morsels

OCTOBER 27, 2023

Shah 2017] In Turkey, it has a “reliable correlation.” Gültekingil-Keser 2017] Broselow out-performed age-based formulas (Theron, APLS, and Shann) in New Zealand, estimating within 10% of actual weight 73% of the time. 2017), Evaluation of the accuracy of common weight estimation formulae in a Zambian paediatric surgical population.

E-9-1-1 269

E-9-1-1 Emergency Medical Services Life Support ALS 269

Core EM

JANUARY 25, 2024

Joaquín Valle Alonso, Ganapathiram Lakshmanan, Yasser Saleem, Use of POCUS Ultrasound in sepsis, bedside diagnosis of necrotizing fasciitis, QJM: An International Journal of Medicine , Volume 110, Issue 10, October 2017, Pages 687–688. Magalhães L, Martins SR, Nogué R. The Ultrasound Journal. 2020;12(1).

E-9-1-1 246

E-9-1-1 Emergency Department OR 246

Pediatric EM Morsels

APRIL 5, 2024

However, it is often overlooked that tickborne illnesses are among the most common travel-related illnesses globally (CDC Traveller’s Health 2017). 2017 Nov 3;11(11):e0006062. We frequently ask children and their parents if they have had recent tick bites when they present for fever after a recent camping activity.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

Critical Care Scenarios

DECEMBER 9, 2019

2017 Dec 7;377(23):2253-2265. 2017 Dec 7;377(23):2253-2265.* 2017 May;99(5):341-346. * 2017 Nov;43(11):1585-1593* Weng TC, Chen CC, Toh HS, Tang HJ. A troubling case of a painful finger. Resources References Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. N Engl J Med. Necrotizing Soft-Tissue Infections.

ALS 100

ALS 100

The Skeptics' Guide to EM

OCTOBER 28, 2017

[display_podcast] Date: October 24th, 2017 Reference: Harrison et al. Pediatrics 2017 Guest Skeptic: Dr. Anthony Crocco is a Pediatric Emergency Physician and is the Medical Director & Division Head of the Division of Pediatric Emergency at McMaster’s Children’s Hospital. Anthony is also the creator of SketchyEBM.

ALS 130

ALS Emergency Department OR ED 130

The Skeptics' Guide to EM

DECEMBER 8, 2017

[display_podcast] Date: November 28th, 2017 Reference: Motov S et al. display_podcast] Date: November 28th, 2017 Reference: Motov S et al. Guest Skeptic: Dr. Salim Rezaie is a faculty physician at Greater San Antonio Emergency Physicians (GSEP) in San Antonio, Texas. .

Emergency Department 130

Emergency Department ALS OR EMS 130

ALiEM

SEPTEMBER 1, 2023

2017 Mar;78(3 Suppl 2):S28-S31. Treatment includes not only drainage and systemic antibiotic therapy, but also emergent surgical intervention if complicated by necrotizing fasciitis. References Chen CE, Shih YC. Monomicrobial Klebsiella pneumoniae Necrotizing Fasciitis With Liver Abscess: A Case Report and Literature Review. Ann Plast Surg.

161

161

The Skeptics' Guide to EM

DECEMBER 29, 2017

[display_podcast] Date: December 28th, 2017 This is a special year end episode of the SGEM. It is time to reflect upon 2017 while at the same time look forward to 2018. display_podcast] Date: December 28th, 2017 This is a special year end episode of the SGEM. It has been an incredible year for a number of reasons.

130

130

The Skeptics' Guide to EM

SEPTEMBER 10, 2017

[display_podcast] Date: September 7th, 2017 Reference: Cohen et al. display_podcast] Date: September 7th, 2017 Reference: Cohen et al. Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial.

Emergency Department 130

Emergency Department ALS OR 130

ALiEM

APRIL 12, 2023

DOI 10.1016/B978-0-444-53632-7.01010-8 LeDonne S, Sengupta D. US Probe: Ultrasound Water Bath for Distal Extremity Evaluation. Alerhand S, Singh M, editors. emDOCs.net – Emergency Medicine Education.

Emergency Department 258

Emergency Department ALS ED 258

The Skeptics' Guide to EM

SEPTEMBER 3, 2017

[display_podcast] Date: September 2nd, 2017 Reference: Caputo et al. display_podcast] Date: September 2nd, 2017 Reference: Caputo et al. EmergeNcy Department use of Apneic Oxygenation versus usual care during rapid sequence intubation: A randomized controlled trial (The ENDAO Trial). Reference: Caputo et al.

Emergency Department 130

Emergency Department Operating Room Critical Care ALS 130

The Skeptics' Guide to EM

JULY 16, 2017

[display_podcast] Date: July 11th, 2017 Reference: Bookman K et al. AEM July 2017. display_podcast] Date: July 11th, 2017 Reference: Bookman K et al. AEM July 2017. AEM July 2017. Reference: Bookman K et al.

Emergency Department 130

Emergency Department ALS EMS 130

The Skeptics' Guide to EM

MAY 21, 2017

[display_podcast] Date: May 19th, 2017 Reference: Willman et al. Clinical Toxicology 2017. display_podcast] Date: May 19th, 2017 Reference: Willman et al. Clinical Toxicology 2017. Clinical Toxicology 2017. Do heroin overdose patients require observation after receiving naloxone? Reference: Willman et al.

Naloxone 130

Naloxone Overdose First Responder Emergency Department 130

The Skeptics' Guide to EM

SEPTEMBER 16, 2017

[display_podcast] Date: September 12th, 2017 Reference: Sinert et al. J Allergy Clin Immunol Pract 2017. display_podcast] Date: September 12th, 2017 Reference: Sinert et al. J Allergy Clin Immunol Pract 2017. J Allergy Clin Immunol Pract 2017. Reference: Sinert et al.

Epinephrine 130

Epinephrine ALS Emergency Department EMS 130

Core EM

JANUARY 8, 2024

Design Design Multi-center, retrospective study of 201 consecutive ED patients spanning from April 1, 2017, to April 22, 2017. Clinical Question What is the diagnostic accuracy of using CT abdomen pelvis (CT AP) without contrast compared to contrast-enhanced CT AP in ED patients with acute abdominal pain?

Emergency Department 100

Emergency Department EMS ED ALS 100

Core EM

OCTOBER 16, 2024

2017 Jul 1;9(1):4-8. L., & Arora, S. Blood product transfusions and reactions. Hematology/Oncology Clinics of North America , 31 (6), 1159–1170. link] Pollard R, Boraski M, Block JG. Hypotensive Transfusion Reaction Treated With Vasopressin in a Patient Taking an Angiotensin-Converting Enzyme Inhibitor: A Case Report. A A Case Rep.

Allergic Reaction 145

Allergic Reaction Plasma ED Epinephrine 145

ALiEM

FEBRUARY 16, 2024

Indian J Gastroenterol 36, 66–67 (2017). Initial treatment includes broad-spectrum antibiotics and cholecystostomy tube decompression. References Indiran, V., Prabakaran, N. & & Kannan, K. Hole sign” of the gallbladder. link] Jeffrey RB, Laing FC, Wong W, Callen PW. Gangrenous cholecystitis: diagnosis by ultrasound. 148.1.6856839.

Coronary 161

Coronary OR 161

FOAMcast

MARCH 27, 2023

Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Epub 2017 Oct 31. 2017 Dec 13;12(12):CD007720. Intensive Care Med.

Critical Care 52

Critical Care ACS ALS 52

ALiEM

FEBRUARY 20, 2024

2017 Jul;17(3):260-266. Valentino MA, Panakos A, Ragupathi L, Williams J, Pavri BB. Flecainide Toxicity: A Case Report and Systematic Review of its Electrocardiographic Patterns and Management. Cardiovasc Toxicol. PMID: 27435408. Wilgenhof A, Michiels V, Cosyns B. An irregular, extremely broad QRS complex rhythm. Am J Emerg Med.

Life Support 183

Life Support Overdose ED 183

The Skeptics' Guide to EM

NOVEMBER 18, 2017

[display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Critical Care Medicine 2017. display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Critical Care Medicine 2017.

ICU 130

ICU ED Emergency Department Critical Care 130

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

[display_podcast] Date: September 19th, 2017 Reference: Cournoyer et al. September 2017. display_podcast] Date: September 19th, 2017 Reference: Cournoyer et al. September 2017. Prehospital advanced cardiac life support for out-of-hospital cardiac arrest: a cohort study. Academic Emergency Medicine.

Life Support 130

Life Support CPR Advanced Life Support Defibrillator 130

The Skeptics' Guide to EM

OCTOBER 14, 2023

March 2023 * Population: Children 0-16 years recruited consecutively from October 2017 to September 2020 from three emergency departments and one urgent care centre in England- serving populations with significant inequalities in health and life expectancty. A prospective study. J Paediatr Child Health.

Life Support 221

Life Support Advanced Life Support Emergency Department ALS 221

ALiEM

SEPTEMBER 25, 2023

2017 Mar 13;1(2):104-107. Phlebology. 2021 Jun;36(5):392-400. doi: 10.1177/0268355520975581. Epub 2020 Nov 25. PMID: 33236674. Schroeder M, Shorette A, Singh S, Budhram G. Phelgmasia Cerulea Dolens Diagnosed by Point-of-Care Ultrasound. Clin Pract Cases Emerg Med. doi: 10.5811/cpcem.2016.12.32716. 2016.12.32716.

OR 152

OR 152

The Skeptics' Guide to EM

JULY 8, 2023

Wallach et al JAMA Intern Med 2017 , previously reported that subgroup claims are often not corroborated by subsequent studies and rarely confirmed. A subgroup analysis of the Lancet RCT showed that older, sicker patients with comorbidities and longer previous symptom duration recovered 2–3 days sooner.

ALS 237

ALS Emergency Department EMS ED 237

The Skeptics' Guide to EM

OCTOBER 22, 2017

[display_podcast] Date: October 19th, 2017 Reference: Hofmann et al. NEJM Sept 2017. display_podcast] Date: October 19th, 2017 Reference: Hofmann et al. NEJM Sept 2017. Oxygen Therapy in Suspected Acute Myocardial Infarction. Guest Skeptic: Marcus Prescott is a nurse in Norway. He is also now a first-year medical student.

Emergency Medical Services 130

Emergency Medical Services Coronary ALS STEMI 130

This Podcast Will Kill You

SEPTEMBER 3, 2024

” (2017). ” Current opinion in virology 22 (2017): 64-70. ” Nausea and vomiting: diagnosis and treatment (2017): 15-25. Environmental transmission of norovirus gastroenteritis. Current opinion in virology , 2 (1), pp.96-102. Davenport, Caillan, and Shushma Malik. Teunis, P.F.M., Sukhrie, F.H.A., Vennema, H.,

ALS 52

ALS OR 52

ALiEM

DECEMBER 18, 2023

2017 Jun 9;18(6):1243. Corticosteroids are the mainstay of treatment with gradual tapering over multiple months. References Cho YT, Yang CW, Chu CY. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS): An Interplay among Drugs, Viruses, and Immune System. Int J Mol Sci. doi: 10.3390/ijms18061243. PMID: 28598363; PMCID: PMC5486066.

Emergency Department 177

Emergency Department OR 177

ALiEM

JUNE 15, 2023

Elsevier; 2017. Convallatoxin, the primary cardiac glycoside in lily of the valley (Convallaria majalis), induces tissue factor expression in endothelial cells. Vet Med Sci. 2021 Nov;7(6):2440-2444. PMID 34469053 Graeme KA. Toxic plant ingestions. Auerbach’s wilderness medicine, 7e. Nelson LS, Shih RD, Balick MJ. In: Individual plants.

ALS 246

ALS ED OR 246

Don't Forget the Bubbles

AUGUST 19, 2024

2017 Sep;49(3):223-226. Epub 2017 May 23. Jang YN, Sohn HS, Cho SY, Choi SM. Primary Sternal Osteomyelitis caused by Staphylococcus aureus in an Immunocompetent Adult. Infect Chemother. doi: 10.3947/ic.2017.49.3.223. 2017.49.3.223. PMID: 28608656; PMCID: PMC5620390. Street M, Puna R, Huang M, Crawford H. J Pediatr Orthop.

Emergency Department 104

Emergency Department OR 104