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). Balk et al.,

E-9-1-1 246

E-9-1-1 Emergency Department ALS OR 246

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

ECG #1 Interpretation: ECG #1 shows sinus rhythm at a heart rate of 77 bpm. Following more detailed questioning — it turned out the patient had started taking 9 different herbal remedies to ease lethargy and unspecific neurological symptoms. For clarity in Figure-1 — I've reproduced the initial ECG in today's case.

E-9-1-1 104

E-9-1-1 ALS Defibrillator OR 104

ACEP Now

FEBRUARY 13, 2024

A radiograph is shown (see figure 1). LEARN MORE The most common nerve blocks in this study are shown in Table 1. 1–4 Emergency physicians commonly prescribe opioid pain medications, and there is significant variability among prescribing patterns. In the January issue of Annals of Emergency Medicine , Merz-Herrara, et al.,

E-9-1-1 52

E-9-1-1 Emergency Department ED ALS 52

This Podcast Will Kill You

JANUARY 2, 2024

2002): 1-7. 2017): 128-129. Nature Reviews Endocrinology , 7 (9), pp.540-557. Devogelaer, Jean-Pierre, et al. Endocrine reviews , 43 (1), pp.61-90. Molecular and Cellular Pediatrics , 7 (1), pp.1-9. Sochett, E. Annual review of biochemistry , 78 , pp.929-958. and Glorieux, F.H., Bickel, Ralph K.

E-9-1-1 52

E-9-1-1 ALS OR 52

Don't Forget the Bubbles

JULY 17, 2023

’, ‘ Does the language of the patient influence A&E triage? ’, ‘ What is the association between breastfeeding duration and educational achievement? ’, and ‘ What are the findings of the SCOUT trial? ’. You will find the list is broken down into four sections: 1.Reviews Sethi SK, et al. Agostino H, et al. 2023 Jun 1.

E-9-1-1 98

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

Dr. Smith's ECG Blog

AUGUST 14, 2024

R waves 6 through 9 have no preceding P waves and are suspiciously regularly spaced. Depolarization wavefronts exit the sinus node through one or several sinoatrial conduction pathways (SACP) as seen in the histology section below taken from Li et al. Impulses E, F, G, H, and I were blocked. This is consistent with sinus rhythm.

E-9-1-1 94

E-9-1-1 OR ALS 94

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. 2009 Jun 11.

E-9-1-1 97

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

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

To me, it was clearly atrial flutter with 1:1 conduction. Continue Eliquis 5mg BID, should be continued for 3 months == MY Comment , by K EN G RAUER, MD ( 9/18 /2024 ): == I found the following aspects of today's case of special interest. Why did Dr. Smith immediately say the rhythm was AFlutter with 1:1 AV conduction?

E-9-1-1 64

E-9-1-1 ALS OR ED 64

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% per year incidence of SCD in this cohort [1].

E-9-1-1 70

E-9-1-1 CAD OR STEMI 70

REBEL EM

NOVEMBER 6, 2024

1998 Jan-Feb;6(1):15-23. PMID: 32644703 Robinson PM, Griffiths E, Watts AC. 2017 Jul;9(3):195-204. PMID: 29681420 Gottschalk HP, Eisner E, Hosalkar HS. 1999 Jan;13(1):58-9. J Am Acad Orthop Surg. doi: 10.5435/00124635-199801000-00002. PMID: 9692937 Decker N, Norse A. Anterior Elbow Dislocation.

E-9-1-1 59

E-9-1-1 ACS OR Emergency Department 59

EMDocs

JULY 17, 2023

1 While less common than small bowel obstruction (SBO), obstruction of the large bowel is more likely to be a surgical emergency and is often associated with a serious underlying condition. 1 The most common causes of non-cancer-related LBO are cecal and sigmoid volvulus. Small bowel dilation may also be seen.

E-9-1-1 76

E-9-1-1 ED Operating Room ALS 76

This Podcast Will Kill You

NOVEMBER 12, 2024

1996 Jul;10(9):1002-13. Dermato-endocrinology , 1 (3), pp.162-169. International journal of women’s dermatology , 8 (1), p.e003. Aesthetic Surgery Journal , 30 (1), pp.74-77. The Journal of clinical and aesthetic dermatology , 14 (9), p.33. Bagatin, E., Routledge, 2013. Draelos, ZK, editor. Amichai, B.

E-9-1-1 52

E-9-1-1 ALS ED OR 52

This Podcast Will Kill You

SEPTEMBER 10, 2024

Perantoni, E., Kaimakamis, E., In Precision Medicine Powered by pHealth and Connected Health: ICBHI 2017, Thessaloniki, Greece, 18-21 November 2017 (pp. Longtin, Yves, et al. JMIR Medical Informatics, 9(1), p.e22753. Lung sounds recordings: Rocha, B.M., Vogiatzis, I., Natsiavas, P., Oliveira, A.,

E-9-1-1 52

E-9-1-1 ALS 52

This Podcast Will Kill You

NOVEMBER 5, 2024

1996 Jul;10(9):1002-13. Dermato-endocrinology , 1 (3), pp.162-169. International journal of women’s dermatology , 8 (1), p.e003. Aesthetic Surgery Journal , 30 (1), pp.74-77. The Journal of clinical and aesthetic dermatology , 14 (9), p.33. Bagatin, E., Routledge, 2013. Draelos, ZK, editor. Amichai, B.

E-9-1-1 52

E-9-1-1 ALS ED OR 52

EMS 12-Lead

APRIL 28, 2022

Initial vital signs include: NIBP 99/58 HR 150-160 (trend) RR 10 (spontaneous, but shallow) SpO2 86 (RA) BBS CTA The initial rhythm strip is attached: Figure 1 There is a wide complex tachycardia of varying morphology, amplitude, and R-R cycle length. A prominent vertical scar, however, is noted at the sternum.

E-9-1-1 130

E-9-1-1 ALS Coronary EMS 130

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. Blood tests Urine Stool Full blood count with blood film Urinalysis Stool MC&S Coagulation Urine MC&S E.

E-9-1-1 59

E-9-1-1 ALS OR 59

EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? Rosh Review Website Link Further Reading: FOAMed: [link] [link] [link] [link] [link] [link] [link] References : Turi B, Smith D, Kusel K, et al. Updated November 9, 2023. link] Sharma R, Gaillard F, Bell D, et al.

EMS 88

EMS E-9-1-1 ALS OR 88

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. PMID 25629740 Hassen GW et al. PMID 23062323 Kostis JB et al. Zuraw et al.

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

REBEL EM

FEBRUARY 21, 2024

The ceiling pain relief dose for ketorolac is 15 mg IV ( Motov 2017 ). Read More REBEL EM: The Ketorolac Analgesic Ceiling References Irizarry E et al. PMID: 34133820 Arora S et al. Can J Emerg Med 2007; 9(1): 30-2. PMID: 17391598 Wright JM et al. PMID: 7618770 Neighbor ML et al.

E-9-1-1 64

E-9-1-1 Emergency Department ALS ED 64

REBEL EM

MAY 27, 2024

What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy. No significant differences in heart rate 1 minute after cardioversion were observed between the three groups.

OR 137

OR E-9-1-1 ED ALS 137

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? 2022 Jul 5;328(1):57-68. 2020 Feb 12;10(1):2470.

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

EMS 12-Lead

AUGUST 22, 2022

Question 1: What is the rhythm? Beat 1 : Sinus, narrow QRS complex. The assumption is that a premature complex discharged prior to Beat 1, which prolonged its respective refractory period in the same manner as Beat 5. We can, therefore, put down the defibrillation pads, set aside the amiodarone, and look further at the ECG.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

EMDocs

APRIL 10, 2024

1-5] Since then, many more medications have been developed and deployed. 1-5] This post focuses on the identification and management of Local Anesthetic Systemic Toxicity (LAST). 3-5,7] Symptom onset is usually within 1 minute of intravascular injection but can be delayed if multiple injections or continuous infusion. [5]

E-9-1-1 92

E-9-1-1 Plasma Epinephrine Life Support 92

REBEL EM

FEBRUARY 5, 2024

Article: Marx T, Joly LM, Parmentier AL, et al. 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. Panacek, E. Cochrane Database of Systematic Reviews 2017, Issue 9.

E-9-1-1 105

E-9-1-1 ALS Emergency Department OR 105

EMDocs

SEPTEMBER 7, 2023

1 Clinical Questions: When should a clinician suspect diethylene glycol (DEG) toxicity? Metabolism of DEG adapted from Bessenhofer, et al. Toxicity typically evolves through three phases: 2,3,7,8,9 Phase 1: Gastrointestinal symptoms (e.g., References: Abubukar et al. Nelson, et al. Schier, Capt.

E-9-1-1 65

E-9-1-1 ALS Emergency Department Plasma 65

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. References Overgaard, Dzavik et al. Jentzer et al. Circulation 2011.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

This Podcast Will Kill You

NOVEMBER 7, 2023

New England Journal of Medicine, 355(1), pp.51-65. Nature reviews Disease primers, 1(1), pp.1-20. Lee, Carrie, et al. Craythorne, E. and Al-Niami, F., International journal of dermatology, 49(9), pp.978-986. Public Health Research & Practice, 32(1). Taylor & Francis, 2022. Miller, A.J.

E-9-1-1 52

E-9-1-1 ALS ED OR 52

REBEL EM

AUGUST 28, 2023

The ceiling pain relief dose for ketorolac is 15 mg IV ( Motov 2017 ). Read More REBEL EM: The Ketorolac Analgesic Ceiling References Irizarry E et al. PMID: 34133820 Arora S et al. Can J Emerg Med 2007; 9(1): 30-2. PMID: 17391598 Wright JM et al. PMID: 7618770 Neighbor ML et al.

E-9-1-1 52

E-9-1-1 Emergency Department ALS ED 52

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. Actively oozing.

E-9-1-1 139

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

NAEMSP

JANUARY 5, 2023

1] The Adult Cardiac Arrest ACLS algorithm currently includes epinephrine and either amiodarone or lidocaine as recommended pharmacologic therapies. al answered this question with a prospective observational study which showed a significantly shorter time interval to obtain tibial IO access (4.6 1] Table from Hamam et al.

E-9-1-1 52

E-9-1-1 Advanced Life Support Epinephrine Life Support 52

EMDocs

MARCH 30, 2024

Comprehensive physical exam is unremarkable, but she does have pain at the T-12/L-1 region of her back. Her patellar reflexes are 1+ bilaterally, no ankle clonus is noted, and she denies any saddle anesthesia or bowel/bladder incontinence. CT of lower spine is ordered and shows the following: 1 What is the diagnosis?

EMS 89

EMS E-9-1-1 Emergency Department Ambulance 89

EMDocs

JUNE 1, 2023

Source Article: Cooper DJ, Nichol AD, Bailey M, et al. Bradycardia: 18.8% Average ventilator days (8.3 Take Aways: The data do not suggest that targeted hypothermia improves neurological function, reduces death, or reduces hospital length of stay as compared to normothermia. Bradycardia: 18.8% Average ventilator days (8.3 Bradycardia: 18.8%

E-9-1-1 61

E-9-1-1 Emergency Medical Services Emergency Department OR 61

ACEP Now

NOVEMBER 14, 2023

1 However, it is important to understand that death from hemoptysis is almost always due to hypoxia or asphyxiation (blood impedes gas exchange in the lungs, typically because of bleeding from high-pressure bronchial arteries into the lungs) as opposed to hemodynamic instability. 2021;42(1):145-159. Li H, Ding X, Zhai S, et al.

E-9-1-1 52

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

REBEL EM

SEPTEMBER 26, 2022

A meta-analysis of fifteen RCTs comparing blood product transfusion rates of cardiothoracic and surgery patients found significantly lower transfusion rates of FFP in TEG/ROTEM guided group compared to traditional tests, with no difference in survival rates (Fahrendorff 2017). Article: Kumar M et al. 2020;71(1):235-246.

FFP 52

FFP E-9-1-1 ICU ALS 52

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

EMDocs

MARCH 4, 2024

A wide variety of conditions can result in either type of cholestasis (Figure 1). 1 Extrahepatic obstruction is due to mechanical obstruction occurring downstream of the hepatic ducts such as pancreatic disease, gallstone obstruction of the common bile duct, and cancer. 9 How are cholestatic labs defined?

Emergency Department 86

Emergency Department E-9-1-1 ALS OR 86

Don't Forget the Bubbles

JANUARY 10, 2024

Maitland K, Olupot-Olupot P, Kiguli S, et al. doi:10.1056/NEJMoa1900100 Maitland K, Kiguli S, Olupot-Olupot P, et al. The study asked TWO questions: 1. 3,950 children were recruited between September 2014 to May 2017. Transfusion Volume for Children with Severe Anemia in Africa. N Engl J Med. 2019;381(5):420-431.

E-9-1-1 78

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