Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. Intensive Care Research , 1 (3-4), pp.60-64. Epub 2014 Sep 9. Ann Emerg Med.

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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. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. PMID: 29681420 Gottschalk HP, Eisner E, Hosalkar HS. 1999 Jan;13(1):58-9. 2022 Aug 2.

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Don't Forget the Bubbles

JULY 17, 2023

You will find the list is broken down into four sections: 1.Reviews Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. 2023 Jun 1. 2023 Jun 1;76(6):731-736 The Association Between Media-Based Exposure to Nonsuicidal Self-Injury and Emergency Department Visits for Self-Harm. 2023 Jun 9.

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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. Upon arrival in the pediatric emergency department, the patient was conscious and alert to her normal mental status, which included being nonverbal.

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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. Acad Emerg Med 2021; 28(11): 1228-35. Can J Emerg Med 2007; 9(1): 30-2. Ann Emerg Med 1995;26:117-20. Acad Emerg Med; 1998; 5(2): 118-122.PMID:

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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. He reports distension and the sensation of fullness.

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REBEL EM

SEPTEMBER 13, 2023

patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01

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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?

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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.

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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. Actively oozing.

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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.

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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. Acad Emerg Med 2021; 28(11): 1228-35. Can J Emerg Med 2007; 9(1): 30-2. Ann Emerg Med 1995;26:117-20. Acad Emerg Med; 1998; 5(2): 118-122.PMID:

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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. Pneumothorax recurrence within 1 year: 20% for aspirations, 27% for chest tubes. Panacek, E. Strange, C.,

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EMDocs

JUNE 1, 2023

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% Average ventilator days (8.3 Bradycardia: 18.8%

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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., 1 Of the 57 children, 96% had confirmed exposures to the acetaminophen-based teething medication.

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Broome Docs

JANUARY 30, 2023

2017 Dec 7;377(23):2240-2252. PMID: 33933300 Khan A, Saleem MS, Willner KD, Sullivan L, Yu E, Mahmoud O, Alsaid A, Matsumura ME. Association of Chest Pain Protocol-Discordant Discharge With Outcomes Among Emergency Department Patients With Modest Elevations of High-Sensitivity Troponin. 2022 Sep 1;5(9):e2235575.

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EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? Updated November 9, 2023. Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department. Ann Emerg Med. Erratum in: Ann Emerg Med.

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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. 9 Less likely to be satisfied with their care and have a lower understanding of their discharge instructions. Annals of Emergency Medicine. 45:446-458.

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REBEL EM

JANUARY 23, 2023

Patients were randomized in a 1:1 ratio. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Multicenter study of emergency department visits for insect sting allergies. 2005 Sep;116(3):643-9. Multicenter study of emergency department visits for food allergies. Schaefer P.

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ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. or 9 size endotracheal tube to allow for bronchoscopy and/or endobronchial blocker placement whenever necessary. He is the founder and host of Emergency Medicine Cases podcast and website.

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Dr. Smith's ECG Blog

JANUARY 13, 2024

Spikes 2, 3, 4, 5, 7, 8, and 9 all occur either during or immediately after P waves which should never happen. Repeat ECG from the emergency department is shown. Regarding Today's Tracing: For clarity in Figure-1 — I have reproduced and labeled the initial ECG in today's case. The radiologist did not comment on this.

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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. 2021:36:1–2, NP448–NP473 Available at. Review of Cultivating Communities of Practice: A Guide to Managing Knowledge, by Wenger E, McDermott R, Snyder WM].

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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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Don't Forget the Bubbles

JANUARY 10, 2024

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. The study asked TWO questions: 1. 3,950 children were recruited between September 2014 to May 2017. 8% die in hospital, with a further 12% dying in the six months following discharge.

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FOAMfrat

JULY 1, 2023

titled "The Association of Rocuronium Dosing and First-Attempt Intubation Success in Adult Emergency Department Patients" revealed that first-attempt intubation success was the highest when more than 1.4 mg/kg Rocuronium versus 1 to 1.5 mg/kg Rocuronium versus 1 to 1.5 Ann Emerg Med. Updated 2021 Oct 1].

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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. Investigations : Bloods show Hb of 8 g/L, White cell count 13x 10 9 /L, Platelets 570 x10 9 /L, CRP 35mg/L.

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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). However, ABGs have many drawbacks compared to VBGs.

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Don't Forget the Bubbles

SEPTEMBER 18, 2023

This blog post aims to help familiarise you with some of the most common reasons for prescribing antibiotics in the paediatric emergency department. Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review. 2017 Sep 7 [cited 2022 Dec 28];2022(8). 2017 May 8;30(4):319–26.

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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. Low-dose ketamine vs morphine for acute pain in the ED: a randomized controlled trial Am J Emerg Med. 2017.03.004.

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ALiEM

OCTOBER 30, 2024

Due in large part to the proliferation of anonymous chemical factories able to produce industrial volumes of inexpensive synthetic opioids without opium or other controlled precursors, fentanyl spilled into the United States, Canada, and Europe, heroin soon fell to market forces [1, 2]. Xylazine withdrawal is controversial.

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Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Written by Destiny Folk MD, with edits by Meyers, peer reviewed by Smith and Grauer A woman in her late 20s with a past medical history of cervical cancer status post chemotherapy and radiation therapy presented to the emergency department for shortness of breath, chest tightness, and two episodes of syncope. 2013 Sep;26(9):965-1012.e15.

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Dr. Smith's ECG Blog

DECEMBER 27, 2018

A Deep Neural Network learning algorithm outperforms a conventional algorithm for emergency department electrocardiogram interpretation. S-wave is in V2 = 17 mm S-wave V4 = 9 mm Total = 26 (not greater than 28), so not LVH by the new rule! JACC 69(23):1694-1703; April 4, 2017. What an honor. Peguero JG et al.

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EMDocs

OCTOBER 5, 2024

A 62-year-old female patient with a history of recurrent urinary tract infections (UTIs) presents to the emergency department with fever, chills, and dysuria. 3 Epidemiology 4-8 ESBL-producing Enterobacteriaceae (ESBL-E) have been reported worldwide. The gastrointestinal tract is the main reservoir for ESBL-E.

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EMDocs

NOVEMBER 16, 2024

1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 2020 Sep 30;5(9):558-567. 10% of patients.

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REBEL EM

MAY 15, 2024

Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Epub 2017 Nov 22. 2011 Jun;153(6):773-9. Ann Emerg Med. 2017 Jun;69(6):755-764. Support Care Cancer. 2018 May;26(5):1465-1470.

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Don't Forget the Bubbles

SEPTEMBER 20, 2023

Do not obtain abdominal radiographs for suspected constipation The parents of 4-year-old Matthew bring him into the Emergency Department with abdominal pain. Functional constipation and nonspecific, generalized abdominal pain are common presenting complaints for children in emergency departments. 2012;161(1):44–50.e502.

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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. pneumoniae , S. pneumoniae , S. pneumoniae , S.

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