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. 2018 Aug;46(3):144-151.

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

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.

E-9-1-1 77

E-9-1-1 ED ALS Operating Room 77

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 90

EMS E-9-1-1 Emergency Department Ambulance 90

EMDocs

JUNE 7, 2023

1-5 Farmers also treat sheep for parasites using OPs and may become symptomatic after exposure, an illness called Dipper’s Flu. 8 Intermediate syndrome Occurs 1 to 5 days after acute exposure in up to 40% on individuals. 7, 9 Often have absence of excessive cholinergic stimulation. 7 May lead to respiratory failure.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

EMDocs

NOVEMBER 18, 2023

A point of care ultrasound of the liver reveals the following: Image 1: Ultrasound of the liver showing abnormal hepatic artery flow and resistance index 1 Question: What is the diagnosis? Rosh Review Website Link References 1) Karmazyn B, Sağlam D, Rao GS, Jennings SG, Mangus RS. In: Molmenti E, Santibañes M, Santibañes E.

EMS 69

EMS E-9-1-1 ALS Emergency Department 69

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. Addo-Yobo E, Chisaka N, Hassan M, Hibberd P, Lozano JM, Jeena P, et al.

Emergency Department 142

Emergency Department E-9-1-1 ALS OR 142

EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? Updated November 9, 2023. Available from: [link] American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Use of Intravenous tPA for Ischemic Stroke:; Brown MD, Burton JH, Nazarian DJ, Promes SB.

EMS 89

EMS E-9-1-1 ALS OR 89

Don't Forget the Bubbles

AUGUST 28, 2023

Five-year-old Ginny presents to the Emergency Department with a syncopal episode. The median age at diagnosis was 47 months (range 1-173 months). 2014;9(9):S102-S109. doi:10.1136/archdischild-2018-315269 Hammer MM, Miskin N, Madan R, Hunsaker AR. 2019;43(1):98-103.doi:10.1097/RCT.0000000000000782

Emergency Management 96

Emergency Management Emergency Manager E-9-1-1 Critical Care 96

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

E-9-1-1 177

E-9-1-1 Emergency Department ALS ED 177

Broome Docs

OCTOBER 31, 2022

Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. 2022 Jan;48(1):78-91. 2022 Sep;21(9):781-791. 2018 Sep 11;362:k3843. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Emerg Med J. Intensive Care Med.

E-9-1-1 52

E-9-1-1 Defibrillator ICU Critical Care 52

Don't Forget the Bubbles

FEBRUARY 5, 2024

The study surveyed 2855 Canadian adolescents in 2018 and found that those who skipped breakfast were 2.55 Paediatric advocacy still has a long road ahead… You will find the list is broken down into four sections: 1.Reviews 2024 Jan 1;43(1):e11-e13. 2024 Jan 9. 2024 Jan 1;153(1):e2022060119. 2024 Jan 1;178(1):81-84.

E-9-1-1 52

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

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. 2022 Jan;39(1-2):35-48.

ED 85

ED E-9-1-1 ALS OR 85

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].

Critical Care 97

Critical Care E-9-1-1 Paramedicine Paramedicine 97

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.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

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?

E-9-1-1 120

E-9-1-1 OR Coronary ACS 120

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. Acad Emerg Med. 1994 Jul;125(1):57-62. 2018 Mar;28(3):210-217. West J Emerg Med. 2019 Sep;74(9):1186-1190.

E-9-1-1 183

E-9-1-1 Operating Room Emergency Department ALS 183

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! For clarity — I’ve reproduced this ECG, to which I’ve made a few additions ( Figure-1 ).

E-9-1-1 52

E-9-1-1 STEMI ALS OR 52

Don't Forget the Bubbles

JUNE 17, 2024

Introduction: Civility Matters Healthcare environments, particularly emergency departments, are characterised by high levels of Volatility, Uncertainty, Complexity, and Ambiguity ( VUCA ). Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J.

E-9-1-1 105

E-9-1-1 Critical Care CPR ICU 105

Don't Forget the Bubbles

JULY 22, 2024

The 2018 PREVIEW trial reported a significant reduction in length of stay (LOS) in children given prednisolone in Australia (24-71 months, mean 41 months) compared to placebo. study from 200 9. Castro-Rodriguez JA, Beckhaus AA, Forno E. Annals of Emergency Medicine. 2019 Aug;9(8):e028511. Pediatr Pulmonol.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

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

REBEL EM

JANUARY 23, 2023

Second-generation H1 antihistamines (cetirizine, loratadine, and fexofenadine) do not cross the blood-brain barrier as easily (Bernstein J 2018). Patients were randomized in a 1:1 ratio. Philadelphia: Wolters Kluwer Health; 2018. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Ledford, D.

Allergic Reaction 52

Allergic Reaction ED E-9-1-1 Emergency Department 52

EMDocs

JUNE 1, 2023

2018; 320(21):2211-2220. 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

E-9-1-1 61

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

REBEL EM

JANUARY 25, 2024

A 2018 systematic review and meta-analysis of 25 studies focusing on the accuracy of emergency lung ultrasound showed sensitivity of 85-95% and specificity of 75-90% for pneumonia, sensitivity of 78% and specificity of 94% for COPD/asthma, and sensitivity of 75-90% and specificity of 80-90% for acute heart failure [4].

ED 128

ED E-9-1-1 Emergency Department ALS 128

FOAMfrat

OCTOBER 20, 2023

As reported within the 6th edition Manual of Emergency Airway Management, there are cardiac arrest rates between 1% and 4%, with other complications (mostly hypoxemia and hypotension) as high as 30% in patients with first-pass success [1, pg 29; 4-10]. Recommendations : 1. Why is Physiologic Optimization Important?

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

REBEL EM

DECEMBER 10, 2023

Background: The use of ultrasound is well established for trauma patients in the emergency department, with almost every patient receiving a FAST (Focused Assessment with Sonography in Trauma) examination as part of the “ABC’s” of trauma. 2022 Jan 1;92(1):44-48. 2015 Jan;39(1):172-8. Acad Emerg Med.

E-9-1-1 40

E-9-1-1 Emergency Department OR ALS 40

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

EMDocs

JANUARY 6, 2024

1 Indications for transplant include: Non-ischemic cardiomyopathy (49%) Ischemic cardiomyopathy (35%) Restrictive cardiomyopathy (4%) Retransplantation following failed prior transplant (3%) Hypertrophic cardiomyopathy (3%) Congenital heart disease (3%) Valvular cardiomyopathy (3%) The median survival after heart transplant is over 12 years.

EMS 63

EMS E-9-1-1 ACS Coronary 63

REBEL EM

JULY 18, 2022

Am J Emerg Med. 2013 Sep;31(9):1389-92. These authors performed an additional study in 2018, “Topical TXA Vs. Anterior Nasal Packing In Epistaxis With Antiplatelet Drugs” (3) which looked specifically at patients on antiplatelet medications. Ann Emerg Med. Paper: Zahed R, Moharamzadeh P, Alizadeharasi S et al.

E-9-1-1 52

E-9-1-1 Epinephrine ED ALS 52

ACEP Now

JANUARY 13, 2024

1 That is the last line in Dr. Robert Ray, Jr.’s s eye-opening and intensely raw blog, where he details his experiences with institutional and systemic racism during his emergency medicine residency. percent of physicians being Black (as of 2018). 2006;98(9):1415-24. Hill K, Samuels E, Gross C, et al. Grubbs V.

E-9-1-1 52

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

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% 8 The VAN (vision, aphasia, neglect) score ( Figure 1 ), first proposed by Teleb et al. of patients with blunt multisystem trauma.

E-9-1-1 87

E-9-1-1 ALS Emergency Department ED 87

EMDocs

JANUARY 20, 2024

She describes the pain as left-sided, non-radiating, and 9/10 in severity. Answer: Takotsubo Cardiomyopathy 1-18 Background: Also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, stress cardiomyopathy, Gebrochenes-Herz syndrome, and broken-heart syndrome.

E-9-1-1 74

E-9-1-1 EMS Coronary ACS 74

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.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

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. 2018 May;26(5):1465-1470. 2011 Jun;153(6):773-9. Ann Emerg Med. Neutropenic Fever: Fever (one reading of 38.3C Support Care Cancer.

E-9-1-1 104

E-9-1-1 OR Emergency Department ALS 104

Don't Forget the Bubbles

NOVEMBER 5, 2023

They analysed the French National Health Insurance registry of all pregnancies and births from 2010 to 2018 and found that there was an increased risk of hospitalization in children who had had a PPI (with adjusted hazard ratios between 1.34 2023 Oct 9. 2023 Oct 9. Soydan E, et al. Harstad E, et al. 2023 Oct 20.

E-9-1-1 105

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

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 Updated 2021 Oct 1]. This dose is: 1.0

E-9-1-1 52

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

Don't Forget the Bubbles

AUGUST 10, 2023

We will focus on the most important structures when assessing paediatric hands in the emergency department. There are 5 annular ligaments on each finger and 2 for the thumb, 3 Cruciate ligaments associated with each finger and 1 Oblique ligament that is associated with the thumb.

E-9-1-1 52

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