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

This Podcast Will Kill You

JANUARY 16, 2024

Manaresi, E. Hoelzer, Karin, et al. Pt 9 (2008): 2280. History Biology Allison, Andrew B., “Role of multiple hosts in the cross-species transmission and emergence of a pandemic parvovirus.” ” Journal of virology 86.2 2012): 865-872. Heegaard, E.D. and Brown, K.E., Human parvovirus B19. Allison, Andrew B.,

E-9-1-1 95

E-9-1-1 ALS 95

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.

E-9-1-1 123

E-9-1-1 Coronary ACS BLS 123

ALiEM

OCTOBER 30, 2023

It should be no surprise that academic clinical educators are at high risk for burnout, stalled career advancement, and abandonment of academic medicine altogether [1, 2]. PMID 18945997 Elster MJ, O’Sullivan PS, Muller-Juge V, et al. 2022; 11(1):45-52. PMID 29686766 Jordan J, Coates WC, Clarke S, et al.

E-9-1-1 161

E-9-1-1 ALS OR 161

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. Answer : Brainstem stroke specifically in the pons resulting in locked in syndrome.

EMS 89

EMS E-9-1-1 ALS OR 89

Don't Forget the Bubbles

JANUARY 17, 2024

After Meshram et al, 2020 When Orbeez are exposed to water, the water molecules diffuse into the polymer network through osmosis. Image adapted from Mullens et al., After Darracq et al., A recent literature review by Caré et al. Zamora et al., From Mullens et al., His abdominal X-ray looked a lot like this.

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

This Podcast Will Kill You

NOVEMBER 27, 2023

” Cambridge: Cambridge University Press 197 (1993): 9-23. Parasites & Vectors , 15 (1), pp.1-9. Brown, Amanda MV, et al. The Lancet Global Health , 8 (9), pp.e1186-e1194. Ferri, Emanuele, et al. Gerth, Michael, et al. Kaur, Rupinder, et al. Quek, Shannon, et al. Addiss, D. Kenneth, F.

E-9-1-1 52

E-9-1-1 ALS ED 52

This Podcast Will Kill You

OCTOBER 24, 2023

2005): 1-6. Bulletin of Science, Technology & Society , 25 (1), pp.37-45. “Insecticide toxicology, mammalian toxicity of 1-naphthyl-N-methylcarbamate (Sevin insecticide).” Stewart, Nelson E., “Acute toxicity of the insecticide Sevin® and its hydrolytic product 1-naphthol to some marine organisms.”

E-9-1-1 52

E-9-1-1 ED ALS 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. ” Journal of Dermatological Treatment (2019). Taylor & Francis, 2022.

E-9-1-1 52

E-9-1-1 ALS ED OR 52

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 93

E-9-1-1 Plasma Epinephrine EMS 93

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

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.

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

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. Lion KC, et al. Regenstein M, et al.

Emergency Department 82

Emergency Department ALS E-9-1-1 ED 82

EMDocs

JANUARY 17, 2024

1) There are a limited number of antitussives on the US market which include benzonatate, codeine, dextromethorphan, diphenhydramine, and hydrocodone. 9) The safety announcement highlighted the mortality risk of exploratory ingestions in children under 10 years. 5) From 2012 to 2019, pediatric benzonatate prescribing soared by 62%. (9)

E-9-1-1 67

E-9-1-1 Overdose Emergency Medical Services Life Support 67

EMDocs

JUNE 14, 2023

Patellar reflexes are 1+. 1, 2, 4, 9 Organophosphates are one of many types of insecticide and are used worldwide to manage crops. 1, 2 Symmetric sensorimotor axonopathy: leg cramping to extremity weakness and paralysis. 1, 2 Sensory > Motor neurons with predilection for long axons. Muscle tone is normal.

E-9-1-1 70

E-9-1-1 Emergency Department Plasma ED 70

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. McGraw Hill, 2019.

E-9-1-1 66

E-9-1-1 ALS Emergency Department Plasma 66

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

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

EMDocs

JULY 3, 2023

9 Delayed NCHCT is less sensitive due to decreased visibility of blood collection secondary to red blood cell (RBC) degradation. 12 A few studies have shown that phenytoin with a loading dose of 1 g decreases seizure incidence in spontaneous SAH. 2022 Jan;39(1-2):35-48. 2019 Mar;123:184-187. Zanon E, Pasca S.

ED 85

ED E-9-1-1 ALS OR 85

Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Which is a risk of 1 event for 62.5 Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications.

E-9-1-1 130

E-9-1-1 OR ACS ALS 130

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

Don't Forget the Bubbles

JUNE 30, 2023

E – Temp 37.2 Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7% Last year, Kornelson et al. A retrospective cohort study in Japan by Maeda et al.

E-9-1-1 145

E-9-1-1 OR ALS Critical Care 145

Don't Forget the Bubbles

FEBRUARY 26, 2024

In 2015, Silva et al. 2007 Jan 1;25(1):6-9. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. Add in PEFR <33% and SpO2 <92% Management of acute asthma* * as per BTS guidelines Acute asthma is managed in a stepwise fashion using the following guidelines. Frontiers in Pediatrics.

E-9-1-1 72

E-9-1-1 Critical Care OR ALS 72

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. Internet] 2019:23:3, 346-355, DOI: 10.1080/10903127.2018.1502383 Cataldo CG. Fnais N, Soobiah C, Chen MH, et al.

Critical Care 97

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

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Post cath ECG: Now there are hyperacute T-waves again, and recurrent ST depression in V2 This ECG would normally diagnostic of OMI until proven otherwise No further troponins were measured, but it looks like there is recurrent OMI Next day: A CT Coronary Angiogram was done (CTCA) CARDIAC MORPHOLOGY AND FUNCTION: 1. IMPRESSION: 1.

Coronary 104

Coronary E-9-1-1 STEMI ACS 104

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

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.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

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.

E-9-1-1 177

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

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Here they are: Learning Points: 1. 3–8 Shi et al. 7 These 3 studies, as well as 1 smaller meta-analysis, 6 and another small study, 8 make it clear that troponin is associated with increased severity and mortality in COVID when adjusted for multiple other variables. Sandoval Y, Smith SW, Sexter A, et al.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

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. Richards JE et al.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

Dr. Smith's ECG Blog

SEPTEMBER 7, 2020

The Differential Diagnosis is: SVT with aberrancy(#) [AVNRT vs. WPW (also called AVRT*)] Atrial flutter with 1:1 conduction, with aberrancy VT coming from the anterior fascicle ( fascicular VT )@ *AVRT = AV Reciprocating Tachycardia (Tachycardic loop that uses both the AV node and an accessory pathway. See Learning point 1 below.

E-9-1-1 52

E-9-1-1 ALS OR Coronary 52

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-9-1-1 107

E-9-1-1 ALS Defibrillator OR 107

Don't Forget the Bubbles

JULY 22, 2024

Compare this with the Panickar et al. study from 200 9. Fortunately, Lee et al. Lee B, Turner S, Borland M, Csonka P, Grigg J, Guilbert TW, et al. A large proportion of the trials come from Finland (3) and The UK (2) and also from Australia (1) and the US (1), but only a small number took place in the ED.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis [published online ahead of print, 2023 Aug 9]. Am J Emerg Med. 2023;73:34-39. Results: 26,069 studies met initial inclusion criteria.

E-9-1-1 120

E-9-1-1 ALS ACS ICU 120

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

Don't Forget the Bubbles

JUNE 17, 2024

Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J. 2014 Jun 26;23(12):653-9. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. 2020 Jan 1;35(1):70-6. 2019 May 31:bmjqs-2019. 2019 May;27(4):758-64. 2020 Aug 20.

E-9-1-1 105

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