ALiEM

AUGUST 16, 2023

Common agents include local anesthetics, dapsone, quinones, sulfonamides, phenazopyridine, and nitrites [1, 2]. Treatment for methemoglobinemia in G6PD deficiency may consist of ascorbic acid, exchange transfusion, and hyperbaric oxygen [7, 9]. PMID 23953868 Mack E. 2019, McGraw-Hill Education: New York. 1971;75(1):83-86.

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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.

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Pediatric EM Morsels

SEPTEMBER 22, 2023

Negative E-FAST and no signs of long bone injuries should raise concern for neurogenic shock in the hypotensive trauma patient with suspected spinal injury. Alpha 1 agonists are necessary to maintain appropriate blood pressure. McGraw Hill Education; 2019:104-109 Dave S, DAHLSTROM JJ. 2011;46(9):1771. 5 th Edition.

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E-9-1-1 Epinephrine ALS EMS 300

This Podcast Will Kill You

JULY 23, 2024

Official journal of the American College of Gastroenterology| ACG , 118 (1), pp.59-76. 2019): 100. Annals of internal medicine , 172 (1), pp.ITC1-ITC16. ” BMC medicine 17 (2019): 1-20. . ” BMC medicine 17 (2019): 1-20. Gastroenterology , 160 (1), pp.63-75. Burki, Talha Khan.

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ALiEM

MAY 19, 2023

The SB tube was created in 1950 in order to help tamponade variceal bleeds [1]. Apply traction to the tube by tying a roller bandage to the end of it and then the other end to a 1 L bag of IV fluids. Pearl 1: Check the units of pressure being used. The conversion rate is: 1 cmH2O = 0.74 1950 May;131(5):781-9.

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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.,

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EMDocs

FEBRUARY 15, 2024

1 These plants contain tropane alkaloids such as atropine (mixture of d-hyoscyamine and l-hyoscyamine) and scopolamine which are muscarinic receptor antagonists. 2 Jimson weed ( Datura stramonium, Figure 1) is one of several anticholinergic plants that if ingested can cause anticholinergic toxicity. 3 Figure 1. 3 Figure 1.

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E-9-1-1 Overdose ED OR 90

This Podcast Will Kill You

JANUARY 16, 2024

Manaresi, E. Pt 9 (2008): 2280. Adeno-associated virus 2 infection in children with non-A–E hepatitis. ” Annual review of virology 6 (2019): 71-91. ” Parvoviruses 1 (2006): 5-14. European Journal of Obstetrics & Gynecology and Reproductive Biology , 264 , pp.358-362. Carmichael, L. Mokhtari-Azad, T.,

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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.”

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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.

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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.

Emergency Department 94

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

Pediatric EM Morsels

MAY 5, 2023

2018 Dec 20;11(1):5. Hovinen T, Korkalo L, Freese R, Skaffari E, Isohanni P, Niemi M, Nevalainen J, Gylling H, Zamboni N, Erkkola M, Suomalainen A. Lemale J, Mas E, Jung C, Bellaiche M, Tounian P; French-speaking Pediatric Hepatology, Gastroenterology and Nutrition Group (GFHGNP). 2019 Oct;26(7):442-450. Epub 2019 Oct 12.

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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]

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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)

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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]. 2022; 11(1):45-52. 2019 Nov 27;4(Suppl 1):S130-S139. PMID 32130055 Schulte EE, Alderman E, Feldman J, et al. Perspect Med Educ. J Grad Med Educ.

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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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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. Craythorne, E. International journal of dermatology, 49(9), pp.978-986. ” Journal of Dermatological Treatment (2019). Public Health Research & Practice, 32(1). Taylor & Francis, 2022.

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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.

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

This Podcast Will Kill You

NOVEMBER 27, 2023

” Cambridge: Cambridge University Press 197 (1993): 9-23. Parasites & Vectors , 15 (1), pp.1-9. The Lancet Global Health , 8 (9), pp.e1186-e1194. Laura Baldo, and Michael E. Addiss, D. Lymphatic filariasis. World Scientific, 2000. Lourens, G.B. and Ferrell, D.K., Lymphatic filariasis. Kenneth, F. Turner, H.C.,

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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. On exam, the patient opens eyes to voice, has extraocular movements intact, is unable to speak, and has 0/5 strength in all extremities. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Simply Psychology.

EMS 89

EMS E-9-1-1 ALS OR 89

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.

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Don't Forget the Bubbles

JANUARY 17, 2024

Around 80% of those reported pass spontaneously, with another 10-20% requiring endoscopic removal and only 1% requiring surgical intervention. BMC Pediatrics , 21 (1), Jackson, J., Journal of The Korean Society of Emergency Medicine , 33 (1), pp.134-138. 2012 Jan;3(1):6. 2012;47(9):E19-E22. Metro, D.C., Alharbi, N.

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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.

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

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Learning Point: 1. For examples of such exceptions — See My Comment in the January 9, 2019 — August 22, 2020 — and June 30, 2023 posts in Dr. Smith's ECG Blog ). Figure-1: Comparison between the first 3 ECGs in today's case. How Would YOU Interpret the Serial Tracings in Figure-1? EMS arrived — and recorded 2 ECGs.

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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

Dr. Smith's ECG Blog

NOVEMBER 14, 2019

The patient had musculoskeletal shoulder pain. = = MY Comment by K EN G RAUER, MD ( 11/14/2019 ): == A subject well worth periodic review — is the concept of T erminal Q RS D istortion ( T- QRS - D ). Isn’t it tempting to say there is T-QRS-D in the initial ECG that was done in the ED ( = E CG # 1 in Figure-2 ) ?

E-9-1-1 52

E-9-1-1 OR ED 52

Don't Forget the Bubbles

FEBRUARY 26, 2024

2007 Jan 1;25(1):6-9. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. Changes in the use of invasive and noninvasive mechanical ventilation in pediatric asthma: 2009–2019. Start low and increase for the comfort/tolerance of the patient and talk to the patient throughout the process.

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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

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% 2019 Nov 9;394(10210):1713-1723. Epub 2019 Oct 14. in the placebo group).

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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. McGraw Hill, 2019. 1, 2010, pp.

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

EMDocs

JUNE 25, 2024

Estimate TBSA: may use Lund-Browder chart (most accurate assessment in children and adults), Rule of Nines, or palm method (measure the burn by using patient’s entire palmar surface and fingers as 1% TBSA). National Burn Repository 2019 Update, Report of data from 2009–2018. link] (2019). 2002 Nov;28(7):665-9.

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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.

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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. April 2019. January 2019. 45:446-458.

Emergency Department 82

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

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. PLoS ONE [Internet] 2014 9(8): e104720.

Critical Care 97

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

Dr. Smith's ECG Blog

DECEMBER 10, 2019

The pain is described as located in the midsternal area, radiating to the right arm, described as 8-9/10 and worse with deep inspirations. In the evening, he became diaphoretic and complained of 9/10 continuous chest pain. Today’s case provides perhaps the best example of s erial E CG e volution of this elusive entity.

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Dr. Smith's ECG Blog

OCTOBER 17, 2022

There are some unusual ECG findings in today's tracing ( that I labeled in Figure-1 ). Figure-1: I've labeled the ECG in today's case to highlight leads with ST elevation and J-point notching. There is No Acute Cardiac Event: As per Dr. Smith — there is no acute cardiac event in ECG #1. There is no reciprocal ST depression.

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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.

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