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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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. Annals of Emergency Medicine.

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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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EMDocs

JANUARY 17, 2024

She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). 1) There are a limited number of antitussives on the US market which include benzonatate, codeine, dextromethorphan, diphenhydramine, and hydrocodone. 11) A bolus dose at 1.5

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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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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.

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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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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.

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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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Don't Forget the Bubbles

JANUARY 17, 2024

Curious Ken is brought into your emergency department. Around 80% of those reported pass spontaneously, with another 10-20% requiring endoscopic removal and only 1% requiring surgical intervention. Pediatric Emergency Care , 31 (6), pp.416-418. Pediatric Emergency Care , 35 (6), pp.426-427. 2012 Jan;3(1):6.

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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.

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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. 2019 Nov 15;16(22):4515. Emerg Med J. 2007 Feb 1;24(2):128–9.

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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. Internet] 2019:23:3, 346-355, DOI: 10.1080/10903127.2018.1502383 Cataldo CG. PLoS ONE [Internet] 2014 9(8): e104720.

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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

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Dr. Smith's ECG Blog

MARCH 9, 2023

Sent by anonymous, written by Pendell Meyers A man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chest pain. Proven STEMI has an open artery in 19% to 36% of cases, depending on whether it is TIMI −1, −2, or −3 flow. Pol Arch Intern Med. 2017;127:401–411.

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Dr. Smith's ECG Blog

JANUARY 10, 2020

Here is the parasternal short axis, performed by a real expert in emergency department point of care cardiac ultrasound: There does not appear to be an anterior wall motion abnormality. I was relieved to see this MRI result: MRI IMPRESSION 1) Mildly decreased LV function with no focal wall motion abnormalities. Pericarditis?

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Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Here they are: Learning Points: 1. Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury. Am J Med [Internet] 2017;130(12):1431–9.e4. Clin Chem [Internet] 2017;63(1):101–7.

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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. 2019 Sep;74(9):1186-1190. Epub 2019 Jul 16. 2016 Feb;30(1):3-11.

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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.

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Don't Forget the Bubbles

JULY 22, 2024

study from 200 9. 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. References BTS_SIGN Guideline for the management of asthma 2019.pdf. Castro-Rodriguez JA, Beckhaus AA, Forno E. 2019 Aug;9(8):e028511.

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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 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. 2023 Jun 6:1-11. 2023 Jun 9. Low yield from imaging after non -E.

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Dr. Smith's ECG Blog

NOVEMBER 30, 2022

mm of ST segment elevation, V2 and V3 have 1 mm of elevation, v4 has 2 mm of elevation and v5 around 1.5 Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting." Note 1: Levels were significantly lower in takotsubo that presented with T-wave inversion.

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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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ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. 1 Immediately after the purchase, the real estate holdings of the hospitals were spun off into a separate company owned by Paladin and other PE investors. Appelbaum E, Batt R. Published September 5, 2019.

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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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REBEL EM

JANUARY 23, 2023

Moreover, the FDA approved intravenous (IV) cetirizine to treat acute urticaria in 2019. Patients were randomized in a 1:1 ratio. However, according to the American Academy of Allergy, Asthma, and Immunology, “oral antihistamine therapy is equivalent to IV therapy” (Ledford D 2019). 2005 Sep;116(3):643-9.

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Don't Forget the Bubbles

SEPTEMBER 13, 2023

The parents of 18-month-old Susie brought her to the Emergency Department after she had a seizure at home. When considering tumours, 37 observation studies involving 2661 children found that 3% (95% CI 1-7%) had tumours. 2019-0134 Hirtz D, Ashwal S, Berg A, et al. 2021;26(1):50-57 NICE. J Am Coll Radiol.

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REBEL EM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

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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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EMDocs

OCTOBER 30, 2023

1 The shortage in supply posed difficulties for hospitals that significantly depend on GE Healthcare as their supplier, which encompassed approximately 50% of hospitals in the United States (US). 11 Table 1. Preparation 9 Hospitals had to prepare for the impending contrast shortage as soon as potential shortage news occurred.

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REBEL EM

FEBRUARY 21, 2024

Surgical Patients Quereshi 2019 Double-blind RCT IM diclofenac 75 mg vs PO diclofenac 100 mg Small difference favoring IM in terms of speed to pain relief Authors conclude PO superior due to time to prepare injection The data looks fairly clear in terms of analgesic efficacy but, don’t some patients simply prefer to receive a shot?

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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?

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Dr. Smith's ECG Blog

APRIL 22, 2022

But these cases show the potential dangers of delayed recognition and treatment of inferior reperfusion Take away 1. ECG’s can be labeled as ‘normal’ by the computer (and confirmed by cardiology) even with diagnostic signs of occlusion or reperfusion References 1. JAMA Intern Med 2019 9. C ASE # 1: Great point by Drs.

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REBEL EM

AUGUST 28, 2023

Surgical Patients Quereshi 2019 Double-blind RCT IM diclofenac 75 mg vs PO diclofenac 100 mg Small difference favoring IM in terms of speed to pain relief Authors conclude PO superior due to time to prepare injection The data looks fairly clear in terms of analgesic efficacy but, don’t some patients simply prefer to receive a shot?

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EMDocs

MAY 29, 2023

Louis); Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 54-year-old female with a past medical history of rheumatoid arthritis presents to the emergency department (ED) with generalized fatigue. ESR and CRP are widely used in monitoring and detecting multiple inflammatory conditions.

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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. Allen Lane, an imprint of Penguin Books; 2019. 2006;98(9):1415-24. Hill K, Samuels E, Gross C, et al. Jefferson T.

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ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. Out-of-hospital cardiac arrest unfortunately occurs relatively commonly and emergency physicians must be equipped to diagnose and treat this rapidly. 2018;13(9):e0204169. Margey R, Browne L, Murphy E, et al. Resuscitation. Resuscitation.

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