International Journal of Paramedicine

OCTOBER 8, 2024

Data were obtained from the National Emergency Services Information System (NEMSIS) database for 2019. The objective of this study was to examine the relationship between patient acuity and level of EMS care adjusting for rurality and insurance. The results indicate that acuity and service level vary according to insurance and rurality.

BLS 52

BLS Advanced Life Support ALS Community Paramedicine 52

REBEL EM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. 2 Despite these recommendations there are no randomized clinical trials to help guide practice until now.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

The Skeptics' Guide to EM

AUGUST 10, 2019

Date: August 6th, 2019 Guest Skeptic: Dr. Alyssa Stroud (@TheBlondeMD) is a PGY2 surgery resident who is trying to survive the hardships of residency and dating, one glass of wine at a time. To be more inclusive in 2019 I would tweak the quote to be gender neutral…but the world needs more love. It is an active noun like struggle.

OR 100

OR EMS 100

ALiEM

OCTOBER 11, 2024

American Society of Hematology 2019 guidelines for immune thrombocytopenia. 2019 Dec 10;3(23):3829-3866. On the day of presentation, she developed a painful, intermittently bleeding “blood blister” to the left lower cheek that had increased in size, as well as new red spots on her arms and legs. Physical Exam Vitals : 98.3°F;

OR 152

OR ALS 152

ALiEM

OCTOBER 21, 2024

2019 Aug;276(8):2199-2203. Epub 2019 May 11. This is a case of perichondritis of the auricle, or a bacterial infection of the ear’s cartilage. It often occurs in the setting of trauma, which may be occult. Findings suggestive of perichondritis (versus cellulitis) include sparing of the ear’s lobule. Klug TE, Holm N, Greve T, Ovesen T.

ED 169

ED OR 169

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A healthy 45-year-old female presented with chest pain, with normal vitals. The computer interpretation was “ST elevation, consider early repolarization, pericarditis or injury.” What do you think? There’s normal sinus rhythm, normal conduction, borderline right axis, and normal voltages. There’s TWI in aVL but this is concordant to its QRS.

OR 66

OR STEMI ACS Coronary 66

The Skeptics' Guide to EM

JUNE 20, 2020

A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. Case: A 5-week-old full term female presents to the Emergency Department […] The post SGEM#296: She’s Got the Fever but Does She Need an LP, Antibiotics or an Admission? Reference: Kuppermann et al. JAMA Pediatr.

OR 100

OR Emergency Department ALS ED 100

Pediatric EM Morsels

AUGUST 4, 2023

Okamoto, 2019) Superior Mesenteric Artery Syndrome: Presentation Presenting complaints are often vague but include epigastric abdominal pain, gastric distension, early satiety, and vomiting. Okamoto, 2019) In unable to tolerate PO intake next steps include nasojejunal tube feed or TPN if necessary. Pictures are worth a 1000 words!

E-9-1-1 246

E-9-1-1 ED OR EMS 246

Pediatric EM Morsels

JULY 21, 2023

We use the GCS score in both trauma and medical patients, but where did this score come from? When is it useful and what does it tell us? Is it actually validated in children, like the Ottawa Ankle Rules or are we using a tool for something other than that for which it was designed and validated, like using Kocher criteria for knee and ankle joints?

Critical Care 246

Critical Care ALS OR Life Support 246

ALiEM

OCTOBER 4, 2023

2019 Aug;9(4):337-342. 2019 Oct;123(4):457-463. Epub 2019 Jun 24. This kit has historically been issued to US service members for treating nerve agent toxicity from agents such as soman, sarin, tabun, and VX, all of which are organophosphates and cause a cholinergic toxidrome. What are nerve agents? [1-3] McGraw Hill.

Plasma 195

Plasma OR ED 195

Core EM

JANUARY 25, 2024

It was found that patients exposed to deep sedation in the ED had an independent higher incidence of continued deep sedation on ICU day one ( Fuller, 2019 ). The authors found that deep early sedation within the first four hours was an independent predictor for delayed extubation and increased mortality. Short acting.

ICU 246

ICU Emergency Department Critical Care ALS 246

Core EM

MARCH 1, 2024

Epub 2019 Apr 17. 2019 Jul;42(4):673-685. Epub 2019 Jan 28. McGraw-Hill Education; 2019. Significance of the Inverted V Sign : This MRI sign is pathognomonic for subacute combined degeneration, indicating it is a distinct marker for this condition. PMID: 27293327; PMCID: PMC4888679. Transverse Myelitis. 2020:952–9.

Emergency Department 162

Emergency Department ED OR ALS 162

Pediatric EM Morsels

NOVEMBER 3, 2023

2019; 17: 98. 2019; 47(2): 183–193. It appears after an asymptomatic period. It takes 3 negative smears collected at 12-24 hours to exclude malaria as the cause of fever in a returning traveler from an endemic region. Treating malaria is an ART! For non-complicated malaria use oral Co ART em. Add oral Primaquine if known to have P.

ALS 278

ALS Critical Care EMS OR 278

ALiEM

AUGUST 26, 2024

His vision slowly improved though it never normalized. He continued to have pain, so he presented for evaluation. He also reported seeing floaters and denied pain with eye movement, increased light sensitivity, or eye discharge. Additional Images Physical Exam Eyes : Lids without injury. Visual acuity was 20/50 OD, 20/30 OS. References Knoop, K.

Emergency Department 177

Emergency Department OR 177

Pediatric EM Morsels

APRIL 5, 2024

Silva-Ramos 2021) Majority of cases arise from travel to South Africa. (Frean 2019) The classic triad described is fever, eschar and rash. Ricardi 2019) Tick-Borne Encephalitis has a biphasic pattern of symptoms. Ricardi 2019) Initial symptoms are nonspecific and include fever, malaise, headache, nausea, vomting and myalgias.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

Pediatric EM Morsels

JULY 7, 2023

Horan, 2006 ] Anatomy of the PTF Joint [ Cunningham, 2019 ] The PTF joint is a synovial joint between the lateral condyle of the tibia and the head of the fibula. Cunningham, 2019 ] Treatment [ Horan, 2006 ] 1st option for Subluxation and Anterolateral Dislocation is Manual Reduction ( similar to reducing that Nursemaid’s Elbow ).

OR 141

OR EMS 141

Pediatric EM Morsels

JUNE 30, 2023

Fetal Congenital Cystic Adenomatoid Malformation (CCAM): Pathogenesis, Diagnosis, and Clinical Management: A Case Report. Clinical and Experimental Obstetrics & Gynecology. Dec 46 (6) 999–1002, [link]. Leblanc C, Baron M, Desselas, E, Phan, MH, Rybak A, Thouvenin G, Lauby C, Irtan S.

E-9-1-1 281

E-9-1-1 ED EMS OR 281

The Skeptics' Guide to EM

FEBRUARY 18, 2023

Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019.

Emergency Department 130

Emergency Department ALS ED EMS 130

Pediatric EM Morsels

OCTOBER 27, 2023

2019 Jan;22(1):147-156. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. Krug 2007] What If the Child is Obese or Emaciated? of children; PAWPER predicted within 10% for 89.2% x exp[0.02

E-9-1-1 269

E-9-1-1 Emergency Medical Services Life Support ALS 269

Pediatric EM Morsels

SEPTEMBER 22, 2023

McGraw Hill Education; 2019:104-109 Dave S, DAHLSTROM JJ. McGraw Hill Education; 2019:125-138 Ziu E, Mesfin FB. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. It may, however, be seen preceding or concurrently with neurogenic shock.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

Core EM

JANUARY 25, 2024

link] Published October 28, 2019. EVALUATION: Scan the affected and contralateral body part for comparison with a sterile cover (or Tegaderm) overlying a high frequency linear probe. REFERENCES: Castleberg E, Jenson N, Dinh VA. Diagnosis of necrotizing faciitis with bedside ultrasound: The staff exam. Western Journal of Emergency Medicine.

E-9-1-1 246

E-9-1-1 Emergency Department OR 246

The Good, The Bad & The Ugly Paramedic

JULY 1, 2020

As paramedics, whilst we often take great offence at being called ambulance drivers, the question is, when it’s our turn to drive, what exactly is it that we are providing? Do we fully engage in shared patient care with our attending partner, or do we switch off so that we can simply drive the ambulance and take it easy?

Ambulance Driver 52

Ambulance Driver Paramedic Ambulance OR 52

Pediatric EM Morsels

JULY 26, 2024

Epub 2019 Dec 19. While it is important for us to maintain a safe work environment for our patients and our team, managing the agitated patient requires more of us than administering Droperidol or Ketamine. Make sure to consult your friendly neighborhood pediatric neurologist and/or rheumatologist! The prevalence ranges from 12.5%-61%

Plasma 269

Plasma OR ED Critical Care 269

Paramedics World

JANUARY 25, 2024

The NHTSA reports that out of 5,114 motorcycles in 2019, 2,811 (or 55%) were involved in… The post 7 Surefire Tips to Prevent Motorcycle Accidents appeared first on Paramedics World. Are you worried about your safety while riding a motorcycle? Well, you’re not alone.

Paramedic 98

Paramedic OR 98

Pediatric EM Morsels

JUNE 21, 2024

Chaganti 2019] Other studies have not shown a difference in infection rates between silver-containing creams and antimicrobial ointments. Or maybe you have the adventurous adolescent who was a little too aggressive with the lighter fluid before igniting the campfire.

ALS 169

ALS OR EMS 169

Pediatric EM Morsels

JUNE 9, 2023

Specific Therapies for Variceal Hemorrhage : [ Luoto, 2020 ; Castillo, 2019; Garcia-Tsao, 2007 ] Antibiotic prophylaxis (usually for 7 days) Ceftriaxone is reasonable 1st choice. Castillo, 2019 ] Somatostatin (or its analogues, like Octreotide) Guidelines do recommend this… There is great variability in its administration, though.

OR 152

OR Critical Care EMS 152

ALiEM

JANUARY 5, 2024

2019 Dec 9;21(1):96-101. What does the Electronic Residency Application Service (ERAS) preliminary data show just far for the 2024 residency application season? Has the program signaling option been working? Have there been any surprises or changes during interview season? What should students think about in the post-interview stage?

EMS 177

EMS ALS OR 177

ALiEM

APRIL 12, 2024

The Cochrane database of systematic reviews, 2019(10), CD002312. Obstruction may also occur from clotted blood [9] or pleural effusion loculations [12, 13] within the catheter lumen. The pigtail catheter for pleural drainage: a less invasive alternative to tube thoracostomy. Br J Radiol. 2000;73(871):786-790. doi: [link] Altmann, E.

E-9-1-1 183

E-9-1-1 ALS Critical Care Emergency Department 183

Pediatric EM Morsels

OCTOBER 6, 2023

Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective. Lancet Infect Dis.

OR 161

OR EMS ED 161

EMDocs

NOVEMBER 19, 2024

Second-generation antipsychotics (see Table 1 below) improve both positive and negative symptoms of schizophrenia and are less likely to be associated with EPS. 1,2 Most second-generation antipsychotics act as D 2 antagonists and inhibit the 5-HT 2A receptor. Atypical antipsychotics come in daily and long-acting forms.

Overdose 74

Overdose EMS Emergency Medical Services OR 74

Pediatric EM Morsels

MARCH 17, 2023

Since we all inhabit the same beautiful world , and sometimes we humans overtake previous habitats of animals, we inevitably will cross paths with an animal that bites us. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ). Sometimes it’s a beloved pet who gets surprised or has an “off” day ( Dog Bites and PTSD ).

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

REBEL EM

SEPTEMBER 7, 2023

BACKGROUND: intracerebral hemorrhage (ICH) makes up 10-15% of all strokes and significantly contributes to overall stroke-related morbidity and mortality ( Hostettler 2019 ). Lancet Neurology 2022; 21:781-91. PMID: 35963261. They selected adult patients with spontaneous intracerebral hemorrhage on CT imaging within 24 hours of symptom onset.

OR 133

OR ALS EMS 133

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Date: September 11th, 2019 Reference: Putzu et al. Date: September 11th, 2019 Reference: Putzu et al. The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Critical Care Medicine. Critical Care Medicine. Reference: Putzu et al.

ICU 130

ICU Critical Care ALS Emergency Department 130

The Skeptics' Guide to EM

SEPTEMBER 21, 2019

Date: September 18th, 2019 Reference: Scheuermeyer et al. AEM Sept 2019 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and clinical lecturer in Calgary. Date: September 18th, 2019 Reference: Scheuermeyer et al. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM.

Emergency Department 130

Emergency Department ALS OR 130

The Skeptics' Guide to EM

DECEMBER 7, 2019

Date: October 2nd, 2019 Reference: Ramgopal et al. Pediatrics 2019 Guest Skeptic: Dr. Katie Noorbakhsh is a pediatric emergency physician at the Children’s Hospital of Pittsburgh. Date: October 2nd, 2019 Reference: Ramgopal et al. Changes in the Management of Children With Brief Resolved Unexplained Events (BRUEs).

CPR 130

CPR ALS OR 130

Pediatric EM Morsels

MAY 5, 2023

2019 Oct;26(7):442-450. Epub 2019 Oct 12. Supplementation is key! Key nutrients and vitamins are not always found in specialized diets (or picky children) and adherence to multivitamins is a must! Look out for nutritional deficiencies ! References: Alexy U, Fischer M, Weder S, Längler A, Michalsen A, Sputtek A, Keller M. Arch Pediatr.

E-9-1-1 130

E-9-1-1 OR EMS 130

The Skeptics' Guide to EM

DECEMBER 14, 2019

Date: December 13th, 2019 Reference: Belisle et al. AEM December 2019 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. Date: December 13th, 2019 Reference: Belisle et al. first appeared on The Skeptics Guide to Emergency Medicine. Reference: Belisle et al.

ALS 130

ALS Emergency Department OR 130