ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. The SB tube was created in 1950 in order to help tamponade variceal bleeds [1]. Pearl 1: Check the units of pressure being used. The conversion rate is: 1 cmH2O = 0.74

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Pediatric EM Morsels

FEBRUARY 2, 2024

2021 May; 8:1-16. While there is no “right” work up for these patients, hopefully this morsel will help illuminate your evaluation of Travel-Related Illness in Children: Travel-related Illness: Basics International travel has been significantly increasing since commercial airlines made travel much easier. References Abdel-Haq N, Asmar BI.

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EMDocs

NOVEMBER 6, 2024

He denies any past medical history other than polysubstance abuse and depression. What are important clinical features differentiating strychnine and tetanus toxicity to aid with diagnosis? How does the clinical management of strychnine and tetanus differ? Site of action of strychnine and tetanus. Neurotransmitter. 2015;2:10-14800/nt.

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EMDocs

OCTOBER 8, 2024

Discharging a patient with abnormal vital signs has been linked to unanticipated death (1-4). 2005;2(1):44-52. doi:10.1038/ncpcardio0068 Sklar DP, Crandall CS, Loeliger E, Edmunds K, Paul I, Helitzer DL. Unanticipated death after discharge home from the emergency department. Ann Emerg Med. Ann Emerg Med.

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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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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

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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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. 2020 Aug 20. 2014 Jun 26;23(12):653-9. 2020 Jan 1;35(1):70-6.

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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?

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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. 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.

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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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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. OPTN/SRTR 2020 Annual Data Report: Liver.

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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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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. Reaffirmed October 17, 2020 Jaffe M, Bar-Joseph G, Tirosh E. 2021;26(1):50-57 NICE.

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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?

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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

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 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

JULY 29, 2023

A 75-year-old male with past history of HTN, CVA, DM II presents to the emergency department with right facial swelling since last night. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E. RR 18, SpO2 97% on RA.

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NAEMSP

APRIL 19, 2023

However, evidence emerged in the 1980’s demonstrating that calcium chloride had no effect on return of spontaneous circulation (ROSC) rates, and in fact could be detrimental (Landry, Foran, & Koyfman, 2014). 2020) thus lending itself to a potential drug for cardiac arrest.

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EMDocs

NOVEMBER 4, 2023

aureus infections among patients in the emergency department. Skin and Soft Tissue Infections in the Emergency Department. Emerg Med Clin North Am. 2008;1(1):165. doi:10.1186/1757-1626-1-165 Hackett B, Sletten Z, Bridwell R E (July 03, 2020) Testicular Abscess and Ischemia Secondary to Epididymo-orchitis.

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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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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. Castro-Rodriguez JA, Beckhaus AA, Forno E. Annals of Emergency Medicine. 2019 Aug;9(8):e028511. Pediatr Pulmonol.

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ACEP Now

JULY 7, 2024

One night I found myself on the other side of the stretcher, as a patient waiting for a psychiatric assessment in an emergency department (ED). 9 By speaking out, I hope to once again find my calling in medicine. and her emergency medicine residency in Syracuse, N.Y., American College of Emergency Physicians.

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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. As always, we should consider new data as it emerges. 2022 Jan 1;92(1):44-48.

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REBEL EM

JANUARY 23, 2023

Ann Emerg Med 2020. Patients were randomized in a 1:1 ratio. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Multicenter study of emergency department visits for insect sting allergies. 2005 Sep;116(3):643-9. 2010 Apr;65(4):459-66. Epub 2010 Feb 8. PMID: 20146728.

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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. Annals of Emergency Medicine. 45:446-458.

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REBEL EM

JANUARY 30, 2023

PSA, also referred to as intravenous sedation in this paper, requires considerable resources, including 1:1 nursing observation, and burdens the emergency department (ED). weight of the entire meta-analysis, and 9/12 carried more than 8% weight. J Emerg Med. 1995 Jan-Feb;13(1):37-42. PMID: 7782623.

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ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. or 9 size endotracheal tube to allow for bronchoscopy and/or endobronchial blocker placement whenever necessary. He is the founder and host of Emergency Medicine Cases podcast and website.

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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. Am J Emerg Med 2020 3. JAMA Intern Med 2019 9.

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ACEP Now

SEPTEMBER 3, 2024

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. 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.

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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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Don't Forget the Bubbles

JANUARY 10, 2024

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. The study asked TWO questions: 1. Immediate vs delayed transfusion In uncomplicated severe anaemia, immediate blood transfusion did not alter mortality at 1- or six months compared to controls.

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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.

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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. 2020 May;10(5):e035343. 2020 Nov 18;m4238. 2020 May;220:132-138.e2.

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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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AAEM RSA

AUGUST 27, 2020

Douglas, MD; Taylor Conrad, MD, MS; Theodore Segarra, MD; Christianna Sim, MD, MPH Editors: Kelly Maurelus MD FAAEM, Kami Hu MD FAAEM Originally published: Common Sense July/August 2020 Introduction The ability to obtain good neurological outcomes after cardiac arrest is often limited. Kirkegaard H, Soreide E, de Haas, I et al.

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