Core EM

JANUARY 25, 2024

REFERENCES: Castleberg E, Jenson N, Dinh VA. 2014;15(1):111-113. 2020;12(1). Accessed March 9, 2022. Updated 2021 Jul 27]. Diagnosis of necrotizing faciitis with bedside ultrasound: The staff exam. Western Journal of Emergency Medicine. Clark ML, Fisher KL. Sonographic Detection of Necrotizing Fasciitis.

E-9-1-1 246

E-9-1-1 Emergency Department OR 246

Pediatric EM Morsels

AUGUST 4, 2023

England, 2021) The third portion of the duodenum courses between the SMA and the aorta, which can lead to external compression of the duodenum. England, 2021) In SMA syndrome the angle is decreased to < 22 o and the normal distance <8 mm. England, 2021) This condition is often attributed to rapid weight loss.

E-9-1-1 246

E-9-1-1 ED OR EMS 246

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.

E-9-1-1 245

E-9-1-1 Emergency Department ICU OR 245

ACEP Now

DECEMBER 17, 2024

1 His tragic loss underscores the urgent need for mental health support for residents and fellows. Accessed December 9, 2024. Accessed 9 December 2024. Trends in labor unionization among US health care workers, 2009-2021. Adelman LC. Is it time to unionize? link] Published April 15, 2024. Beresford L. Int J Health Serv.

E-9-1-1 105

E-9-1-1 Emergency Department ALS OR 105

Pediatric EM Morsels

AUGUST 9, 2024

Worldwide, congenital syphilis complicates about 1 million pregnancies / year. 2019, there were 1,875 and this trend has continued to increase (2,157 case in 2020; 2,855 cases in 2021). Usually in 1st week of lif e Copious, white-ish drainage Teeming with spirochetes! gross ) Rash Occurs 1-2 weeks after rhinitis.

E-9-1-1 154

E-9-1-1 Plasma Emergency Department OR 154

Pediatric EM Morsels

NOVEMBER 17, 2023

2021 Jun;31(6):713-719. Epub 2021 Apr 11. Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. 1994 Jul;125(1):57-62. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments.

E-9-1-1 187

E-9-1-1 Operating Room Emergency Department ALS 187

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. NEJM 1994. [2] Richards JE et al.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

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

E-9-1-1 177

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

Pediatric EM Morsels

MAY 5, 2023

Vegan Diets in Children: Basics Vegan Diets avoid/prohibit consumption of any animal products Exclusion of meat, eggs, honey, dairy products, etc This is often adopted due to heightened concern of animal maltreatment, but also for religious reasons or health benefits Roughly 2-5% of Western nation populations follow a vegan based diet (Sutter, 2021) (..)

E-9-1-1 130

E-9-1-1 OR EMS 130

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-9-1-1 127

E-9-1-1 Coronary ACS BLS 127

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.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

EMS 12-Lead

APRIL 28, 2022

Initial vital signs include: NIBP 99/58 HR 150-160 (trend) RR 10 (spontaneous, but shallow) SpO2 86 (RA) BBS CTA The initial rhythm strip is attached: Figure 1 There is a wide complex tachycardia of varying morphology, amplitude, and R-R cycle length. A prominent vertical scar, however, is noted at the sternum.

E-9-1-1 130

E-9-1-1 ALS Coronary EMS 130

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. 2021; 43(10):1210-1213. PMID 32130055 Schulte EE, Alderman E, Feldman J, et al.

E-9-1-1 161

E-9-1-1 ALS OR 161

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-9-1-1 113

E-9-1-1 ALS Defibrillator OR 113

Don't Forget the Bubbles

NOVEMBER 29, 2023

Intensive Care Research , 1 (3-4), pp.60-64. Epub 2014 Sep 9. Pappal RD, Roberts BW, Mohr NM, Ablordeppey E, Wessman BT, Drewry AM, Winkler W, Yan Y, Kollef MH, Avidan MS, Fuller BM. 2021 May;77(5):532-544. 2021 May;77(5):532-544. Epub 2021 Jan 21. 2013 Jan;31(1):222-6. Burgart, A.M. and Kanaris, C.,

E-9-1-1 135

E-9-1-1 Emergency Department ED CPR 135

REBEL EM

SEPTEMBER 27, 2023

Dosing: 1-2 mEq/kg bolus If there is a response, initiate an infusion: 150 mEq in 1L of D5W at maintenance Severely poisoned patients, may require multiple boluses of sodium-bicarbonate until the QRS narrows. Mohan 2021 ) Recall that the subsequently alkalemia will shift potassium intracellular. 1985 Aug 22;313(8):474-9.

E-9-1-1 100

E-9-1-1 Overdose EMS 100

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.

E-9-1-1 110

E-9-1-1 Overdose ED OR 110

ACEP Now

NOVEMBER 8, 2024

1 Prehospital endotracheal intubation and EGAs are typically placed without paralytics and are reserved for unconscious, apneic, and out-of-hospital cardiac arrest patients. 9 LMAs use an inflatable mask expanded using a similar technique to the endotracheal tube cuff. Published August 2021. John Wiley & Sons; 2021:21-29.

E-9-1-1 40

E-9-1-1 Emergency Medical Services Emergency Medical Technician AEMT 40

This Podcast Will Kill You

JULY 23, 2024

Official journal of the American College of Gastroenterology| ACG , 118 (1), pp.59-76. 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. ” Internal and emergency medicine 9 (2014): 249-256.

E-9-1-1 98

E-9-1-1 ALS OR 98

REBEL EM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. The first evaluation of the patient was to be done within 1 hour of arrival to ED (Including the first POCUS). to −0.66) and −1.66 (95% CI −2.09

ED 125

ED E-9-1-1 Emergency Department ALS 125

Don't Forget the Bubbles

JANUARY 17, 2024

2021 A plain abdominal X-ray shows multiple dilated loops of bo wel. 2021 These beads, once hydrated inside the body, reached considerable sizes. 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.,

E-9-1-1 111

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

EMDocs

FEBRUARY 7, 2024

Despite a plateau in overall union membership of around 10% in 2023 1 , major labor actions shook the U.S. there were 31 recorded healthcare strikes in 2021, 39 recorded healthcare strikes in 2022, and 37 healthcare strikes in 2023 as of November 3rd. months between 1993 and 2021 to one strike every 1.4 2023 October 9.

E-9-1-1 97

E-9-1-1 Ambulance OR 97

EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? Updated November 9, 2023. Epub 2019 Dec 9. On exam, the patient opens eyes to voice, has extraocular movements intact, is unable to speak, and has 0/5 strength in all extremities. Available from: [link] Guy-Evans, Olivia.

EMS 109

EMS E-9-1-1 ALS OR 109

EMDocs

MAY 25, 2024

Massaging the gland causes expression of purulent material. What is the diagnosis?

EMS 98

EMS E-9-1-1 OR ED 98

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 Ross 2021) Predisposing risk factors including older age , trauma to tendons or joints , and a family history of MAEs. Arthropathy was seen in 13.7%

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

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. ” Parvoviruses 1 (2006): 5-14. . “Host-specific parvovirus evolution in nature is recapitulated by in vitro adaptation to different carnivore species.” ” PLoS pathogens 10.11 (2014): e1004475.

E-9-1-1 95

E-9-1-1 ALS 95

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. What are the treatment options for a benzonatate overdose?

E-9-1-1 86

E-9-1-1 Overdose Emergency Medical Services Life Support 86

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation. Figure-1: The initial ECG in today's case — obtained after ROSC.

E-9-1-1 98

E-9-1-1 Defibrillator CPR STEMI 98

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 109

Coronary E-9-1-1 STEMI ACS 109

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 93

EMS E-9-1-1 ALS Emergency Department 93

EMDocs

NOVEMBER 4, 2023

McGraw Hill; 2021. 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. Radiographics. 2013;33(3):721-740. doi:10.1148/rg.333125158 333125158 Moore, S and Ryan Pedigo. Scrotal Abscess. Accessed April 26, 2023.

EMS 92

EMS E-9-1-1 Emergency Department ALS 92

EMDocs

AUGUST 3, 2023

PMID: 25133498 Ghannoum M, Kazim S, Grunbaum AM, Villeneuve E, Gosselin S. 2004;20(9):649-650. Extracorporeal treatment for acetaminophen poisoning: recommendations from the EXTRIP workgroup. Clin Toxicol (Phila). 2014 Sep-Oct;52(8):856-67. doi: 10.3109/15563650.2014.946994. Epub 2014 Aug 18. Clin Toxicol (Phila). doi: 10.1136/gut.2004.043505.

Overdose 98

Overdose E-9-1-1 OR ED 98

This Podcast Will Kill You

OCTOBER 1, 2024

Medical journal of Australia , 190 (9). Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-α-1, 3-galactose. Ronmark, E. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1, 3-galactose.

E-9-1-1 52

E-9-1-1 ALS OR 52

Don't Forget the Bubbles

DECEMBER 16, 2024

Coverage of the 6-in-1 vaccine measured at 12 months of age in England for Q4 2023 to 2024 Source: ONS under the Open Government License v3.0 Young infants and immunosuppressed individuals are particularly at risk of severe disease, resulting in significant morbidity and associated mortality rates of 1-3 per 1,000 cases. Pediatrics.

E-9-1-1 59

E-9-1-1 OR ALS Emergency Department 59

This Podcast Will Kill You

NOVEMBER 27, 2023

” Cambridge: Cambridge University Press 197 (1993): 9-23. Parasites & Vectors , 15 (1), pp.1-9. Global programme to eliminate lymphatic filariasis: progress report, 2021– Weekly Epidemiological Record , 97 (41), pp.513-524. The Lancet Global Health , 8 (9), pp.e1186-e1194. 2021): 879-893. 2021): 3-23.

E-9-1-1 52

E-9-1-1 ALS ED 52

Dr. Smith's ECG Blog

MAY 30, 2023

We recorded an ECG in which V1-V3 were put in the position of V4R-V6R, and V4-6 were placed in V7-9 to (academically) confirm posterior OMI. 1 mg of Atropine was given and the heart rate increased transiently to 60. Atropine usually works in junctional rhythm with a narrow complex 9. What to do? RVMI explains part of the shock.

E-9-1-1 97

E-9-1-1 STEMI Coronary OR 97

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. Review of Cultivating Communities of Practice: A Guide to Managing Knowledge, by Wenger E, McDermott R, Snyder WM].

Critical Care 98

Critical Care E-9-1-1 Paramedicine Paramedicine 98