Core EM

JANUARY 25, 2024

Accessed April 29, 2022. Pfenning CL, Slovis CM: Electrolyte Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. Retrieved April 29, 2022, from [link] Vantour L, Goltzman D. Diagnosis and management of hypocalcaemia. Diagnostic approach to hypocalcemia.

Critical Care 246

Critical Care ED ALS OR 246

ACEP Now

JANUARY 5, 2025

Her vital signs are normal, except for a heart rate of 115 bpm. Its going to take time to get her to a tertiary center. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. A patient’s mouth packed with gauze after tonsillectomy surgery. CREDIT: Dr. P.

Operating Room 98

Operating Room Epinephrine ALS ED 98

The Skeptics' Guide to EM

FEBRUARY 11, 2023

Date: February 7, 2023 Reference: Cheskes et al. Date: February 7, 2023 Reference: Cheskes et al. Reference: Cheskes et al. NEJM 2022 * Population: Ontario patients who were at least 18 years of age and had an OHCA and refractory ventricular fibrillation. Defibrillation Strategies for Refractory Ventricular Fibrillation.

Defibrillator 142

Defibrillator Medical Transportation OR CPR 142

Pediatric EM Morsels

OCTOBER 27, 2023

PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. Zhu 2022] In Nepalese children, the Broselow correlated well at lower weights, but accuracy decreased at higher weights >18 kg. [K Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Krug 2007] What If the Child is Obese or Emaciated?

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

Pediatric EM Morsels

JULY 21, 2023

Jain 2022] Now used for critically ill trauma and medical patients in >75 countries. Jain 2022] Now used for critically ill trauma and medical patients in >75 countries. Jain 2022] Glasgow Coma Scale in Children – How do you perform it correctly? When is it useful and what does it tell us?

Critical Care 246

Critical Care ALS Life Support OR 246

Pediatric EM Morsels

SEPTEMBER 22, 2023

Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Updated 2022 Feb 10]. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Updated 2022 Mar 3]. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Moral of the Morsel Anatomy Matters!

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

Core EM

JANUARY 25, 2024

source: “Thrombotic Thrombocytopenic Purpura (TTP)”, 2022 , National Heart, Lung, and Blood Institute. An example of petechiae and purpura frequently seen with thrombocytopenic disorders. link] ) Laboratory Evaluation: Clinical presentation and laboratory findings can help suggest TTP in the emergency department.

Plasma 246

Plasma Frozen Plasma Emergency Department FFP 246

ALiEM

OCTOBER 11, 2023

Hassoun AER, Ujević I, Jemaa S et al. 2022 Feb 8;14(2):123. Treasure Island (FL): StatPearls Publishing; August 8, 2022. Alhatali B, Al Lawatia S, Khamis F, Kantur S, Al-Abri S, Kapil V, Thomas J, Johnson R, Hamelin EI, Coleman RM, Kazzi Z. 2022 Feb;60(2):262-266. 2022 Nov 8;19(22):146-8.

E-9-1-1 204

E-9-1-1 ALS OR 204

EMDocs

NOVEMBER 19, 2024

10 Table 1: Second-Generation Antipsychotics and Associated Adverse Effects Adapted from: UpToDate 8 with additional sources Micromedex 9 and Riboldi, et al 11 *SL=sublingual, IM=intramuscular, PO=oral, ODT=orally disintegrating tablets, ER=extended release, IR=immediate release. +to 1 Seizures may occur due to lowered seizure threshold.

Overdose 111

Overdose EMS Emergency Medical Services OR 111

Pediatric EM Morsels

JULY 28, 2023

Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 or serum bicarbonate between 11-17 mmol/L Moderate : venous pH < 7.2 or serum bicarbonate between 5-10 mmol/ L Severe : venous pH < 7.1 Neuroimaging is NOT required. GCS score is not sensitive enough.

E-9-1-1 246

E-9-1-1 ALS OR Critical Care 246

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 114

E-9-1-1 ACS OR Emergency Department 114

The Skeptics' Guide to EM

AUGUST 10, 2024

Date: July 29, 2024 Reference: Connolly SJ et al (ANNEXA-I investigators) Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage. Reversal of Warfarin: Freeman et al. Reversal of Warfarin: Freeman et al. Blood Pressure Control: There is a lot of debate about the aggressiveness of blood pressure lowering.

Emergency Medical Services 224

Emergency Medical Services ALS Emergency Department ED 224

Core EM

JANUARY 25, 2024

Lipophilic with adipose deposition, withdrawal symptoms after prolonged infusion Hydromorphone 5 – 15 min 2 – 3 hr 0.5 – 3 mg/hr No active metabolites however parent drug can accumulate in renal failure Morphine 5 – 10 min 3 – 4 hr 2 – 30 mg/hr Active metabolites can accumulate in renal failure Remifentanil 1 – 3 min 3 – 10 min Loading dose: 1.5

ICU 246

ICU Emergency Department Critical Care ALS 246

EMDocs

OCTOBER 30, 2023

” – Musings of an American ED resident in July 2022 when US healthcare was affected simultaneously by supply chain issues from GE Healthcare (contrast media) and Abbott Laboratories (Similac baby formula). 16 In a study conducted by Millet et al. A baby formula milk shortage for adults.” 11 Table 1.

E-9-1-1 101

E-9-1-1 Emergency Department ALS CCT 101

ALiEM

FEBRUARY 5, 2024

Reference Lin M, Phipps M, Chan TM, et al. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Please go to the above link. You will need to create a free, 1-time login account. Ann Emerg Med. 2023;82(1):55-65.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The original term " benign early repolarization" has fallen out of favor since the seminal paper by Haïssaguerre et al. Smith's ECG Blog — with detailed description of this entity in the May 23, 2022 post by Dr. McLaren ( Please check out My Comment and illustrative Figure at the bottom of the page of this post ). link] Lupu, L.,

E-9-1-1 131

E-9-1-1 OR Coronary ACS 131

REBEL EM

MAY 27, 2024

What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy. This absence of detail leaves the study open to bias.

OR 137

OR E-9-1-1 ED ALS 137

Don't Forget the Bubbles

MARCH 21, 2025

Thats exactly what Shane George et al. George S, Williams T, Humphreys S, et al. Children under 16 undergoing emergency intubation between May 2017 and October 2022 were eligible for inclusion if consent could be obtained from their parent or legal guardian either prospectively or retrospectively.

ICU 108

ICU Critical Care ED OR 108

ALiEM

OCTOBER 14, 2023

Reference Lin M, Phipps M, Chan TM, et al. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Please go to the above link. You will need to create a free, 1-time login account.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

Pediatric EM Morsels

JUNE 2, 2023

Allergy Asthma Clin Immunol 18, 54 (2022). Rare diseases are not confined to the pages of a textbook or computer screen. Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! J Asthma Allergy. 2017 Jun 27;10:197-207.

Emergency Department 193

Emergency Department ALS EMS OR 193

EMS 12-Lead

MARCH 30, 2024

The University of Maryland found that capture occurred in only 42-78% of patients, dependent on pad positioning (Moayedi et al, 2022). The patient did have massive pulmonary emboli, but he also had profound intraventricular and subarachnoid hemorrhages. The patient was ultimately discharged with a poor neurologic outcome.

CPR 312

CPR Paramedic Ambulance Epinephrine 312

FOAMfrat

SEPTEMBER 24, 2024

It’s probably safe to assume that your patient has a traumatic brain injury, so at what point in your treatment pathway do you reach for an antiepileptic drug (AED)? Are you carrying antiepileptics on your truck or aircraft? To give an AED or not to give an AED, that is the question. (Bet Bet you thought you left Shakespeare in high school).

OR 105

OR ALS 105

ALiEM

NOVEMBER 3, 2023

Reference Lin M, Phipps M, Chan TM, et al. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Please go to the above link. You will need to create a free, 1-time login account. Ann Emerg Med. 2023;82(1):55-65.

Critical Care 211

Critical Care EMS Emergency Department ALS 211

Core EM

JANUARY 25, 2024

Written By: Kaitlynn Tracy, MD Edited By: Sean Schnarr, MD and Gregg Chesney, MD Definition/Background: Burns are classified as being major, moderate, or minor in severity. 4 Survival rate for all burn injuries is around 97%, which is a notable increase from 75% in the 1960’s.

ED 246

ED E-9-1-1 First Aid OR 246

ACEP Now

JULY 7, 2023

References Tsao CW, et al. Heart disease and stroke statistics-2022 update: A report from the American Heart Association. Benjamin EJ, et al. Kimblad H, et al. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. There are some differing guidelines as to what constitutes “refractory” VT or VF.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

Core EM

JANUARY 25, 2024

link] [3] Morrison RS, Magaziner J, Gilbert M, et al. Published February 4, 2022. Accessed September 29, 2022, [link] [6] Pepe J, Ausman C, Madhani NB. 2022, Accessed September 29, 2022, [link] [8] Luftig J, Dreyfuss A, Mantuani D, Howell K, White A, Nagdev A. 2012;5(1):28-32. Ultrasound-Guided Nerve Blocks.

Epinephrine 246

Epinephrine ED Emergency Department OR 246

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

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

EMDocs

JANUARY 11, 2025

Up to 1/3 of adults over 60 suffer from chronic constipation. Evaluation: A good history and a high index of clinical suspicion is paramount, especially in high-risk patient populations 4 CT of the abdomen and pelvis with contrast is the best choice for diagnosis. Enemas (some studies show this may be associated with perforation risk).

E-9-1-1 98

E-9-1-1 EMS Emergency Department OR 98

The Skeptics' Guide to EM

MAY 14, 2022

Date: May 13th, 2022 Reference: Abril et al. J Emerg Med 2022 Guest Skeptic: Dr. Sergey Motov is an Emergency Physician in the Department of Emergency Medicine, Maimonides Medical Center in New York City. Date: May 13th, 2022 Reference: Abril et al. The Relative Efficacy of Seven Skeletal Muscle Relaxants.

ALS 130

ALS Emergency Department ED OR 130

ALiEM

NOVEMBER 29, 2023

PMID: 34529640 Ayub S, Parnia S, Poddar K, et al. PMID: 24769343 Ehrman-Dupre R, Kaigh C, Salzman M et al. Journal of Addiction Medicine 16(5):p 595-598, 9/10 2022. Published 2022 Aug 19. PMID: 36148197 Love JS, Levine M, Aldy K, et al. PMID: 37014353 Ball NS, Knable BM, Relich TA et al. Forensic Sci Int.

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

ALiEM

AUGUST 9, 2023

Ultrasound Technique Background The lungs were traditionally considered poorly accessible to ultrasound, as ultrasound waves cannot penetrate air-filled structures; however, lung POCUS relies on the interpretation of patterns of artifacts to evaluate the normal, air-filled lungs. Warm gel helps with the child’s comfort.

E-9-1-1 246

E-9-1-1 Emergency Department ALS OR 246

The Skeptics' Guide to EM

NOVEMBER 12, 2022

Date: November 10th, 2022 Reference: de-Madaria E et al. Date: November 10th, 2022 Reference: de-Madaria E et al. Reference: de-Madaria E et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Guest Skeptic: Dr. Salim R. Guest Skeptic: Dr. Salim R.

ALS 130

ALS Emergency Department OR EMS 130

First Responder Wellness

FEBRUARY 25, 2025

Given the high propensity for police officers to be exposed to such events, it is not surprising that we see a higher rate of PTSD in officers than in the general population (Lewis-Schroeder et al., One survey found that 61% of officers screened positive for symptoms of PTSD (Jetelina et al., and at least one avoidance symptom (i.e.,

First Responder 78

First Responder Public Safety ALS OR 78

The Skeptics' Guide to EM

FEBRUARY 26, 2022

Date: February 21st 2022 Reference: Kim et al. AEM February 2022. Date: February 21st 2022 Reference: Kim et al. AEM February 2022. Reference: Kim et al. AEM February 2022. She is […] The post SGEM#360: We Care a Lot – The EmPATH Study first appeared on The Skeptics Guide to Emergency Medicine.

ED 130

ED ALS Emergency Department OR 130

The Skeptics' Guide to EM

APRIL 2, 2022

Date: March 31st, 2022 Reference: Butt et al. AEM March 2022 Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. Date: March 31st, 2022 Reference: Butt et al. Reference: Butt et al.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. Reference: Finfer et al. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. Early work suggested potential harm from 0.9%

ICU 132

ICU Plasma Critical Care ALS 132

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Studies such as those by Moise et al 14 and Ellis et al 39 have shown that the relative risk of developing an acute myocardial infarction in the territory supplied by an artery with a 70%. Thus, the lumen observed may actually still be the same size as the original, normal lumen. Nor was there a challenge to look for coronary spasm.

Coronary 122

Coronary ACS OR EMR 122