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

EMDocs

MARCH 4, 2024

Darnall Army Medical Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, (@long_brit) Disclaimer: The views expressed in this post are those of the authors and do not reflect the official policy or position of the Department of the Army, DoD, or the US Government.

Emergency Department 86

Emergency Department E-9-1-1 ALS OR 86

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. 2022 May 11;10:864766. Acad Emerg Med. 2022 Apr;29(4):406-414. Epub 2022 Jan 12. 1994 Jul;125(1):57-62.

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E-9-1-1 Operating Room Emergency Department ALS 183

ALiEM

MAY 13, 2024

Case Introduction: Child with abdominal pain Wendy is a 7-year-old girl who comes into the emergency department with redness, swelling, and pain on her left calf. Her symptoms started 1 week ago as a scratch which progressively got more red and painful. Pediatric Soft Tissue POCUS Ultrasound Technique Figure 1.

E-9-1-1 161

E-9-1-1 ALS Emergency Department OR 161

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk.

E-9-1-1 161

E-9-1-1 ED OR Emergency Department 161

REBEL EM

NOVEMBER 6, 2024

1998 Jan-Feb;6(1):15-23. 2022 Aug 2. PMID: 32644703 Robinson PM, Griffiths E, Watts AC. 2017 Jul;9(3):195-204. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. PMID: 29681420 Gottschalk HP, Eisner E, Hosalkar HS. 1999 Jan;13(1):58-9.

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E-9-1-1 ACS OR Emergency Department 118

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). 11 Table 1. A baby formula milk shortage for adults.”

E-9-1-1 73

E-9-1-1 Emergency Department ALS ED 73

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.

ED 129

ED E-9-1-1 Emergency Department ALS 129

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. An expert committee appraised the evidence behind recommendations to avoid imaging to inform the 2022 NICE guidance. Reaffirmed October 17, 2020 Jaffe M, Bar-Joseph G, Tirosh E. 2021;26(1):50-57 NICE.

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E-9-1-1 Emergency Department ALS OR 131

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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E-9-1-1 OR Coronary ACS 117

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

Broome Docs

MARCH 28, 2024

Am J Emerg Med. 2022 Feb;52:85-91. PMID: 34890894 Myth 1: Kayexalate is safe and useful. A non-inferiority randomized controlled trial comparing nebulized ketamine to intravenous morphine for older adults in the emergency department with acute musculoskeletal pain. 2024 Jan 2;53(1):afad255. 2021.11.030.

E-9-1-1 107

E-9-1-1 ICU Emergency Department ALS 107

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 20:archdischild-2022-324884. 2023 Jun 5:archdischild-2022-325148. 2023 Jun 1;76(6):731-736 The Association Between Media-Based Exposure to Nonsuicidal Self-Injury and Emergency Department Visits for Self-Harm.

E-9-1-1 98

E-9-1-1 ALS Emergency Department Emergency Medical Services 98

Broome Docs

OCTOBER 31, 2022

Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. 2022 Jan;48(1):78-91. 2022 Sep;21(9):781-791. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. 2022 Sep 15;387(11):989-1000. Emerg Med Australas.

E-9-1-1 52

E-9-1-1 Defibrillator ICU Critical Care 52

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?

EMS 90

EMS E-9-1-1 Emergency Department Ambulance 90

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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E-9-1-1 Critical Care CPR ICU 105

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. BMC Pediatrics , 21 (1), Jackson, J., Pediatric Emergency Care, 31 (8), pp.605-607. 2012 Jan;3(1):6.

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

EMDocs

OCTOBER 8, 2024

Discharging a patient with abnormal vital signs has been linked to unanticipated death (1-4). Treasure Island (FL): StatPearls Publishing; April 30, 2022. 2005;2(1):44-52. doi:10.1038/ncpcardio0068 Sklar DP, Crandall CS, Loeliger E, Edmunds K, Paul I, Helitzer DL. Ann Emerg Med. Acad Emerg Med. Clin Cardiol.

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E-9-1-1 Emergency Department ED ALS 95

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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E-9-1-1 ICU ACS EMS 75

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.

E-9-1-1 113

E-9-1-1 ALS OR Emergency Department 113

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.

E-9-1-1 71

E-9-1-1 EMS Emergency Department OR 71

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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E-9-1-1 Overdose Emergency Medical Services Life Support 67

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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E-9-1-1 ALS ACS ED 105

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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E-9-1-1 ALS Emergency Department Plasma 65

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.

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? Updated November 9, 2023. Available from: [link] American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Use of Intravenous tPA for Ischemic Stroke:; Brown MD, Burton JH, Nazarian DJ, Promes SB.

EMS 89

EMS E-9-1-1 ALS OR 89

This Podcast Will Kill You

DECEMBER 10, 2024

Racial disparities in pain management of children with appendicitis in emergency departments. Factors associated with potentially missed diagnosis of appendicitis in the emergency department. Nature Reviews Gastroenterology & Hepatology , 20 (9), pp.615-624. 2016): 1-9. Conficconi, E.,

E-9-1-1 52

E-9-1-1 ALS Emergency Department OR 52

Broome Docs

JANUARY 30, 2023

2022 Nov 6. Am J Emerg Med. 2022 Nov;61:87-89. Epub 2022 Aug 28. Acad Emerg Med. 2022 Nov;29(11):1403-1404. Epub 2022 Aug 17. PMID: 33933300 Khan A, Saleem MS, Willner KD, Sullivan L, Yu E, Mahmoud O, Alsaid A, Matsumura ME. 2022 Aug 1;5(8):e2226809. 2022 Sep 1;5(9):e2235575.

E-9-1-1 52

E-9-1-1 Emergency Department Defibrillator ALS 52

Don't Forget the Bubbles

NOVEMBER 27, 2024

C presents to your emergency department. FIDO was designed to assess the management of young febrile infants presenting to emergency departments in the UK and Ireland , report risk factors for IBI, and apply CDAs that do not exclusively rely on PCT testing. An additional 1 ml of blood was taken for PCT from some infants.

E-9-1-1 81

E-9-1-1 Emergency Department Ambulance ED 81

NAEMSP

APRIL 19, 2023

This CI does include 1; and further and further analysis of the data showed that the likelihood that calcium has a beneficial effect (e.g. The overall conclusion was that as less than 1% of cardiac arrest etiologies fall into a group that would potentially benefit from calcium, that routine use should be avoided (Padrao, et.

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E-9-1-1 Advanced Life Support Overdose CPR 52

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. October 2022.

Emergency Department 81

Emergency Department ALS E-9-1-1 ED 81

REBEL EM

OCTOBER 26, 2023

1–4 Antimicrobial resistance is a global health crisis, underscoring the importance of antibiotic stewardship. Enrollment: Recruited patients from primary care offices, emergency departments, and inpatient wards at Children’s Hospital of Philadelphia and UPMC Children’s Hospital of Pittsburgh.

E-9-1-1 81

E-9-1-1 Emergency Department OR ALS 81

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. October 2022.

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E-9-1-1 Emergency Department ED OR 58

Don't Forget the Bubbles

OCTOBER 19, 2023

Over 1,500 children in EDs, aged 1 to 4 with acute hypoxemic respiratory failure needing hospital admission, across 14 emergency departments in Australia and New Zealand were randomly allocated 1:1 to high-flow oxygen therapy OR standard oxygen therapy (approximately 750 children in each group). days compared to 1.50

E-9-1-1 81

E-9-1-1 ED OR Emergency Department 81

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. American Journal of Emergency Medicine 2022 4.

E-9-1-1 52

E-9-1-1 STEMI ALS ED 52

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.

E-9-1-1 77

E-9-1-1 ALS EMS OR 77

REBEL EM

OCTOBER 5, 2023

1-6 We now have the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial. Patients admitted to the ICU with severe community-acquired pneumonia were randomized in a 1:1 ratio to receive hydrocortisone or a placebo. However, except for one trial, none showed a between-group difference regarding mortality.

Critical Care 94

Critical Care ICU E-9-1-1 ALS 94