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

Pediatric EM Morsels

AUGUST 9, 2024

Neonates presenting to the Emergency Department often cause a lot of uncertainty. Let’s review how Congenital Syphilis may present to our Emergency Departments: Congenital Syphilis : Basics Occurs when the spirochete Treponema pallidum is transmitted from mother to fetus. 2024 Jan 16;17(1):e257694.

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

ALiEM

AUGUST 9, 2023

Child with Cough and Fever: Case Introduction A 6-year-old boy presents to the emergency department complaining of cough for 3 days and fever for the last day. Technique Positioning and Probe Figure 1: Younger children can sit in their parent’s lap and give a hug for lateral and posterior lung scanning.

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

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 105

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

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 187

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.”

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

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

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.

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

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 131

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

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

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

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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E-9-1-1 EMS Emergency Department OR 97

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 Plasma Emergency Department 94

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.

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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 105

EMS E-9-1-1 Emergency Department Ambulance 105

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 105

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 92

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

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 111

EMS E-9-1-1 ALS OR 111

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.

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E-9-1-1 ICU Emergency Department ALS 96

EMDocs

JANUARY 4, 2024

1 In addition to intentional overdoses, there are multiple case studies of abuse (ingestion, insufflation, injection). QRS > 100 msec can give sodium bicarbonate 1-2 mEq/kg IV boluses. 9-12 Do not use this prophylactically in bupropion overdoses. Accessed 12/18/2022. 2014;52(9):969-72. Clin Toxicol (Phila).

Overdose 94

Overdose E-9-1-1 ALS Emergency Department 94

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

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 A review of child deaths in England and Wales from 2019 to 2022 revealed that delayed or missed vaccinations were a contributing factor in 3% of cases.

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

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 105

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

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

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.

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

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

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 59

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

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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.

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E-9-1-1 STEMI ALS ED 52

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

ACEP Now

OCTOBER 9, 2024

In the emergency department (ED), physicians face the challenge of making rapid decisions that can significantly impact patient outcomes. Furthermore, this genetic cardiac disease is autosomal dominant, presenting 1 in 500 in our general population. 4 This is seen in the parasternal long axis image (Image 1). Circulation.

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

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. 2022 Jan 1;92(1):44-48. 2015 Jan;39(1):172-8. Acad Emerg Med.

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E-9-1-1 Emergency Department OR ALS 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Written by Destiny Folk MD, with edits by Meyers, peer reviewed by Smith and Grauer A woman in her late 20s with a past medical history of cervical cancer status post chemotherapy and radiation therapy presented to the emergency department for shortness of breath, chest tightness, and two episodes of syncope. 2013 Sep;26(9):965-1012.e15.

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E-9-1-1 OR ED Emergency Department 40

EMDocs

NOVEMBER 16, 2024

1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 2022 Jul;3(7):543-548. BJO-2022-0026.R1.

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EMS E-9-1-1 Operating Room Emergency Department 98