ALiEM

APRIL 14, 2023

Highlighted Quality Posts: Procedures Site Article Author Date Label Rebel EM Intra Articular Lidocaine vs Sedation in Shoulder Reductions Nordia Matthews, MD 30 Jan 2023 AIR EM Docs Video Laryngoscopy in the ED Cameron Jones, MD 8 Aug 2022 AIR First 10 EM Lacerations: Does closure technique matter? Please go to the above link.

EMS 246

EMS Emergency Department ED OR 246

The Skeptics' Guide to EM

JANUARY 6, 2024

Case: After your shift in the emergency department (ED) one day, the medical director pulls you aside. Background: Back in August of 2022, we announced the start of #SGEMPeds for SGEM Season 11. July 2023 * Population: ED leadership across the United States. She is nationally known for her work as an EMS researcher and educator.

Emergency Department 340

Emergency Department Emergency Medical Services ALS ED 340

The Skeptics' Guide to EM

MARCH 25, 2023

Trauma Surg Acute Care Open 2022 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. Casey […] The post SGEM#398: Another Ab Gets BUSED – POCUS in the ED for Biliary Disease first appeared on The Skeptics Guide to Emergency Medicine.

ED 130

ED Critical Care Emergency Department ALS 130

Don't Forget the Bubbles

MARCH 21, 2025

A total of eleven intensive care units (ten PICUs and one non-maternity NICU) and four emergency departments (EDs) took part in the study. Given the emergency setting, the trial used a research without prior consent model, with delayed consent-to-continue obtained from the childs legal guardian as soon as practical. Who were the patients?

ICU 108

ICU Critical Care ED OR 108

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

The SQuID Protocol (Subcutaneous Insulin in Diabetic Ketoacidosis): Impacts on ED Operational Metrics. Data was collected from August 1, 2021 – February 20, 2022. Potential Impact To Current Practice ED boarding continues to be a major nationwide issue, and ICU bed availability is often limited.

EMS 246

EMS ICU ED OR 246

Dr. Smith's ECG Blog

OCTOBER 15, 2024

He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon. He arrived to the ED by ambulance at 1529, only a half hour after the start of his chest pain around 1500 while eating. Patient 2 , EKG 1: What do you think? The patient had none of these conditions.

OR 116

OR STEMI Coronary ED 116

ACEP Now

JANUARY 5, 2025

A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. On exam, you see bright red blood trickling down her left tonsillar fossa.

Operating Room 98

Operating Room Epinephrine ALS ED 98

Pediatric EM Morsels

JUNE 30, 2023

I’m sure you can recall at least several parents who bring their children into the ED for concern of recurrent pneumonias. Often the parents focus on a possible underlying immunodeficiency. Fortunately, most commonly these pneumonias are due to viral infections, and we can often offer reassurances to the parent. Dec: 9 (12): 1830.

E-9-1-1 284

E-9-1-1 ED EMS OR 284

Pediatric EM Morsels

AUGUST 23, 2024

Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. It does NOT have structural brain damage visible on standard neuroimaging. Br J Sports Med.

Emergency Department 281

Emergency Department OR ED EMS 281

EMDocs

OCTOBER 9, 2023

Yoo, MD (Assistant Professor/Core Faculty, San Antonio, TX) // Reviewed by Brit Long, MD (@long_brit) Case An 18-year-old man with a history of asthma and medication noncompliance presents to the emergency department (ED) with acute onset shortness of breath. He states that he recently moved to Texas from Colorado. Which one do you select?

ED 109

ED Life Support Advanced Life Support CPR 109

Core EM

JANUARY 25, 2024

1 2 3 4 This article will focus on three lower extremity (LE) nerve blocks commonly used for acute lower extremity pain in the ED. 1 2 3 4 This article will focus on three lower extremity (LE) nerve blocks commonly used for acute lower extremity pain in the ED. Published February 4, 2022. Am J Emerg Med. 2014;32(7):801-803.

Epinephrine 246

Epinephrine ED Emergency Department OR 246

REBEL EM

MAY 27, 2024

Clinical Question: Does simultaneously performing the modified valsalva maneuver and administering intravenous adenosine, compared to either treatment alone, have greater success in achieving normal sinus rhythm in patients presenting to the ED with PSVT? This absence of detail leaves the study open to bias.

OR 137

OR E-9-1-1 ED ALS 137

EMDocs

DECEMBER 1, 2024

A 52-year-old male with a history of essential hypertension presents to your South Texas ED for his second visit this week complaining of indolent fever, shortness of breath, pleuritic chest pain, and a rash on his trunk and extremities. We’ll keep it short, while you keep that EM brain sharp.

EMS 105

EMS E-9-1-1 OR ED 105

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." 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

The Skeptics' Guide to EM

AUGUST 10, 2024

Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table. When he arrives at your ED, the family tells you he was doing fine until dinner. He was confused, slurring his speech, and had trouble moving his right side.

Emergency Medical Services 224

Emergency Medical Services ALS Emergency Department ED 224

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). 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013.

E-9-1-1 101

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

EMDocs

NOVEMBER 19, 2024

His roommate found an empty pill bottle on the floor next to him. Second-generation antipsychotics (see Table 1 below) improve both positive and negative symptoms of schizophrenia and are less likely to be associated with EPS. 1,2 Most second-generation antipsychotics act as D 2 antagonists and inhibit the 5-HT 2A receptor.

Overdose 111

Overdose EMS Emergency Medical Services OR 111

Core EM

JANUARY 25, 2024

Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients. Short acting. mg/kg IV followed by 0.05 – 0.4

ICU 246

ICU Emergency Department Critical Care ALS 246

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. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.

ED 129

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

Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. 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 x exp[0.02

E-9-1-1 271

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

ALiEM

FEBRUARY 5, 2024

Take the AIR Toxicology Module at ALiEMU Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link. You will need to create a free, 1-time login account. Reference Lin M, Phipps M, Chan TM, et al.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

Pediatric EM Morsels

JULY 26, 2024

It is commonly missed during the first few ED visits. Keep a high index of suspicion for anti-NMDAr encephalitis in children and adolescents who have had multiple ED visits for new and worsening psych/behavioral concerns, seizures, and/or movement disorders over several months. 2022 Jul 6;9(5):e200013. doi: 10.1212/NXI.0000000000200013.

Plasma 271

Plasma OR ED Critical Care 271

ALiEM

FEBRUARY 28, 2024

July 27, 2022. References Iverson C, ed. Clinical photograph for: Ludwig Angina. CorePendium. For Media Without an Associated Publication: This type of citation may be helpful if the image is used in multiple places within a publication, or if it is not tied to a particular publication. Last Name First Initial. Media title.

OR 130

OR ED 130

EMDocs

NOVEMBER 13, 2024

Major takeaway: Consider SBP in any patient who comes into the ED with ascites. Literature concerning risk with PPIs is controversial. Presentation: Classic presentation is abdominal pain or tenderness, fever, and altered mental status. Literature suggests 10-33% of patients are asymptomatic or only have mild symptoms. increase in mortality.

E-9-1-1 105

E-9-1-1 ALS OR ED 105

ALiEM

OCTOBER 14, 2023

These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Take the AIR Respiratory Module at ALiEMU Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

EMS 12-Lead

MARCH 30, 2024

On ED arrival ROSC is achieved. The University of Maryland found that capture occurred in only 42-78% of patients, dependent on pad positioning (Moayedi et al, 2022). They are unable to feel a pulse and resume CPR. The receiving staff suspects pulmonary embolism due to S1Q3T3 on the ECG and administers TPA.

CPR 312

CPR Paramedic Ambulance Epinephrine 312

ALiEM

OCTOBER 4, 2023

Epub 2022 Dec 30. May 24, 2022. This kit has historically been issued to US service members for treating nerve agent toxicity from agents such as soman, sarin, tabun, and VX, all of which are organophosphates and cause a cholinergic toxidrome. What are nerve agents? [1-3] They have been used in Europe recently for assassinations [4].

Plasma 195

Plasma OR ED 195

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. You wonder whether a model of care involving a specifically designed unit would improve their patient experience and ED boarding times. AEM February 2022. Reference: Kim et al.

ED 130

ED ALS Emergency Department OR 130

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

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. amiodarone or lidocaine).

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

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. The right ankle is swollen and tender.

Emergency Department 130

Emergency Department ALS ED OR 130

ACEP Now

NOVEMBER 8, 2024

6 According to a 2022 survey of 1,000 people across multiple organizations, 91 percent of respondents do not know how common neurodivergent conditions are. But what exactly are neurodivergence and neurodiversity? 12 Each person has their unique approach to learning and understanding, and we adapt and use techniques that suit us best.

Emergency Department 52

Emergency Department ED OR ALS 52

The Skeptics' Guide to EM

SEPTEMBER 10, 2022

Date: August 25th, 2022 Reference: Martin et al. 2022 Guest Skeptic: Dr. Harrison Hayward is a Pediatric Emergency Medicine fellow at Children’s National Hospital. Date: August 25th, 2022 Reference: Martin et al. 2022 Guest Skeptic: Dr. Harrison Hayward is a Pediatric Emergency Medicine fellow at Children’s National Hospital.

Emergency Department 130

Emergency Department ALS ED OR 130

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

male presents to the ED at 6:45 AM with left sided chest dull pressure that woke him up from sleep at 3am. He arrived to the ED at around 6:45am, and stated the pain has persisted. Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. The pain radiated to both shoulders.

Coronary 122

Coronary ACS OR EMR 122

The Skeptics' Guide to EM

OCTOBER 1, 2022

Date: September 28th, 2022 Reference: Hartford et al. AEM September 2022. Date: September 28th, 2022 Reference: Hartford et al. AEM September 2022. Patients with migraines often present to the ED looking for pain relief. AEM September 2022. They took 400 mg ibuprofen at home without relief.

Emergency Department 130

Emergency Department ALS ED OR 130

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188