Core EM

JANUARY 25, 2024

Accessed March 9, 2022. link] Accessed February 28, 2022. Treasure Island (FL): StatPearls Publishing; 2022 Jan. EVALUATION: Scan the affected and contralateral body part for comparison with a sterile cover (or Tegaderm) overlying a high frequency linear probe. REFERENCES: Castleberg E, Jenson N, Dinh VA. 2014;15(1):111-113.

E-9-1-1 246

E-9-1-1 Emergency Department OR 246

Pediatric EM Morsels

JULY 19, 2024

2022 Sep-Oct;43(5):103582. Epub 2022 Aug 6. Your support staff…depending on the amount of bleeding, you are about to have your hands full and may need IV access, medications, airway management, etc. Get a hold of ENT early as OR management and/or admission are common. Set up suction x2 in the room! Headlamps can also be helpful!

E-9-1-1 285

E-9-1-1 Epinephrine OR Emergency Department 285

ALiEM

JUNE 5, 2023

Human illness is most commonly acquired by handling animal fluids or pelts. There are several forms of anthrax, however cutaneous is the most common (95% of cases) and the least complicated to treat [2]. What are the symptoms of cutaneous anthrax? [3, 3, 4] Naturally occurring cases develop after spores of B. Is cutaneous anthrax reportable? [6,

ALS 256

ALS OR ED 256

Pediatric EM Morsels

AUGUST 9, 2024

Early Congenital Syphilis Present before 2 years of age [ Hussain, 2023 ; Foles, 2024; Fang, 2022; Morrisroe, 2021 ] Only ~33% of newborns present with symptoms at birth and can be subtle. Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal? Is this bloody stool concerning?

E-9-1-1 152

E-9-1-1 Emergency Department Plasma OR 152

Pediatric EM Morsels

MARCH 1, 2024

Wojsyk-Banaszak, 2018 ) Mainstay of initial therapeutic management is: ( Wojsyk-Banaszak, 2018 ; Fernando, 2022 ) Prolonged course of IV antibiotics Chest physiotherapy Patients managed with medical strategies (compared to surgical) had lower complication rates and shorter hospitalizations. 2022 Jul;92(7-8):1850-1855. Epub 2022 Jun 9.

EMS 169

EMS Critical Care OR 169

ALiEM

NOVEMBER 17, 2023

Accessed January 5, 2022. Accessed January 5, 2022. The grandmother first noted blood in the patient’s underwear the previous morning when she was helping the patient wipe and she noticed it again prior to arrival, this time saturating the patient’s underwear. The patient in this case was treated with a 4-week estrogen cream taper.

Emergency Department 250

Emergency Department OR 250

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

ALiEM

JULY 20, 2023

Highlighted Quality Posts: Infectious Disease Site Article Author Date Label SGEM Lumbar punctures in febrile infants with positive urinalysis – it’s just overkill Dennis Ren, MD December 31, 2022 AIR EMDocs Bacterial Meningitis Mounir Contreras Cejin, MD January 28, 2023 HM ALiEM The Febrile Infant Corey Ziemba, MD, Justin Hacnik, MD and J.D.

Emergency Department 188

Emergency Department EMS OR 188

ALiEM

FEBRUARY 5, 2024

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 Toxicology Module at ALiEMU Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

ALiEM

MARCH 11, 2024

In July 2022, a 32-year-old male with a past medical history of HIV (on antiretroviral therapy, CD4 390, viral load undetectable) presented to the emergency department with constitutional symptoms and a rash for 4-5 days. Epub 2022 Jul 27. The 2022 outbreak and the pathobiology of the monkeypox virus. 2022 Jul;131:102855.

Emergency Department 141

Emergency Department ALS OR 141

ALiEM

OCTOBER 11, 2023

2022 Feb 8;14(2):123. Treasure Island (FL): StatPearls Publishing; August 8, 2022. 2022 Feb;60(2):262-266. 2022 Nov 8;19(22):146-8. [4, 5] Onset: Most cases will present within 5-30 minutes of ingestion; however, onset of symptoms as late as 20 hours after ingestion is reported. Toxins (Basel). Channels (Austin).

E-9-1-1 204

E-9-1-1 ALS OR 204

Dr. Smith's ECG Blog

DECEMBER 12, 2022

Comment by K EN G RAUER, MD ( 12/12 /2022 ): = I will summarize in 4 words the important message conveyed by Dr. Meyers in today's post = "Be Aware of Pseudo-Normalization!" In other words, to get from hyperacute T waves and STE to terminal T wave inversion, the ST and T wave must pass transiently through a state of near-normal.

OR 52

OR ACS STEMI Coronary 52

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

US Patriot

JANUARY 19, 2023

Patriot Tactical partnered with the non-profit Hero Hut at the 2022 Valero Alamo Bowl in San Antonio, TX, to give back to our brave men and women in uniform. US service members display the American Flag on the field at the 2022 Valero Alamo Bowl. Supporting Veterans through Community Last December, U.S.

First Responder 52

First Responder OR Public Safety EMT 52

Pediatric EM Morsels

APRIL 5, 2024

CDC 2022) Testing for many of these illnessess can take time during the acute phase as many are ELISA or PCR tests. CDC 2022) Divided into Soft tick relapsing fever and Hard tick relapsing fever , depending on what type of ticks carry the Borrelia sp (CDC 2022) There is also a louse which carries a Borrelia sp.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

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-9-1-1 268

E-9-1-1 Emergency Medical Services Life Support ALS 268

Pediatric EM Morsels

AUGUST 23, 2024

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. In the research setting, abnormalities can be found via functional, blood flow, or metabolic imaging. Br J Sports Med. 2023 Jun;57(11):695-711.

Emergency Department 243

Emergency Department OR ED EMS 243

The Skeptics' Guide to EM

JANUARY 28, 2023

Date: January 22, 2022 Reference: Samuels-Kalow M et al. Date: January 22, 2022 Reference: Samuels-Kalow M et al. The ruling of the US Supreme Court on June 24, 2022 in Dobbs v Jackson Women’s Health Organization overturned Roe v Wade and allowed individual US states to determine their own restrictions on abortion.

ALS 130

ALS OR 130

Pediatric EM Morsels

MARCH 17, 2023

Since we all inhabit the same beautiful world , and sometimes we humans overtake previous habitats of animals, we inevitably will cross paths with an animal that bites us. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ). Sometimes it’s a beloved pet who gets surprised or has an “off” day ( Dog Bites and PTSD ).

Frozen Plasma 130

Frozen Plasma First Aid Plasma OR 130

Core EM

JANUARY 25, 2024

Calculate the maximum safe local anesthetic dosage for the patient. 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. In: StatPearls. Am J Emerg Med.

Epinephrine 246

Epinephrine ED OR Emergency Department 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. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Guest Skeptic: Dr. Salim R. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Guest Skeptic: Dr. Salim R.

ALS 130

ALS Emergency Department OR EMS 130

The Skeptics' Guide to EM

JANUARY 7, 2023

AJEM 2022 Guest Skeptics: Dr. Timlin Glaser currently a fourth-year resident in emergency medicine at Lehigh Valley Health Network and future medical toxicology fellow at the University of Arizona College of Medicine – Phoenix. Date: January 4th, 2023 Reference: Hasbrouck et al.

Emergency Department 100

Emergency Department OR ALS Ambulance 100

The Skeptics' Guide to EM

AUGUST 10, 2024

The 2022 AHA/ASA guidelines give several recommendations on blood pressure lowering and coagulopathy reversal along with an algorithm. Blood Pressure Control: There is a lot of debate about the aggressiveness of blood pressure lowering. Reversal of Warfarin: Freeman et al. Reversal of Warfarin: Freeman et al. Blood Pressure Lowering:

Emergency Medical Services 183

Emergency Medical Services ALS Emergency Department ED 183

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Smith : this ECG is definitely not OMI, but could be mistaken for Swirl pattern, which is a septal OMI with STE in V1 and STD in V6. See these cases: Precordial Swirl -- 20 cases of Swirl or Look-Alikes Subsequent serial high sensitivity troponin I measurements were all below the level of detection. AMI was ruled out altogether.

OR 119

OR STEMI EMS ED 119

Pediatric EM Morsels

AUGUST 11, 2023

2022 Sep;68(9):661-663. There is increasing resistance patterns though, so it is best to select your antibiotics keeping in mind your local resistance patterns. Inpatient Vs Outpatient Therapy No standard approach… but… here is what I say: “ Always Fear Infections in the Hands, Feet, or Face.” Cipro may be the hero !

EMS 130

EMS OR 130

The Skeptics' Guide to EM

JANUARY 14, 2023

AJEM 2022 Guest Skeptic: Dr. Kevan Sternberg is a urologist/endourologist. AJEM 2022 Guest Skeptic: Dr. Kevan Sternberg is a urologist/endourologist. Date: January 13, 2023 Reference: Razi et al. Dexamethasone and ketorolac compare with ketorolac alone in acute renal colic: A randomized clinical trial.

ALS 130

ALS Emergency Department ED OR 130

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

In 2022 Mobasseri et al published a review of 9 such diagnostic studies and concluded that from an orthopedic perspective that the accuracy was not acceptable, the lack of a randomized controlled trial meant that there was not enough data to support the use of ultrasound over X-ray as an initial diagnostic test [7]. Reference: Snelling et al.

Critical Care 316

Critical Care ALS ED Emergency Department 316

The Skeptics' Guide to EM

OCTOBER 22, 2022

Date: October 18th, 2022 Reference: Moore et al. Resuscitation 2022 Guest Skeptic: Clay Odell is a Paramedic, Firefighter, and registered nurse (RN). Date: October 18th, 2022 Reference: Moore et al. Resuscitation 2022 Guest Skeptic: Clay Odell is a Paramedic, Firefighter, and registered nurse (RN).

CPR 130

CPR Defibrillator Epinephrine Firefighter 130

Pediatric EM Morsels

MARCH 29, 2024

Pediatr Rev (2022) 43 (7): 371–383. To keep things simple, IEM is characterized by the inability to break down macromolecules (fatty acids, carbohydrates, and proteins) or store energy (glycogen). Timing of Presentation / Diagnosis: For severe forms of IEM will present in the first few days of life —before the newborn screen is back!

ED 289

ED Plasma OR EMS 289

Dr. Smith's ECG Blog

AUGUST 18, 2024

We've periodically reviewed cases regarding Pacemaker Troubleshooting ( See the February 18, 2024 post — the January 13, 2024 post — the October 19, 2022 post — the August 3, 2022 post — the May 21, 2023 post — the June 19, 2024 post — and the November 9, 2018 post , to name a number of them ).

OR 92

OR 92

Pediatric EM Morsels

JULY 26, 2024

2022 Jul 6;9(5):e200013. While it is important for us to maintain a safe work environment for our patients and our team, managing the agitated patient requires more of us than administering Droperidol or Ketamine. Make sure to consult your friendly neighborhood pediatric neurologist and/or rheumatologist! The prevalence ranges from 12.5%-61%

Plasma 265

Plasma OR ED Critical Care 265

EMDocs

DECEMBER 19, 2023

Accessed August 25, 2022. Possible early antibiotic treatment Minor Marine Trauma Mechanism: Bites, Stings, Nematocysts Envenomation Presentation: All can cause localized pain, erythema, and warmth Dermatologic: Urticaria, burning, pruritus, localized paresthesia. Marine Trauma and Envenomation. McGraw Hill; 2020. link] Edward OJ.

First Aid 92

First Aid ED OR ALS 92

The Skeptics' Guide to EM

DECEMBER 10, 2022

Date: November 30th, 2022 Reference: Johnson et al. Date: November 30th, 2022 Reference: Johnson et al. Bone Joint J 2022 Guest Skeptic: Dr.Matt Schmitz is an Orthopaedic Surgeon specializing in Adolescent Sports Medicine and Young Adult Hip Preservation. There is not a diagnostic dilemma in this case.

Emergency Department 130

Emergency Department ALS ED OR 130

Pediatric EM Morsels

SEPTEMBER 22, 2023

Updated 2022 Feb 10]. 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. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues. Thought to be a “stunning” of the spinal cord. 5 th Edition.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

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 OR First Aid 246

The Skeptics' Guide to EM

JULY 23, 2022

Date: July 22nd, 2022 Reference: Perry et al. Date: July 22nd, 2022 Reference: Perry et al. The Lancet 2022 Guest Skeptic: Dr. Tessa Davis is a Paediatric Emergency Consultant at the Royal London Hospital, Senior Lecturer at Queen Mary University of London, Co-founder of Don’t Forget The Bubbles ( DFTB ). Reference: Perry et al.

ALS 130

ALS Emergency Department ED OR 130

ALiEM

NOVEMBER 3, 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 Trauma 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 211

Critical Care EMS Emergency Department ALS 211