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). A baby formula milk shortage for adults.” 11 Table 1. If there are no limitations linked to body habitus (i.e.

E-9-1-1 73

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

Pediatric EM Morsels

NOVEMBER 3, 2023

More specifically they have seen this trend continue to rise in the era of post-COVID travel (Choy 2022). Another change is the CDC approved the use of IV artesunate for malaria treatment in the US in May 2022. WHO 2022) In a previous PEM morsel, we mentioned Sickle Cell Trait is only protective against P. falciparum.

ALS 278

ALS Critical Care EMS OR 278

Broome Docs

OCTOBER 31, 2022

2022 Jan;48(1):78-91. 2022 Sep;21(9):781-791. 2022 Sep 15;387(11):989-1000. 2022 Sep 18. 2022 Aug;41(4):101096. Epub 2022 Apr 28. 2022 Aug 3;11:100284. 2022 Jul 26:emermed-2021-211540. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Lancet Neurol.

E-9-1-1 52

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

Dr. Smith's ECG Blog

NOVEMBER 17, 2024

When in need of a "Refresher" on what BTWI may look like — I suggest periodically checking out Dr. Meyers' March 22, 2022 post — in which he shows a series of cases illustrating BTWI in "all of its flavors". Since the patient has active pain, that is less likely. Is this: 1) inferior OMI with benign T-wave inversion in precordial leads?

OR 72

OR 72

Core EM

JANUARY 25, 2024

Accessed April 29, 2022. Retrieved April 29, 2022, from [link] Vantour L, Goltzman D. Diagnosis and management of hypocalcaemia. Prevalence and clinical implications of hypocalcemia in acutely ill patients in a medical intensive care setting. Am J Med 1988; 84:209. Goltzman, D. Diagnostic approach to hypocalcemia. Louis, Mosby, Inc.,

Critical Care 246

Critical Care ED ALS OR 246

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

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

Don't Forget the Bubbles

OCTOBER 2, 2024

2022 Mar 10;5(3). Guidelines for the management of pediatric severe traumatic brain injury, third edition: Update of the brain trauma foundation guidelines. Pediatric Critical Care Medicine. How This study was an observational, comparative effectiveness study comparing 3% hypertonic saline with mannitol rather than to a control. Voellger, B.,

OR 49

OR Critical Care ALS Emergency Department 49

Pediatric EM Morsels

AUGUST 2, 2024

Balanitis and Balanoposthitis – Basics Terminology [Assim 2022, Dynamedex 2024, Perkins 2024] Balanitis – Inflammation of the glans penis Posthitis – Inflammation of the foreskin (prepuce) Balanoposthitis – Inflammation of both (ouch!) It’s even more distressing when the skin problem affects the penis.

Allergic Reaction 152

Allergic Reaction OR EMS 152

ACEP Now

JULY 7, 2023

Heart disease and stroke statistics-2022 update: A report from the American Heart Association. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. amiodarone or lidocaine). References Tsao CW, et al.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Review of the 2 ECGs in today's case is insightful ( Figure-1 ): The initial ECG shows sinus rhythm, LAHB and meets Peguero Criteria for LVH ( See My Comment in the August 15, 2022 post of Dr. Smith's ECG Blog for more on LVH criteria ). Thus, the lumen observed may actually still be the same size as the original, normal lumen.

Coronary 115

Coronary ACS OR EMR 115

Broome Docs

AUGUST 2, 2022

2022 Jun 23;386(25):2387-2398. 2022 Jan;175(1):20-28. 2022 Jan;175(1):29-35. 2022 May 1;176(5):486-492. 2022 Mar;135(3):369-379.e1. 2022 Mar 16;56:10-12. Vitamin C in sepsis: STOP IT, we do not LOVE IT Lamontagne F, Masse MH, Menard J, et al; LOVIT Investigators and the Canadian Critical Care Trials Group.

ED 52

ED Emergency Department ALS Critical Care 52

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

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-9-1-1 286

E-9-1-1 Epinephrine Emergency Department OR 286

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

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 Plasma Emergency Department OR 152

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

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

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

SEPTEMBER 9, 2024

NOTE: For review of 20 cases of "Swirl" vs Swirl "Look-Alikes" — Check out the October 15, 2022 post in Dr. Smith's ECG Blog. In a large proportion of cath labs, the operator would probably have ended the case at this point. Smith comment : a very high proportion of MINOCA are ruptured plaque with lysed thrombus.

OR 66

OR Coronary ACS EMS 66

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

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 OR Life Support 246

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-9-1-1 269

E-9-1-1 Emergency Medical Services Life Support ALS 269

Dr. Smith's ECG Blog

OCTOBER 8, 2024

For more on Precordial Swirl — See the October 15, 2022 post in Dr. Smith's ECG Blog ). In support of my impression that the ST-T wave changes in the chest leads are acute until proven otherwise — is the ST segment flattening and depression in lead II — as well as the J-point ST depression in lead I ( BLUE arrows in these leads ).

OR 107

OR STEMI ICU Coronary 107

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

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

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 Plasma First Aid 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

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)!

Emergency Department 189

Emergency Department ALS EMS OR 189

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