ALiEM

MAY 19, 2023

The SB tube was created in 1950 in order to help tamponade variceal bleeds [1]. Apply traction to the tube by tying a roller bandage to the end of it and then the other end to a 1 L bag of IV fluids. Pearl 1: Check the units of pressure being used. The conversion rate is: 1 cmH2O = 0.74 1950 May;131(5):781-9.

E-9-1-1 245

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

Pediatric EM Morsels

SEPTEMBER 22, 2023

Negative E-FAST and no signs of long bone injuries should raise concern for neurogenic shock in the hypotensive trauma patient with suspected spinal injury. Alpha 1 agonists are necessary to maintain appropriate blood pressure. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues. Basics are the Best!

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

Pediatric EM Morsels

JULY 28, 2023

Rates of type 1 diabetes have increased since the COVID-19 pandemic. Kendra Jackson and Rebecca Raffler While we’ve gotten to snack on a Morsel on this subject before , new guidelines and research surrounding DKA and cerebral edema have come to light since the first go ‘round! Neuroimaging is NOT required. GCS score is not sensitive enough.

E-9-1-1 245

E-9-1-1 ALS OR Critical Care 245

ALiEM

OCTOBER 2, 2023

F) temporal; Resp 18; SpO2 99%, RA Skin : Large, 3 x 3cm indurated, erythematous lesion located over the patient’s right temporal scalp (Image 1). Minakova E, Doniger SJ. 2014 Jun;30(6):437-9. An outpatient ultrasound was performed showing “multiple scalp echogenic nodular lesions measuring from 0.5 cm in the long axis diameter.”

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E-9-1-1 Emergency Department OR 189

EMDocs

OCTOBER 5, 2024

Answer : ESBL-producing organisms Background 1-3 Extended spectrum beta-lactamases (ESBL) are enzymes produced by certain bacteria that can break down a broad range of beta-lactam antibiotics. 3 Epidemiology 4-8 ESBL-producing Enterobacteriaceae (ESBL-E) have been reported worldwide. ceftriaxone, cefepime).

E-9-1-1 74

E-9-1-1 EMS ALS OR 74

Pediatric EM Morsels

JUNE 30, 2023

References Dessole F, Virdis G, Andrisani A, Vitagliano A, Cappadona R, Dessole S, Cosmi E, Capobianco G. Leblanc C, Baron M, Desselas, E, Phan, MH, Rybak A, Thouvenin G, Lauby C, Irtan S. Dec: 9 (12): 1830. Fetal Congenital Cystic Adenomatoid Malformation (CCAM): Pathogenesis, Diagnosis, and Clinical Management: A Case Report.

E-9-1-1 258

E-9-1-1 ED EMS OR 258

This Podcast Will Kill You

JULY 23, 2024

Official journal of the American College of Gastroenterology| ACG , 118 (1), pp.59-76. Annals of internal medicine , 172 (1), pp.ITC1-ITC16. ” BMC medicine 17 (2019): 1-20. Gastroenterology , 160 (1), pp.63-75. Suddenly, grocery stores were filled with gluten-free crackers, cookies, buns, you name it. Kelly, C.P.,

E-9-1-1 98

E-9-1-1 ALS OR 98

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Moreover , the patient has ongoing symptoms and has an unexplained elevated troponin, so she is having an MI and the only question is whether it is type 1 or type 2 due to hypertension. Case continued She was loaded with aspirin 325 mg, and repeat troponin drawn around the time of EKG 1 resulted at 267 ng/L. At midnight. At midnight.

E-9-1-1 118

E-9-1-1 ACS Coronary STEMI 118

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. This is written by Willy Frick, an amazing cardiology fellow in St. He described it as "10/10" intensity, radiating across his chest from right to left.

E-9-1-1 113

E-9-1-1 Coronary ACS BLS 113

This Podcast Will Kill You

OCTOBER 1, 2024

Medical journal of Australia , 190 (9). Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-α-1, 3-galactose. Ronmark, E. The relevance of tick bites to the production of IgE antibodies to the mammalian oligosaccharide galactose-α-1, 3-galactose.

E-9-1-1 52

E-9-1-1 ALS OR 52

EMDocs

FEBRUARY 15, 2024

1 These plants contain tropane alkaloids such as atropine (mixture of d-hyoscyamine and l-hyoscyamine) and scopolamine which are muscarinic receptor antagonists. 2 Jimson weed ( Datura stramonium, Figure 1) is one of several anticholinergic plants that if ingested can cause anticholinergic toxicity. 3 Figure 1. 3 Figure 1.

E-9-1-1 90

E-9-1-1 Overdose ED OR 90

ACEP Now

FEBRUARY 13, 2024

A radiograph is shown (see figure 1). LEARN MORE The most common nerve blocks in this study are shown in Table 1. 1–4 Emergency physicians commonly prescribe opioid pain medications, and there is significant variability among prescribing patterns. 2023 Sep 2;15(9):e44583. 2023 Oct 1;19(6):379-385.

E-9-1-1 52

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

EMDocs

FEBRUARY 20, 2024

Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. 2023 Mar 22;27(1):122. Management: 1) Discontinue meds causing hypertriglyceridemia, 2) Gemfibrozil 600 mg BID, 3) Electrolyte repletion, 4) Gentle dextrose/insulin infusion, 5) Nutritional support. N Engl J Med.

E-9-1-1 83

E-9-1-1 ICU ALS OR 83

ACEP Now

OCTOBER 11, 2024

1 Pediatric rapid sequence intubation (RSI) in the ED is associated with a higher frequency of failed first attempts and adverse effects than in adult patients. Paralytic agents include rocuronium at 1 mg/kg IV and succinylcholine at 1-2 mg/kg IV. What is the most appropriate treatment at this time? mg/kg IV, ketamine at 1.5–2

E-9-1-1 52

E-9-1-1 Emergency Department Advanced Life Support ALS 52

EMDocs

MARCH 2, 2024

Answer : Pneumocephalus 1-21 Background: Pneumocephalus is defined by the presence of air within the cranial cavity. 1-3] The most common location is the frontal region, followed by the occipital and temporal regions. [4] 1-3] The most common location is the frontal region, followed by the occipital and temporal regions. [4]

EMS 114

EMS E-9-1-1 OR ED 114

Pediatric EM Morsels

MAY 5, 2023

2018 Dec 20;11(1):5. Hovinen T, Korkalo L, Freese R, Skaffari E, Isohanni P, Niemi M, Nevalainen J, Gylling H, Zamboni N, Erkkola M, Suomalainen A. Supplementation is key! Key nutrients and vitamins are not always found in specialized diets (or picky children) and adherence to multivitamins is a must! 2021 May 18;13(5):1707.

E-9-1-1 130

E-9-1-1 OR EMS 130

Broome Docs

JANUARY 30, 2023

PMID: 33933300 Khan A, Saleem MS, Willner KD, Sullivan L, Yu E, Mahmoud O, Alsaid A, Matsumura ME. 2022 Sep 1;5(9):e2235575. doi: 10.1007/s00381-022-05455-1. Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis. N Engl J Med. 2017 Dec 7;377(23):2240-2252. doi: 10.1056/NEJMoa1615066. Am J Emerg Med.

E-9-1-1 52

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

Don't Forget the Bubbles

MARCH 18, 2024

The Royal Children’s Hospital in Melbourne summarises them in an easy-to-follow flow diagram (figure 1). Typical HUS has a diarrheal prodrome, usually caused by an infection with a Shiga-toxin-producing E. Typical HUS has a diarrheal prodrome, usually caused by an infection with a Shiga-toxin-producing E. What is typical HUS?

E-9-1-1 59

E-9-1-1 ALS OR 59

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? Other lung fields unremarkable. C or 100.4 mg/kg, max 0.4

E-9-1-1 76

E-9-1-1 ICU ACS EMS 76

EMDocs

APRIL 13, 2024

1] In a survey of college wrestlers, the incidence of auricular hematoma was found to be 52% for those who do not wear headgear versus 26% who wore ear protection.[2] 1] In a survey of college wrestlers, the incidence of auricular hematoma was found to be 52% for those who do not wear headgear versus 26% who wore ear protection.[2]

EMS 82

EMS E-9-1-1 OR Emergency Department 82

ALiEM

OCTOBER 30, 2023

It should be no surprise that academic clinical educators are at high risk for burnout, stalled career advancement, and abandonment of academic medicine altogether [1, 2]. After spending her first year acclimating to the new department and achieving board certification, Dr. Garcia finds herself at a bit of a crossroad. In short, no.

E-9-1-1 161

E-9-1-1 ALS OR 161

EMDocs

SEPTEMBER 7, 2024

1 Risk Factors: 1-4 Spontaneous Anticoagulants (Apixaban, Rivaroxaban, etc.) Older Age (median age of 70 years) 1 Abnormal vasculature/neoplasm of the kidney (e.g., 5 Clinical Presentation: 1-3 Variable presentation but may present with dropping hemoglobin/hematocrit without other findings in spontaneous cases.

EMS 75

EMS E-9-1-1 Operating Room OR 75

EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? On exam, the patient opens eyes to voice, has extraocular movements intact, is unable to speak, and has 0/5 strength in all extremities. The patient was intubated for acute hypercapnic and hypoxic respiratory failure and airway protection.

EMS 89

EMS E-9-1-1 ALS OR 89

Don't Forget the Bubbles

SEPTEMBER 16, 2023

You will find the list is broken down into four sections: 1.Reviews 2023 Aug 23:e2023062806. 2023 Aug 23. 2023 Aug 16. 2023 Aug 2. 2023 Aug 10:e2023062307 Rosacea in children: a review. 2023 Aug 10:e2023062307 Rosacea in children: a review. 2023 Aug 9. 2023 Aug 2. 2023 Aug 21.

E-9-1-1 75

E-9-1-1 ALS OR ED 75

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

To me, it was clearly atrial flutter with 1:1 conduction. Continue Eliquis 5mg BID, should be continued for 3 months == MY Comment , by K EN G RAUER, MD ( 9/18 /2024 ): == I found the following aspects of today's case of special interest. Why did Dr. Smith immediately say the rhythm was AFlutter with 1:1 AV conduction?

E-9-1-1 65

E-9-1-1 ALS OR ED 65

Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. C Examination notable for diaphoresis, 1+ bilateral lower extremity edema, regular heart rate and rhythm, and no signs of respiratory distress with normal breath sounds. What do you think? In fact, Kosuge et al. Stein et al.

E-9-1-1 133

E-9-1-1 ACS Emergency Department ALS 133

EMDocs

FEBRUARY 7, 2024

Despite a plateau in overall union membership of around 10% in 2023 1 , major labor actions shook the U.S. there were 31 recorded healthcare strikes in 2021, 39 recorded healthcare strikes in 2022, and 37 healthcare strikes in 2023 as of November 3rd. October 16, 2023. 2023 October 9. Frequency : In the U.S.,

E-9-1-1 77

E-9-1-1 Ambulance OR 77

EMDocs

NOVEMBER 29, 2023

EBM Update: Fluids in Pancreatitis, Hypertriglyceridemic Pancreatitis #1: de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. 2023 Mar 22;27(1):122. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000. Systematic review and meta-analysis.

E-9-1-1 66

E-9-1-1 ICU ALS OR 66

Don't Forget the Bubbles

DECEMBER 6, 2023

Their analyses revealed an association between social media use and e-cigarette and tobacco use. 2023 Nov 15. 2023 Nov 1;152(5):e2023062911. We suggest this list can help you discover relevant or interesting articles for your local journal club or allow you to keep a finger on the pulse of paediatric research. Eur J Pediatr.

E-9-1-1 52

E-9-1-1 ALS OR Critical Care 52

EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). What alternative testing can be done in these circumstances?

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

EMDocs

MAY 25, 2024

Massaging the gland causes expression of purulent material. What is the diagnosis?

EMS 80

EMS E-9-1-1 OR ED 80

ACEP Now

JANUARY 9, 2024

FIGURE 1: Abdominal X-ray showing particulate radiopaque foreign bodies involving the stool. 1 Children are particularly vulnerable. 9 Lead exerts its toxic effects by interfering with various organ functions, primarily targeting the nervous system and hematopoietic system, as well as impairing liver and kidney functions.

E-9-1-1 52

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

EMDocs

JULY 29, 2023

Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E.

E-9-1-1 71

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

Don't Forget the Bubbles

MAY 8, 2024

You will find the list is broken down into four sections: 1.Reviews 2024 Apr 9. 2024 Apr 25:archdischild-2023-326533. 2024 Apr 18:fetalneonatal-2023-326679. 2024 Apr 16:archdischild-2023-326247. 2024 Apr 16:archdischild-2023-326331. Reviews and opinion articles Approach to simple kidney cysts in children.

E-9-1-1 69

E-9-1-1 ALS Emergency Department Epinephrine 69

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

EMDocs

NOVEMBER 18, 2023

A point of care ultrasound of the liver reveals the following: Image 1: Ultrasound of the liver showing abnormal hepatic artery flow and resistance index 1 Question: What is the diagnosis? She came today because her sister is a nurse who noticed her eyes were yellow. She denies fever or a new rash. LFTs are in the thousands.

EMS 69

EMS E-9-1-1 ALS Emergency Department 69

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Learning Point: 1. link] = My Comment by K EN G RAUER, MD ( 11/14 /2023 ): = One of the most helpful clinical clues in support that an acute cardiac event is ongoing — is the finding of " dynamic " ECG changes. Figure-1: Comparison between the first 3 ECGs in today's case. How Would YOU Interpret the Serial Tracings in Figure-1?

E-9-1-1 101

E-9-1-1 Coronary EMS ED 101