EMDocs

OCTOBER 19, 2024

We’ll keep it short, while you keep that EM brain sharp. to 1 case per 100,000 children. 2][3][9] Hypoxia, respiratory muscle retractions, fatigue, altered mental status, and decreased breath sounds are signs indicative of impending airway failure. [2] A 6-year-old girl presents to the ED with 1 day of fevers up to 104.1°F

EMS 110

EMS E-9-1-1 Epinephrine OR 110

EMDocs

SEPTEMBER 7, 2024

We’ll keep it short, while you keep that EM brain sharp. 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., 1 May need IR or surgical consultations for intervention. F, RR 16, SpO2 97% on room air.

EMS 97

EMS E-9-1-1 Operating Room OR 97

EMDocs

JULY 13, 2024

We’ll keep it short, while you keep that EM brain sharp. 1997 Mar;11(1):203-22. A 37-year-old G2P2 female with no other past medical history presents to the ED with a 2-day history of intermittent fever and foul-smelling vaginal discharge. Infect Dis Obstet Gynecol. 2000;8(2):77-82. PMID: 10805361; PMCID: PMC1784665. Casey BM, Cox SM.

EMS 89

EMS E-9-1-1 Plasma OR 89

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

When EMS found her, she was dyspneic and diaphoretic. Here is lead I from ECGs 1 and 2 shown side-by-side to highlight the change in axis from borderline right to completely normal. Figure-1: I've labeled the initial ECG in today's case. I've excerpted the Table shown below in Figure-2 from My Comment in that June 17, 2024 post.

E-9-1-1 128

E-9-1-1 Coronary STEMI ALS 128

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Her husband called EMS when the patient experienced new onset seizures accompanied by micturition. The ECG below was recorded by EMS. ECG #1 Interpretation: ECG #1 shows sinus rhythm at a heart rate of 77 bpm. For clarity in Figure-1 — I've reproduced the initial ECG in today's case. What is your assessment?

E-9-1-1 113

E-9-1-1 ALS Defibrillator OR 113

REBEL EM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 1, 4, 6 The overall incidence of VAP is somewhere around 5%-40% of all intubated patients, depending on the study and country from which it is reported. Mimoz (2024). 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 119

E-9-1-1 ICU ALS OR 119

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. Accessed May 28, 2024. What do you think?

E-9-1-1 139

E-9-1-1 ACS Emergency Department Coronary 139

Dr. Smith's ECG Blog

OCTOBER 1, 2024

== MY Comment , by K EN G RAUER, MD ( 8/30 /2024 ): == I was sent the ECG shown in Figure-1 — knowing only that the patient was being seen in the ED ( E mergency D epartment ). Figure-1: The initial ECG in today's case. After seeing ECG #2 — Can you explain: i ) Why no negative P wave was seen in lead V1 of ECG #1? —

E-9-1-1 113

E-9-1-1 STEMI ED OR 113

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-9-1-1 110

E-9-1-1 Overdose ED OR 110

ACEP Now

NOVEMBER 8, 2024

Emergency medical services (EMS) scope of practice is governed by the state, but national scope of practice guidelines are available for the four different EMS provider levels. 9 LMAs use an inflatable mask expanded using a similar technique to the endotracheal tube cuff. Accessed October 17, 2024. 2014;4(1):77-87.

E-9-1-1 40

E-9-1-1 Emergency Medical Services Emergency Medical Technician AEMT 40

REBEL EM

MAY 27, 2024

No significant differences in heart rate 1 minute after cardioversion were observed between the three groups. 2010;17(1):44-49. Qiu, S., & Zhang, Q. Combined modified Valsalva maneuver with adenosine supraventricular tachycardia: A comparative study. The American Journal of Emergency Medicine, 78, 157–162. seconds (range: 22.5,

OR 137

OR E-9-1-1 ED ALS 137

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Learning Point: 1. The Queen of Hearts AI app will hopefully be FDA approved in Q1 of 2024. For examples of such exceptions — See My Comment in the January 9, 2019 — August 22, 2020 — and June 30, 2023 posts in Dr. Smith's ECG Blog ). Figure-1: Comparison between the first 3 ECGs in today's case.

E-9-1-1 116

E-9-1-1 Coronary EMS ED 116

FOAMfrat

MAY 19, 2024

Many of us grew up in the age of EMS, which emphasized the need to memorize everything. While transporting to the emergency department, the patient’s mother informed me that PDCD affects less than 1 in 50,000 individuals and is more common in males than females. 2007 9. van Dongen S, Brown RM, Brown GK, Thorburn DR, Boneh A.

E-9-1-1 98

E-9-1-1 ALS EMT EMT 98

FOAMfrat

APRIL 22, 2024

Simulation allows EMS clinicians to train for scenarios they may encounter in the field. Depending on the EMS providers, these scenarios may be ones that they have already encountered or those that they have yet to see in real life. 2024 Mar 15:1-9. Robichaud L, Ross D, Proulx MH, Légaré S, Vacon C, Xue X, Segal E.

E-9-1-1 78

E-9-1-1 ACS Paramedic Critical Care 78

ESO

DECEMBER 19, 2024

While its true that beating th e clock is vital , its only one of many factors to consider. The 2024 ESO Fire Service Index shows that: 67% of all calls are EMS-related, while 3% are fire-related. Tracking your departments data year after year helps you see where youre doing well and where theres room to improve. population.

E-9-1-1 52

E-9-1-1 NFPA Firefighter EMS 52

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. References Long E, Sabato S, Babl FE. mg/kg IV, ketamine at 1.5–2

E-9-1-1 52

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

ACEP Now

JULY 7, 2024

9 By speaking out, I hope to once again find my calling in medicine. Accessed May 19, 2024. Accessed May 19, 2024. 2024;15(1):3-16. Muir-Cochrane E, Oster C. 2020;55(3 Suppl 1):7-16. Why are women leaving EM?: 2024;46(1):1,21. and her emergency medicine residency in Syracuse, N.Y.,

E-9-1-1 52

E-9-1-1 First Responder ALS Emergency Department 52

ALiEM

OCTOBER 30, 2024

Due in large part to the proliferation of anonymous chemical factories able to produce industrial volumes of inexpensive synthetic opioids without opium or other controlled precursors, fentanyl spilled into the United States, Canada, and Europe, heroin soon fell to market forces [1, 2]. Xylazine withdrawal is controversial.

E-9-1-1 161

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

EMDocs

NOVEMBER 16, 2024

We’ll keep it short, while you keep that EM brain sharp. 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. 2020 Sep 30;5(9):558-567. 10% of patients. Hip Pelvis.

EMS 97

EMS E-9-1-1 Operating Room Emergency Department 97

EMDocs

OCTOBER 5, 2024

We’ll keep it short, while you keep that EM brain sharp. 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. The gastrointestinal tract is the main reservoir for ESBL-E.

E-9-1-1 97

E-9-1-1 EMS ALS OR 97

ACEP Now

APRIL 5, 2024

11 “The 2021 report strives to highlight that ‘excited delirium with severe agitation’ is not a diagnosis in the living or the deceased,” explained Dr. Jeffrey Goodloe, who serves as an EMS Chief Medical Officer, ACEP Board member, and one of the authors of this recent work. Accessed March 26, 2024. Accessed March 26, 2024.

E-9-1-1 49

E-9-1-1 ALS Paramedic OR 49

Pediatric EM Morsels

APRIL 5, 2024

CDC 2024) Generally, most ticks require >24 hours of attachment for there to be a risk of transfer of the infectious agent. Other Rickettsial Disease of concern from non-tick vectors (CDC Yellow Book 2024) Murine Typhus Causative Agent: Rickettsia typhi and the principal vector is the Asiatic rat flea. These resolve within 1 week.

E-9-1-1 164

E-9-1-1 ALS OR EMS 164

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? 2022 Jul 5;328(1):57-68. C or 100.4 mg/kg, max 0.4

E-9-1-1 97

E-9-1-1 ICU ACS EMS 97

REBEL EM

NOVEMBER 11, 2024

4 The 2023 ACORN Trial ( covered here on REBEL EM ) randomized 2,511 patients requiring antipseudomonal coverage to receive either cefepime or piperacillin-tazobactam. What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018.

E-9-1-1 108

E-9-1-1 ICU ALS Critical Care 108

Pediatric EM Morsels

FEBRUARY 2, 2024

2021 May; 8:1-16. While there is no “right” work up for these patients, hopefully this morsel will help illuminate your evaluation of Travel-Related Illness in Children: Travel-related Illness: Basics International travel has been significantly increasing since commercial airlines made travel much easier. References Abdel-Haq N, Asmar BI.

E-9-1-1 164

E-9-1-1 ED OR Emergency Department 164

EMDocs

NOVEMBER 4, 2024

Bhana, MD (EM Resident Physician, University of Massachusetts/UMass Chan Medical School); Clarence Kong, MD (Pain Fellow, Eastern Virginia Medical School – Virginia Health Sciences at Old Dominion University); Mani Hashemi, MD (EM Attending, HCA Florida Mercy Hospital); S.M. Authors: Nikhil B.

E-9-1-1 105

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

Don't Forget the Bubbles

AUGUST 4, 2024

You will find the list is broken down into four sections: 1.Reviews 2024 Jul 9:e2023064794. 2024 Jul 8. 2024 Jul 21. Beaulieu E, Beno S. 2024 Jul 22;29(4):255-269. 2024 Jul 29. 2024 Jul 20;404(10449):277-293. 2024 Jul 11. 2024 Jul 11. Vassilopoulou E, et al.

E-9-1-1 52

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

EMDocs

JANUARY 25, 2025

Well keep it short, while you keep that EM brain sharp. Answer : Leukopenia Overview Leukopenia is defined as total WBC count < 4000/mm 3 Neutropenia is the most common subset of leukopenia and is defined on absolute neutrophil count: 1 Mild (1.01.5 10^9/L) Moderate (0.50.9 10^9/L) Severe (< 0.5

E-9-1-1 94

E-9-1-1 EMS Allergic Reaction ED 94

EMDocs

FEBRUARY 8, 2025

Well keep it short, while you keep that EM brain sharp. He reported having a COVID-19 infection 3 weeks ago but felt better 1-2 weeks ago. 1 WHO Critical Priority Fungal Pathogens Cryptococcus neoformans Globally distributed, found in soil/wood/trees 1 C. Four days ago, he presented to the ED for a COPD exacerbation.

ED 72

ED E-9-1-1 EMS ICU 72

ACEP Now

FEBRUARY 11, 2025

1 The number of elderly adults in the United States continues to increase, resulting in higher utilization of Medicare. 9 The 2024 MGMA Provider Compensation and Production Reportshowed that emergency medicine had the biggest five-year decrease in compensation (inflation-adjusted) among specialties in the United States.

E-9-1-1 80

E-9-1-1 ED Emergency Department ALS 80

EMDocs

FEBRUARY 3, 2025

Collins, MD (EM Resident Physician, San Antonio, Texas); Michael J. Although these autoantibodies may be present in a variety of individuals, the development of clinical disease is thought to require exposure to an environmental risk factor such as certain viruses, cigarette smoke or other environmental toxins (1). Authors: William J.

ED 70

ED E-9-1-1 ALS OR 70

ACEP Now

FEBRUARY 19, 2025

Emergency medicine (EM) is a team-based specialty, where a diverse group works together to rapidly deliver acute, unscheduled patient care. Accessed September 19, 2024. Accessed December 20, 2024. 2024;184(9):1125-1127. Chenais G, Lagarde E, Gil-Jardin C. Accessed November 10, 2024. 2014;3(4):1.

E-9-1-1 51

E-9-1-1 ALS ED Emergency Department 51

REBEL EM

FEBRUARY 24, 2025

1 They noticed how spontaneously breathing patients had their IVC collapse with inspiration; and ventilated patients had their IVC dilate during positive pressure ventilation. This might appear as a kissing of the IVCs walls during inspiration, a view that most emergency medicine physicians are likely to be familiar with in 2024.

ALS 75

ALS E-9-1-1 Critical Care OR 75

Core EM

JANUARY 16, 2025

An EM Residents Guide to Basic Airway Management Authors: Justin Rice, MD Sagar Desai, MD Eunice Monge, MD William Chiang, MD Preface: Airway management is one of the most critical skills in emergency medicine, yet it can be one of the most challenging to master. Introduction Airway management is a critical ED skill to master.

E-9-1-1 130

E-9-1-1 EMS ALS OR 130

EMDocs

FEBRUARY 22, 2025

Well keep it short, while you keep that EM brain sharp. He was transported from the scene by EMS. Epub 2021 Sep 9. doi: 10.1007/s10143-022-01797-1. A 37-year-old male comes in with facial trauma after his head slammed into the steering wheel during an MVC. However, he has a headache that has become more painful.

EMS 65

EMS E-9-1-1 Plasma OR 65

EMDocs

NOVEMBER 2, 2024

We’ll keep it short, while you keep that EM brain sharp. Ocular and auditory manifestations of syphilis are considered a form of neurosyphilis and are generally seen in 3% to 5% of all individuals infected with syphilis in the US [3,4] Syphilis is traditionally classified into three stages: primary, secondary, and tertiary [1].

EMS 114

EMS E-9-1-1 Plasma ALS 114

EMDocs

DECEMBER 28, 2024

Well keep it short, while you keep that EM brain sharp. at one, five, and ten years, respectively) 3,4 Clinical Presentation: AACG most commonly manifests itself with pain radiating from the eye, visual impairment, conjunctival hyperemia, and nausea and vomiting with a tense, rock-hard globe 1 Corneal edema (i.e.

EMS 98

EMS E-9-1-1 ALS OR 98