REBEL EM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). Amiodarone versus digoxin for acute rate control of atrial fibrillation in the emergency department. Am J Emerg Med. Am J Emerg Med. 2022 Sep 7.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

Broome Docs

DECEMBER 22, 2024

PARAMEDIC 3 randomized 6,000 (but they were supposed to get to 15,000) patients with out of hospital arrest from multiple EMS agencies in the UK to either an IO or IV to start. Piroxicam and paracetamol in the prevention of early recurrent pain and emergency department readmission after renal colic: Randomized placebo-controlled trial.

E-9-1-1 52

E-9-1-1 ACS Paramedic Emergency Department 52

Dr. Smith's ECG Blog

MAY 20, 2024

He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic. Smith comment : Is the ACS (rupture plaque) with occlusion that is now reperfusing? Diagnosis of Type I vs. Type II Myocardial Infarction in Emergency Department patients with Ischemic Symptoms (abstract 102).

CAD 124

CAD STEMI Coronary ACS 124

REBEL EM

SEPTEMBER 11, 2023

1 It is a quickly deployable and easily interpreted study that can be done in real time to guide decisions in the Emergency Department. Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. and specificity of 88.0% Trauma Surg Acute Care Open.

ED 68

ED ACS Emergency Department OR 68

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. References: 1. Lindahl B, Baron T, Erlinge D, et al.

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. With EMS, patient had a GCS of 3 and was saturating 60% on room air. Vital signs were within normal limits on arrival to the Emergency Department. or basilar ischemia.

STEMI 114

STEMI Coronary Emergency Department OR 114

REBEL EM

FEBRUARY 12, 2024

There are greater than 2 million annual emergency department visits for suspected renal colic in the US, and Ct scanning is performed for more than 90% of patients who receive a diagnosis of kidney stone. PMID: 25229916 DOI: 10.1056/NEJMoa1404446 Westphalen AC, Hsia RY, Maselli JH, Wang R, Gonzales R. N Engl J Med.

Emergency Department 73

Emergency Department ALS ACS EMS 73

NCOAE

DECEMBER 11, 2023

A study published by Cambridge University Press examined patient outcomes over a decade during which Emergency Medical Service (EMS) systems decreased backboard use as they transitioned from SI to SMR protocols. My Experience with Spinal Motion Restriction My EMS experience supports the data.

OR 52

OR Emergency Medical Technician Emergency Department Emergency Medical Services 52

Don't Forget the Bubbles

MAY 17, 2023

Hegeman EM, et al. Schwindt EM, et al. Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study. De Alwis AC, et al. Osteomyelitis in Sickle Cell Anemia: Does Age Predict Risk of Salmonella Infection? Pediatr Infect Dis J.

ALS 72

ALS ACS Emergency Department EMS 72

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. 1] European guidelines add "regardless of biomarkers". But only 6.4%

STEMI 120

STEMI Coronary ALS CAD 120

Dr. Smith's ECG Blog

DECEMBER 26, 2020

The EM provider asked if the cardiologist thought it was a "STEMI." On arrival to the PCI center's Emergency Department, the receiving team recorded an ECG on arrival: Persistent atrial flutter, however this time the QRS occurs on a slightly different portion of the flutter wave.

STEMI 52

STEMI ACS Coronary Emergency Department 52

ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. EMS physicians report he was found in ventricular fibrillation. Canadian Journal of Emergency Medicine. Emmerson AC, Whitbread M, Fothergill RT. Simon EM, Tanaka K. He was found by bystanders after he collapsed and 911 was called.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

Pediatric EM Morsels

SEPTEMBER 20, 2024

Diarrhea is one of the most common complaints in the pediatric emergency department, especially in the summer and early fall. Predicting Adverse Outcomes for Shiga Toxin-Producing Escherichia coli Infections in Emergency Departments. 2021 May;232:200-206.e4. doi: 10.1016/j.jpeds.2020.12.077. 2020.12.077. Epub 2021 Jan 5.

Emergency Department 167

Emergency Department ACS ALS EMS 167

The Skeptics' Guide to EM

MAY 29, 2021

The patient is an adult male with a gunshot wound to the chest, and they’re combative with emergency medical services (EMS). According to a recent study in the Journal of Surgical Research [3] , 44% of all penetrating thoracic trauma patients presented to a non-trauma center (not a level 1 or level 2 ACS defined trauma center).

Emergency Medical Services 130

Emergency Medical Services ACS ALS Emergency Department 130

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. link] Fesmire, F. Wharton, D.

STEMI 106

STEMI Coronary Heart Attack ACS 106

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. Kosuge et al.

E-9-1-1 138

E-9-1-1 ACS Emergency Department Coronary 138

EMDocs

SEPTEMBER 25, 2023

Personal take: While discussing this approach with many EM physicians whom we respect, one recurring critique was “We fought so hard to get the right to use paralytics in the ED, why would you want to go backwards.” References: Heffner AC et al. Int J Emerg Med. J Emerg Med. ” Academic Emergency Medicine 20.1

ED 94

ED Emergency Department ALS Paramedic 94

ACEP Now

JUNE 6, 2023

Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesophageal reflux disease (GERD), stroke, and spinal-cord compression. The patient is admitted for ACS to a cardiologist who says he will see the patient in the morning.

ACS 85

ACS ALS ED OR 85

EMS 12-Lead

APRIL 21, 2022

Such aggressive investigation was particularly warranted in this case because of symptoms compatible with ACS, as well as an equally frightening revelation of family history. New insights into the use of the 12 Lead Electrocardiogram for diagnosing Acute Myocardial Infarction in the emergency department. link] [1] Mirand, D.

Coronary 130

Coronary ALS OR ACS 130

Don't Forget the Bubbles

MAY 3, 2023

This single-centre academic urban institution in the United States (US) undertook a 10-year retrospective observational study of paediatric intubation and bougie use in their emergency department (ED). Garabon JJW, Gunz AC, Ali A, Lim R. Prehosp Emerg Care. Prehosp Emerg Care. 2023;27(2):221-226. Garabon et al.

CPR 52

CPR Emergency Department ALS ICU 52

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm.

Operating Room 52

Operating Room ACS Critical Care Coronary 52

Dr. Smith's ECG Blog

JUNE 8, 2023

Written by Jesse McLaren A 75 year old with a history of CABG called EMS after 24 hours of chest pain. STEMI negative : the EMS automated interpretation read, “STEMI negative. Cardiology documented “late presentation STEMI but likely aborted given resolution of ST changes from EMS to hospital.” HR 40, BP 135/70, RR16, O2 100%.

STEMI 86

STEMI Coronary Paramedic ALS 86

Dr. Smith's ECG Blog

OCTOBER 2, 2021

Today’s pain lasted around 20 mins, but was severe enough that the patient called EMS. Pain largely resolved prior to EMS arrival but completely subsided after prehospital NTG and aspirin. Approximately 4 hours after arrival, the patient was re-examined by the emergency physician. There is no age cut-off for ACS.

OR 52

OR ACS STEMI Coronary 52

Don't Forget the Bubbles

JUNE 30, 2023

Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. b) Emergency thoracotomy Let’s be clear: YOU will not be doing any of this. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. Bourke Tillmann and Scott Weingart for their expertise on the EM Cases podcast that inspired this column. Dr. Helman is an emergency physician at North York General Hospital in Toronto.

E-9-1-1 52

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

FOAMfrat

OCTOBER 20, 2023

Dr. Jarvis of The EMS Lighthouse Project podcast also covers this paper in detail here: [link] ^^^ I highly recommend listening! Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Intern Emerg Med. Acad Emerg Med. Crit Care Med.

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

EMDocs

FEBRUARY 12, 2024

Authors: Rachel Kelly, MD ( EM Resident Physician, Stony Brook University Hospital); Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Int J Emerg Med. Eur J Emerg Med. Emerg Med J. 140.11.1122.

Emergency Department 98

Emergency Department E-9-1-1 ED ICU 98

Don't Forget the Bubbles

SEPTEMBER 18, 2023

This blog post aims to help familiarise you with some of the most common reasons for prescribing antibiotics in the paediatric emergency department. Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review. Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, et al.

Emergency Department 143

Emergency Department E-9-1-1 ALS OR 143

EMDocs

OCTOBER 7, 2023

We’ll keep it short, while you keep that EM brain sharp. A 17-year-old girl, in moderate distress, is brought in by EMS after a motor vehicle collision. EMS reports that she was “pinned” underneath the dashboard, and it took several hours to extricate her. J Emerg Med. Goodman AD, Got CJ, Weiss AC. Critical Care.

EMS 98

EMS E-9-1-1 Emergency Department ALS 98

EMDocs

JANUARY 20, 2024

We’ll keep it short, while you keep that EM brain sharp. A 67-year-old female with past medical history of hypertension presents with acute onset of chest pain without associated symptoms.

E-9-1-1 103

E-9-1-1 EMS Coronary ACS 103

EMDocs

JANUARY 6, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University School of Medicine, St. Louis, MO); Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine, St. We’ll keep it short, while you keep that EM brain sharp. A 64-year-old male presents by EMS to the ED with shortness of breath.

EMS 92

EMS E-9-1-1 ACS Coronary 92

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. J Emerg Med. Acad Emerg Med. Ann Emerg Med.

ED 106

ED E-9-1-1 Emergency Department ALS 106

Dr. Smith's ECG Blog

APRIL 8, 2015

in 2010 EM Clinics of North America (full text link) For an Exhaustive Review of Syncope and its full management outside the ED environment, go to the 2009 European Society of Cardiology Guidelines (full text pdf). 2) Boston syncope rule: J Emerg Med. The ROSE (Risk Stratification of syncope in the emergency department) Study.

Emergency Department 52

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

ALiEM

DECEMBER 9, 2024

A 25-year-old female with no pertinent past medical history presented to an emergency department in Massachusetts with four days of generalized malaise, myalgias, congestion, low-grade fever, and a rash behind her left knee. link] www.cdc.gov/lyme/ Steere AC. Platelets : 223 Sodium : 139 Creatinine : 0.8 Clin Infect Dis.

Emergency Department 152

Emergency Department ACS EMS OR 152

ACEP Now

FEBRUARY 11, 2025

A 33-year-old male with a history of drug use presented to the emergency department (ED) for extreme agitation after receiving two doses of 2 mg naloxone by EMS for respiratory depression. Kruegel AC, Gassaway MM, Kapoor A, et al. Gold MS, Pottash AC. J Med Chem. 2020;63(1):433-439. J Am Chem Soc. Ann N Y Acad Sci.

NARCAN 89

NARCAN Naloxone Overdose Mental Health Services 89

REBEL EM

DECEMBER 23, 2024

Paper: Alwang AK, Law AC, Klings ES, Cohen RT, Bosch NA. PMID: 28106307 Alwang AK, Law AC, Klings ES, Cohen RT, Bosch NA. appeared first on REBEL EM - Emergency Medicine Blog. To assess the clinical impact and relevance of these concerns, Alwang et al. performed the retrospective cohort study below ( Alwang 2024 ).

ALS 128

ALS ED ACS EMR 128

REBEL EM

FEBRUARY 3, 2025

Training Set= 15641 Internal Validation Set=1738 Test Set N=1318 Clinical Validation Set ECGs from patients with chest pain who visited the emergency department of Severance Hospital in 2020, regardless of percutaneous coronary intervention. (N=2699)

STEMI 84

STEMI Coronary Emergency Department ALS 84