Core EM

JANUARY 25, 2024

Written by: Sadakat Chowdhury MD Edited by: Mak Sarich MD, Jay Lin MD, Jonathan Kobles MD Background: Ultrasound (US) guided nerve blocks offer an applicable option for achieving analgesia in the emergency department. This is a motor sparing block – so it will allow your patients to ambulate. J Emerg Trauma Shock.

Epinephrine 246

Epinephrine ED Emergency Department OR 246

The Skeptics' Guide to EM

JANUARY 7, 2023

Date: January 4th, 2023 Reference: Hasbrouck et al. Acute management of atrial fibrillation in congestive heart failure with reduced ejection fraction in the emergency department. Date: January 4th, 2023 Reference: Hasbrouck et al. Be critical and evaluate what you believe in.”

OR 100

OR Emergency Department ALS Ambulance 100

Don't Forget the Bubbles

NOVEMBER 8, 2023

7-year-old Tilly is brought to your emergency department at 11 p.m. Abdominal pain in children is common, accounting for over 1 in 20 attendances to paediatric emergency departments [1]. Clinical scoring tools have improved diagnostic performance in assessing suspected appendicitis in the emergency department.

Emergency Department 105

Emergency Department ALS OR Ambulance 105

ACEP Now

MAY 10, 2024

Patients often seek care in the emergency department (ED) setting when flares of pain affect their ability to ambulate, climb stairs, or even stand up from sitting. In our experience, patients have been able to ambulate comfortably with no motor deficits in approximately 30 minutes. J Emerg Med. Surg Technol Int.

Emergency Department 92

Emergency Department Ambulance ED OR 92

FOAMfrat

MAY 19, 2024

The patient’s mother accompanied me in the patient compartment of the ambulance on our 30-minute ride to the children's hospital. 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. J Inherit Metab Dis.

E-9-1-1 98

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

EMDocs

MARCH 30, 2024

Answer : Thoracic and Lumbar Spine Trauma Epidemiology: Approximately half of the vertebral injuries that are seen in the emergency department are thoracic and lumbar injuries. A 27-year-old man was brought into the emergency department via EMS after being stabbed. J Emerg Med. Diagnosis includes imaging.

EMS 106

EMS E-9-1-1 Emergency Department Ambulance 106

EMDocs

JUNE 9, 2023

EMS Environment Ok, we’ve got the patient calmed down and gotten them into the ambulance. If you have restraints in your ambulance, are those restraints appropriately sized for pediatric patients? NASEMSO: Clinical care and restraint of agitated or combative patients by emergency medical service practitioners.

Emergency Medical Services 98

Emergency Medical Services EMS Emergency Department Ambulance 98

ACEP Now

JUNE 14, 2024

1 As fresh challenges of the pandemic and hospital operations changed emergency medicine practice, one of the more challenging areas was the movement of admitted patients out of the first emergency department (ED). emergency departments. What Is the Burden of These Patients on EDs and Ambulance Providers?

Emergency Department 52

Emergency Department ED Ambulance OR 52

Irish College of Paramedics

SEPTEMBER 26, 2018

Crewing Models: There are varying models of pre-hospital care ranging from paramedic provision of care through the mix of First Aid (Tanigawa and Tanaka 2006) Basic Life Support (BLS), immediate care, Advanced Life Support (ALS) and the many associated specialist paramedicine grades. 2000, Stiell et al. 2004, Jayaraman et al.

Emergency Medical Technician 52

Emergency Medical Technician Paramedicine Paramedicine Advanced Life Support 52

Dr. Smith's ECG Blog

DECEMBER 13, 2024

Written by Magnus Nossen and Ken Grauer ( with Comment by Smith ) The ECG in Figure-1 was electronically transmitted by the ambulance service for evaluation. The patient was transported by EMS to the emergency department, where the ECG was interpreted as showing VT ( V entricular T achycardia ). Cited References: (1) Ren, J.,

ALS 103

ALS Emergency Department Ambulance OR 103

REBEL EM

DECEMBER 19, 2022

REBEL Cast Ep113 – Defibrillation Strategies for Refractory Ventricular Fibrillation Click here for Direct Download of the Podcast Paper: Cheskes S, et al. The fragility index of these findings found to be 1 for VC and 9 for DED Obtaining a second defibrillator in the emergency department or intensive care unit can be very easy to do.

Defibrillator 52

Defibrillator Paramedic CPR EMS 52

ACEP Now

JULY 7, 2023

Case A 91-year-old Russian-speaking female on dual-antiplatelet therapy presented to the ED via ambulance with a left-sided nosebleed. Carvey (@MATTCARVEY123) is a second-year resident through the MetroHealth and Cleveland Clinic Foundation emergency medicine residency program in Cleveland, Ohio. References Prekker ME, et al.

Emergency Medical Services 45

Emergency Medical Services ALS EMS OR 45

Dr. Smith's ECG Blog

MARCH 6, 2023

I am sure that I posted it, but don't know when or where: This patient arrived to the ED by ambulance with chest pain that had resolved. Reference: • Writing Committee, Kontos MC, de Lemos JA, et al. Is the ability to diagnose posterior reperfusion a useful skill? Here is a case from a while back. J Am Coll Cardiol 2022;80(20):1925–60.

OR 52

OR STEMI ED Critical Care 52

Don't Forget the Bubbles

NOVEMBER 1, 2023

This month, Bubble Wrap has teamed up with Sheffield Children’s Hospital Emergency Department to have a look at what’s new in paediatric literature. Ebenebe CU, Schriever K, Apostolidou S, et al. Emergency Medicine Journal 2023; 40: 583-587. Pediatric Emergency Care. What’s it about? What’s it about?

Emergency Department 140

Emergency Department ALS OR Ambulance 140

EMDocs

NOVEMBER 16, 2024

9,23 Disposition: Dislocation : If successfully reduced in the emergency department may discharge with strict mobility restrictions and Orthopedic follow up. An 80-year-old man with a history of hip arthroplasty presents by ambulance after falling at home. Available from: [link] Maradit Kremers H, Larson DR, Crowson CS, et al.

EMS 97

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

The Skeptics' Guide to EM

APRIL 8, 2023

There have been many “temporary” rural emergency department closures during the past last year. In Ontario alone there have been approximately 160 emergency departments (ED) temporarily closed since the beginning of 2022. This is an SGEM Xtra episode.

Emergency Department 142

Emergency Department ED Ambulance ALS 142

The Skeptics' Guide to EM

JANUARY 19, 2019

Date: January 17th , 2019 Reference: Clemency et al. Date: January 17th , 2019 Reference: Clemency et al. He is alert and oriented times three with normal vital signs by the time he arrives in the emergency department. This teaching has been challenged by a systematic review by Willman et al 2017.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

NAEMSP

OCTOBER 9, 2024

In the emergency department, a lack of awareness about Addison’s disease led to delayed steroid administration. In the emergency department, the patient was evaluated and safely discharged. These cases highlight the impact of adrenal insufficiency on patients, especially during encounters with emergency care systems.

EMS 122

EMS Crisis Prevention Emergency Department BLS 122

EMDocs

DECEMBER 18, 2023

F) in the ambulance. 1 The rationale for the shift away from normal saline in 2021 derived from multiple trials, including the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) and Saline Against Lactated Ringer’s or Plasma-Lyte in the Emergency Department (SALT ED). Rhee C, Dantes R, Epstein L, et al.

E-9-1-1 90

E-9-1-1 ALS Emergency Department Plasma 90

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. In fact, Kosuge et al. Stein et al. This is a paper worth reading : Marchik et al. Kosuge et al.

E-9-1-1 138

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

ACEP Now

OCTOBER 9, 2023

The other night I stood in the trauma bay, listening to rain patter against the automatic doors, awaiting an ambulance. Wearing a cut-up trauma sheet as a hijab, she walked out of our emergency department several hours later, intact and not traumatized. Kaufman EJ, Richmond TS, Wiebe DJ, et al. 2017;152(9):843.

Heart Attack 126

Heart Attack Life Support Emergency Department Ambulance 126

ACEP Now

AUGUST 15, 2023

And as you power-walk to prepare for the incoming ambulance and tell Room 4 you will be delayed, thoughts interrupt you: “I’m worried about Room 3; if BiPAP doesn’t turn her around, I’ll have to intubate her.” In the end, we may just realize the burden we feel is transient, like the ebb and flow of our emergency department census.

ALS 90

ALS Emergency Department OR CPR 90

Don't Forget the Bubbles

AUGUST 12, 2024

The air ambulance service intubated him at the scene and pre-alerted the department before arrival. What neuroprotective measures can we undertake in the emergency department? Neuroprotective strategies should be initiated as soon as possible in the emergency department and continued further in the PICU.

ALS 75

ALS Emergency Department Plasma OR 75

Don't Forget the Bubbles

JUNE 30, 2023

Grabbing a pristine white table napkin to apply pressure to the wound, Ranulf’s class teacher and expedition leader called the ambulance as chaos descended on the restaurant. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. The trauma call goes out.

E-9-1-1 139

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

FOAMfrat

JANUARY 23, 2024

Nevertheless, with their proliferation, new challenges have emerged - chief among them the growing threat of antibiotic resistance and life-threatening allergies. Antibiotics serve as a potent weapon against the invading pathogens, halting their spread and preventing further organ dysfunction (Baghdadi et al.,

EMS 52

EMS Emergency Department ALS Ambulance 52

FOAMfrat

AUGUST 15, 2024

However, O- blood is always in such short supply that it is not feasible for it to be stocked in every ambulance, helicopter, and resuscitation bay. so I often overlook the simplistic act of turning on the heat in the ambulance, but it’s really important. Any emergency department has more blood availability than you.

Plasma 69

Plasma Ambulance ALS Emergency Department 69

ECG & Echo Learning

JANUARY 18, 2023

I B Patients transferred to PCI centres can bypass the emergency department to undergo primary PCI without delay. I B Ambulance personnel must be trained and equipped to identify STEMI and administer fibrinolysis if necessary. I B Designated PCI centres should provide angiography and reperfusion 24/7 without delay.

STEMI 40

STEMI Coronary OR Defibrillator 40

The Skeptics' Guide to EM

DECEMBER 26, 2020

Date: December 18th, 2020 Reference: Hulme et al. Mortality among patients with frequent emergency department use for alcohol-related reasons in Ontario: a population-based cohort study. CMAJ 2020 Guest Skeptic: Dr. Hasan Sheikh is an emergency and addictions physician in Toronto and a lecturer at the University of Toronto.

ED 130

ED Emergency Department Emergency Medical Services ALS 130

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. Bakr A, Silva D, Cramb R, et al.

ED 98

ED E-9-1-1 ALS OR 98

ACEP Now

JUNE 14, 2024

And, finally, patients with a history of COPD frequently present to the emergency department with dyspnea. Although dyspnea in this setting likely represents an AECOPD, other emergent differentials must be considered. Adeloye D, Song P, Zhu Y, et al. Canut A, Martín-Herrero JE, Labora A, et al. Ann Emerg Med.

ALS 52

ALS Coronary OR ED 52

NAEMSP

MARCH 13, 2023

An ALS crew arrives on scene to find a woman who is tachypneic, hypoxic, tachycardic, and hypotensive, with diffuse rales and rhonchi throughout her lung fields. Upon arrival to the ambulance, the EMT notices that the patient’s heart rate is 22 bpm. Prehospital Emergency Medicine Secrets. Prehosp Emerg Care.

EMS 52

EMS Emergency Medical Services EMT EMT 52

ACEP Now

APRIL 5, 2024

I want to be involved in training cops to recognize the signs of a medical emergency.” In a comprehensive review of the history of this term, Bhatia, et al. 18-21 In a recent systematic review, Strömmer, et al. Bhatia BS, Heisler M, et al. American College of Emergency Physicians. DeBard ML, Adler J, et al.

E-9-1-1 49

E-9-1-1 ALS Paramedic OR 49

Dr. Smith's ECG Blog

DECEMBER 16, 2024

male who hasn't doctored in several years presented to the emergency department by ambulance for chief complaint of chest pain. Conclusion: you may take a few moments to look for dissection with your bedside ultrasound, but when it is a clear STEMI, do NOT waste time with a CT scan. Case 2 A 50-something y.o. 29, 2024 ).

STEMI 105

STEMI Coronary Critical Care ED 105

ACEP Now

MARCH 10, 2025

You follow the recommended emergency department (ED) lab workup for hypertensive disorders of pregnancy, including urine protein/creatinine ratio, serum creatinine, platelet count, complete blood count, and renal liver function tests. Mihu D, Costin N, Mihu CM, et al. Garovic VD, Dechend R, Easterling T, et al.

ALS 52

ALS OR ED Emergency Department 52

FOAMfrat

NOVEMBER 21, 2024

Hypothermia Hypothermia, defined as core temperature less than 35oC (95oF) has been identified in up to 2/3 of trauma patients upon arrival to the emergency department. Increasing cabin temperatures in your aircraft or ambulance might be uncomfortable for you, but important to your patient’s survival. normal value is between 0.8

ICU 119

ICU Emergency Department OR ED 119