ALiEM

NOVEMBER 3, 2023

8 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. Reference Lin M, Phipps M, Chan TM, et al. Reference Lin M, Phipps M, Chan TM, et al. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care.

Critical Care 211

Critical Care EMS Emergency Department ALS 211

EMOttawa

JUNE 24, 2024

5 Usefulness: 2/5 Nasr Isfahani M, et al. Methodology: 3.5/5 BMC Emerg Med. 2024 Jan 25;24(1):15. Question and Methods: This triple blinded RCT of 158 patients with isolated closed limb fractures assessed pain scores at 1-hour following the administration of intravenous acetaminophen, acetaminophen plus ibuprofen, or morphine.

OR 52

OR ALS 52

REBEL EM

NOVEMBER 20, 2023

Paper: Jansen JO, Hudson J, Cochran C, et al. Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. 2023;e2320850. 97% of patients sustained blunt trauma.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

ALiEM

OCTOBER 14, 2023

6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. Reference Lin M, Phipps M, Chan TM, et al. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. Please go to the above link. Ann Emerg Med.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

The Skeptics' Guide to EM

JANUARY 13, 2024

Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. Resuscitation 2023. Resuscitation 2023. We have looked at OHCA more than a dozen times on the SGEM.

CPR 223

CPR Defibrillator First Responder Epinephrine 223

The Skeptics' Guide to EM

NOVEMBER 11, 2023

Date: November 2, 2023 Reference: Coventry et al. Date: November 2, 2023 Reference: Coventry et al. DISCLAIMER: THE VIEWS AND OPINIONS OF THIS BLOG AND PODCAST DO NOT REPRESENT THE UNITED STATES GOVERNMENT OR THE US MILITARY. Reference: Coventry et al. Which clinical features best predict occult scaphoid fractures?

ALS 244

ALS Emergency Department ED OR 244

EMOttawa

JANUARY 2, 2024

Methodology: 4/5 Usefulness: 2/5 Liu L, et al. They monitored BP at baseline, during […] The post Early versus delayed antihypertensive treatment in patients with acute ischaemic stroke: multicentre, open label, randomised, controlled trial appeared first on EMOttawa Blog. 2023 Oct 9;383:e076448.

ALS 98

ALS OR Critical Care 98

ALiEM

JANUARY 5, 2024

Read and Listen to the Other EM Match Advice Episodes Blog posts: [link] Author information Sara M. What does the Electronic Residency Application Service (ERAS) preliminary data show just far for the 2024 residency application season? Has the program signaling option been working? What should students think about in the post-interview stage?

EMS 177

EMS ALS OR 177

EMS 12-Lead

MAY 15, 2024

TCP in the ROSC Patient: False Electrical Capture at 75mA Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the second installment of a blog series showing how transcutaneous pacing (TCP) can be difficult and how you can improve your skills. Epinephrine administered intravenously. Approach TCP with skepticism.

Epinephrine 331

Epinephrine Paramedic CPR ED 331

Dr. Smith's ECG Blog

JUNE 5, 2024

As per my review of this subject ( Check out My Comment at the bottom of the page in the November 16, 2023 post in Dr. Smith's ECG Blog ) — the 3 most common Causes of ACS ( A cute C oronary S yndrome ) with a "negative" cath are: i ) Myocarditis; ii ) Takotsubo cardiomyopathy; and , iii ) MINOCA.

Coronary 107

Coronary ACS ALS OR 107

Dr. Smith's ECG Blog

JUNE 17, 2023

mm of STE in II and III, or III and aVF, or V4 and V5, so some might say it fulfills STEMI criteria (remember, the interrater reliability of STEMI criteria is poor as shown in references below): McCabe et al. Carley et al. Tandberg et al. Journal of the American Heart Association 2013;2:e000268. What’s the point of ST elevation?

OR 52

OR STEMI ALS EMS 52

Dr. Smith's ECG Blog

OCTOBER 3, 2024

Not OMI with High Confidence Click here to sign up for Queen of Hearts Access We showed that the Queen of Hearts decreases false positive cath lab activations: 1) Published recently in Prehospital Emergency Care Baker PO et al. 2) To be presented at AHA conference in Chicago in 2 weeks: Sharkey SW et al. What do you think, Steve?

E-9-1-1 111

E-9-1-1 Coronary ALS ED 111

Don't Forget the Bubbles

OCTOBER 12, 2024

Hibberd O, Chylinska AA, Finn K , et al. Moyo has moderate croup and this blog post explores the evidence supporting corticosteroid use for moderate croup. Much of the evidence in this blog is a translation of a recent 2023 Cochrane review of 45 randomised control trials involving 5888 children. What is croup?

Emergency Department 85

Emergency Department ALS OR 85

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. Salim is also the creator and founder of REBEL EM and REBEL Cast, a free, critical appraisal blog and podcast that try to cut down knowledge translation gaps of research to bedside clinical practice.

ALS 130

ALS Emergency Department OR EMS 130

REBEL EM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Available at: HERE Branch KHR et al. Back on June 1st, 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? Resus 2023.

CPR 145

CPR ICU EMS ALS 145

EMS 12-Lead

MARCH 30, 2024

Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the first installment of a blog series showing how transcutaneous pacing (TCP) can be difficult, and how you can improve your skills. The University of Maryland found that capture occurred in only 42-78% of patients, dependent on pad positioning (Moayedi et al, 2022).

CPR 312

CPR Paramedic Ambulance Defibrillator 312

REBEL EM

MAY 29, 2024

EMRAP HD: Epistaxis Posterior Pack References Cassisi NJ et al. PMID: 5569677 Zeyyan E et al. PMID: 20938948 Loftus BC et al. PMID: 8170679 Viducich RA et al. Take Home Points: Posterior epistaxis is a rare, life-threatning presentation. Literature doesn’t defend this approach but, the lit is pretty sparse.

ICU 105

ICU ALS ACS EMS 105

The Skeptics' Guide to EM

APRIL 16, 2022

Date: April 16th, 2022 Reference: Blom et al. Disclaimer: The views and opinions of this blog […] The post SGEM#365: Stop! Date: April 16th, 2022 Reference: Blom et al. Disclaimer: The views and opinions of this blog and podcast do not represent the United States Government or the US Military. Tricoci et al.

Emergency Department 100

Emergency Department ALS OR ED 100

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. Richards JE et al. NEJM 1994. [2]

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

REBEL EM

APRIL 29, 2024

A study by Lee et al ( 7) compared femoral CVC placement to IO and demonstrated a first-pass success pass rate with IO of 90.3% Over the years emergency and critical care physicians have tried many ways to establish IV access in emergencies including the “crash” or “dirty” central line. compared to only 37.5% in the CVC group.

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

Dr. Smith's ECG Blog

DECEMBER 12, 2022

This " imbalance of precordial T waves" is not seen very often — and in the “right” clinical setting, has been associated with recent OMI from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM ). This is termed " pseudo-normalization."

OR 52

OR ACS STEMI Coronary 52

The Skeptics' Guide to EM

DECEMBER 10, 2022

Date: November 30th, 2022 Reference: Johnson et al. Date: November 30th, 2022 Reference: Johnson et al. DISCLAIMER: THE VIEWS AND OPINIONS OF THIS BLOG AND PODCAST DO NOT REPRESENT THE UNITED STATES GOVERNMENT OR THE US MILITARY. Physical examination of patients with a FOOSH injury include palpating for snuff box tenderness.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

JULY 18, 2020

He has a great new blog post about increasing diversity in medicine using something called the BSAP approach and an interesting Broome Doc podcast with Dr. Casey Parker called EBM 2.0. Reference: Ebell et al. Reference: Ebell et al. Reference: Ebell et […] The post SGEM#298: What’s the Signs and the Symptoms of Pneumonia?

ALS 130

ALS Emergency Department OR 130

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

See our other blog posts of hypothermia and Osborn waves -- Massive Osborn Waves of Severe Hypothermia (23.6 Rituparna et al — as well as Chauhan and Brahma ( Int. His temperature was brought back to normal over time in the ICU. He was extubated and had normal neurologic function. He did well and was discharged.

ICU 132

ICU OR ALS ED 132

REBEL EM

FEBRUARY 15, 2024

Paper: Freund Y et al. References: Freund Y et al. PMID: 38019968 Post Peer Reviewed By: Anand Swaminathan, MD (Twitter/X: @EMSwami ) The post The NICO Trial: NIV in Comatose Patients with Acute Poisoning appeared first on REBEL EM - Emergency Medicine Blog. This decreases generalizability to other substances.

ICU 141

ICU ALS ED OR 141

The Skeptics' Guide to EM

FEBRUARY 19, 2022

CMAJ 2021 TRIGGER WARNING: As a warning to those listening to the podcast or reading this blog post, there may be some things discussed that could be upsetting. If you are feeling upset by the content, then please stop listening to the podcast or reading the blog. Reference: Graham T. Physician heal thyself. Reference: Graham T.

Emergency Department 130

Emergency Department ALS OR 130

FOAMfrat

MAY 17, 2024

In this blog we will explore the basic goals of ECMO and the four main components seen in every ECMO circuit. We will explore these customizations in the next MCS blog post. Let’s get started! My first real job at age 15 was at Burger King, and I'm pretty sure my first car still smells like fryer grease.

Life Support 98

Life Support OR ALS EMS 98

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

As discussed often in Dr. Smith's ECG Blog — quick determination of heart rate often provides an important clue to the etiology of certain regular SVT ( S upra V entricular T achycardia ) rhythms ( See My Comment in the July 19, 2023 post , among others ). I favor simply dividing 300 by the number of large boxes in the R-R interval. (

E-9-1-1 64

E-9-1-1 ALS OR ED 64

REBEL EM

JULY 1, 2024

Paper: Goren NZ et al. References: Goren NZ et al. PMID: 34462252 Abubacker AP et al. Background: Non-invasive positive pressure ventilation (NIPPV) is an effective treatment modality for patients with both hypoxemic or hypercapnic respiratory failure and has been shown to decrease the need for intubation [2]. Balkan Med J 2021.

ED 133

ED Emergency Department ALS OR 133

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

See Costagliola et al — Ann Clin Transl Neurol 8(7): 1557-1568, 2021 — for more on the complex "Brain-Heart Interaction" in Epilepsy ). It is important to be aware that this does not rule out congenital long QT syndrome (LQTS). The patient did not have a positive family history of epilepsy, sudden cardiac death (SCD) or recurrent syncope.

E-9-1-1 104

E-9-1-1 ALS Defibrillator OR 104

The Skeptics' Guide to EM

DECEMBER 19, 2020

Date: December 16th, 2020 Reference: Butler et al. He has a great new blog post about how […] The post SGEM#312: Oseltamivir is like Bad Medicine – for Influenza first appeared on The Skeptics Guide to Emergency Medicine. Date: December 16th, 2020 Reference: Butler et al. There has been some controversy around oseltamivir.

ALS 145

ALS OR 145

The Skeptics' Guide to EM

OCTOBER 17, 2020

It is a free, critical appraisal blog and podcast […] The post SGEM#305: Somebody Get Me A Doctor – But Do I Need TXA by EMS for a TBI? It is a free, critical appraisal blog and podcast that try to cut down knowledge translation gaps of research to bedside clinical practice. Reference: Rowell et al. Reference: Rowell et al.

EMS 130

EMS Emergency Medical Services ALS OR 130

REBEL EM

SEPTEMBER 23, 2024

PMID: 21373823 Cohen L et al. PMID: 25064742 Kotani Y et al. J Crit Care 2023;77: PMID: 37127020 Koroki T, Kotani Y, Yaguchi T, et al. appeared first on REBEL EM - Emergency Medicine Blog. What The Evidence Says: Etomidate has long been the favored induction agent for ED RSI in the US. Intensive Care Med.

ALS 75

ALS EMS ED OR 75

EMS 12-Lead

APRIL 21, 2022

Dedicated followers of the Smith ECG Blog know that the STD of true subendocardial ischemia does not localize, yet some of the examples listed below demonstrate the opposite, and were subsequently labeled “diffuse ischemia” or “generic subendocardial changes” as a diagnosis of convenience. Here is the time-zero ECG (0939 hours).

Coronary 130

Coronary ALS OR ACS 130

REBEL EM

MARCH 6, 2024

Melatonin Farahmand S, et al. Morgenthaler TI et al; Standards of Practice Committee of the American Academy of Sleep Medicine. Driving Sleepy Barger LK, Cade BE, Ayas NT, et al. Green W, Gao X, Li K, et al. PMID: 6663508; PMCID: PMC1193807. Crowley SJ, Lee C, Tseng CY, Fogg LF, Eastman CI. 2004 Sep 15;27(6):1077-87.

ALS 105

ALS OR EMS 105

Dr. Smith's ECG Blog

APRIL 17, 2023

For review — I've copied below my summary of this entity from My Comment in the February 10, 2023 post of Dr. Smith's ECG Blog. NOTE: For illustrative purposes — I’ve adapted Figure-1 from the original manuscript by deWinter et al, published in this 2008 NEJM citation. de Winter et al in N Engl J Med 359:2071-2073, 2008.

OR 52

OR STEMI ACS Emergency Department 52

Dr. Smith's ECG Blog

AUGUST 2, 2024

Readers of this blog can easily appreciate the hyperacute T waves in the precordium, clearest in V1-V4. 118.007305) from Heitner et al. , We've highlighted a considerable number of acute RV MI cases in Dr. Smith's ECG Blog ( See the October 7, 2019 and May 10, 2024 posts , to name just two ). His ECG is shown below.

STEMI 109

STEMI ALS OR 109