ALS, Books and ED - Paramedicine Now

Post-Intubation Sedation and Analgesia

Core EM

JANUARY 25, 2024

Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients.

Emergency Department

Emergency Department ICU Critical Care ALS

SGEM#263: Please Stop, Prescribing – Antibiotics for Viral Acute Respiratory Infections

The Skeptics' Guide to EM

JULY 27, 2019

Date: July 22nd, 2019 Reference: Yadav et al. Date: July 22nd, 2019 Reference: Yadav et al. AEM July 2019 Guest Skeptic: Dr. Emergency departments (EDs) in the United States write 10 million antibiotic prescriptions each year, approximately half of which are inappropriate [2, 3, 4]. Reference: Yadav et al.

Emergency Department

Emergency Department ED ALS

Episode 9: Right heart failure and the SAVIOR protocol with Habib Srour (part 2)

Critical Care Scenarios

JUNE 14, 2020

The book Buy the new textbook (Bryan edited, Brandon authored a chapter) here or on Amazon: Concepts in Surgical Critical Care, First Edition ed. Figure 1 from Srour et al (vide infra). 1 mg/kg ketamine* 2 mg/kg propofol*.3 3 mg/kg etomidate* 4 mg/kg thiopental Resources The SAVIOR algorithm.

Critical Care

Critical Care ED ALS OR

Unstable Pelvic Trauma Patient: ED Presentations, Evaluation, and Management

EMDocs

JUNE 3, 2023

The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. Figure 2: Open book pelvic fracture. This is less critical in ED management of the unstable pelvic fracture, as the optimal site for identification of rectal or vaginal tears is the operating room.

ED

ED Operating Room ALS Frozen Plasma

Episode 9: Right heart failure and the SAVIOR protocol with Habib Srour (part 1)

Critical Care Scenarios

MAY 31, 2020

The book Buy the new textbook (Bryan edited, Brandon authored a chapter) here or on Amazon: Concepts in Surgical Critical Care, First Edition ed. Figure 1 from Srour et al (vide infra). Resources The SAVIOR algorithm. References * Srour H, Shy J, Klinger Z, Kolodziej A, Hatton KW.

Critical Care

Critical Care Epinephrine ED ALS

SGEM#227: A Message to you Rudy – About Rudeness

The Skeptics' Guide to EM

SEPTEMBER 1, 2018

[display_podcast] Date: August 22nd, 2018 Reference: Riskin A, Erez A, Foulk TA, et al. display_podcast] Date: August 22nd, 2018 Reference: Riskin A, Erez A, Foulk TA, et al. Case: You are working in the emergency department (ED) and have just been involved in a difficult case in the resuscitation room. Pediatrics. Pediatrics.

ALS

ALS Emergency Department OR EMS

Spooky Scary Sequela: Clinical Factors Impacting Trauma Outcomes

FOAMfrat

NOVEMBER 21, 2024

upon ED arrival incur mortality rates of up to 3-5x that of patients without coagulopathy. One study out of Taiwan observed mortality rates of 100% when patients met all three trauma triad criteria and had a systolic blood pressure <60mmHg upon arrival to the ED. Jessica Dawkins Mills BSN, et al. normal value is between 0.8

ICU

ICU Emergency Department OR Ambulance

SGEM#322: TXA for SAH – Won’t Stop Me Now

The Skeptics' Guide to EM

MARCH 13, 2021

Reference: Post et al. Reference: Post et al. Lancet 2021 Case: You’re working a busy evening shift in your community emergency department (ED) when a 58 year old female presents with a rapid onset terrible intensity headache. Robert Edmonds is an emergency physician in the US Air Force in Ohio.

ALS

ALS Emergency Department ED OR

SGEM#224: Battlefield Acupuncture – Don’t Do Me Like That

The Skeptics' Guide to EM

JUNE 29, 2018

[display_podcast] Date: June 20th, 2018 Reference: Fox LM et al. display_podcast] Date: June 20th, 2018 Reference: Fox LM et al. Background: Lower back pain is one of the most common emergency department (ED) complaints, comprising approximately 2.6 The first time was with Dr. Al Sacchetti. Reference: Fox LM et al.

Emergency Department

Emergency Department ALS ED EMS

PEM POCUS Series: Pediatric Lung Ultrasound

ALiEM

AUGUST 9, 2023

Distractions such as a toy, book, or phone/tablet can also help ease anxiety. Study N Sensitivity Specificity Comments Pereda et al., Balk et al., Tsou et al., ED Course The patient received antibiotics for pneumonia. PMID: 14722643 Pereda MA, Chavez MA, Hooper-Miele CC, et al. Intensive Care Med.

E-9-1-1

E-9-1-1 Emergency Department ALS OR

Reference ranges of paediatric heart rate and respiratory rate

Don't Forget the Bubbles

AUGUST 7, 2023

The controversy around what is ‘normal’ in infants’ and children’s vitals was demonstrated in a 2011 systematic review by Fleming et al. and two cohort studies, one performed in Australia by O’Leary et al. and one in the US by Bonafide et al. Brennan et al. Our study supports previous work by Nijman et al.

Life Support

Life Support Advanced Life Support ALS Emergency Department

REBEL Core Cast 91.0 – Testicular Torsion

REBEL EM

NOVEMBER 30, 2022

Perform manual detorsion after diagnosis Read More: Video: The New Testicular Torsion Traction Technique Ben-Israel T et al. Clinical predictors for testicular torsion as seen in the pediatric ED. PMID: 20837255 Sidler D et al. Mellick LB et al. Am J Emerg Med 2010; 28:786-789. S Afr Med J. 1997;87(12) 1696-8.

ALS

ALS ED OR EMS

Target Acquired

EMS 12-Lead

APRIL 2, 2022

So, when I first began teaching ECGs and writing my books (in the early 1980s) — I decided to synthesize my impressions of the literature into what I felt (e.g. Chou’s Electrocardiography in Clinical Practice, 6th ed. 4] Baranchuk, A, et al. Goldberger’s Clinical Electrocardiography: A Simplified Approach, 9th ed.

ALS

ALS STEMI Coronary OR

Emergency Medicine Deserves to “Re-Brand” Itself as a Cost Saver

ACEP Now

JULY 6, 2023

Of course, the bill for any episode of emergency department (ED) care can be substantial, exceeding the billed charges for equivalent care provided in some primary care offices. Now, many acute pyelonephritis patients receive an IV antibiotic, analgesia, and an antiemetic in the ED.

ALS

ALS Emergency Department STEMI ED

An elderly male with shortness of breath

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

ECG 1 at time zero EARLY REPOLARIZATION ABNORMAL ECG ED final official overread: "early repol vs hyperacute T, minimal changes from previous (previous shown below)" What do YOU think? Lemkes et al. See these casese (and I have many others): First ED ECG is Wellens' (pain free). A 70-something y.o. Eur Heart J 2018.

STEMI

STEMI ACS Critical Care OR

POCUS findings of hemodynamically unstable PE with cardiac arrest

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Case A 25-year-old-female presented to the ED in cardiac arrest. Alerhand et al described ten individual echocardiographic findings of RV strain that suggest PE. 10,11 Vid 1. EKG RV strain.

ED

ED NARCAN ALS OR

The Private Equity Wave in Health Care

ACEP Now

SEPTEMBER 3, 2024

25 Wesley Barnett had heard disturbing stories about the firm staffing his hometown critical-access ED as he was nearing the end of residency at the University of Kentucky, so he founded an independent physician group to try to take back the contract. Sheffler RM, Alexander L, Fulton BD, et al. Salley et al v. Cai C, Song Z.

E-9-1-1

E-9-1-1 ALS OR Emergency Department

Chest pain, a ‘normal’ ECG, a 'normal trop', and low HEART and EDACS scores: Discharge home? Stress test? Many errors here.

Dr. Smith's ECG Blog

APRIL 22, 2022

Backus BE, Six AJ, Kelder JC, et al. Moumneh T, Sun BC, Baecker A, et al. Shah ASV, Anand A, Sandoval Y, et al. Patel J, Alattar F, Koneru J, et al. Gulati M, Levy P, Mukherjee D, et al. Greenslade J, Cho E, Van Hise C, et al. Int J Cardiol 2013 2. Shin YS, Ahn S, Kim YJ. Am J Med 2021 5. Lancet 2015 6.

E-9-1-1

E-9-1-1 STEMI ALS ED

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Dr. Smith's ECG Blog

MARCH 11, 2016

Her prehospital ECG was identical to her first ED ECG, and the cath lab was activated: There is massive ST elevation (greater than 15 mm) in V2 and V3, with ST elevation in I and aVL and reciprocal ST depression in II, III, aVF. Raitt MH, et al. This comes from chapter 28 of my book The ECG in Acute MI ). Methods: Oliva et al.

ALS

ALS STEMI OR ED

Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

OCTOBER 30, 2024

Our experience: Traditionally, ED physicians do not like ordering urine drug screens (UDS). In our study, we used COWS alone in the ED, which does utilize restlessness, anxiety, and tachycardia as part of the formula, as the sole evaluation tool for tranq dope withdrawal. Some patients require re-dosing in the ED. 2023 [book].

E-9-1-1

E-9-1-1 Naloxone Emergency Department ALS

ROCURONIUM: The "ROC" Block

FOAMfrat

JULY 1, 2023

Their recommendation, as I can tell, appears to come from two things: A paper by Levin NM et al. I also find the following information useful: Succinylcholine has an onset of approximately 45 seconds, whereas Rocuronium has an approximate onset of 60 to 90 seconds -- Depending on what book you read. Jain A, Wermuth HR, Dua A, et al.

E-9-1-1

E-9-1-1 Emergency Department OR ALS

If you had recorded an ECG during chest pain, what would it have shown?

Dr. Smith's ECG Blog

JUNE 28, 2018

de Zwaan C et al. I believe that I was the first to represent Wellens as a reperfusion syndrome, in my book , The ECG in Acute MI , pages 22-23 and 51, and in chapter 27 on Reperfusion and Reocclusion. Am Heart J. 1982 Apr;103(4 Pt 2):730-6. Am Ht J 117(3): 657-665; March 1989. More outcome Peak troponin I was 0.58

STEMI

STEMI Coronary OR ALS

LVH with anterior ST Elevation. When is it anterior STEMI?

Dr. Smith's ECG Blog

DECEMBER 29, 2015

Case history A middle-aged woman with a history of HTN, but no prior CAD, presented to the ED with chest pain. The criteria of Armstrong et al. LVH usually has concave-upwards ST segments, but conVEX-upwards can also be seen, e.g. in these cases from Dr Smith’s book: The ECG in Acute MI : Case 22-1. AT, Jaffa EJ, et al.

STEMI

STEMI Coronary ALS CAD

SGEM#285: And I See Your True Colours Calming You – From your Anxiety

The Skeptics' Guide to EM

FEBRUARY 29, 2020

Date: February 28th, 2020 Reference: Rajendran et al. Date: February 28th, 2020 Reference: Rajendran et al. Case: One night during an overnight shift, you are taking care of a patient who presented to the emergency department (ED) due to anxiety and vague suicidal ideation. Reference: Rajendran et al.

Emergency Department

Emergency Department ALS ED OR

Episode 124 The full spectrum of color vision deficiency

This Podcast Will Kill You

SEPTEMBER 12, 2023

Kawamura, Shoji, et al. Metropolitan books, 2010. The history of color blindness. Wayenborgh Publishing, 2018. Gegenfurtner, K.R. and Kiper, D.C., Color vision. Annual review of neuroscience , 26 (1), pp.181-206. An immense world: How animal senses reveal the hidden realms around us. Knopf Canada, 2022. Simunovic, M.P., Caine, Nancy G.,

ALS

ALS ED

SGEM#337: Amazing GRACE-1 How Sweet the Guidelines – Recurrent, Low Risk Chest Pain in the Emergency Department

The Skeptics' Guide to EM

JULY 10, 2021

Dr. Carpenter also wrote the book on diagnostic testing and clinical decision rules. Reference: Musey et al. Case: You are seeing a patient who has returned to the emergency department (ED) with recurrent chest pain. He is also a Guidelines Methodologist within CAEP and the SAEM GRACE groups.

Emergency Department

Emergency Department ACPE EMS ALS

Paramedicine Now

Post-Intubation Sedation and Analgesia

SGEM#263: Please Stop, Prescribing – Antibiotics for Viral Acute Respiratory Infections

Trending Sources

Episode 9: Right heart failure and the SAVIOR protocol with Habib Srour (part 2)

Unstable Pelvic Trauma Patient: ED Presentations, Evaluation, and Management

Episode 9: Right heart failure and the SAVIOR protocol with Habib Srour (part 1)

SGEM#227: A Message to you Rudy – About Rudeness

Spooky Scary Sequela: Clinical Factors Impacting Trauma Outcomes

SGEM#322: TXA for SAH – Won’t Stop Me Now

SGEM#224: Battlefield Acupuncture – Don’t Do Me Like That

PEM POCUS Series: Pediatric Lung Ultrasound

Reference ranges of paediatric heart rate and respiratory rate

REBEL Core Cast 91.0 – Testicular Torsion

Target Acquired

Emergency Medicine Deserves to “Re-Brand” Itself as a Cost Saver

An elderly male with shortness of breath

POCUS findings of hemodynamically unstable PE with cardiac arrest

The Private Equity Wave in Health Care

Chest pain, a ‘normal’ ECG, a 'normal trop', and low HEART and EDACS scores: Discharge home? Stress test? Many errors here.

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ROCURONIUM: The "ROC" Block

If you had recorded an ECG during chest pain, what would it have shown?

LVH with anterior ST Elevation. When is it anterior STEMI?

SGEM#285: And I See Your True Colours Calming You – From your Anxiety

Episode 124 The full spectrum of color vision deficiency

SGEM#337: Amazing GRACE-1 How Sweet the Guidelines – Recurrent, Low Risk Chest Pain in the Emergency Department

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