REBEL EM

AUGUST 7, 2023

Background: Getting a definitive airway in a critically ill trauma patient can be a stressful situation. REBEL Cast Ep122: Delayed vs Rapid Sequence Intubation in Agitated Trauma Patients Click here for Direct Download of the Podcast Paper: Bandyopadhyay A et al. References: Bandyopadhyay A et al. Anesth Analg 2023.

ALS 98

ALS OR EMS 98

Dr. Smith's ECG Blog

OCTOBER 24, 2018

Therefore, this does not meet the definition of myocardial infarction ( 4th Universal Definition of MI ), which requires at least one troponin above the 99% reference range. You can see the deficiency of the definition of MI. Thelin et al. Mokhtari et al. This is subtle — but it is definitely present.

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 52

The Skeptics' Guide to EM

DECEMBER 7, 2019

Date: October 2nd, 2019 Reference: Ramgopal et al. Date: October 2nd, 2019 Reference: Ramgopal et al. Most of the definition is in the name itself. * The name was not reassuring and the definition was vague. Changes in the Management of Children With Brief Resolved Unexplained Events (BRUEs).

CPR 130

CPR ALS OR 130

Dr. Smith's ECG Blog

JUNE 5, 2024

The ECG does not show any definite signs of ischemia. Uncontrolled coronary spasm may be associated with serious arrhythmias , including cardiac arrest ( Looi et al — Postgrad Med, 2012 ; Tan et al — Eur Heart J Case Rep, 2018 ; Chevalier et al — JACC, 1998 ; Rodriguez-Manero — EP Europace, 2018 ).

Coronary 106

Coronary ACS ALS OR 106

The Skeptics' Guide to EM

OCTOBER 20, 2018

[display_podcast] Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Ann Emerg Med 2018 (CRD42017056195) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. display_podcast] Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Reference: Aycock, Westafer et al.

Coronary 174

Coronary Emergency Department ALS OR 174

ALiEM

SEPTEMBER 29, 2023

In cases where the nature of the missile is known, plain films or POCUS may be a reasonable first step, but CT imaging would be definitive. References Goodwin RB, Beery PR 2nd, Dorbish RJ, et al. Penetrating wounds can be deceptively innocuous, and a high index of suspicion is required. The Journal of Trauma.

ALS 177

ALS OR 177

Pediatric EM Morsels

APRIL 7, 2023

References: Al Kasab S, Lynn MJ, Turan TN, Derdeyn CP, Fiorella D, Lane BF, Janis LS, Chimowitz MI; SAMMPRIS Investigators. No fibrinolytic here – transfusion to help increase the percentage of adult vs sickle cell hemoglobin is treatment of choice for ischemic infarcts!

ALS 130

ALS OR Critical Care EMS 130

EMDocs

NOVEMBER 13, 2024

Definition: SBP is an infection of the peritoneal ascitic fluid without an intra-abdominal focus of infection. Biggins SW, Angeli P, Garcia-Tsao G, et al. Mattos AA, Wiltgen D, Jotz RF, et al. Aithal GP, Palaniyappan N, China L, et al. Angeli P, Bernardi M, Villanueva C, et al. Arvaniti V, D’Amico G, Fede G, et al.

E-9-1-1 72

E-9-1-1 ALS OR ED 72

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

The Skeptics' Guide to EM

MAY 6, 2023

Date: April 25, 2023 Reference: Walsh et al. Date: April 25, 2023 Reference: Walsh et al. At that time, we recognized there was no universally accepted definition of excited delirium. WJEM 2023 There were five key points raised in the article: Continuing lack of a clear definition for excited delirium

Emergency Medical Services 101

Emergency Medical Services Paramedic ALS EMS 101

The Skeptics' Guide to EM

JANUARY 1, 2022

Reference: Grotta JC et al. Reference: Grotta JC et al. The primary outcomes reported better neurologic outcome at seven days but not at one day post treatment by a MSU compared to conventional care ( Fatima et al Int J Stroke 2020 ). Reference: Grotta JC et al. Howie also has a Master of Public Health.

Emergency Medical Services 130

Emergency Medical Services Firefighter Paramedic ALS 130

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% References: 1 Astasio-Picado Á et al. Ong MEH, Chan YH, Oh JJ, et al. Iserson KV et al. PMID: 8913236 7 Lee PM et al. 9 Zhang W et al. compared to only 37.5% in the CVC group.

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. References: Jaff MR et al. PMID: 21422387 Wan S et al. PMID: 15262836 Sharifi M et al. PMID: 27422214 Wang C et al. PMID: 19741062 Kucher N et al. PMID: 24226805 Piazza G et al. Clin Exp Emerg Med 2023. CHEST 2010.

ALS 137

ALS ACS OR CPR 137

ACEP Now

AUGUST 14, 2024

Second, the outcomes definitions rate and rhythm control at four and 24 hours are far beyond times relevant in emergency medicine in the U.S. References Joglar JA, Chung MK, Armbruster AL, et al. Fromm C, Suau SJ, Cohen V, et al. January CT, Wann LS, Alpert JS, et al. Niforatos JD, Ehmann MR, Balhara KS, et al.

ALS 105

ALS Emergency Department ED OR 105

Pediatric EM Morsels

SEPTEMBER 22, 2023

Definition A series of hemodynamic changes related to autonomic denervation and loss of sympathetic tone. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Main symptoms include hypotension and bradycardia. They may even need atropine and/or pacing for persistent bradycardia.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

Emergency Medicine Ireland

OCTOBER 14, 2024

And as we all know if there is a complication possible it’s almost definitely going to happen with greater frequency in the ICU cohort. I am unclear of the provenance of this list but it seems to have been drawn loosely from the 2017 thoracic surgery guidelines and some the intereventional trials we’ll talk about later.

Critical Care 52

Critical Care ICU ALS OR 52

EMS 12-Lead

APRIL 2, 2022

1, 2] The most clinically useful definition to account for this entire constellation is intraventricular conduction delay. You will see that they were initially ischemic, by definition, because of the subsequent voltage attenuation. Additional findings include a patently leftward frontal plane axis, an intriniscoid deflection (i.e.,

ALS 130

ALS STEMI Coronary OR 130

ACEP Now

NOVEMBER 14, 2023

The definition of massive hemoptysis is variable across publications with expectorated blood volumes ranging from 100 to 1,000 mL per 24 hours, as these volumes are difficult to estimate for any given patient. Atchinson PRA, Hatton CJ, Roginski MA, et al. Ittrich H, Bockhorn M, Klose H, et al. Li H, Ding X, Zhai S, et al.

E-9-1-1 52

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

REBEL EM

FEBRUARY 15, 2024

These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications. Paper: Freund Y et al. References: Freund Y et al.

ICU 141

ICU ALS ED OR 141

REBEL EM

AUGUST 30, 2023

REBEL Core Cast 107.0 – Vertebral Osteomyelitis Click here for Direct Download of the Podcast Definition Inflammation of the vertebrae due to a pyogenic, fungal or mycobacterial organism. Graphics Image 1: [link] Image 2: [link] References Berbari EF, Kanj SS, et al. PMID: 26316526 Boody B, et al. J Antimicrob Chemother.

E-9-1-1 104

E-9-1-1 ALS ED OR 104

ACEP Now

MARCH 14, 2024

Tracheo-innominate fistula (TIF) is an unusual and frequently lethal complication of such definitive airway placement. 15 Definitive Treatment Definitive treatment of TIF has traditionally involved median sternotomy and ligation of the innominate artery. Scalise P, Prunk SR, Healy D, et al. Mun JH, Jun PS, Sim Y-J, et al.

E-9-1-1 52

E-9-1-1 ALS Operating Room OR 52

REBEL EM

JANUARY 18, 2024

Paper: Varney J et al. Any of the outcomes could be statistically significant by chance alone as mortality was not the primary outcome in all the included studies Too few studies included in the meta-analysis (4 trials total) to draw any definitive conclusions. References: Varney J et al. Health Sci Rep 2022.

ICU 132

ICU ALS EMS 132

Broome Docs

FEBRUARY 22, 2024

PMID: 36946338 Bottom line: This is a well done RCT that demonstrates pretty convincingly that you should not bother trying to but fingernails back on after nail bed repair (and my guess is you definitely shouldn’t be removing them either). Carson JL, Brooks MM, Hébert PC, et al; MINT Investigators. N Engl J Med. 2023 Nov 11.

Emergency Department 103

Emergency Department ALS OR ED 103

The Skeptics' Guide to EM

NOVEMBER 1, 2022

Date: October 27th, 2022 Reference: Hayashi et al. Date: October 27th, 2022 Reference: Hayashi et al. There have been a few randomized control trials (RCTs) of peripheral nerve blocks for shoulder dislocation, but without definitive results (Raeyat Doost 2017; Blaivas 2011).

ALS 154

ALS Emergency Department OR ED 154

ACEP Now

JULY 7, 2023

17,18 Given this, the advent of extracorporeal membrane oxygenation (ECMO) presents an opportunity to bridge care between traditional resuscitation of refractory VF patients in the ED and more definitive management in the catheterization lab. References Tsao CW, et al. Benjamin EJ, et al. Kimblad H, et al. Sakai T, et al.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

REBEL EM

JUNE 22, 2023

However, the medical community is only just starting to understand long-COVID (WHO Definition: the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation). Article: Bramante CT et al. References: Bramante CT et al.

ALS 145

ALS OR EMS ED 145

Dr. Smith's ECG Blog

JANUARY 27, 2024

Deutch et al. Over the years — various definitions have been proposed for what should constitute a " significant " Q wave , based on width and/or depth of the Q wave. Validity of computer-interpreted ‘normal’ or ‘otherwise normal’ ECG in emergency department triage pateints. West J Emerg Med 2024).

STEMI 101

STEMI Coronary ACS ED 101

NAEMSP

MARCH 5, 2024

Article Summary by Sarah Fabiano, MD, FACEP, FAAEM Lyng JW, Braithwaite S, Abraham H, et al. There has been literature to support the use of air in trauma-both because of the time to definitive care but also the critical care that can be started at the scene. Prehosp Emerg Care 2021 Nov-Dec;25(6):854-73.

Critical Care 52

Critical Care Medical Transportation CPR EMS 52

ACEP Now

NOVEMBER 7, 2024

These various post-hoc analyses required accounting for receipt of sedation and varying alternative definitions of delirium and coma, but do little to refute the prevailing notion of increased neurotoxicity relating to cefepime. References Rhee C, Chen T, Kadri SS, et al. Qian ET, Casey JD, Wright A, et al. JAMA Netw Open.

Emergency Department 64

Emergency Department ALS OR 64

ALiEM

OCTOBER 30, 2023

Let’s start with the obligatory definition of coaching. PMID 18945997 Elster MJ, O’Sullivan PS, Muller-Juge V, et al. PMID 29686766 Jordan J, Coates WC, Clarke S, et al. PMID 29760865 Bentley S, Stapleton SN, Moschella PC, et al. PMID 32072117 Wolff M, Deiorio NM, Juve AM, et al. Perspect Med Educ.

E-9-1-1 161

E-9-1-1 ALS OR 161

ACEP Now

MAY 9, 2024

Taking a different approach than the authors of the AHRQ report, Auerbach et al used a “look back” approach to perform both qualitative and quantitative evaluations of the types and frequencies of errors occurring in hospital settings. References Newman-Toker DE, Peterson SM, Badihian S, et al. Auerbach AD, Lee TM, Hubbard CC, et al.

Emergency Department 52

Emergency Department ICU ALS ACS 52

ACEP Now

NOVEMBER 8, 2024

Historically, the endotracheal tube (ETT) has been considered the definitive airway of choice in both the prehospital and in-hospital setting. Benger JR, Kirby K, Black S, et al. Wang HE, Schmicker RH, Daya MR, et al. Ramaiah R, Das D, Bhananker SM, et al. Agro F, Frass M, Benumof JL, et al. 2018;320(8):779-791.

E-9-1-1 52

E-9-1-1 Emergency Medical Services Emergency Medical Technician AEMT 52

Don't Forget the Bubbles

JULY 22, 2024

Compare this with the Panickar et al. Fortunately, Lee et al. Lee B, Turner S, Borland M, Csonka P, Grigg J, Guilbert TW, et al. This is a broad definition of “pre-school” wheeze , and whilst this addresses a large population, the aforementioned concerns of including children under two prevail. study from 200 9.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

The Skeptics' Guide to EM

APRIL 6, 2019

Date: April 5th, 2019 Reference: Connolly et al. Date: April 5th, 2019 Reference: Connolly et al. We covered the interim analysis of 90 patients included in a prospective cohort study by Pollack et al NEJM 2015 on SGEM#139. Full Study Report of Andexanet Alfa for Bleeding Associated with Factor Xa Inhibitors.

Frozen Plasma 130

Frozen Plasma Plasma ALS EMS 130

The Skeptics' Guide to EM

JANUARY 30, 2021

Reference: George et al. Reference: George et al. This was based on two definitions. Steve is currently an Assistant Professor in the Department of Family Medicine at Western University (London, Ontario) working at the Fowler Clinic and the Roth McFarlane Hand and Upper Limb Centre. J Bone Joint Surg Am. J Bone Joint Surg Am.

OR 130

OR ALS 130

FOAMcast

OCTOBER 17, 2023

Apple Podcasts , Spotify , Listen Here Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive way of providing resuscitative aortic occlusion in severe hemorrhage to gain temporary hemorrhage control as a bridge to definitive procedures. ” As a result, Jansen et al. 2023 JAMA.

ACS 52

ACS ALS OR 52

REBEL EM

JUNE 26, 2024

Definition: A serum potassium level > 5.5 PMID: 20855477 Wrenn K et al. PMID: 1952310 Aslam S et al. PMID: 12198216 Montague BT et al. PMID: 18235147 Mattu A et al. PMID: 18936701 Moussavi K et al. rhabdomyolysis -> hydration) Remove inciting factors (i.e. CMAJ 2010; 182(15): 1631-5.

ALS 59

ALS OR EMS 59