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

The Skeptics' Guide to EM

DECEMBER 28, 2024

Date: December 26, 2024 Reference: Steinhauser S et al. Reference: Steinhauser S et al. Exclusions: Patients unable to consent, non-English speakers, prisoners, acutely psychotic patients, critically ill patients, those suffering from dementia and those without a definitive diagnosis of OUD. AEM December 2024 Guest Skeptic:Dr.

Emergency Department 158

Emergency Department Overdose ED ALS 158

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

The Skeptics' Guide to EM

DECEMBER 9, 2023

Date: November 20, 2023 Reference: Jones et al. Date: November 20, 2023 Reference: Jones et al. SGEM listeners are probably familiar with the placebo effect, but can you give us a brief definition or description? Time to reflect on open-label placebos and their value for clinical practice.

ALS 198

ALS OR 198

Dr. Smith's ECG Blog

MAY 7, 2024

My response: "Definitely not polymorphic VT. Definitely atrial fibrillation. Here is the post cardioversion ECG: Definite pre-excitation (delta waves due to accessory pathway, "bypass tract"). Goyal et al — StatPearls: July, 2023 ). Probably WPW but is very slow for atrial fib withWPW.

ALS 117

ALS OR 117

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

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

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 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

Core EM

JANUARY 25, 2024

Written By: Kaitlynn Tracy, MD Edited By: Sean Schnarr, MD and Gregg Chesney, MD Definition/Background: Burns are classified as being major, moderate, or minor in severity. Tintinalli, et al. 4 Survival rate for all burn injuries is around 97%, which is a notable increase from 75% in the 1960’s. Wiktor, Arek, and David Richards.

ED 246

ED E-9-1-1 First Aid OR 246

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 136

ALS ACS OR CPR 136

The Skeptics' Guide to EM

MARCH 2, 2019

Date: February 26th, 2019 Reference: Benger et al. Date: February 26th, 2019 Reference: Benger et al. They had a difficult time getting a definitive airway pre-hospital. Reference: Benger et al, Effect of a Strategy of a Supraglottic Airway Device
vs. Effect of a Strategy of a Supraglottic Airway Device
vs.

CPR 130

CPR Firefighter Paramedic Defibrillator 130

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 EMS Critical Care 130

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

The Skeptics' Guide to EM

FEBRUARY 15, 2020

Date: February 11th, 2020 Reference: Yeh et al. Date: February 11th, 2020 Reference: Yeh et al. Only then would we have definitive evidence that a parachute was effective in preventing death and major trauma related to gravitational challenges. Reference: Yeh et al. Guest Skeptic: Marcus Prescott is a nurse in Norway.

ALS 130

ALS Emergency Department OR 130

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

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

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

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

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

[display_podcast] Date: September 26th, 2017 Reference: Kaufman, et al. display_podcast] Date: September 26th, 2017 Reference: Kaufman, et al. Faster clean catch urine collection (Quick-Wee method) from infants: randomised controlled trial. BMJ April 17. BMJ April 17.

Emergency Department 130

Emergency Department ALS OR 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

The Skeptics' Guide to EM

JUNE 27, 2020

I used the original definition of EBM given by Dr. David Sackett: “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.” ( Sackett et al BMJ 1996 ) There are three pillars to EBM than can be represented in a Venn diagram.

ALS 130

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 107

Coronary ACS ALS OR 107

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

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 118

ALS Emergency Department OR ED 118

The Skeptics' Guide to EM

DECEMBER 16, 2017

[display_podcast] Date: November 27th, 2017 Reference: Legriel et al. display_podcast] Date: November 27th, 2017 Reference: Legriel et al. The American Epilepsy Society has guidelines on the acute management of convulsive status epilepticus ( Glauser et al Epilepsy Currents 2016 ). Reference: Legriel et al.

ALS 100

ALS ICU Emergency Department Paramedic 100

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

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

Broome Docs

JUNE 20, 2023

Here we go… Liu S, Yao C, Xie J, et al. Bramante CT, Buse JB, Liebovitz DM, et al. PMID: 35723686 Pacheco LD, Clifton RG, Saade GR, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. JAMA Intern Med. 2023 May 1:e230780. doi: 10.1001/jamainternmed.2023.0780.

Emergency Department 132

Emergency Department ALS 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

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 40

E-9-1-1 STEMI ACS Coronary 40

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-9-1-1 103

E-9-1-1 ALS ED OR 103

The Skeptics' Guide to EM

JULY 25, 2020

Reference: Carley et al. It was great that it started with a definition of evidence-based medicine (EBM). He is Professor of Emergency Medicine at Manchester Metropolitan University and a Consultant in adult and paediatric Emergency Medicine at Manchester Foundation Trust. Dr. Carley is even verified on twitter as @EMManchester.

ED 130

ED ALS OR 130

The Skeptics' Guide to EM

MARCH 4, 2018

[display_podcast] Date: February 27th, 2018 Reference: Moran et al. display_podcast] Date: February 27th, 2018 Reference: Moran et al. With the difficulty to definitively determine the source, Beta-hemolytic streptococci are presumed to be the dominant pathogens. Reference: Moran et al. JAMA May 2017. JAMA May 2017.

ALS 100

ALS OR EMS 100

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

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 102

STEMI Coronary ACS ED 102

EMS 12-Lead

AUGUST 22, 2022

They are not premature, by definition. The blue arrows show RBBB morphology, and it’s tempting to deploy a compulsory diagnosis of PVC’s, but remember: these wide QRS complexes arrive subsequent to a regularly timed P wave. The green arrows, however, do show premature complexes. References Chiale, P. JACC, Vol 23, No 3; 724-32. Friedman, M.,

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130