The Skeptics' Guide to EM

JANUARY 1, 2022

He became double board certified in Emergency Medicine (EM) and Emergency Medical Services (EMS). Reference: Grotta JC et al. He became double board certified in Emergency Medicine (EM) and Emergency Medical Services (EMS). Reference: Grotta JC et al. Reference: Grotta JC et al.

Emergency Medical Services 130

Emergency Medical Services Firefighter Paramedic ALS 130

EMDocs

APRIL 27, 2024

We’ll keep it short, while you keep that EM brain sharp. link] Al Aaraj MS, Kelley C. Al-Noury, K., & Lotfy, A. link] The post EM@3AM: Malignant/Necrotizing Otitis Externa appeared first on emDOCs.net - Emergency Medicine Education. He says the pain is worse at night and when he is chewing. What is the diagnosis?

EMS 105

EMS ED OR ALS 105

EMDocs

MARCH 30, 2024

We’ll keep it short, while you keep that EM brain sharp. 14 CT is the imaging modality of choice and indicated for definitive clarification of injury; it can specify the type of injury and assist with definitive management. A 27-year-old man was brought into the emergency department via EMS after being stabbed.

EMS 106

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

REBEL EM

NOVEMBER 6, 2024

Commentary on an article by Marc Schnetzke, MD, et al.: “Determination of Elbow Laxity in a Sequential Soft-Tissue Injury Model. PMID: 31082090 Post Peer Reviewed By: Anand Swaminathan MD, MPH (Insta @EMSwami) The post Elbow Dislocations appeared first on REBEL EM - Emergency Medicine Blog. In: StatPearls [Internet].

E-9-1-1 114

E-9-1-1 ACS OR Emergency Department 114

EMDocs

JUNE 17, 2023

We’ll keep it short, while you keep that EM brain sharp. 2018.75010 Miranda-Barrios J, Bravo-Queipo-de-Llano B, Baquero-Artigao F, et al. 2009-1709 The post EM@3AM: Periorbital Cellulitis appeared first on emDOCs.net - Emergency Medicine Education. There is mild warmth but no crusting or active drainage. What is the diagnosis?

EMS 97

EMS OR Emergency Department ALS 97

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Here is the case: Report from EMS was witnessed syncope, his son did CPR, but the patient had pulses when EMS arrived. When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. Hope you’re doing well! How excited would you have been about this case?" No Chest Pain, but somnolent.

EMS 114

EMS CPR ED Coronary 114

EMDocs

JULY 1, 2023

We’ll keep it short, while you keep that EM brain sharp. link] The post EM@3AM: Kawasaki Disease appeared first on emDOCs.net - Emergency Medicine Education. A 3-year-old male with no past medical history presents to the ED with one week of daily fevers >102°F associated with four days of rash on the trunk. Lakhani, N.

EMS 93

EMS Coronary ED OR 93

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. Emergency medical services (EMS) scope of practice is governed by the state, but national scope of practice guidelines are available for the four different EMS provider levels.

E-9-1-1 40

E-9-1-1 Emergency Medical Services Emergency Medical Technician AEMT 40

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

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. The post Sickle Cell Disease and Stroke appeared first on Pediatric EM Morsels. Stroke in patients with sickle cell disease. Expert Rev Hematol. 2013 Jun;6(3):301-16. doi: 10.1586/ehm.13.25. PMID: 23782084.

ALS 130

ALS OR EMS Critical Care 130

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

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

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

DECEMBER 16, 2017

[display_podcast] Date: November 27th, 2017 Reference: Legriel et al. display_podcast] Date: November 27th, 2017 Reference: Legriel et al. Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure. Reference: Legriel et al. He is known to have poorly controlled epilepsy.

ALS 100

ALS ICU Emergency Department Paramedic 100

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. He also hosts a great #FOAMed blog and podcast called TOTAL EM. With the difficulty to definitively determine the source, Beta-hemolytic streptococci are presumed to be the dominant pathogens.

ALS 100

ALS OR EMS 100

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

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Critical Care 94

Critical Care ED EMS OR 94

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

APRIL 17, 2023

Article: Kim DJ et al. We need high-quality evidence to provide a definite conclusion. The neck and thyroid are particularly vulnerable to radiation (Tipnis et al.). However, there simply is not enough high-quality evidence to provide a definite conclusion. appeared first on REBEL EM - Emergency Medicine Blog.

ALS 129

ALS OR ED EMS 129

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 96

E-9-1-1 ALS ED OR 96

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

EMDocs

DECEMBER 4, 2023

Johnson, MD ( Community EM, Salina Regional Health Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (Cleveland Clinic Foundation, EM-CCM); Brit Long, MD (@long_brit) Case A 40-year-old woman presents to a rural emergency department (ED) with left leg pain and swelling for the past 5 days.

ALS 96

ALS Emergency Department ED OR 96

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. References: Singer S, et al. PMID: 36108346 Cole JB, et al. PMID: 31270748 Maheshwari K, et al. PMID: 29872882 Jones AE, et al. PMID: 17035422 Holler JG, et al. PMID: 25789927 Schwartz MB, et al. The safety and efficacy of push dose vasopressors in critically ill adults.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

When EMS found her, she was dyspneic and diaphoretic. S 1 Q 3 T 3 — Whereas the diagnostic value of this pattern is limited when seen as an isolated finding — a definite S1Q3T3 pattern ( as seen in Figure-1 ) — is very helpful in today's case, given association with other ECG evidence pointing to a large acute PE.

E-9-1-1 127

E-9-1-1 Coronary STEMI ALS 127

Dr. Smith's ECG Blog

DECEMBER 19, 2023

EMS obtained the following vital signs: pulse 50, respiratory rate 16, blood pressure 96/49. It appears EMS obtained two EKGs, but unfortunately these were not saved in the medical record. The EMS crew was only BLS certified, so EKG interpretation is not within their scope of practice.

E-9-1-1 127

E-9-1-1 Coronary ACS BLS 127

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Written by Pendell Meyers A teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. A Child with Blunt Trauma -- See how the ECG can be definite for myocardial contusion, but subtle, and what happens if you miss it.

ALS 115

ALS Emergency Department OR EMS 115

FOAMfrat

MARCH 4, 2025

Manifestations You might be asking yourself why Im writing about eating disorders, considering the rarity of EMS responses to them. While eating disorders dont necessarily prompt a call or request for 911, complications from them can create the need for EMS assessment and intervention. Hambleton, Ashlea, et al. 2022, [link].

ALS 96

ALS Ambulance OR EMS 96

NAEMSP

MARCH 5, 2024

Article Summary by Sarah Fabiano, MD, FACEP, FAAEM Lyng JW, Braithwaite S, Abraham H, et al. Appropriate air medical services utilization and recommendations for integration of air medical services resources into the EMS system of care: a joint position statement and resource document of NAEMSP, ACEP, and AMPA.

Critical Care 52

Critical Care Medical Transportation CPR EMS 52

REBEL EM

DECEMBER 5, 2023

This varied incidence can be due to inconsistent definitions or inclusion of mild reactions. The Skeptics Guide to EM Should I Stay or Should I Go Related Topics: Are steroids and antihistamines really effective for anaphylaxis?: The American Journal of Emergency Medicine 2018 Aug;36(8):1480-1485 Shaker M, et al. Read More: 1.

Epinephrine 81

Epinephrine Allergic Reaction Emergency Department Emergency Management 81

Don't Forget the Bubbles

AUGUST 28, 2023

A biopsy is often ultimately required for a definitive diagnosis. You contact ICU, anaesthetics, ENT, and oncology with a plan to attempt more definitive imaging in the prone position (which Ginny tells you is much comfier) What’s the evidence for our emergent management? 0000000000000294 Carter BW, Benveniste MF, Madan R, et al.

Emergency Management 97

Emergency Management Emergency Manager E-9-1-1 Critical Care 97

Dr. Smith's ECG Blog

DECEMBER 13, 2024

The patient was transported by EMS to the emergency department, where the ECG was interpreted as showing VT ( V entricular T achycardia ). Definite treatment is in the electrophysiology lab where ablation of the accessory pathway can be performed. Smith's ECG Blog for review on the Cabrera Format ). R-R intervals less than 240 msec.

ALS 103

ALS Emergency Department Ambulance OR 103

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

When Pendell and I are coding ECGs for the Queen's training, this is one category: "Definite ischemia, difficult to differentiate between posterior OMI and subendocardial ischemia." Hayakawa A, Tsukahara K, Miyagawa S, et al. Smith's ECG Blog — in which I review ECG findings from the original 2008 manuscript by deWinter et al ).

ACS 82

ACS Coronary ALS CAD 82

REBEL EM

AUGUST 22, 2022

Background: Traumatic lacerations presenting to the emergency department are, by definition, contaminated (ie non-sterile). Paper: Zwaans JJM et al. References: Zwaans JJM et al. PMID: 35882525 [ Access on Read by QxMD ] Perelman VS et al. appeared first on REBEL EM - Emergency Medicine Blog. Emerg Med J 2022.

Emergency Department 58

Emergency Department ALS ED EMS 58

REBEL EM

JULY 20, 2022

REBEL Core Cast 85.0 – Superficial Venous Thrombosis Click here for Direct Download of the Podcast Definition: The presence of a clot in a superficial vein. References: Frappe P, et al the STEPH Study Group. PMID: 12814979 Blumenberg RM, et al.: PMID: 9510288 Coon WW et al. PMID: 25903684 Guyatt GH et al.

ALS 52

ALS OR ED EMS 52

REBEL EM

FEBRUARY 22, 2023

Open angle Closed angle Definitions Increased resistance to aqueous outflow through the trabecular meshwork. et al, Emergency Medicine Clinical Essentials ed 2. Ophthalmology, in Marx J et al (eds): Rosens Emergency Medicine: Concepts and Practice, ed 9. Transient vision loss defined as vision loss <24 hours. Bagheri 2015 ).

Emergency Department 52

Emergency Department ALS ED Coronary 52

REBEL EM

MARCH 22, 2023

REBEL Core Cast 98.0 – AVNRT Click here for Direct Download of the Podcast Definition: A regular, narrow-complex rhythm with a ventricular rate that is typically > 160 bpm. Amal Mattu’s ECG Blog has an excellent review of AVNRT vs. VT and REBEL EM reviews the sensitivity and specificity of various algorithms. Lancet 2015.

ALS 52

ALS EMS ED OR 52

High Performance EMS

DECEMBER 27, 2023

Figure 2 Sample data demonstrating ALS (green) and BLS (blue) call volume comparisons by hour-of-the-day and day-of-the-week. Once a query definition is set, it can be tested in Demand Monitor to see how many records it will return. It is also common for ambulances to be busy longer than an hour in our post-pandemic world.

UHU 130

UHU BLS Emergency Medical Services Unit Hour 130