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. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues. Moral of the Morsel Anatomy Matters!

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 116

E-9-1-1 ACS OR Emergency Department 116

The Skeptics' Guide to EM

DECEMBER 21, 2019

Only then would there be definitive evidence for the efficacy of parachutes. It was published last year in the 2018 BMJ holiday edition ( Yeh et al BMJ Dec 2018 ). Laupacis A et al NEJM 1988 ). Dr. Joshua Reynolds is […] The post SGEM Xtra: NNT – WET or DRI first appeared on The Skeptics Guide to Emergency Medicine.

OR 100

OR ALS ED 100

Don't Forget the Bubbles

JUNE 19, 2023

However, there are no agreed-upon definitions for growth restriction, and there are significant knowledge gaps. Refer to your local or national guidelines to decide whether a patient is SGA or not, but remember that, depending on which definition is used, both over- and underdiagnosis can occur.

ALS 143

ALS OR 143

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. Most were positive and interested.

ALS 209

ALS OR 209

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. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. amiodarone or lidocaine).

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

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

REBEL EM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Paper: Jansen JO, Hudson J, Cochran C, et al. Background: Hemmorhage is a major cause of preventable death in trauma patients. 2 Despite these recommendations there are no randomized clinical trials to help guide practice until now. 2023;e2320850.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

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 130

ALS OR 130

EMDocs

NOVEMBER 6, 2023

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. This post will focus on the key parts of the guideline that affect ED evaluation and management. Top 10 Take Home Pearls 1.

Naloxone 115

Naloxone OR BLS Overdose 115

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. 4 Survival rate for all burn injuries is around 97%, which is a notable increase from 75% in the 1960’s.

ED 246

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

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. A 49-year-old male was triaged to the Fast Track area with complaints of an abrasion to the neck following an assault.

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

Broome Docs

JANUARY 27, 2025

These results are not definitive, but considering the rarity of demyelination, and the magnitude of the mortality results, this should probably influence clinical practice until we get the proper RCTs. 100% seems too good to be true Morello et al., Welcome to the first episode of the Broomedocs podcast for 2025. Listen in and learn!

ED 101

ED OR ACS Critical Care 101

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 Epinephrine 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

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

EMS 12-Lead

APRIL 2, 2022

1, 2] The most clinically useful definition to account for this entire constellation is intraventricular conduction delay. Upon arrival he was found alert and oriented, and without gross distress. He denied difficulty breathing, epigastric pain, or chest discomfort. He denied any chest discomfort, or difficulty breathing. Figure 1-2.

ALS 130

ALS STEMI Coronary OR 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. Observation, interaction with patient, as well as parent information is key to bring the whole picture together!

ALS 130

ALS OR EMS Critical Care 130

ALiEM

OCTOBER 30, 2023

Let’s start with the obligatory definition of coaching. After spending her first year acclimating to the new department and achieving board certification, Dr. Garcia finds herself at a bit of a crossroad. She likes teaching, but are not sure residency or medical student education leadership is for her. But what can Dr. Garcia – or you – do?

E-9-1-1 161

E-9-1-1 ALS OR 161

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety profile [3][4]. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

ALS 136

ALS ACS OR CPR 136

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. This decreases generalizability to other substances.

ICU 141

ICU ALS ED OR 141

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. The decision to obtain an invasive sample is a clinical one.

Emergency Department 130

Emergency Department ALS OR 130

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

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 122

Coronary ACS ALS OR 122

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 123

ALS Emergency Department OR ED 123

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. 9 LMAs use an inflatable mask expanded using a similar technique to the endotracheal tube cuff.

E-9-1-1 40

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

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.

Epinephrine 105

Epinephrine ALS Critical Care Emergency Department 105

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. Anesth Analg 2023.

ALS 98

ALS OR EMS 98

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

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

Don't Forget the Bubbles

DECEMBER 16, 2024

The clinical case definition for pertussis is broadly consistent worldwide, with key features including paroxysmal coughing, post-tussive vomiting, inspiratory whoop, apnoea, and a cough lasting at least two weeks. Studies examining the sensitivity and specificity of this case definition highlight its limitations.

E-9-1-1 59

E-9-1-1 OR ALS Emergency Department 59

ACEP Now

AUGUST 14, 2024

The American Heart Association and American College of Cardiology released a comprehensive guideline on the management of atrial fibrillation (AF). 1 Most of the AHA/ACC recommendations are either irrelevant to the general emergency physician or common sense. Often, the best means of rate control is control of the underlying disease process (e.g.,

ALS 105

ALS Emergency Department ED OR 105

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 102

Emergency Medical Services Paramedic ALS EMS 102

Dr. Smith's ECG Blog

JANUARY 27, 2024

Deutch et al. In inferior aneurysm, we usually see QR-waves, whereas for anterior aneurysm, we see QS-waves (no R- or r-wave at all!). This ECG has Q-waves, but they are not very wide nor very deep, and so I doubt that the inferior STE is due to old MI. West J Emerg Med 2024).

STEMI 117

STEMI Coronary ACS ED 117

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

EMS 12-Lead

AUGUST 22, 2022

They are not premature, by definition. A 12 Lead ECG was recorded secondary to bizarre telemetry findings at bedside. From afar, there is gross tachycardia, cadence irregularities, and narrow QRS complexes that may, or may not, be Sinus in origin; and finally – a cacophony of wide complexes that might very well be ventricular in origin.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130