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-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

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

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 Critical Care EMS 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% 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.

ALS 104

ALS Epinephrine Critical Care Emergency Department 104

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

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 OR First Aid 246

REBEL EM

FEBRUARY 7, 2024

Take Home Points Infections are a leading cause of maternal mortality worldwide. Prompt recognition is critical in management. Most infectious processes will require admission and close observation for improvement or decompensation. References: Abbrescia, K. Sheridan (2003). “Complications of second and third trimester pregnancies.”

ED 104

ED ALS OR EMS 104

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 171

Coronary Emergency Department ALS OR 171

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 110

Coronary ACS ALS OR 110

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

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

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

Don't Forget the Bubbles

OCTOBER 4, 2023

Formentin C, et al. Jørgensen RM, et al. Harris J, et al. Bhatia S, et al. Vivarelli M, et al. Morello W, et al. McGowan EC, et al. Hirata K, et al. Shaikh N, et al. Determining the Best Definition for a Positive Urine Culture in Young Children. Wald ER, et al. 2023 Sep 13.

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

ACEP Now

MARCH 14, 2024

Tracheo-innominate fistula (TIF) is an unusual and frequently lethal complication of such definitive airway placement. He has had a tracheostomy for approximately 15 months since his injury. Blood is spurting from the orifice of the tube. In one case series of seven patients, the average patient age was 15.7

E-9-1-1 52

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

The Skeptics' Guide to EM

MARCH 5, 2022

Date: February 24th, 2022 Reference: Parish et al. Date: February 24th, 2022 Reference: Parish et al. Tricoci et al. The definitions used for each level of evidence are as follows: An update was published by Fanaroff et al in JAMA 2019. We have covered some of these over the 10 years.

Epinephrine 100

Epinephrine ALS OR 100

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. The initiation of empiric antibiotics in hemodynamically stable, neurologically intact patients should be done on a case-by-case basis.

E-9-1-1 103

E-9-1-1 ALS ED OR 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. Suppose you had used the formula? But maybe not.

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 52

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. Alpha dominant: 7.9% Delta dominant 8.3%

ALS 145

ALS OR EMS ED 145

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 152

ALS Emergency Department OR ED 152

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. 2023 Mar 30;110(4):432-438.

Emergency Department 103

Emergency Department ALS OR ED 103

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

The Skeptics' Guide to EM

MAY 12, 2018

[display_podcast] Date: May 12th, 2018 Reference: Gonin P et al. display_podcast] Date: May 12th, 2018 Reference: Gonin P et al. Over 150 years since it was first described, there is still no standardized definition of ExDS and diagnostic criteria have not been universally recognized. Reference: Gonin P et al.

Emergency Department 130

Emergency Department ALS OR 130

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 105

STEMI Coronary ACS ED 105

Dr. Smith's ECG Blog

APRIL 17, 2023

NOTE: For illustrative purposes — I’ve adapted Figure-1 from the original manuscript by deWinter et al, published in this 2008 NEJM citation. de Winter et al in N Engl J Med 359:2071-2073, 2008. de Winter et al in N Engl J Med 359:2071-2073, 2008. QOH: "Not OMI, High confidence." NSTEMI is worthless garbage diagnosis!

OR 52

OR STEMI ACS Emergency Department 52

This Podcast Will Kill You

MAY 7, 2024

Dietary supplements: a definition that is black, white, and gray. Djaoudene, Ouarda, et al. Herasimenka, Aliaksandr, et al. Does it seem like the supplement section of your grocery store gets bigger every time you go in? You’re not imagining things. History Biology Sneader, Walter. Drug discovery: a history. 2023): 771. .

ALS 98

ALS OR 98

REBEL EM

JUNE 26, 2024

Definition: A serum potassium level > 5.5 Definition: A serum potassium level > 5.5 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.

ALS 57

ALS OR EMS 57

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

Dr. Smith's ECG Blog

AUGUST 9, 2024

Although recognition of OMI was not affected by administration of morphine in this case, use caution with analgesia in ongoing ACS without a definitive plan for angiography. Bigger et al. Sadowski ZP, Alexander JH, Skrabucha B, et al. Bigger JR Jr, Dresdale RJ, Heissenbuttel RH, et al. Do not treat AIVR. Leave it alone.

STEMI 88

STEMI Coronary Heart Attack ACS 88

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. 6 Three cases, Hall v.

Emergency Department 52

Emergency Department ICU ALS ACS 52

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 Defibrillator Epinephrine 130

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

EMDocs

NOVEMBER 1, 2023

2 Despite advances in imaging and surgical methods, overall mortality approaches 20%, which doubles to 40% with delays to definitive management exceeding than 24 hours. 2 Despite advances in imaging and surgical methods, overall mortality approaches 20%, which doubles to 40% with delays to definitive management exceeding than 24 hours.

Critical Care 67

Critical Care ED EMS OR 67

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.

ACS 52

ACS ALS OR 52

Dr. Smith's ECG Blog

JULY 21, 2024

There is no definite evidence of acute ischemia. (ie, This is an important finding related to the etiology and treatment of these malignant arrhythmias — since by definition, PMVT with a prolonged QTc is classified as Torsades de Pointes ( and entails different treatment recommendations ). What are additional treatment options?

Defibrillator 117

Defibrillator Coronary ALS STEMI 117

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. Kapoor et al. Oppressive quietness heavy with professionals’ suppressed emotions mixed with raw parental grief. That piercing parental cry rips through the room. Our bodies primed for the fight. Or exhausted from it. Some feel a nothingness.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

EMDocs

AUGUST 12, 2023

Answer : Flexor tendon injury Epidemiology: Secondary to deep penetration with sharp objects or blunt trauma at tendinous attachments to bone 2 Common in young men in manual labor (20-45 years) Literature has conflicting data regarding dominance of hand injured 2,3 Usually injured when using a sharp object or catching a falling object Overall epidemiology (..)

EMS 69

EMS ALS Emergency Department OR 69

REBEL EM

APRIL 17, 2023

Article: Kim DJ et al. Clinical evaluation may prove difficult since many PTA and peritonsillar cellulitis symptoms overlap. Physical examination is approximately 75% sensitive and 50% specific for identifying PTA. CT and aspiration or drainage are considered the gold standard for diagnosis. Acad Emerg Med. 2023 Jan 10. Epub ahead of print.

OR 128

OR ALS ED EMS 128