ALiEM

MARCH 7, 2024

Ultrasound probes from left to right: linear (nenoates), phased array (infants/younger children), and curvilinear (older children/adolescents) Pro tips for performing renal/bladder POCUS on a child [1] Addressing potential anxiety leads to a more efficient and comfortable examination.

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E-9-1-1 Emergency Department ALS ED 177

ACEP Now

DECEMBER 17, 2024

We deal with difficult and traumatizing situations daily, and nowhere is this more apparent than in the emergency department, where sickness, violence, and death are routine. 1 His tragic loss underscores the urgent need for mental health support for residents and fellows. Accessed December 9, 2024. died by suicide.

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E-9-1-1 Emergency Department ALS OR 105

EMDocs

MARCH 4, 2024

Darnall Army Medical Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, (@long_brit) Disclaimer: The views expressed in this post are those of the authors and do not reflect the official policy or position of the Department of the Army, DoD, or the US Government.

Emergency Department 104

Emergency Department E-9-1-1 ALS OR 104

ALiEM

MAY 13, 2024

Case Introduction: Child with abdominal pain Wendy is a 7-year-old girl who comes into the emergency department with redness, swelling, and pain on her left calf. Her symptoms started 1 week ago as a scratch which progressively got more red and painful. Pediatric Soft Tissue POCUS Ultrasound Technique Figure 1.

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E-9-1-1 ALS Emergency Department OR 161

ACEP Now

DECEMBER 7, 2024

1 A wide spectrum of severity exists in PE presentations, ranging from mild shortness of breath to cardiac arrest. References Silver MJ, Giri J, Duffy , et al. 2023;2(1):100548. Shah IK, Merfeld JM, Chun J, et al. Meyer G, Vicaut E, Danays T, et al. Mathbout MF, Al Hennawi H, Khedr A, et al.

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E-9-1-1 ALS Critical Care OR 52

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. Acad Emerg Med. 1994 Jul;125(1):57-62. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. Paediatr Anaesth.

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E-9-1-1 Operating Room Emergency Department ALS 187

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage.

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E-9-1-1 ACS Emergency Department Coronary 139

Broome Docs

SEPTEMBER 3, 2024

In a surprise to no one who reads First10EM, clinical judgment is better than all decision tools for sepsis Knack SKS, Scott N, Driver BE, Prekker ME, Black LP, Hopson C, Maruggi E, Kaus O, Tordsen W, Puskarich MA. Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients.

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E-9-1-1 Emergency Department ICU ALS 95

EMS 12-Lead

APRIL 28, 2022

Initial vital signs include: NIBP 99/58 HR 150-160 (trend) RR 10 (spontaneous, but shallow) SpO2 86 (RA) BBS CTA The initial rhythm strip is attached: Figure 1 There is a wide complex tachycardia of varying morphology, amplitude, and R-R cycle length. A prominent vertical scar, however, is noted at the sternum.

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E-9-1-1 ALS Coronary EMS 130

Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. She calls out her findings: A – OK B – 1 puncture mark to the anterior left chest wall, covered with a three-sided dressing. Actively oozing.

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E-9-1-1 FFP Plasma Emergency Department 139

EMDocs

SEPTEMBER 23, 2023

Answer : Brugada Syndrome Epidemiology and Etiology Rare genetic disorder that affects approximately 1 in 5,000 individuals worldwide 1. More common in males than females, with a male-to-female ratio of approximately 8:1 1. Type 1 “Brugada sign” The only type that is considered diagnostic.

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E-9-1-1 EMS ALS Defibrillator 103

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. ECG 1 What do you think?

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E-9-1-1 OR Coronary ACS 131

REBEL EM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. Article: Arvig MD, Lassen AT, Gæde PH, et al. Emerg Med J. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility.

ED 125

ED E-9-1-1 Emergency Department ALS 125

EMDocs

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? Rosh Review Website Link Further Reading: FOAMed: [link] [link] [link] [link] [link] [link] [link] References : Turi B, Smith D, Kusel K, et al. Updated November 9, 2023. link] Sharma R, Gaillard F, Bell D, et al.

EMS 109

EMS E-9-1-1 ALS OR 109

Don't Forget the Bubbles

SEPTEMBER 13, 2023

The parents of 18-month-old Susie brought her to the Emergency Department after she had a seizure at home. When considering tumours, 37 observation studies involving 2661 children found that 3% (95% CI 1-7%) had tumours. doi:10.1093/tropej/fmz071 Expert Panel on Pediatric Imaging, Trofimova A, Milla SS, et al. Pediatrics.

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FOAMfrat

MAY 19, 2024

While transporting to the emergency department, the patient’s mother informed me that PDCD affects less than 1 in 50,000 individuals and is more common in males than females. Upon arrival in the pediatric emergency department, the patient was conscious and alert to her normal mental status, which included being nonverbal.

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E-9-1-1 ALS Emergency Department EMT 98

EMDocs

OCTOBER 8, 2024

Discharging a patient with abnormal vital signs has been linked to unanticipated death (1-4). 2005;2(1):44-52. doi:10.1038/ncpcardio0068 Sklar DP, Crandall CS, Loeliger E, Edmunds K, Paul I, Helitzer DL. Unanticipated death after discharge home from the emergency department. Ann Emerg Med. Acad Emerg Med.

E-9-1-1 105

E-9-1-1 Emergency Department ED ALS 105

REBEL EM

SEPTEMBER 13, 2023

patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01

Frozen Plasma 101

Frozen Plasma Allergic Reaction FFP Plasma 101

EMDocs

MARCH 30, 2024

Comprehensive physical exam is unremarkable, but she does have pain at the T-12/L-1 region of her back. Her patellar reflexes are 1+ bilaterally, no ankle clonus is noted, and she denies any saddle anesthesia or bowel/bladder incontinence. CT of lower spine is ordered and shows the following: 1 What is the diagnosis?

EMS 105

EMS E-9-1-1 Emergency Department Ambulance 105

Broome Docs

DECEMBER 22, 2024

2024 Oct 9. There were no differences in survival (12% with IO vs 10% with IV) or neurologically intact survival (9% vs 8%). Acad Emerg Med. 2024 Nov 1. Piroxicam and paracetamol in the prevention of early recurrent pain and emergency department readmission after renal colic: Randomized placebo-controlled trial.

E-9-1-1 52

E-9-1-1 ACS Paramedic Emergency Department 52

Don't Forget the Bubbles

JANUARY 17, 2024

After Meshram et al, 2020 When Orbeez are exposed to water, the water molecules diffuse into the polymer network through osmosis. Curious Ken is brought into your emergency department. Image adapted from Mullens et al., After Darracq et al., A recent literature review by Caré et al. Zamora et al.,

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

EMDocs

FEBRUARY 26, 2024

1 While PJP gained significant recognition among HIV-positive adults during the early AIDS epidemic, the growing utilization of immunosuppressants has resulted in an increased incidence of the disease in individuals who are HIV-negative. A recent study by Gaborit et al. 9 The signs and symptoms of PJP infection are non-specific.

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E-9-1-1 ED ALS OR 108

EMDocs

OCTOBER 30, 2023

1 The shortage in supply posed difficulties for hospitals that significantly depend on GE Healthcare as their supplier, which encompassed approximately 50% of hospitals in the United States (US). 11 Table 1. Preparation 9 Hospitals had to prepare for the impending contrast shortage as soon as potential shortage news occurred.

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E-9-1-1 Emergency Department ALS CCT 94

REBEL EM

AUGUST 30, 2023

Epidemiology 1 to 2.4 cases per 100,000 people ( Zimmerli 2010 ) More common in males with M:F of 3:1 Rate is also increasing due to increased number of spinal procedures Typically affects adults, with most cases occurring in patients over 50 years old. Other pathogens include: E. PMID: 26316526 Boody B, et al.

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E-9-1-1 ALS ED OR 88

EMDocs

AUGUST 22, 2024

1 However, we recognize that many patients prefer to speak a language other than English regardless of their English proficiency, and this does not indicate a deficiency. 9 Less likely to be satisfied with their care and have a lower understanding of their discharge instructions. Lion KC, et al. Regenstein M, et al.

Emergency Department 102

Emergency Department ALS E-9-1-1 ED 102

EMDocs

NOVEMBER 18, 2023

A point of care ultrasound of the liver reveals the following: Image 1: Ultrasound of the liver showing abnormal hepatic artery flow and resistance index 1 Question: What is the diagnosis? Rosh Review Website Link References 1) Karmazyn B, Sağlam D, Rao GS, Jennings SG, Mangus RS. In: Molmenti E, Santibañes M, Santibañes E.

EMS 91

EMS E-9-1-1 ALS Emergency Department 91

EMDocs

SEPTEMBER 7, 2023

1 Clinical Questions: When should a clinician suspect diethylene glycol (DEG) toxicity? Metabolism of DEG adapted from Bessenhofer, et al. Toxicity typically evolves through three phases: 2,3,7,8,9 Phase 1: Gastrointestinal symptoms (e.g., What is the management of suspected or confirmed DEG toxicity?

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E-9-1-1 ALS Plasma Emergency Department 87

EMDocs

APRIL 13, 2024

1] In a survey of college wrestlers, the incidence of auricular hematoma was found to be 52% for those who do not wear headgear versus 26% who wore ear protection.[2] 1] In a survey of college wrestlers, the incidence of auricular hematoma was found to be 52% for those who do not wear headgear versus 26% who wore ear protection.[2]

EMS 102

EMS E-9-1-1 OR Emergency Department 102

EMDocs

NOVEMBER 4, 2023

link] =2969&sectionid=250456991 Moran GJ, Krishnadasan A, Gorwitz RJ, et al. aureus infections among patients in the emergency department. Skin and Soft Tissue Infections in the Emergency Department. Emerg Med Clin North Am. 2008;1(1):165. Methicillin-resistant S. N Engl J Med. 2018;36(4):723-750.

EMS 90

EMS E-9-1-1 Emergency Department ALS 90

Broome Docs

MARCH 28, 2024

Great evidence for button battery ingestions (if you are treating a dead pig) Chiew AL, Lin CS, Nguyen DT, Sinclair FAW, Chan BS, Solinas A. Ann Emerg Med. Am J Emerg Med. PMID: 34890894 Myth 1: Kayexalate is safe and useful. 2024 Jan 2;53(1):afad255. 2023 Sep 19:S0196-0644(23)00671-6. doi: 10.1016/j.annemergmed.2023.08.018.

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E-9-1-1 ICU Emergency Department ALS 96

Don't Forget the Bubbles

JUNE 17, 2024

Introduction: Civility Matters Healthcare environments, particularly emergency departments, are characterised by high levels of Volatility, Uncertainty, Complexity, and Ambiguity ( VUCA ). Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J.

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E-9-1-1 Critical Care CPR ICU 105

REBEL EM

FEBRUARY 5, 2024

Article: Marx T, Joly LM, Parmentier AL, et al. Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Recurrence of pneumothorax within 1 year. Panacek, E. Am J Respir Crit Care Med. Strange, C.,

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E-9-1-1 ALS Emergency Department OR 98

ACEP Now

SEPTEMBER 3, 2024

1 Immediately after the purchase, the real estate holdings of the hospitals were spun off into a separate company owned by Paladin and other PE investors. 1 Immediately after the purchase, the real estate holdings of the hospitals were spun off into a separate company owned by Paladin and other PE investors. Appelbaum E, Batt R.

E-9-1-1 113

E-9-1-1 ALS Emergency Department OR 113

EMDocs

JANUARY 17, 2024

She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). 1) There are a limited number of antitussives on the US market which include benzonatate, codeine, dextromethorphan, diphenhydramine, and hydrocodone. 11) A bolus dose at 1.5

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E-9-1-1 Overdose Emergency Medical Services Life Support 84

EMDocs

AUGUST 7, 2023

1 A D-dimer level can, therefore, be used as a non-specific and indirect biomarker for the presence of intravascular clotting, which may be useful in the diagnosis of VTE. 1-3 In this patient population, the NPV of a negative D-dimer level is high, such that a negative test makes further evaluation for VTE unnecessary.

E-9-1-1 91

E-9-1-1 ALS Plasma OR 91

ACEP Now

JANUARY 5, 2025

The PREOXI trial compared oxygen mask pre-oxygenation versus noninvasive positive-pressure ventilation (NIPPV) in patients requiring intubation in emergency departments (EDs) and intensive care units. 1 The primary outcome was the frequency of observed hypoxemia, defined as any pulse oximetry reading below 85 percent.

ALS 40

ALS E-9-1-1 ED Emergency Department 40

Don't Forget the Bubbles

DECEMBER 16, 2024

Coverage of the 6-in-1 vaccine measured at 12 months of age in England for Q4 2023 to 2024 Source: ONS under the Open Government License v3.0 Young infants and immunosuppressed individuals are particularly at risk of severe disease, resulting in significant morbidity and associated mortality rates of 1-3 per 1,000 cases.

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