ALiEM

MAY 13, 2024

Her symptoms started 1 week ago as a scratch which progressively got more red and painful. Pediatric Soft Tissue POCUS Ultrasound Technique Figure 1. Cellulitis with cobblestoning Video 1. Abscess with irregular borders and surrounding cellulitis E. Superficial abscess with well-circumscribed borders Table 1.

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EMDocs

NOVEMBER 18, 2023

We’ll keep it short, while you keep that EM brain sharp. 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? doi:10.1007/s00247-020-04811-0 2) Kwong AJ, Ebel NH, Kim WR, et al.

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EMDocs

MARCH 30, 2024

We’ll keep it short, while you keep that EM brain sharp. 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. Diagnosis includes imaging.

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Core EM

JANUARY 25, 2024

7 86% of burn injuries are thermal burns (as opposed to chemical or electric), with 43% resulting from a direct exposure to fire, 34% from scalding liquid, and 9% from a hot object. 9 Apply a topical antimicrobial (eg. Tintinalli, et al. 2004 Jun 19;328(7454):1487-9. Wiktor, Arek, and David Richards. doi: 10.1136/bmj.328.7454.1487.

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EMDocs

NOVEMBER 4, 2023

We’ll keep it short, while you keep that EM brain sharp. A 54-year-old male with a history of diabetes presents with “pain in my groin” for the past two weeks. He reports approximately one month of dysuria, and around two weeks ago noticed a dull aching sensation in his testicles that has progressively gotten worse.

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Pediatric EM Morsels

SEPTEMBER 22, 2023

To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Alpha 1 agonists are necessary to maintain appropriate blood pressure. Tenenbein M, Macias CG, Sharieff GQ, et al, eds.

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Dr. Smith's ECG Blog

DECEMBER 19, 2023

[link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. EMS obtained the following vital signs: pulse 50, respiratory rate 16, blood pressure 96/49. cTnI drawn at the same was 0.011 ng/mL (ref.

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Pediatric EM Morsels

APRIL 5, 2024

Time from tick bite to onset of symptoms generally ranges from 1 week to 4 weeks but can start within 2 days (CDC 2022) Tick-Borne Encephalitis can also be transmitted in unpasturized dairy. These resolve within 1 week. 2004 Nov 15;39(10):1493-9. John H, Jian J, RIchards AL. 2018 Mar; 3(1): 8. 2019 Apr:62:1-6.

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FOAMfrat

MAY 19, 2024

Many of us grew up in the age of EMS, which emphasized the need to memorize everything. 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. The reality is, nothing could be farther from the truth! Absolutely!

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Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. C Examination notable for diaphoresis, 1+ bilateral lower extremity edema, regular heart rate and rhythm, and no signs of respiratory distress with normal breath sounds. In fact, Kosuge et al. In fact, Kosuge et al.

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EMDocs

JUNE 27, 2024

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? 2022 Jul 5;328(1):57-68. C or 100.4 mg/kg, max 0.4

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EMDocs

JULY 17, 2023

1 While less common than small bowel obstruction (SBO), obstruction of the large bowel is more likely to be a surgical emergency and is often associated with a serious underlying condition. 1 The most common causes of non-cancer-related LBO are cecal and sigmoid volvulus. Small bowel dilation may also be seen.

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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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EMDocs

APRIL 10, 2024

Authors: Alex Rogers, MD (EM Resident Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX); J.D. 1-5] Since then, many more medications have been developed and deployed. 1-5] This post focuses on the identification and management of Local Anesthetic Systemic Toxicity (LAST).

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EMDocs

JANUARY 17, 2024

When emergency medical services (EMS) arrived, she was in asystole with an empty, recently full, bottle of benzonatate 100 mg capsules. 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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EMDocs

JUNE 14, 2023

Patellar reflexes are 1+. 1, 2, 4, 9 Organophosphates are one of many types of insecticide and are used worldwide to manage crops. 1, 2 Symmetric sensorimotor axonopathy: leg cramping to extremity weakness and paralysis. 1, 2 Sensory > Motor neurons with predilection for long axons. Muscle tone is normal.

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Don't Forget the Bubbles

DECEMBER 6, 2023

Their analyses revealed an association between social media use and e-cigarette and tobacco use. Parga-Belinkie JJ, et al. Balk SJ, et al. Abrams EM, et al. Yang K, et al. Varghese D, et al. Sanderson KR, et al. Huang N, et al. Hepnar L, et al. Chiu M, et al. Eur J Pediatr.

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ACEP Now

JANUARY 14, 2024

1-3 We may be unaware of potentially dangerous drug interactions when we order and prescribe medications in the ED. Many thanks to Dr. David Juurlink and Dr. Walter Himmel for their expert contributions to the EM Cases podcast that inspired this article. References Hohl CM, Robitaille C, Lord V, et al. 2008;178:1563-9.

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EMDocs

FEBRUARY 12, 2024

Authors: Rachel Kelly, MD ( EM Resident Physician, Stony Brook University Hospital); Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. However, ABGs have many drawbacks compared to VBGs.

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EMDocs

JULY 3, 2023

Authors: Mikalah Ward, MD (EM Resident Physician, University of Kentucky); Susan Owens, MD (EM Attending Physician, University of Kentucky) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. 2022 Jan;39(1-2):35-48. Avest E, Taylor S, Wilson M, et al. J Neurotrauma.

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EMS 12-Lead

AUGUST 22, 2022

Question 1: What is the rhythm? Beat 1 : Sinus, narrow QRS complex. The assumption is that a premature complex discharged prior to Beat 1, which prolonged its respective refractory period in the same manner as Beat 5. We can, therefore, put down the defibrillation pads, set aside the amiodarone, and look further at the ECG.

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EMDocs

JUNE 7, 2023

1-5 Farmers also treat sheep for parasites using OPs and may become symptomatic after exposure, an illness called Dipper’s Flu. 8 Intermediate syndrome Occurs 1 to 5 days after acute exposure in up to 40% on individuals. 7, 9 Often have absence of excessive cholinergic stimulation. 7 May lead to respiratory failure.

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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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EMDocs

MARCH 4, 2024

Authors: Amelia Campbell, MD (EM Resident Physician, Carl R. Darnall Army Medical Center) and Alec Pawlukiewicz, MD (EM Attending Physician, Carl R. A wide variety of conditions can result in either type of cholestasis (Figure 1). 9 How are cholestatic labs defined? hepatocellular pattern is by using the R factor.

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Don't Forget the Bubbles

NOVEMBER 22, 2023

Of these signs, mortality in children is associated with hepatomegaly and fever; meanwhile, mortality in adults is associated with hyperkalaemia, traumatic brain injury, propofol infusion rates >5mg kg -1 h -1 and ECG changes. 1998;8(6):491-9. Filho EM, Riechelmann MB. Why does PRIS occur? References Bray RJ.

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ACEP Now

JULY 7, 2024

9 By speaking out, I hope to once again find my calling in medicine. References Chieze M, Hurst S, Kaiser S, et al. 2024;15(1):3-16. Muir-Cochrane E, Oster C. Gold KJ, Andrew LB, Goldman EB, et al. “I 2020;55(3 Suppl 1):7-16. Why are women leaving EM?: 2024;46(1):1,21. Front Psychiatry.

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EMDocs

AUGUST 7, 2023

Schnapp, MD, MEd (Associate Program Director, University of Wisconsin) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF), Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 36-year-old pregnant woman at 21 weeks gestation presents to the ED with chest pain.

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NAEMSP

JANUARY 5, 2023

1] The Adult Cardiac Arrest ACLS algorithm currently includes epinephrine and either amiodarone or lidocaine as recommended pharmacologic therapies. al answered this question with a prospective observational study which showed a significantly shorter time interval to obtain tibial IO access (4.6 1] Table from Hamam et al.

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Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Which is a risk of 1 event for 62.5 PMID: 27940800 Hersch AL, Gerber JS, Hicks LA, Pavia AT. PMID: 26407358 Meesters K, Mauel R, Dhont E, Walle JV, De Bruyne P. Pediatrics.

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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.

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Emergency Department ALS E-9-1-1 ED 82

Don't Forget the Bubbles

MAY 29, 2023

A study of teams over a 1-year period highlights that people witnessing incivility are also affected, which could lead to individuals feeling unsupported in their teams. 2021:36:1–2, NP448–NP473 Available at. Review of Cultivating Communities of Practice: A Guide to Managing Knowledge, by Wenger E, McDermott R, Snyder WM].

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Critical Care E-9-1-1 Paramedicine Paramedicine 97

Don't Forget the Bubbles

AUGUST 28, 2023

The median age at diagnosis was 47 months (range 1-173 months). See their website for more: [link] References Carter BW, Marom EM, Detterbeck FC. 2014;9(9):S102-S109. 0000000000000294 Carter BW, Benveniste MF, Madan R, et al. 2019;43(1):98-103.doi:10.1097/RCT.0000000000000782 2019;19(1):2126.doi:10.1016/j.bjae.2018.10.001

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Emergency Management Emergency Manager E-9-1-1 Critical Care 96

Broome Docs

OCTOBER 31, 2022

2022 Jan;48(1):78-91. PMID: 34904190 Not surprisingly, this paper has been covered by basically everyone who talks about research, so if you want to hear some other opinions, check out the SGEM , REBEL EM , or St. The PEACH trial: No body had a fit, so… we have no clue Peter-Derex L, Philippeau F, Garnier P, et al.

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REBEL EM

JULY 3, 2023

Article: Rossi N et al. Investigators enrollend 660 patients in 9 years in 5 EDs; or approximately 6 patients per month; or 1 patient per /month for each ED. The inclusion of p-values in Table 1 might lead to misinterpretation or improper use of statistical significance. Am J Emerg Med.

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E-9-1-1 EMR Emergency Department ED 97

ACEP Now

OCTOBER 9, 2023

9 Being bilingual is often not enough to be a medical interpreter, which requires precision, experience, and knowledge of medical jargon, as well as culturally specific idioms and phrases. Centers for Medicare and Medicaid Services, et al. Ginde A, Sullivan A, Corel B, at al. Benda NC, Bisantz AM, Butler R, et al.

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Emergency Department E-9-1-1 ALS OR 64

REBEL EM

AUGUST 21, 2023

Paper: Eastwood G, et al. Figure 2 : Extended Glasgow Outcome Scale (GOS-E) (credit: Doc_HG ) Secondary Modified Rankin Score Secondary outcomes included death within 6 months. PMID: 33571603 Part 9: Post–cardiac arrest care | circulation – aha/ASA journals. link] Petran J, et al. PMID: 35644204 Zhou D, et al.

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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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