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.

E-9-1-1 161

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

Dr. Smith's ECG Blog

OCTOBER 3, 2024

This was sent to me from Sam Ghali ( @EM_Resus ) with no other information. I agree, however: 1) I don't think you can get a good enough ech o without bubble contrast. 3) E cho is another step that takes time. I had only 9 false positives but I missed 2 OMI. I assumed it was a patient with acute chest pain. Full text !

E-9-1-1 115

E-9-1-1 Coronary ALS ED 115

ALiEM

AUGUST 9, 2023

Technique Positioning and Probe Figure 1: Younger children can sit in their parent’s lap and give a hug for lateral and posterior lung scanning. The patient should be in a position of comfort: supine, sitting, or in parent’s lap (Figure 1). Identify anatomical landmarks on ultrasound (Figure 3, Video 1). Balk et al.,

E-9-1-1 246

E-9-1-1 Emergency Department ALS OR 246

ALiEM

AUGUST 16, 2023

Common agents include local anesthetics, dapsone, quinones, sulfonamides, phenazopyridine, and nitrites [1, 2]. Treatment for methemoglobinemia in G6PD deficiency may consist of ascorbic acid, exchange transfusion, and hyperbaric oxygen [7, 9]. PMID 23953868 Mack E. Nelson, et al., Nelson, et al., 1971;75(1):83-86.

E-9-1-1 130

E-9-1-1 ALS OR 130

ALiEM

OCTOBER 30, 2023

It should be no surprise that academic clinical educators are at high risk for burnout, stalled career advancement, and abandonment of academic medicine altogether [1, 2]. PMID 18945997 Elster MJ, O’Sullivan PS, Muller-Juge V, et al. 2022; 11(1):45-52. PMID 29686766 Jordan J, Coates WC, Clarke S, et al.

E-9-1-1 161

E-9-1-1 ALS OR 161

Dr. Smith's ECG Blog

AUGUST 14, 2024

R waves 6 through 9 have no preceding P waves and are suspiciously regularly spaced. Depolarization wavefronts exit the sinus node through one or several sinoatrial conduction pathways (SACP) as seen in the histology section below taken from Li et al. Impulses E, F, G, H, and I were blocked. This is consistent with sinus rhythm.

E-9-1-1 98

E-9-1-1 OR ALS 98

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.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis [published online ahead of print, 2023 Aug 9]. Am J Emerg Med. 2023;73:34-39. Results: 26,069 studies met initial inclusion criteria.

E-9-1-1 122

E-9-1-1 ALS ACS ICU 122

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. If this EKG were handed to you to screen from triage without any clinical information, what would you think? In fact, Kosuge et al. In fact, Kosuge et al. Stein et al. Kosuge et al. What do you think?

E-9-1-1 138

E-9-1-1 ACS Emergency Department Coronary 138

FOAMfrat

MAY 19, 2024

" The patient’s mother informed us that the patient suffers from PDCD and is generally non-verbal but interactive with limited motor function. 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.

E-9-1-1 97

E-9-1-1 ALS Emergency Department EMT 97

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.

E-9-1-1 83

E-9-1-1 EMS ALS Defibrillator 83

Don't Forget the Bubbles

SEPTEMBER 16, 2023

You will find the list is broken down into four sections: 1.Reviews Cruz AT, et al. Singh A, et al. Meoli M, et al. Forster J, et al. Shirley DA, et al. Chiriac A, et al. 2023 Aug 9. ’: The ethics of information sharing with parents in paediatric care. Antolovich G, et al.

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E-9-1-1 ALS OR ED 75

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. Image adapted from Mullens et al., Closer to home, the New South Wales Poisons Information Centre (NSWPIC) reported 129 incidents involving water-absorbing beads since 2004. After Darracq et al.,

E-9-1-1 111

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

REBEL EM

MAY 27, 2024

No significant differences in heart rate 1 minute after cardioversion were observed between the three groups. The study lacks detailed information on recruitment and the randomization process, such as whether it was computer-generated or if patients were enrolled consecutively. Duration of Antiarrhythmic Effect: MVM group: 35.44

OR 137

OR E-9-1-1 ED ALS 137

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. Answer : Brainstem stroke specifically in the pons resulting in locked in syndrome.

EMS 88

EMS E-9-1-1 ALS OR 88

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.

E-9-1-1 87

E-9-1-1 ED ALS OR 87

REBEL EM

JANUARY 25, 2024

Article: Arvig MD, Lassen AT, Gæde PH, et al. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. The first evaluation of the patient was to be done within 1 hour of arrival to ED (Including the first POCUS). Emerg Med J.

ED 130

ED E-9-1-1 Emergency Department ALS 130

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. Am J Respir Crit Care Med. 2023;207(11):1475-1485.

E-9-1-1 105

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

EMDocs

JANUARY 17, 2024

1) There are a limited number of antitussives on the US market which include benzonatate, codeine, dextromethorphan, diphenhydramine, and hydrocodone. 9) The safety announcement highlighted the mortality risk of exploratory ingestions in children under 10 years. What are the treatment options for a benzonatate overdose?

E-9-1-1 67

E-9-1-1 Overdose Emergency Medical Services Life Support 67

EMDocs

APRIL 10, 2024

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). 3-5,7] Symptom onset is usually within 1 minute of intravascular injection but can be delayed if multiple injections or continuous infusion. [5]

E-9-1-1 92

E-9-1-1 Plasma Epinephrine Life Support 92

Don't Forget the Bubbles

SEPTEMBER 13, 2023

An expert committee appraised the evidence behind recommendations to avoid imaging to inform the 2022 NICE guidance. When considering tumours, 37 observation studies involving 2661 children found that 3% (95% CI 1-7%) had tumours. Epilepsy charities can also be a useful source of information and support for parents and caregivers.

E-9-1-1 131

E-9-1-1 Emergency Department ALS OR 131

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. 11 Unlikely to receive language assistance.

Emergency Department 81

Emergency Department ALS E-9-1-1 ED 81

Don't Forget the Bubbles

JUNE 17, 2024

Exposure impairs information sharing and overall team collaboration. Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J. 2014 Jun 26;23(12):653-9. Frich JC, Brewster AL, Cherlin EJ, Bradley EH. 2020 Jan 1;35(1):70-6. 2020 Aug 20.

E-9-1-1 105

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

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.

E-9-1-1 73

E-9-1-1 Emergency Department ALS ED 73

REBEL EM

SEPTEMBER 26, 2022

It provides highly descriptive, real-time information on clot formation, clot strength, platelet function, and fibrinolysis, which is superior to traditional coagulation tests such as INR, aPTT, and platelet count. Article: Kumar M et al. 2020;71(1):235-246. Hepatology. Significant coagulopathy: INR > 1.8

FFP 52

FFP E-9-1-1 ICU ALS 52

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 89

EMS E-9-1-1 Emergency Department Ambulance 89

REBEL EM

JULY 3, 2023

Article: Rossi N et al. Critical information such as HR, SBP, drug administration times were occasionally missing. Investigators enrollend 660 patients in 9 years in 5 EDs; or approximately 6 patients per month; or 1 patient per /month for each ED. Am J Emerg Med. They enrolled cohort is likely a convenience sample.

E-9-1-1 98

E-9-1-1 EMR Emergency Department ED 98

REBEL EM

OCTOBER 26, 2023

1–4 Antimicrobial resistance is a global health crisis, underscoring the importance of antibiotic stewardship. Paper: Zaoutis T, Shaikh N, Fisher BT, et al. After consent, children were randomized 1:1 to receive 5 additional days of antibiotics or 5 days of a matching placebo. 9 excluded after randomization.

E-9-1-1 81

E-9-1-1 Emergency Department OR ALS 81

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Post cath ECG: Now there are hyperacute T-waves again, and recurrent ST depression in V2 This ECG would normally diagnostic of OMI until proven otherwise No further troponins were measured, but it looks like there is recurrent OMI Next day: A CT Coronary Angiogram was done (CTCA) CARDIAC MORPHOLOGY AND FUNCTION: 1. IMPRESSION: 1.

Coronary 105

Coronary E-9-1-1 STEMI ACS 105

Dr. Smith's ECG Blog

NOVEMBER 9, 2023

Over the last 1 week, her exertional chest pain became worse both in intensity and triggering threshold. link] Shvilkin et al. link] Shvilkin et al. By contrast with today's case — I offer this tracing from a 60-year old woman with dyspnea and the ECG in Figure-1 showing LBBB conduction every-other-beat.

E-9-1-1 78

E-9-1-1 ACS ALS OR 78

Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Clinical Course of Children 1 to 24 Months Old With Positive Urine Cultures Without Pyuria. 2024;24(1):111-118. Giannoni, E., Acad Pediatr. doi:10.1016/j.acap.2023.06.023 2023.06.023 What’s it about? Schlapbach, L.J., Hagenbuch, N.,

E-9-1-1 75

E-9-1-1 Emergency Department OR ALS 75

Don't Forget the Bubbles

FEBRUARY 26, 2024

In 2015, Silva et al. 2007 Jan 1;25(1):6-9. uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2019. Add in PEFR <33% and SpO2 <92% Management of acute asthma* * as per BTS guidelines Acute asthma is managed in a stepwise fashion using the following guidelines. Frontiers in Pediatrics.

E-9-1-1 72

E-9-1-1 Critical Care OR ALS 72

EMDocs

MARCH 4, 2024

A wide variety of conditions can result in either type of cholestasis (Figure 1). 1 Extrahepatic obstruction is due to mechanical obstruction occurring downstream of the hepatic ducts such as pancreatic disease, gallstone obstruction of the common bile duct, and cancer. 9 How are cholestatic labs defined?

Emergency Department 86

Emergency Department E-9-1-1 ALS OR 86

REBEL EM

MAY 8, 2023

Paper: Smith JA, Secombe P, Aromataris E. Only 1 RCT and 1 cohort study had only mechanically ventilated patients. However, this data was driven by a single small trial (Enderson et al.), The pendulum is swinging towards conservative management for occult pneumothoraces. J Trauma Acute Care Surg. in ICC group, 5.8%

E-9-1-1 59

E-9-1-1 Critical Care ICU OR 59

Dr. Smith's ECG Blog

APRIL 22, 2022

But these cases show the potential dangers of delayed recognition and treatment of inferior reperfusion Take away 1. ECG’s can be labeled as ‘normal’ by the computer (and confirmed by cardiology) even with diagnostic signs of occlusion or reperfusion References 1. Backus BE, Six AJ, Kelder JC, et al. JAMA Intern Med 2019 9.

E-9-1-1 52

E-9-1-1 STEMI ALS ED 52

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

An ECG was texted to me (Smith) without any clinical information: What did I say? This clinical information followed: "The patient had a COPD exacerbation with a prehospital SpO2 of 60%. 4 important features that indicate acute right hear strain: 1. Kosuge et al. Witting et al. This is NOT Wellens. of controls.

E-9-1-1 52

E-9-1-1 ACS ALS OR 52

Dr. Smith's ECG Blog

MARCH 9, 2023

He had episodes of chest pain off and on all night, until about 1 hour prior to arrival when the pain became constant, crushing, 10/10 chest pain that radiated to both arms. Proven STEMI has an open artery in 19% to 36% of cases, depending on whether it is TIMI −1, −2, or −3 flow. 25] Stone et al found that 72% have TIMI 0 or 1 flow.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52