ALiEM

OCTOBER 11, 2023

Most pufferfish contain tetrodotoxin , a dangerous marine toxin up to 1200 times more toxic to humans than cyanide [1]. 4, 9-12] Consider activated charcoal for patients presenting within 60 minutes of ingestion if the patient’s airway is not an imminent threat or has been secured. Hassoun AER, Ujević I, Jemaa S et al.

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E-9-1-1 ALS OR 204

Pediatric EM Morsels

OCTOBER 27, 2023

Initially tested in Johannesburg, South Africa: 1 month old to 12 years old Broselow predicted within 10% of weight in 63.6% Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. x exp[0.02

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E-9-1-1 Emergency Medical Services Life Support ALS 269

EMDocs

NOVEMBER 13, 2024

Commonly a monomicrobial infection with gram-negative bacteria like E. Paracentesis is a safe procedure with a low complication rate (< 1%). For the remaining fluid inject 1 mL into a purple top EDTA blood tube for cell count; send 2-3 mL for Gram stain in a red-top tube or sterile urine container. coli (50-90% of cases).

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E-9-1-1 ALS OR ED 80

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. 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

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

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. Epub 2024 Apr 9. 2024 Mar;27(1):26-29. Cook D, Deane A, Lauzier F, et al. 2024 Jul 4;391(1):9-20.

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E-9-1-1 Emergency Department ICU ALS 109

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).

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

FOAMfrat

NOVEMBER 28, 2024

Journal of Intensive Care, 9 , 54. Al-Hassani, A., & Al-Thani, H. "Cuff pressures are an important consideration, but in the field, you’re often operating in a time-sensitive, high-stakes environment. "I’d say that EMS providers already do a phenomenal job managing complex airways in challenging conditions.

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E-9-1-1 Critical Care ICU EMS 52

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.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

Dr. Smith's ECG Blog

OCTOBER 3, 2024

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. 2) To be presented at AHA conference in Chicago in 2 weeks: Sharkey SW et al. I assumed it was a patient with acute chest pain. Full text !

E-9-1-1 113

E-9-1-1 Coronary ALS ED 113

EMDocs

OCTOBER 29, 2024

General: Intubated sedated CV: Tachycardic, regular rhythm, systolic murmur Pulm: Clear to auscultation bilaterally Skin: Mottled and cool Neuro: GCS 3T What is the underlying this patient’s vasopressor and inotrope refractory shock? m/s)—problematic and elevated > 50 mm Hg (2.5 m/s)—problematic and elevated > 50 mm Hg (2.5

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E-9-1-1 ICU Epinephrine EMS 87

This Podcast Will Kill You

JULY 23, 2024

Official journal of the American College of Gastroenterology| ACG , 118 (1), pp.59-76. Annals of internal medicine , 172 (1), pp.ITC1-ITC16. Caio, Giacomo, et al. ” BMC medicine 17 (2019): 1-20. . ” BMC medicine 17 (2019): 1-20. Cenit, María Carmen, et al. Gastroenterology , 160 (1), pp.63-75.

E-9-1-1 98

E-9-1-1 ALS OR 98

Pediatric EM Morsels

SEPTEMBER 22, 2023

Negative E-FAST and no signs of long bone injuries should raise concern for neurogenic shock in the hypotensive trauma patient with suspected spinal injury. Alpha 1 agonists are necessary to maintain appropriate blood pressure. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Thought to be a “stunning” of the spinal cord.

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E-9-1-1 Epinephrine ALS EMS 300

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

ECG #1 Interpretation: ECG #1 shows sinus rhythm at a heart rate of 77 bpm. Following more detailed questioning — it turned out the patient had started taking 9 different herbal remedies to ease lethargy and unspecific neurological symptoms. For clarity in Figure-1 — I've reproduced the initial ECG in today's case.

E-9-1-1 106

E-9-1-1 ALS Defibrillator OR 106

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]. After spending her first year acclimating to the new department and achieving board certification, Dr. Garcia finds herself at a bit of a crossroad. In short, no.

E-9-1-1 161

E-9-1-1 ALS OR 161

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. What are the symptoms of Methemoglobinemia? doi:10.1053/j.jvca.2013.02.005.

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E-9-1-1 ALS OR 130

REBEL EM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 1, 4, 6 The overall incidence of VAP is somewhere around 5%-40% of all intubated patients, depending on the study and country from which it is reported. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 126

E-9-1-1 ICU OR ALS 126

This Podcast Will Kill You

NOVEMBER 26, 2024

Emerging Microbes & Infections , 1 (1), pp.1-10. Emerging Microbes & Infections , 1 (1), pp.1-10. Emerging Microbes & Infections , 1 (1), pp.1-10. London journal of primary care , 9 (5), pp.77-79. Mathematical Biosciences , 215 (1), pp.84-104. Robbens, E., Dick, George F.,

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E-9-1-1 ALS OR 52

EMDocs

NOVEMBER 6, 2024

Exam is notable for tremulous extremities. Shortly after labs are obtained, he yells and arches his back. He becomes rigid in all extremities and his abdomen. There is no convulsive activity or eye deviation, and the patient is yelling in pain. Questions: What is the differential diagnosis for toxicologic causes of severe muscle spasm and tetany?

E-9-1-1 78

E-9-1-1 ALS EMS OR 78

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. Challenge QUESTION: The relative change in T-QRS-D is not the only thing that changes during period of time that passed between recording of the 2 ECGs shown in Figure-1.

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E-9-1-1 Coronary ACS BLS 121

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. Janssen, P. & Fedorov, V.

E-9-1-1 97

E-9-1-1 OR ALS 97

This Podcast Will Kill You

OCTOBER 1, 2024

Medical journal of Australia , 190 (9). Cabezas-Cruz, Alejandro, et al. Delayed anaphylaxis, angioedema, or urticaria after consumption of red meat in patients with IgE antibodies specific for galactose-α-1, 3-galactose. Cabezas-Cruz, Alejandro, et al. Ronmark, E. Cabezas-Cruz, Alejandro, et al. 2013): 1-11.

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E-9-1-1 ALS OR 52

EMDocs

FEBRUARY 20, 2024

Fluids in Pancreatitis #1 : de-Madaria E, Buxbaum JL, Maisonneuve P, et al; ERICA Consortium. 2: Li XW, Wang CH, Dai JW, et al. 2023 Mar 22;27(1):122. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000. to 9.8L) Moderate: 5.5L (Range 4.0

E-9-1-1 83

E-9-1-1 ICU ALS OR 83

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. Often used interchangeably with osteomyelitis.

E-9-1-1 104

E-9-1-1 ALS ED OR 104

ACEP Now

OCTOBER 11, 2024

1 Pediatric rapid sequence intubation (RSI) in the ED is associated with a higher frequency of failed first attempts and adverse effects than in adult patients. Paralytic agents include rocuronium at 1 mg/kg IV and succinylcholine at 1-2 mg/kg IV. What is the most appropriate treatment at this time? mg/kg IV, ketamine at 1.5–2

E-9-1-1 52

E-9-1-1 Emergency Department Advanced Life Support ALS 52

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Here is lead I from ECGs 1 and 2 shown side-by-side to highlight the change in axis from borderline right to completely normal. Consider the following: We become attuned to looking for acute coronary occlusion in patients who present with acute symptoms to the ED ( E mergency D epartment ). Answer : Bedside ultrasound!

E-9-1-1 113

E-9-1-1 Coronary STEMI ALS 113

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. Clin Infect Dis.

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. 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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E-9-1-1 ACS Emergency Department Coronary 137

Don't Forget the Bubbles

JULY 22, 2024

Compare this with the Panickar et al. study from 200 9. Fortunately, Lee et al. Lee B, Turner S, Borland M, Csonka P, Grigg J, Guilbert TW, et al. However, there was no difference in LOS (83 minutes for placebo vs 79 minutes for prednisolone) in participants who were discharged straight from the ED ( 32% ).

E-9-1-1 104

E-9-1-1 ALS ACS ED 104

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.

E-9-1-1 78

E-9-1-1 ED Operating Room ALS 78

Don't Forget the Bubbles

JULY 17, 2023

This month’s list features answers to intriguing questions such as: ‘ Which are more relevant to childhood community-acquired pneumonia – viruses or bacteria? ’, ‘ Does the language of the patient influence A&E triage? You will find the list is broken down into four sections: 1.Reviews Sethi SK, et al. Goulet K, et al.

E-9-1-1 98

E-9-1-1 ALS Emergency Department Emergency Medical Services 98

Dr. Smith's ECG Blog

NOVEMBER 3, 2024

Below in Figure-1 is a tracing obtained from the in-house telemetry. The rhythm strip in Figure-1 shows four ECG leads. Figure-1: The initial rhythm strip in today’s case. Figure-1: The initial rhythm strip in today’s case. Beat #9 is wide, and manifests a different QRS morphology than the other wide beats.

E-9-1-1 65

E-9-1-1 ALS OR 65

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 84

E-9-1-1 EMS ALS Defibrillator 84

EMDocs

OCTOBER 8, 2024

Discharging a patient with abnormal vital signs has been linked to unanticipated death (1-4). The full differential diagnosis of sinus tachycardia in isolation is extensive ranging from benign etiologies such as anxiety to severely life threatening etiologies such as sepsis. At this point there are two large questions. #1. SPO2 Any hypoxia?

E-9-1-1 95

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

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

To me, it was clearly atrial flutter with 1:1 conduction. Continue Eliquis 5mg BID, should be continued for 3 months == MY Comment , by K EN G RAUER, MD ( 9/18 /2024 ): == I found the following aspects of today's case of special interest. Why did Dr. Smith immediately say the rhythm was AFlutter with 1:1 AV conduction?

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E-9-1-1 ALS OR ED 64

ACEP Now

FEBRUARY 13, 2024

A radiograph is shown (see figure 1). LEARN MORE The most common nerve blocks in this study are shown in Table 1. 1–4 Emergency physicians commonly prescribe opioid pain medications, and there is significant variability among prescribing patterns. In the January issue of Annals of Emergency Medicine , Merz-Herrara, et al.,

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E-9-1-1 Emergency Department ED ALS 52