Core EM

JANUARY 25, 2024

More than 1/3 of geriatric trauma patients presenting to the ED after a fall return to the ED or die within one year of initial evaluation. 4 Elderly patients, who comprise only 8-12% of total ED major trauma cases, represent a disproportionate 15-30% of trauma mortalities and costs. Perdue &al. Caterino &al.

ALS 246

ALS ED ICU OR 246

The Skeptics' Guide to EM

APRIL 27, 2024

Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Date: April 25, 2024 Guest Skeptic: Missy Carter is a PA working in an ICU in the Tacoma area and an adjunct faculty member with the Tacoma Community College paramedic program.

ICU 193

ICU Defibrillator CPR Paramedic 193

The Skeptics' Guide to EM

JUNE 22, 2024

Reference: Peters MJ, et al. Dr. Anireddy Reddy Case: A 3-year-old girl presents to the emergency department (ED) with fever and respiratory distress. Your ED team quickly intubates her and places her on a ventilator. Reference: Peters MJ, et al. Her oxygen saturation is 78% on room air.

Critical Care 133

Critical Care ICU ALS Emergency Department 133

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Reference: Cashen K, Reeder RW, Ahmed T, et al. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Reference: Cashen K, Reeder RW, Ahmed T, et al. Background: We often manage patients in cardiac arrest in the ED or the intensive care unit (ICU).

CPR 130

CPR ICU Critical Care Epinephrine 130

The Skeptics' Guide to EM

APRIL 22, 2023

Date: April 20, 2023 Reference: Franklin D, et al. Date: April 20, 2023 Reference: Franklin D, et al. Case: A 14-month-old boy presents to the emergency department (ED) with two days of upper respiratory symptoms and respiratory distress. Reference: Franklin D, et al. He has a cough, fever of 38.5°C,

ICU 130

ICU Emergency Department ALS ED 130

EMDocs

NOVEMBER 29, 2023

EBM Update: Steroids in Severe CAP and CT in Post ROSC OHCA #1: Dequin PF, Meziani F, Quenot JP, et al; CRICS-TriGGERSep Network. Question: In adult patients admitted to the ICU with severe CAP, does hydrocortisone compared to placebo reduce 28-day all-cause mortality? Reyes LF, Garcia E, Ibáñez-Prada ED, et al.

ICU 80

ICU CAD ALS OR 80

ALiEM

JUNE 1, 2023

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? Is phenobarbital safe for the treatment of EtOH withdrawal in the ED? References Rosenson J, Clements C, Simon B, et al. If not, you probably should be. Well not exactly.

Emergency Department 246

Emergency Department ICU ED OR 246

Broome Docs

SEPTEMBER 3, 2024

PMID: 38592662 Bottom line: Would you be happy if you kid follow-ed your footsteps into emergency medicine? For the most part, central lines can be left to the ICU team during day time hours (and a good percentage of patients will never need one). Cook D, Deane A, Lauzier F, et al. Burton C, Mooney C, Sutton L, et al.

E-9-1-1 99

E-9-1-1 Emergency Department ICU ALS 99

ACEP Now

JULY 7, 2024

1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). 2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus). Am J Emerg Med.

Emergency Department 52

Emergency Department Critical Care ALS ICU 52

Critical Care Scenarios

NOVEMBER 15, 2020

Takeaway lessons Many decisions in the ED are less about what to do, and more about when to do it. Takeaway lessons * Many decisions in the ED are less about what to do, and more about when to do it. Goals of care starts in the ED, and not with lip service. ICU time and ED time are different. JAMA Intern Med.

ICU 100

ICU Life Support Emergency Department ED 100

The Skeptics' Guide to EM

JUNE 6, 2020

Date: June 2nd, 2020 Reference: Permpikul et al. Date: June 2nd, 2020 Reference: Permpikul et al. Max is then going to Georgetown to be an attending in both EM and ICU. Case: It’s another day in your emergency department (ED). Reference: Permpikul et al. Respir Crit Care Med 2019. Respir Crit Care Med 2019.

EMR 130

EMR ALS ICU Emergency Department 130

The Skeptics' Guide to EM

MARCH 27, 2021

Reference: Schuster et al. 2020 Case: A 74-year-old woman who suffered a fall earlier today presents to the emergency department (ED) and is found to have five rib fractures to her right thorax, but no other injury. His team found grip strength was weakly correlated with frailty in older ED patients [6].

ICU 100

ICU ALS Emergency Department ED 100

Don't Forget the Bubbles

AUGUST 23, 2023

Very rarely are the ED team allowed to stand, in silence, with a purpose. Kapoor et al. 2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. It gives us permission to stop, breathe, recognise the enormity of what has happened, and provide a platform for acknowledgement. 112 (9),pp. 2 (57-68).

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

EMDocs

JUNE 22, 2024

A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in. The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. Electronic address, p. link] j.ajog.2016.03.012

EMS 96

EMS Ambulance FFP ICU 96

EMS 12-Lead

AUGUST 22, 2022

A 65 y/o Female was admitted to the ICU for septic shock. The combination of prolonged QT and deep T wave inversion throughout the precordium is typical of Takotsubo syndrome, or Stress Cardiomyopathy – which can occur in the context of a physiologically distressed ICU patient, further compromising their hemodynamics. Friedman, M.,

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

EMS 12-Lead

MAY 8, 2022

This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2] The following ECG was captured upon arrival at the receiving ED. The ED resulted an 8.7 An ECG is recorded.

STEMI 130

STEMI ED EMS Firefighter 130

The Skeptics' Guide to EM

NOVEMBER 16, 2019

Date: November 6th, 2019 Reference: Lascarrou et al. Date: November 6th, 2019 Reference: Lascarrou et al. Case: A 59-year-old woman comes is brought into your emergency department (ED) by EMS in cardiac arrest. The patient achieved return of spontaneous circulation (ROSC) on arrival to the ED. Reference: Lascarrou et al.

ALS 100

ALS CPR ICU EMS 100

ACEP Now

DECEMBER 10, 2023

A middle-aged male with squamous cell carcinoma and extensive metastases is brought to the emergency department (ED) after being found unresponsive following a believed suicide attempt (SA) by methadone ingestion. You ultimately begin a slow naloxone infusion and admit him to the medical ICU. Wilson MP, Moutier C, Wolf L, et al.

Naloxone 52

Naloxone Life Support Paramedic ALS 52

ACEP Now

MAY 9, 2024

It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergency department (ED). percent of ED visits resulted in preventable death as result of diagnostic error. Further diagnostic testing in the ICU identified salicylate toxicity.

Emergency Department 52

Emergency Department ICU ALS ACS 52

EMDocs

JUNE 27, 2024

An 8-year old male with a history of sickle cell anemia presents to the ED for evaluation of fever for 2 days and “feeling like I can’t get a full breath”. 768: Epidemiology of Hospital Based ED Visits due to Sickle Cell Crisis and Acute Chest Syndrome in Kids. Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK.

E-9-1-1 76

E-9-1-1 ICU ACS EMS 76

Dr. Smith's ECG Blog

JUNE 17, 2024

The patient was upgraded to the ICU for closer monitoring. In fact, Kosuge et al. Stein et al. This is a paper worth reading : Marchik et al. Kosuge et al. Witting et al. This does not contradict the conclusions of Kosuge et al. studied ECG findings of PE in 6049 patients, 354 of whom had PE.

E-9-1-1 134

E-9-1-1 ACS Emergency Department ALS 134

ACEP Now

MARCH 13, 2024

Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. ED crowding impairs this mission. The Emergency Medical Treatment and Labor Act (EMTALA) mandates examination, treatment, and stabilization of anyone who comes to the ED.

Emergency Department 52

Emergency Department ED ALS OR 52

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). His blood sugar was normal en route to the ED, and his initial rhythm on the cardiac monitor was asystole. Carsten L, et al. Forti A, Brugnaro P, Rauch S, et al.

Defibrillator 85

Defibrillator CPR Epinephrine Life Support 85

EMDocs

JUNE 7, 2023

F, HR 48, RR 28, BP 104/62, SPO2 88% on non-rebreather mask The patient’s friend who brought her to the ED tells you the patient made suicidal statements earlier in the day and was found in her yard shed. These are send-out labs with turn-around times that make them unlikely to affect the ED course or guide treatment.

E-9-1-1 84

E-9-1-1 ICU Emergency Department ED 84

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

He was intubated on arrival at the ED for mental status and airway protection due to vomiting. His temperature was brought back to normal over time in the ICU. Rituparna et al — as well as Chauhan and Brahma ( Int. There is also large T wave inversion and long QT. Initial vitals included heart rate 109 bpm and BP 145/92 mmHg.

ICU 127

ICU OR ALS ED 127

EMDocs

APRIL 10, 2024

These medications are a vital tool in the care of ED patients, from simple local analgesia for a laceration repair to regional analgesia for painful procedures. Hemodynamics slowly begin to stabilize, and the patient is transferred to the ICU for further post-cardiac arrest care. doi:10.1007/BF03161199 Olson K, Smollin C, eds.

E-9-1-1 94

E-9-1-1 Plasma Epinephrine Life Support 94

EMDocs

FEBRUARY 12, 2024

As the only respiratory therapist in the ED has been paged and is starting BiPAP for this patient, an overhead call for two incoming trauma alerts from a multivehicle collision sounds. Because the RT responsible for drawing arterial blood gases is busy caring for these patients, ABGs will be delayed.

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

EMDocs

OCTOBER 21, 2023

Median time from ED arrival to diagnosis was 8 hours 24 min in one study, with only 19% being diagnosed within the 4.5-hour All patients who receive thrombolytics for ischemic stroke should be admitted to a neurosurgical, neurologic, or medical ICU for management and monitoring, as this is shown to decrease mortality and length of stay.

EMS 74

EMS ALS OR ACS 74

EMDocs

NOVEMBER 1, 2023

A 39-year-old male with history of achalasia with recent endoscopic dilation 24 hours prior presents to the ED for progressively worsening chest pain with radiation to his left shoulder. Disposition : Admission to ICU with potential GI, IR, and/or surgical management. In: Yuh DD, Vricella LA, Yang SC, Doty JR, eds.

Critical Care 67

Critical Care ED EMS OR 67

EMDocs

AUGUST 15, 2023

He was initially seen at a regional ED and was administered 10 vials of crotalidae equine immune F(ab’) 2 (ANAVIP®) antivenom before transfer to your referral center. link] Kanaan NC, Ray J, Stewart M, et al. His father confirmed the snake was a copperhead. Accessed May 7, 2022. link] Buchanan JT, Thurman J. Crotalidae Envenomation.

Emergency Department 82

Emergency Department OR EMS ED 82

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Case A 25-year-old-female presented to the ED in cardiac arrest. Alerhand et al described ten individual echocardiographic findings of RV strain that suggest PE. 10,11 Vid 1. EKG RV strain.

ED 82

ED NARCAN ALS OR 82

EMDocs

JUNE 3, 2023

A 53-year-old female with a past medical history significant for hypertension presents to the ED with headache and dizziness. Patients receiving thrombolysis will require ICU admission for neurologic monitoring. Tintinalli JE, ed.). Fogwe DT, Sandhu DS, Goyal A, et al. Lui F, Foris LA, Willner K, et al.

EMS 74

EMS ALS OR ED 74

EMDocs

FEBRUARY 26, 2024

A recent study by Gaborit et al. The ED clinician should inquire about a relevant history of HIV infection, malignancy, high-dose corticosteroid use, chemotherapy, organ transplant, or use of immunosuppressive drugs for other indications. She reports occasional central chest pain exacerbated by coughing. and specificity of 71.4%).

E-9-1-1 88

E-9-1-1 ED ALS OR 88

EMDocs

MAY 25, 2023

This increases applicability or ED care. Reference: Kapur J, Elm J, Chamberlain JM, et al. Nearly half of all patients treated with the studied anti-convulsant medications had seizure resolution and improving mental state within 60 minutes. Study included children, as well as adults. N Engl J Med. 2019; 381(22): 2103-2113.

Emergency Department 64

Emergency Department ICU OR ALS 64

ACEP Now

MAY 9, 2024

JHS’ chart review project, which identified 163 patients presenting to the ED with gluteal AFT complications in a 30-month period between 2020 and 2023, provides one of the most comprehensive and informative datasets on the breadth of AFT complications as they are currently being performed. Al Jazeera. units per patient.

Emergency Department 52

Emergency Department Operating Room Critical Care ALS 52

EMDocs

SEPTEMBER 25, 2023

However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). While RSI should remain the gold standard in the vast majority of patients in the ED, FI presents an additional technique to mitigate anatomic or physiologic risk. To date, ketamine has been the agent of choice (12).

ED 66

ED Emergency Department ALS Paramedic 66

Don't Forget the Bubbles

AUGUST 28, 2023

You contact ICU, anaesthetics, ENT, and oncology with a plan to attempt more definitive imaging in the prone position (which Ginny tells you is much comfier) What’s the evidence for our emergent management? 0000000000000294 Carter BW, Benveniste MF, Madan R, et al. Arch Dis Child Educ Pract Ed. J Thorac Oncol.

Emergency Management 97

Emergency Management Emergency Manager E-9-1-1 Critical Care 97