The Skeptics' Guide to EM

NOVEMBER 13, 2021

Date: November 10th, 2021 Reference: Andersen, et al: Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest. Case: A code blue is called for a 71-year-old male in-patient that is boarding in the emergency department (ED). JAMA Sept 2021. JAMA Sept 2021.

Epinephrine 100

Epinephrine Critical Care Life Support Emergency Department 100

Don't Forget the Bubbles

AUGUST 7, 2023

Heart rate (HR) and respiratory rate (RR) are THE major vital signs used in Advanced Paediatric Life Support ( APLS) guidance , sepsis guidelines , and Paediatric Early Warning Scores (e.g., The controversy around what is ‘normal’ in infants’ and children’s vitals was demonstrated in a 2011 systematic review by Fleming et al.

Life Support 98

Life Support Advanced Life Support ALS Emergency Department 98

ACEP Now

DECEMBER 6, 2024

Advanced cardiac life support protocol was initiated, and the patient was intubated. Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm. Dr. Rad is ED faculty at Wellstar Kennestone Regional Medical Center in Marietta, Ga.,

Coronary 98

Coronary Life Support ALS Emergency Department 98

EMDocs

NOVEMBER 6, 2023

This post will focus on the key parts of the guideline that affect ED evaluation and management. High-dose insulin therapy is recommended early in the treatment of patients with life-threatening β-blocker and calcium channel blocker poisoning. Editorial Comment : Use standard BLS/ALS measures, especially if in cardiac arrest.

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Naloxone OR BLS Overdose 115

Don't Forget the Bubbles

JUNE 30, 2023

She was intubated at the scene and transported to your ED, with cardiopulmonary resuscitation (CPR) performed en route. Mazur P, Kosinski S, Podsiadlo P, et al.: Extracorporeal life support rewarming rate is associated with survival with good neurological outcome in accidental hypothermia. Meert et al. Meert et al.

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CPR Life Support Critical Care ALS 145

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. It is unclear how long he was down.

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Defibrillator CPR Epinephrine Life Support 109

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. Although historically used quite frequently, dopamine is no longer recommended by advanced life support guidelines for septic shock unless adrenaline/noradrenaline are unavailable. After 40ml/kg of IV 0.9%

Advanced Life Support 143

Advanced Life Support ED ALS OR 143

EMDocs

JUNE 22, 2024

A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. Treatment is supportive with respiratory therapy, critical care, inotropic therapy, and cardiac life support. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in.

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EMS FFP Ambulance ICU 111

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. Supportive care includes: protecting the airway if necessary, supplemental oxygen if needed, and vasopressor support if the patient is hypotensive. 2022;59:42-48.

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E-9-1-1 Plasma Epinephrine Life Support 111

EMDocs

AUGUST 22, 2023

Capnography has several novel uses in other disease states commonly seen in the ED such as trauma, DKA, sepsis and obstructive lung disease. PMID: 26447854 Godwin SA, Burton JH, Gerardo CJ, et al. PMID: 28395927 Panchal AR, Berg KM, Hirsch KG, et al. PMID: 28395927 Panchal AR, Berg KM, Hirsch KG, et al. Ann Emerg Med.

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Emergency Department ALS Life Support OR 94

FOAMfrat

JULY 3, 2024

If they are not already there, get ALS-level care to the patient as soon as possible. According to the CDC (Centers for Disease Control, 2023) some respiratory exposures can result in the long-term development of “reactive airway dysfunction syndrome (RADS)” This is a type of chemical induced asthma and is a life-long condition.

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Life Support ALS Emergency Response OR 105

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.

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ED NARCAN ALS OR 98

NCOAE

AUGUST 12, 2022

Here, we present them in alphabetical order: ABC – Airway, Breathing and Circulation – “This is the Golden Rule of emergency medical professionals” AED – Automated External Defibrillator – The device that delivers electric shock to the heart of patients experiencing sudden cardiac arrest A-EMT – Advanced EMT ALS – Advanced Life Support Anaphylaxis— (..)

EMS 52

EMS EMT EMT Emergency Medical Technician 52

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. 5 This cannot feasibly be performed in the ED as it requires a significant amount of time and a multi-disciplinary assessment.

Naloxone 52

Naloxone Life Support Paramedic ALS 52

EMDocs

JANUARY 17, 2024

She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). Upon ED arrival, she had a heart rate (HR) of 160 and blood pressure (BP) of 80s/40s.

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E-9-1-1 Overdose Emergency Medical Services Life Support 89

REBEL EM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). Paper: Mason JM, et al. The average time to control HR in the IV amiodarone was 1.7h, which is usually the average time for disposition from the ED. Am J Emerg Med.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

ACEP Now

OCTOBER 11, 2024

Introduction Pediatric intubations in the emergency department (ED) occur at only a tenth the frequency of adult intubations. 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. Kerrey BT, Rinderknecht AS, Geis GL, et al.

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

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Tintinalli JE, Stapczynski J, Ma O, et al. Arnoldo BD, Purdue GF, Kowalske K, et al. 2023 Jul 17. In: StatPearls [Internet].

Operating Room 52

Operating Room ACS Critical Care Coronary 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

The patient was put on Extracorporeal Life Support in the ED 3 hours after initial resuscitation, the core temp was 30° C and the patient was defibrillated with a single attempt. This Transesophageal ED Echo was recorded: Cardiac POCUS.mov from Stephen Smith on Vimeo. Chest compressions and ventilation were begun.

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CPR Defibrillator Life Support ED 40

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

This is a 30-something healthy patient presented with COVID pneumonia who presented to the ED. He was started on Extracorporeal Life Support ("VA ECMO") Here is the ECG on ECMO: Very low voltage On Day 3, the EF recovered (that seems quick!) 3–8 Shi et al. Sandoval Y, Smith SW, Sexter A, et al.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. What additional workup is necessary in the ED?

ED 98

ED E-9-1-1 ALS OR 98

Don't Forget the Bubbles

FEBRUARY 5, 2025

Ali, a 12-year-old male, is pre-alerted by ambulance to ED. How would you prepare for the patient’s arrival to ED? Do I have emergency blood available in the ED? Lee, a 14-year-old male, is brought into the ED by his friends, stating he has been in a fight. Which investigations would you consider?

E-9-1-1 59

E-9-1-1 CPR Ambulance ED 59

Don't Forget the Bubbles

FEBRUARY 24, 2025

Because of their worsening respiratory acidosis, they were intubated in the ED, The initial chest-x ray shows a right-sided consolidation, in keeping with bronchopneumonia. In a prospective multi-centre study, Berger et al. Rowlands et al. Hodder et al. Namachivayam et al. 2007;8:207211 Garoudet et al.

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ALS Critical Care OR Life Support 59