The Skeptics' Guide to EM

APRIL 13, 2024

Reference: Albers GW et al. Reference: Albers GW et al. Case: A 70-year-old woman was brought into the emergency department by EMS after her family reported she was having trouble talking. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. TIMELESS Investigators.

ALS 343

ALS Emergency Department OR EMS 343

The Skeptics' Guide to EM

JANUARY 6, 2024

Reference: Remick KE, et al. Reference: Remick KE, et al. She is an executive lead for the EMS for Children Innovation and Improvement Center. She is the co-Principal Investigator for the EMS for Children Data Center. She is nationally known for her work as an EMS researcher and educator. JAMA Netw Open.

Emergency Department 340

Emergency Department Emergency Medical Services ALS ED 340

High Performance EMS

AUGUST 9, 2024

Dispatching the right unit to an EMS call was much simpler when all resources had the same capabilities and a response time was the primary measure of success. The following example of a “ priority 2 ” request may search for an ALS unit capable of meeting a particular response time standard directed by evidence-based patient outcomes.

BLS 264

BLS CAD Advanced Life Support Life Support 264

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Date: September 18, 2024 Reference: Dillon et al. August 20, 2024 Guest Skeptic: Dr. Chris Root is an emergency medicine and emergency medicine service (EMS) physician at the University of New Mexico, Albuquerque. Chris completed his emergency medicine residency and EMS fellowship at UNM. JAMA Network Open.

Naloxone 260

Naloxone NARCAN Overdose CPR 260

ALiEM

JANUARY 5, 2024

Read and Listen to the Other EM Match Advice Episodes Blog posts: [link] Author information Sara M. Have there been any surprises or changes during interview season? What should students think about in the post-interview stage? Association of American Medical Colleges. PMID: 31913827 ; PMCID: PMC6948692.

EMS 177

EMS ALS OR 177

The Skeptics' Guide to EM

OCTOBER 5, 2024

Date: October 2, 2024 Reference: Paxton et al. Case: The family of a 69-year-old woman activated emergency medical services (EMS) for slurred speech that they noticed when she woke up a couple of hours before. Prehospital identification of LVO stroke remains a significant challenge for emergency medical services (EMS) [6].

Emergency Medical Services 288

Emergency Medical Services ALS EMS Paramedic 288

The Skeptics' Guide to EM

JANUARY 13, 2024

Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Chris Root is an EMS fellow in the Department of Emergency Medicine at the University of New Mexico Health […] The post SGEM#426: All the Small Things – Small Bag Ventilation Masks in Out of Hospital Cardiac Arrest first appeared on The Skeptics Guide to Emergency Medicine.

CPR 273

CPR Defibrillator First Responder Epinephrine 273

ACEP Now

JANUARY 5, 2025

Her vital signs are normal, except for a heart rate of 115 bpm. Its going to take time to get her to a tertiary center. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. A patient’s mouth packed with gauze after tonsillectomy surgery. CREDIT: Dr. P.

Operating Room 98

Operating Room Epinephrine ALS ED 98

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. Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care.

ICU 231

ICU Defibrillator Paramedic CPR 231

The Skeptics' Guide to EM

JULY 29, 2023

Date: July 21, 2023 Reference: McDonald et al. Date: July 21, 2023 Reference: McDonald et al. Emergency Medical Services (EMS) is called and on arrival the patient is walking but has obvious facial trauma and is complaining of some neck pain. Reference: McDonald et al.

Emergency Medical Services 246

Emergency Medical Services ALS EMS Emergency Department 246

Pediatric EM Morsels

APRIL 19, 2024

Davidson JS, Brown DJ, Barnes SN, et al. This area of transition is ripe for fracture (Light, 1984) Fracture of only part of the cortex leads to plastic deformity and buckling , giving us the torus (buckle) fracture Fracture and plastic deformity of one side of the cortex give us the greenstick fracture. J Pediatr Orthop. 0000000000001169.

ALS 290

ALS ACS Emergency Department ED 290

The Skeptics' Guide to EM

MARCH 2, 2024

Reference: Gibbons et al. Reference: Gibbons et al. He will need to be transferred to the tertiary care center which is 35 minutes away by ground EMS if it is a dissection. The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol): A multicenter, prospective, observational study.

Operating Room 329

Operating Room Emergency Department ALS ED 329

The Skeptics' Guide to EM

JUNE 1, 2024

Reference: Tavender E, et al. His research focuses on the pre-hospital care of children by EMS. He is the principal investigator for EMSC State Partnership in Washington, DC and is also involved in various multi-center EMS studies with the Pediatric Emergency Care Applied Research Network (PECARN). Reference: Tavender E, et al.

Emergency Medical Services 219

Emergency Medical Services Emergency Department EMS ALS 219

EMDocs

MAY 11, 2024

We’ll keep it short, while you keep that EM brain sharp. A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. Vital signs include BP 168/89, HR 96, T 98.3,

EMS 110

EMS E-9-1-1 ALS OR 110

EMDocs

NOVEMBER 19, 2024

10 Table 1: Second-Generation Antipsychotics and Associated Adverse Effects Adapted from: UpToDate 8 with additional sources Micromedex 9 and Riboldi, et al 11 *SL=sublingual, IM=intramuscular, PO=oral, ODT=orally disintegrating tablets, ER=extended release, IR=immediate release. +to 1 Seizures may occur due to lowered seizure threshold.

Overdose 111

Overdose EMS Emergency Medical Services OR 111

The Skeptics' Guide to EM

JULY 22, 2023

Date: July 21, 2023 Reference: Prekker et al. NEJM 2023 Guest Skeptic: Dr. Jeff Jarvis is the Chief Medical Officer and System Medical Director for the Metropolitan Area EMS Authority in Fort Worth, Texas, also known as MedStar. Date: July 21, 2023 Reference: Prekker et al. Should you go with video or direct laryngoscope?

Emergency Medical Services 245

Emergency Medical Services Defibrillator CPR EMS 245

The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. Date: September 28th, 2021 Reference: Zampieri et al. Case: A 66-year-old woman is brought in by EMS from home with lethargy and hypotension. Reference: Zampieri et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9%

OR 130

OR Critical Care ICU Plasma 130

EMDocs

JUNE 22, 2024

We’ll keep it short, while you keep that EM brain sharp. A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in.

EMS 111

EMS Ambulance FFP ICU 111

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. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Never fear. 5 th Edition.

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

ACEP Now

JUNE 21, 2023

emergency medicine (EM) residency training length has been a decades-long dilemma: four vs. three years. First, is three years enough time to become an EM physician? But critical questions remain unanswered when it comes to specialization, career trajectory, and actual competence as an EM physician.

EMS 114

EMS ALS Emergency Medical Services OR 114

The Skeptics' Guide to EM

JANUARY 9, 2021

Date: January 5th, 2021 Reference: Grunau et al. JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC?

EMS 130

EMS Emergency Medical Services CPR Critical Care 130

The Skeptics' Guide to EM

AUGUST 10, 2024

Date: July 29, 2024 Reference: Connolly SJ et al (ANNEXA-I investigators) Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage. Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table.

Emergency Medical Services 224

Emergency Medical Services ALS Emergency Department ED 224

ALiEM

FEBRUARY 5, 2024

Reference Lin M, Phipps M, Chan TM, et al. Take the AIR Toxicology Module at ALiEMU Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link. You will need to create a free, 1-time login account.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

REBEL EM

MAY 27, 2024

What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy. This absence of detail leaves the study open to bias. Evidence suggests that a weight-based dosing approach (0.1

OR 137

OR E-9-1-1 ED ALS 137

NAEMSP

OCTOBER 9, 2024

However, a recent survey revealed that many patients with adrenal insufficiency are hesitant to give themselves their injections, and many Emergency Medicine and EMS Clinicians are unaware of the appropriate treatment for this condition. She had oral hydrocortisone available and handed EMS a sheet explaining her condition.

EMS 122

EMS Crisis Prevention Emergency Department BLS 122

ALiEM

NOVEMBER 3, 2023

Reference Lin M, Phipps M, Chan TM, et al. Take the AIR Trauma Module at ALiEMU Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link. You will need to create a free, 1-time login account. Ann Emerg Med. 2023;82(1):55-65. doi: 10.1016/j.annemergmed.2023.02.011

Critical Care 211

Critical Care EMS Emergency Department ALS 211

EMDocs

SEPTEMBER 23, 2023

We’ll keep it short, while you keep that EM brain sharp. A 36-year-old female presents to the ED after experiencing an episode of sudden syncope. The patient has no significant past medical history, and reports that she was walking to the end of her driveway to retrieve her mail when she suddenly collapsed to the ground.

E-9-1-1 105

E-9-1-1 EMS ALS Defibrillator 105

The Skeptics' Guide to EM

OCTOBER 17, 2020

Salim is probably better known as the creator and founder of the wonderful knowledge translation project called REBEL EM. It is a free, critical appraisal blog and podcast […] The post SGEM#305: Somebody Get Me A Doctor – But Do I Need TXA by EMS for a TBI? Reference: Rowell et al. Reference: Rowell et al.

EMS 130

EMS Emergency Medical Services ALS OR 130

Pediatric EM Morsels

OCTOBER 27, 2023

2020) The Times & Tapes Are a-Changin’: The Latest Broselow-Luten Tape for EMS , EMS World. link] Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Krug 2007] What If the Child is Obese or Emaciated? x exp[0.02 and Seaver, M.

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

EMDocs

MARCH 2, 2024

We’ll keep it short, while you keep that EM brain sharp. A 58-year-old female with a history of diabetes, hypertension, and chronic back pain presents to the ED with severe headache and nausea. The patient denies any trauma to the head, fevers, nuchal rigidity, changes in vision, focal weakness, paresthesia, or anticoagulation use.

EMS 119

EMS E-9-1-1 OR ED 119

Pediatric EM Morsels

JULY 28, 2023

Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 or serum bicarbonate between 11-17 mmol/L Moderate : venous pH < 7.2 or serum bicarbonate between 5-10 mmol/ L Severe : venous pH < 7.1 Neuroimaging is NOT required. GCS score is not sensitive enough.

E-9-1-1 246

E-9-1-1 ALS OR Critical Care 246

EMDocs

DECEMBER 23, 2024

Now lets walk through them quickly: Ho et al (4) looked at termination of VT in 15 min or hemodynamic deterioration. Gorgels et al (5) looked at procainamide vs lidocaine and again and primary outcome was VTach termination. Manz et al (6) looked at ajmaline vs lidocaine for the termination of VT. Coolest part of this trial?

ALS 75

ALS OR STEMI EMS 75

EMDocs

APRIL 13, 2024

We’ll keep it short, while you keep that EM brain sharp. A 24-year-old male presents to the ED from a mixed marital arts competition after being struck on the side of the right head by a fist earlier today. The patient denies any loss of consciousness, neck pain, vomiting, or use of blood thinners. RR 15, SpO2 99% on room air.

EMS 104

EMS E-9-1-1 OR Emergency Department 104

EMDocs

MAY 25, 2024

We’ll keep it short, while you keep that EM brain sharp. A 70-year-old female with past medical history diabetes mellitus, hypertension, hyperlipidemia, dementia presents from nursing home with acute unilateral swelling along the left side of her face.

EMS 98

EMS E-9-1-1 OR ED 98

The Skeptics' Guide to EM

AUGUST 19, 2023

Mike Pallaci is a Professor of Emergency Medicine (EM) for the Northeast Ohio Medical University, and an Adjunct Clinical Professor of […] The post SGEM#413: But Even You Cannot Avoid…Pressure – Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage first appeared on The Skeptics Guide to Emergency Medicine.

EMS 186

EMS ALS Emergency Department OR 186

EMDocs

APRIL 27, 2024

We’ll keep it short, while you keep that EM brain sharp. A 68-year-old male with a history of poorly controlled diabetes presents to the ED with increasing right-sided ear and facial pain, swelling, and difficulty hearing for two weeks. He says the pain is worse at night and when he is chewing. and Staphylococcus spp.

EMS 105

EMS ED OR ALS 105

Dr. Smith's ECG Blog

JANUARY 2, 2025

Bogossian et al. (1) Bogossian H, Frommeyer G, Ninios I, Hasan F, Nguyen QS, Karosiene Z, Mijic D, Kloppe A, Suleiman H, Bandorski D, et al. Dodd KW, Elm KD, Dodd EM, Smith SW. T-waves are quite tall and possibly peaked (HyperK?), but potassium returned normal. What is the QT interval? Heart Rhythm [Internet]. 2014;11:22732277.

Coronary 116

Coronary OR Defibrillator ALS 116