Paramedics Unlimited

APRIL 19, 2018

What is the difference between ALS and BLS Medical Care? In Advanced Life support (ALS) emergencies, a “single” paramedic or ER doctor can not deliver necessary care. Due to the complexity of advanced medical treatment for critical patients, it is advisable to have a team of at least one paramedic and an EMT at your event.

BLS 52

BLS ALS Emergency Medical Technician Advanced Life Support 52

The Skeptics' Guide to EM

DECEMBER 7, 2019

Date: October 2nd, 2019 Reference: Ramgopal et al. Changes in the Management of Children With Brief Resolved Unexplained Events (BRUEs). Date: October 2nd, 2019 Reference: Ramgopal et al. Changes in the Management of Children With Brief Resolved Unexplained Events (BRUEs).

CPR 130

CPR ALS OR 130

REBEL EM

FEBRUARY 19, 2024

Paper: Yerke JR et al. of cases) ≤24hrs vs >24hrs Infusion Duration: 3.8hrs vs 42.4hrs Max Dose: 10mcg/min vs 10mcg/min Extravasation Events: 24 (4.7%) vs 11 (8.7%) Extravasation incidence/1000d of Peripheral Infusion: 176.4 No Extravasation Event vs Extravasation Event Age: 63 vs 67 years BMI: 28.3 CHEST 2024.

ICU 137

ICU EMS ALS OR 137

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. NEJM 1994. [2]

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Studies such as those by Moise et al 14 and Ellis et al 39 have shown that the relative risk of developing an acute myocardial infarction in the territory supplied by an artery with a 70%. Furthermore, if this occurs at all, it is a rare event. years, with the interval as long as 12 or 18 years in some studies.

Coronary 114

Coronary ACS OR EMR 114

REBEL EM

JUNE 26, 2023

This could potentially help improve thrombin generation, reduce blood product consumption, but also could increase the risk of thromboembolic events. Click here for Direct Download of the Podcast Paper: Bouzat P et al. High-quality studies are needed to determine the utility of this intervention. to 3.33; P = 0.72 to 2.10; P = 0.03

FFP 143

FFP Frozen Plasma ALS Plasma 143

ACEP Now

APRIL 5, 2024

References von Hellmann R, Fuhr N, et al. Koh LK, Kong CE, et al. A study in the February issue of Annals conducted a meta-analysis of 18 studies and concluded that bougie use was associated with increased first-attempt intubation success. Some important limitations of this analysis should be recognized. Ann Emerg Med.2024;83(2):132-144.

OR 73

OR ALS Emergency Department Critical Care 73

REBEL EM

FEBRUARY 15, 2024

Paper: Freund Y et al. Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications.

ICU 141

ICU ALS ED OR 141

Pediatric EM Morsels

JULY 21, 2023

We use the GCS score in both trauma and medical patients, but where did this score come from? When is it useful and what does it tell us? Is it actually validated in children, like the Ottawa Ankle Rules or are we using a tool for something other than that for which it was designed and validated, like using Kocher criteria for knee and ankle joints?

Critical Care 246

Critical Care ALS Life Support OR 246

The Skeptics' Guide to EM

MAY 19, 2018

[display_podcast] Date: May 16, 2018 Reference: Freund et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events
 Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. display_podcast] Date: May 16, 2018 Reference: Freund et al. Reference: Freund et al.

Emergency Department 130

Emergency Department ALS Coronary OR 130

The Skeptics' Guide to EM

MAY 30, 2020

Date: May 29th, 2020 Reference: Erramouspe et al. Date: May 29th, 2020 Reference: Erramouspe et al. You wonder what his over-all chance of dying or developing a thromboembolic event when treated with TXA. in adult trauma patients giving a number needed to treat to prevent one death of 67 ( Shakur et al.

ALS 130

ALS EMS OR 130

The Skeptics' Guide to EM

OCTOBER 31, 2018

[display_podcast] Date: October 30th , 2018 Reference: Raskob GE et al. display_podcast] Date: October 30th , 2018 Reference: Raskob GE et al. In non-cancer patients, new oral anticoagulants (NOACs) like rivaroxaban have been shown to be effective in treatment without increasing bleeding events. Reference: Raskob GE et al.

ALS 130

ALS EMS OR 130

REBEL EM

NOVEMBER 20, 2023

Paper: Jansen JO, Hudson J, Cochran C, et al. Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. 2023;e2320850. 97% of patients sustained blunt trauma.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

The Skeptics' Guide to EM

NOVEMBER 24, 2018

This turned out to be a very meta event. This turned out to be a very meta event. The highest prevalence of burnout (70%) was reported by emergency physicians (Shanafelt et al 2015). One of the most common reasons cited for burnout is the electronic medical record (EMR) (Shanafelt et al 2016). got seriously ill.

EMR 130

EMR ALS Emergency Department OR 130

ALiEM

OCTOBER 11, 2024

Common inciting events include viral infections, autoimmune diseases, or immunodeficiency syndromes [1]. Provan D, Arnold DM, Bussel JB, et al. On the day of presentation, she developed a painful, intermittently bleeding “blood blister” to the left lower cheek that had increased in size, as well as new red spots on her arms and legs.

OR 152

OR ALS 152

The Skeptics' Guide to EM

OCTOBER 10, 2020

Reference: Friedman et al. Reference: Friedman et al. million visits each year in the USA ( Friedman et al Spine 2010 ). However, their use is associated with increased adverse events. These include: acetaminophen ( Williams et al Lancet 2014), muscle relaxants ( Friedman et al JAMA 2015), NSAIDs ( Machado et al

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

JULY 22, 2023

Date: July 21, 2023 Reference: Prekker et al. Date: July 21, 2023 Reference: Prekker et al. Intubation FPS is associated with fewer adverse events, most importantly hypoxia, hypotension, and cardiac arrest. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults.

Emergency Medical Services 166

Emergency Medical Services Defibrillator CPR EMS 166

REBEL EM

MAY 29, 2023

Paper: Ibarra-Estrada, M et al. Most of the research on the use of MB has been in patients with vasoplegia following cardiopulmonary bypass. Limited, small studies on its use in septic shock do not make a clear argument for use. Early Adjunctive Methylene Blue in Patients with Septic Shock: A Randomized Controlled Trial. Crit Care 2023.

ICU 145

ICU ALS Epinephrine OR 145

The Skeptics' Guide to EM

OCTOBER 3, 2020

Reference: Claiborne Johnston S et al. Reference: Claiborne Johnston S et al. Aspirin has been used to prevent a subsequent stroke in patients who suffered an acute ischemic stroke (AIS) or transient ischemic attack (TIA), which occur in approximately 5-10% of patients in the first few months after their primary event.

Emergency Department 100

Emergency Department ALS OR 100

The Skeptics' Guide to EM

OCTOBER 14, 2019

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. Zehtabchi et al published a SRMA of TXA for traumatic brain injuries (TBI). Date: October 14th, 2019 Reference: CRASH-3 Trial Collaborators.

Emergency Department 130

Emergency Department EMS ALS OR 130

The Skeptics' Guide to EM

JANUARY 20, 2018

[display_podcast] Date: January 15th, 2018 Reference: Sadeghirad B, et al. display_podcast] Date: January 15th, 2018 Reference: Sadeghirad B, et al. Reference: Sadeghirad B, et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials.

Emergency Department 130

Emergency Department ALS EMS ED 130

The Skeptics' Guide to EM

APRIL 2, 2022

Date: March 31st, 2022 Reference: Butt et al. Date: March 31st, 2022 Reference: Butt et al. Children represent one group of patients that are less likely to receive adequate analgesia ( Brown et al , Selbst and Clark ). Reference: Butt et al.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

JANUARY 14, 2018

[display_podcast] Date: January 9th, 2018 Reference: Soleimanpour H et al. display_podcast] Date: January 9th, 2018 Reference: Soleimanpour H et al. A study from Bindman et al. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

NOVEMBER 1, 2022

Date: October 27th, 2022 Reference: Hayashi et al. Date: October 27th, 2022 Reference: Hayashi et al. Although minor adverse events, such as brief apnea or hypoxia, are common, significant adverse events are very rare, and the benefits are clear (Bellolio 2016).

ALS 118

ALS Emergency Department OR ED 118

The Skeptics' Guide to EM

SEPTEMBER 1, 2018

[display_podcast] Date: August 22nd, 2018 Reference: Riskin A, Erez A, Foulk TA, et al. display_podcast] Date: August 22nd, 2018 Reference: Riskin A, Erez A, Foulk TA, et al. Reference: Riskin A, Erez A, Foulk TA, et al. Rudeness and Medical Team Performance. Pediatrics. Rudeness and Medical Team Performance. Pediatrics.

ALS 130

ALS Emergency Department OR EMS 130

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. Two large, cluster-randomized trials ( SMART and SALT-ED ) showed a small benefit to the use of balanced crystalloids in preventing a composite outcome of Major Adverse Kidney Events within 30 days (aka MAKE-30).

ICU 132

ICU Plasma Critical Care ALS 132

Don't Forget the Bubbles

NOVEMBER 11, 2024

Kochanek et al. explored the evidence in a 2019 systematic review, which forms part of the Brain Trauma Foundation Guidelines, as did Utsumi et al. The guidelines by Kochanek et al. Should we aim to prevent fever, or should we cool patients? At the scene, his lowest GCS was 5 (E1V2M2). Fever is common among patients with TBI.

ALS 116

ALS Life Support Critical Care OR 116

The Skeptics' Guide to EM

JULY 2, 2022

Date: June 30th, 2022 Reference: McGinnis et al. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Date: June 30th, 2022 Reference: McGinnis et al. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Reference: McGinnis et al.

Coronary 100

Coronary Heart Attack ACS CAD 100

Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Musculoskeletal Adverse Events include: Articular cartilage damage causing arthralgias or arthritis , Tendonitis , and Tendon rupture. Which is a risk of 1 event for 62.5

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety profile [3][4]. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

ALS 136

ALS ACS OR CPR 136

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. Prior literature primarily focused on safety and medication errors, and while this study did the same, they also assessed variables associated with PDP response. The safety and efficacy of push dose vasopressors in critically ill adults. Am J Emerg Med. 2022 Sep 5.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

Don't Forget the Bubbles

NOVEMBER 22, 2023

A systematic review examined 69 articles (mostly cohort studies and clinical trials) looking at the common adverse events (not just PRIS) following the use of propofol in children and neonates. Mortality associated with PRIS has been estimated to be around 33% and becomes even higher if the diagnosis is delayed. References Bray RJ.

E-9-1-1 126

E-9-1-1 Critical Care Operating Room ALS 126

REBEL EM

OCTOBER 30, 2023

Paper: Davenport R et al. Fibrinogen products may also be needed to stabilize clots and stem bleeding. The optimal approach to fibrinogen administration in massive hemorrhage protocols is unknown. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial. to 1.23; p = 0.74

FFP 127

FFP ALS OR EMS 127

REBEL EM

MAY 29, 2024

EMRAP HD: Epistaxis Posterior Pack References Cassisi NJ et al. PMID: 5569677 Zeyyan E et al. Take Home Points: Posterior epistaxis is a rare, life-threatning presentation. The key is in identifying and rapidly gaining control with a posterior pack or foley catheter. Laryngoscope 1971; 81(8): 1261-6.

ICU 101

ICU ALS ACS EMS 101

Don't Forget the Bubbles

AUGUST 23, 2023

This simple intervention aims to acknowledge the tragic and unexpected event humanely and respectfully. The Pause creates an opportunity for loved ones and healthcare workers to respectfully honour the patient and the significant event they have been involved in before moving on to the next task ahead. Kapoor et al. 23 (2), pp.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

Don't Forget the Bubbles

JULY 22, 2024

Compare this with the Panickar et al. 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% ). study from 200 9.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

Core EM

JULY 23, 2024

Because most radiation injuries are not immediately life-threatening, patients with isolated radiation injuries will not require immediate attention in mass casualty events. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. Sources of Radiation Cosmic: Radiation generated by the sun and stars.

ALS 130

ALS OR Emergency Department ED 130