Core EM

JANUARY 25, 2024

Analgesic Onset Elimination Half Life IV Infusion Rates Side Effects and Other Information Fentanyl 1 – 2 min 2 – 4 hr 0.7 – 10 μg/kg/hr Rapid onset. Shehabi Y, Howe BD, Bellomo R, Arabi YM, et al: Early Sedation with Dexmedetomidine in Critically Ill Patients. μg/kg IV Maintenance dose: 0.5 – 15 μg/kg/hr Rapid onset. up to 1.5)

ICU 246

ICU Emergency Department Critical Care ALS 246

EMS 12-Lead

MAY 15, 2024

We will be using redacted information from different cases where paramedics attempted TCP in the field. After 13 minutes of ALS resuscitation, pulses were palpated indicating a return of spontaneous circulation. Details are edited and redacted to preserve patient anonymity. Epinephrine administered intravenously.

Epinephrine 331

Epinephrine Paramedic CPR EMT 331

ALiEM

FEBRUARY 9, 2024

References Writing Committee, Kontos MC, de Lemos JA, et al. 2022.08.750 Collet JP, Thiele H, Barbato E, et al. doi: 10.1177/2048872620935399 Badertscher P, Boeddinghaus J, Twerenbold R, et al. 118.034260 Chew DP, Lambrakis K, Blyth A, et al. 119.042891 Ashburn NP, Snavely AC, O’Neill JC, et al. Circulation.

E-9-1-1 276

E-9-1-1 ED Coronary ALS 276

The Skeptics' Guide to EM

MAY 25, 2024

Reference: Borgundvaag et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. Case 1: A patient presents to the ED with nausea, vomiting and some abdominal pain complaining of alcohol withdrawal.

ED 254

ED Emergency Department ICU ALS 254

The Skeptics' Guide to EM

JUNE 24, 2023

Date: June 16, 2023 Reference: Reed et al. Date: June 16, 2023 Reference: Reed et al. Individuals can then use that information to decide if or how much of the drug to use. Reference: Reed et al.

Overdose 198

Overdose Emergency Department ALS ED 198

ALiEM

APRIL 12, 2023

Accessed April 5, 2023 Afzal S, Zahid M, Rehan ZA, et al. Author information Ivan Ivanov, DO Resident Physician Emergency Department South Brooklyn Health | The post Trick of the Trade: Gel-free ultrasound-guided peripheral IV technique appeared first on ALiEM. Accessed April 5, 2023. 2022 Jan 6;8(1):42. doi: 10.3390/gels8010042.

Emergency Department 258

Emergency Department ALS ED 258

Pediatric EM Morsels

JULY 28, 2023

However, new information tells us that the hyperinflammatory state in DKA with cerebral hypoperfusion may play a big role. PubMed] [Read by QxMD] Rosenbloom AL. PubMed] [Read by QxMD] Muir AB1, Quisling RG, Yang MC, Rosenbloom AL. Dunger D, Sperling M, Acerini C, et al. Lesson = treat early! 2013 Sep;163(3):761-6.

E-9-1-1 246

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

EMS 12-Lead

MARCH 30, 2024

We will be using redacted information from different cases where paramedics attempted TCP in the field. The University of Maryland found that capture occurred in only 42-78% of patients, dependent on pad positioning (Moayedi et al, 2022). Details are edited and redacted to preserve patient anonymity.

CPR 312

CPR Paramedic Ambulance Epinephrine 312

EMDocs

DECEMBER 23, 2024

Lets look at a few and make an informed decision. 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. Multiple studies, including Gorgels et al.

ALS 75

ALS OR STEMI EMS 75

ALiEM

OCTOBER 11, 2023

Hassoun AER, Ujević I, Jemaa S et al. Alhatali B, Al Lawatia S, Khamis F, Kantur S, Al-Abri S, Kapil V, Thomas J, Johnson R, Hamelin EI, Coleman RM, Kazzi Z. Al-Sulaimani S, Titelbaum NV, Ward RE, Zahran TE, Chalhoub S, Kazzi Z. Chowdhury FR, Nazmul Ahasan HA, Mamunur Rashid AK, Al Mamun A, Khaliduzzaman SM.

E-9-1-1 204

E-9-1-1 ALS OR 204

ALiEM

APRIL 12, 2024

If the catheter appears correctly positioned on AP chest x-ray but is malfunctioning, consider obtaining additional imaging to confirm placement [11]: Lateral view chest-xray, or Chest CT (can also help characterize the pleural effusion) References Gammie JS, Banks MC, Fuhrman CR, et al. doi: [link] Broder JS, Al-Jarani B, Lanan B, Brooks K.

E-9-1-1 183

E-9-1-1 ALS Critical Care Emergency Department 183

ALiEM

NOVEMBER 3, 2023

Reference Lin M, Phipps M, Chan TM, et al. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. 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

The Skeptics' Guide to EM

DECEMBER 9, 2023

Date: November 20, 2023 Reference: Jones et al. Date: November 20, 2023 Reference: Jones et al. You pointed out we missed some details in our review and provided some additional information. Time to reflect on open-label placebos and their value for clinical practice. You were the lead author on that study.

ALS 209

ALS OR 209

ALiEM

FEBRUARY 5, 2024

Reference Lin M, Phipps M, Chan TM, et al. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. Ann Emerg Med. 2023;82(1):55-65. doi: 10.1016/j.annemergmed.2023.02.011

Overdose 215

Overdose Critical Care EMS Emergency Department 215

Pediatric EM Morsels

OCTOBER 27, 2023

Practice using the Broselow tape and looking at what information is and is not included on the tape so that it’s of most benefit when you need it. link] Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. 2012.05.028 Silvagni D, Baggio L, Mazzi C, et al. doi:10.1111/1742-6723.12389 Zhu S, Zhu J, Zhou H, et al.

E-9-1-1 271

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

ALiEM

JANUARY 5, 2024

Read and Listen to the Other EM Match Advice Episodes Blog posts: [link] Author information Sara M. Characteristics of Emergency Medicine Residency Programs With Unfilled Positions in the 2023 Match. Ann Emerg Med. 2023;82(5):598-607. doi:10.1016/j.annemergmed.2023.06.002. 2023.06.002. West J Emerg Med. 2019 Dec 9;21(1):96-101. 2019.10.44031.

EMS 177

EMS ALS OR 177

ACEP Now

NOVEMBER 7, 2023

Background As Electronic Health Information (EHI) has increased in prominence, the U.S. The 2015 Edition Cures Act sought to promote “transparency, modern standards, and enhanced health IT capabilities by fostering innovation in the health care technology ecosystem to deliver better information to patients, clinicians, and other users.”

ED 52

ED ALS OR Emergency Department 52

The Skeptics' Guide to EM

AUGUST 19, 2023

The literature should inform and guide our care, but it should not dictate our care. Date: August 14, 2023 Reference: Ma et. The third Intensive Care Bundle with Blood Pressure Reduction in Acute Cerebral Haemorrhage Trial (INTERACT3): an international, stepped wedge cluster randomised controlled trial. Date: August 14, 2023 Reference: Ma et.

EMS 186

EMS ALS Emergency Department OR 186

ALiEM

NOVEMBER 22, 2023

Tarvin RD, Borghese CM, Sachs W, et al. Author information Nathaneal Franks, MD Emergency Medicine Resident Carolinas Medical Center | The post ACMT Toxicology Visual Pearl: Poison Dart Frog appeared first on ALiEM. PMID: 11035772 Toft, Catherine A. Evolution of Diet Specialization in Poison-Dart Frogs (Dendrobatidae).” 2, 1995, pp.

ALS 284

ALS ED OR 284

ALiEM

AUGUST 9, 2023

Study N Sensitivity Specificity Comments Pereda et al., Balk et al., Tsou et al., PMID: 14722643 Pereda MA, Chavez MA, Hooper-Miele CC, et al. PMID: 25780071 Balk DS, Lee C, Schafer J, et al. PMID: 29696826 Tsou PY, Chen KP, Wang YH, et al. PMID: 31211896 Jones BP, Tay ET, Elikashvili I, et al.

E-9-1-1 246

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

REBEL EM

JULY 1, 2024

Paper: Goren NZ et al. References: Goren NZ et al. PMID: 34462252 Abubacker AP et al. Advocates feel that AVAPS is a more comfortable pressure support mode, which varies according to the patient’s needs (This is like PRVC for mechanical ventilation). Balkan Med J 2021. AVAPS: 0.07 AVAPS: 10.20 AVAPS: 0.07 AVAPS: 10.20

ED 133

ED Emergency Department ALS OR 133

ALiEM

NOVEMBER 29, 2023

PMID: 34529640 Ayub S, Parnia S, Poddar K, et al. PMID: 24769343 Ehrman-Dupre R, Kaigh C, Salzman M et al. PMID: 36148197 Love JS, Levine M, Aldy K, et al. PMID: 37014353 Ball NS, Knable BM, Relich TA et al. Notes from the Field: Xylazine Detection and Involvement in Drug Overdose Deaths – United States, 2019.

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

The Skeptics' Guide to EM

JUNE 27, 2020

Certainly there has been a lot of information coming out on the topic and it can seem like you are drinking from a fire hose at times. The evidence informs and guides our care but it does not dictate our care. This could be considered a straw man argument because most medical practices are not parachutes ( Hayes et al CMAJ 2018 ).

ALS 130

ALS OR 130

The Skeptics' Guide to EM

JANUARY 16, 2021

Date: January 5th, 2021 Reference: Shipman et al. Date: January 5th, 2021 Reference: Shipman et al. More information on the where the no topical anesthetic use on corneal abrasions come from can be found on a REBEL EM blog post.

ALS 130

ALS Emergency Department EMS ED 130

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 Gummin DD, Mowry JB, Beuhler M, et al. Core EM.

Overdose 111

Overdose EMS Emergency Medical Services ALS 111

The Skeptics' Guide to EM

DECEMBER 19, 2020

Date: December 16th, 2020 Reference: Butler et al. Date: December 16th, 2020 Reference: Butler et al. This is still the longest Cochrane review (300+ pages) I have ever read ( Jefferson et al 2014a ). The BMJ was involved in a legal battle with Roche for half a decade trying to get access to that information.

ALS 149

ALS OR 149

Pediatric EM Morsels

MAY 24, 2024

One of the most difficult and most satisfying parts of pediatric emergency medicine is using one’s history, exam and clinical tools to make an informed decision and spare children from unnecessary pain , uncomfortable exams, painful procedures and medical imaging. Sources Adelgais KM, Kuppermann N, Kooistra J, et al. 2014.08.014.

ALS 164

ALS EMS Emergency Department OR 164

ALiEM

SEPTEMBER 27, 2023

Hoffman et al. Koppaka V, Thompson DC, Chen Y, et al. Author information Kylee Brooks, MD Emergency Medicine Resident Department of Emergency Medicine Carolinas Medical Center | The post ACMT Toxicology Visual Pearls: Mushroom Mishap appeared first on ALiEM. Encyclopedia of Toxicology (Third Edition), Academic Press.

ALS 169

ALS OR ED 169

Pediatric EM Morsels

JULY 21, 2023

Holmes, James F et al. Conzelmann M, Hoidis A, Bruckner T , et al. Simplifying the use of prognostic information in traumatic brain injury. Ash, Kristian et al. Performance of the Pediatric Glasgow Coma Scale Score in the Evaluation of Children With Blunt Head Trauma. Acad Emerg Med. 2016 Aug;23(8):878-84. PMID: 27197686.

Critical Care 246

Critical Care ALS Life Support OR 246

Don't Forget the Bubbles

MARCH 21, 2025

Thats exactly what Shane George et al. George S, Williams T, Humphreys S, et al. In general, those intubation attempts were associated with abnormal vital signs at the point of failure, so further analysis of this cohort is needed to inform clinical practice.

ICU 108

ICU Critical Care ED OR 108

The Skeptics' Guide to EM

JUNE 11, 2017

[display_podcast] Date: June 5th, 2017 Reference: Baharoglu et al. display_podcast] Date: June 5th, 2017 Reference: Baharoglu et al. Background: In the US, daily or every other day aspirin use has been reported to be as high as 61% in adults aged 65 or older ( Ajani et al Am J Prev Med 2006 ). Reference: Baharoglu et al.

ALS 130

ALS OR EMS 130

ACEP Now

OCTOBER 29, 2024

Caring for critically ill patients with limited information requires snap assessments and judgements for timely resuscitation and efficient emergency department throughput. In the age of big data, more information sounds like a boon. Knack SKS, Scott N, Driver BE, Pet al. Thiruganasambandamoorthy V, Kwong K, Wells GA, et al.

Emergency Department 59

Emergency Department ALS Emergency Medical Services OR 59

ACEP Now

NOVEMBER 8, 2024

Neurodivergence refers to the unique way in which an individual’s brain processes and responds to certain information, differing from the typical or average brain. One common myth is that neurodivergent individuals are intellectually disabled or incapable of understanding complex information. bandwidth” and “deep dive”).

Emergency Department 52

Emergency Department ED OR ALS 52

ALiEM

SEPTEMBER 29, 2023

References Goodwin RB, Beery PR 2nd, Dorbish RJ, et al. Author information Andrew Shannon, MD, MPH Ultrasound Director Associate Professor of Emergency Medicine Lakeland Regional Health | The post SAEM Clinical Images Series: Only a Flesh Wound appeared first on ALiEM. The Journal of Trauma. 2009 Nov;67(5):1046-1050.

ALS 177

ALS OR 177

EMDocs

AUGUST 22, 2024

They are proficient in both the patient’s language and English, ensuring accurate and precise communication without omitting or altering critical information. They may alter information based on personal biases or concerns, potentially hindering effective communication and jeopardizing patient care. Lion KC, et al.

Emergency Department 105

Emergency Department ALS E-9-1-1 ED 105

International Journal of Paramedicine

OCTOBER 8, 2024

Data were obtained from the National Emergency Services Information System (NEMSIS) database for 2019. EMS responses (n = 4,375,568) were analyzed comparing patient acuity and CMS Service level, Advanced Life Support (ALS) vs Basic Life Support (BLS), to assess for associations in acuity and CMS Service level using logistic regression.

BLS 52

BLS Advanced Life Support ALS Community Paramedicine 52

The Skeptics' Guide to EM

OCTOBER 22, 2017

[display_podcast] Date: October 19th, 2017 Reference: Hofmann et al. display_podcast] Date: October 19th, 2017 Reference: Hofmann et al. Studies have shown that oxygen can cause vasoconstriction, increase blood pressure and decrease coronary artery blood flow ( Kones et al AM J Med 2011). NEJM Sept 2017. NEJM Sept 2017.

Emergency Medical Services 130

Emergency Medical Services Coronary ALS STEMI 130