ALiEM

JUNE 15, 2023

Goldfrank’s Toxicologic Emergencies, 11e New York, NY: McGraw-Hill; 2019 Morimoto M, Tatsumi K, Yuui K, et al. PMID 29855084 De Silva HA, Fonseka MM, Pathmeswaran A et al. Lily of the valley ( Convallaria majalis ) is a woodland perennial with a sweet scented, white bell-shaped flower. ouabain, poison rope) Asclepias spp. Vet Med Sci.

ALS 246

ALS ED OR 246

ALiEM

JUNE 5, 2023

Human illness is most commonly acquired by handling animal fluids or pelts. There are several forms of anthrax, however cutaneous is the most common (95% of cases) and the least complicated to treat [2]. What are the symptoms of cutaneous anthrax? [3, 3, 4] Naturally occurring cases develop after spores of B. Is cutaneous anthrax reportable? [6,

ALS 256

ALS OR ED 256

The Skeptics' Guide to EM

NOVEMBER 11, 2023

Date: November 2, 2023 Reference: Coventry et al. Date: November 2, 2023 Reference: Coventry et al. One of the best systematic reviews and meta-analyses on the topic discussing the diagnostic accuracy of the history, physical examination and imaging is by Carpenter et al from AEM 2014 [1]. Reference: Coventry et al.

ALS 241

ALS Emergency Department ED OR 241

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. 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

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

ACEP Now

DECEMBER 7, 2024

What is the trauma-informed approach to care for this patient? Given the prevalence of trauma among ED patients, clinicians should assume that all patients would benefit from a trauma-informed approach to care. The police officer is waiting for the sexual assault evidence kit. These concerns may be a direct result of trauma (e.g.,

Mental Health Services 52

Mental Health Services Emergency Department ED OR 52

ALiEM

FEBRUARY 5, 2024

Reference Lin M, Phipps M, Chan TM, et al. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. 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.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

ALiEM

NOVEMBER 3, 2023

Reference Lin M, Phipps M, Chan TM, et al. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. 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.

Critical Care 211

Critical Care EMS Emergency Department ALS 211

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. Case: A 27-year-old right hand dominant patient presents to the emergency department (ED) with a 2.5 cm left forearm abscess.

Overdose 188

Overdose Emergency Department ALS ED 188

ALiEM

AUGUST 9, 2023

Ultrasound Technique Background The lungs were traditionally considered poorly accessible to ultrasound, as ultrasound waves cannot penetrate air-filled structures; however, lung POCUS relies on the interpretation of patterns of artifacts to evaluate the normal, air-filled lungs. Warm gel helps with the child’s comfort.

E-9-1-1 246

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

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

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

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. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Krug 2007] What If the Child is Obese or Emaciated? of children; PAWPER predicted within 10% for 89.2% x exp[0.02

E-9-1-1 269

E-9-1-1 Emergency Medical Services Life Support ALS 269

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 199

ALS OR 199

ALiEM

JANUARY 5, 2024

Read and Listen to the Other EM Match Advice Episodes Blog posts: [link] Author information Sara M. What does the Electronic Residency Application Service (ERAS) preliminary data show just far for the 2024 residency application season? Has the program signaling option been working? What should students think about in the post-interview stage?

EMS 177

EMS ALS OR 177

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

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 161

ALS EMS Emergency Department OR 161

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

ALiEM

MARCH 7, 2024

Transvere ultrasound views of the bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.) The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Lay the patient supine when possible.

E-9-1-1 177

E-9-1-1 Emergency Department ALS ED 177

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

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. He now presents requesting “Neosporin.”

ALS 177

ALS OR 177

Pediatric EM Morsels

JULY 5, 2024

It seems like just yesterday ( or maybe ~ a month ago ) when we served up a tasty morsel on the PECARN decision rule for intra-abdominal traumatic injuries in children. Our friends at the PECARN injury group have remained busy this spring with generating more externally validated clinical decision rules. High Risk (12.8% High Risk (12.8%

ALS 161

ALS OR ED Emergency Department 161

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 ). Lancet 2016.

ALS 130

ALS OR EMS 130

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. The LD 50 , or dose to kill half of mice in studies, of batrachotoxin is 2-3 μg/kg subcutaneously [5]. 2, 1995, pp.

ALS 284

ALS ED OR 284

ALiEM

JUNE 1, 2023

References Rosenson J, Clements C, Simon B, et al. Author information T. This contrasts the relatively shorter half-life of many available benzodiazepines, which often require more frequent redosing. Is phenobarbital safe for the treatment of EtOH withdrawal in the ED? In short, yes. barbiturates or benzodiazepines). 2012.07.056.

Emergency Department 246

Emergency Department ICU ED OR 246

ALiEM

OCTOBER 14, 2023

Reference Lin M, Phipps M, Chan TM, et al. Author information Chris Belcher, MD Editor, ALiEM AIR Series Assistant Professor and Assistant Program Director Department of Emergency Medicine University of Kentucky College of Medicine | Twitter | The post ALiEM AIR Series | Respiratory 2023 Module appeared first on ALiEM. Ann Emerg Med.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

REBEL EM

JULY 1, 2024

Paper: Goren NZ et al. Background: Non-invasive positive pressure ventilation (NIPPV) is an effective treatment modality for patients with both hypoxemic or hypercapnic respiratory failure and has been shown to decrease the need for intubation [2]. There are very limited studies however in the literature on the AVAPS mode of NIPPV.

ED 133

ED Emergency Department ALS OR 133

ALiEM

JANUARY 29, 2024

Nedelmann, Matt et al. 2015;46:2322–2324 [link] Smith, Austin T et al. Author information Ai Xin Chen, MD Resident Physician Harbor UCLA Medical Center | The post SAEM Clinical Images Series: Retrobulbar Spot Sign appeared first on ALiEM. At the time of presentation, he only sees a speck of light from that eye. Ultraschall Med.

ALS 161

ALS ED OR 161

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. In patients with minimal response to naloxone, xylazine toxicity may be suspected [10]. 2021;70(37):1300-1302.

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

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. Case: A 32-year-old healthy man presents with left eye pain.

ALS 130

ALS Emergency Department EMS ED 130

ALiEM

OCTOBER 11, 2024

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. She reported no recent trauma or history of similar lesions in the past. Physical Exam Vitals : 98.3°F;

OR 152

OR ALS 152

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

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

The Skeptics' Guide to EM

JANUARY 7, 2023

Date: January 4th, 2023 Reference: Hasbrouck et al. Date: January 4th, 2023 Reference: Hasbrouck et al. We know that it can take over ten years for high-quality, clinically relevant information to reach the patient. There is a tsunami of new information being published every day. It can be overwhelming at times.

OR 100

OR Emergency Department ALS Ambulance 100

The Skeptics' Guide to EM

AUGUST 24, 2024

Date: August 19, 2024 Reference: Partyka et al. Interests include information systems and digital health, research and education. Reference: Partyka et al. Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management: The SABRE Randomized Clinical Trial.

Emergency Department 130

Emergency Department ALS OR ED 130

The Skeptics' Guide to EM

FEBRUARY 26, 2022

Date: February 21st 2022 Reference: Kim et al. Date: February 21st 2022 Reference: Kim et al. In that episode we concluded that clinician gestalt was likely to be as accurate and efficient in screening for suicidality as a specific tool (Convergent Functional Information for Suicidality screening tool). Reference: Kim et al.

ED 130

ED ALS Emergency Department OR 130

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