ALiEM

JANUARY 13, 2025

Symptoms started approximately seven hours prior to arrival and progressive, severe pain eventually prompted her visit to the ED. This happened once 10 years ago, requiring reduction in the ED. The patient denied preceding trauma, rubbing her eyes/eye-lids, or any history of thyroid disease. She endorsed right eye blurred vision and severe pain.

Emergency Department 169

Emergency Department ED ALS OR 169

High Performance EMS

AUGUST 9, 2024

In fact, sending advanced life support (ALS) providers that are in short supply to one of these calls can leave citizens exposed when a critical request is received after that resource is committed. If available, the supervisor is added to effectively create an ALS transport ambulance.

BLS 264

BLS CAD Advanced Life Support Life Support 264

The Skeptics' Guide to EM

NOVEMBER 25, 2023

Date: November 22, 2023 Reference: Stopyra et al. Date: November 22, 2023 Reference: Stopyra et al. Reference: Stopyra et al. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. AEM November 2023. first appeared on The Skeptics Guide to Emergency Medicine. AEM November 2023.

Heart Attack 348

Heart Attack STEMI Emergency Medical Services Coronary 348

The Skeptics' Guide to EM

APRIL 13, 2024

Reference: Albers GW et al. Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. A CT angiogram shows a proximal middle cerebral artery occlusion.

ALS 345

ALS Emergency Department OR EMS 345

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

DECEMBER 16, 2023

Reference: Punches et al. Reference: Punches et al. Reference: Punches el al. Patient Perceptions of Microaggressions and Discrimination Towards Patients During Emergency Department Care. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM. AEM Dec 2023.

Emergency Department 322

Emergency Department ED ALS OR 322

The Skeptics' Guide to EM

OCTOBER 28, 2023

Date: October 26, 2023 Reference: Jones et al. Date: October 26, 2023 Reference: Jones et al. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial placebo-controlled trial. He denies any weakness or numbness of the lower extremities or bowel or bladder dysfunction.

ALS 268

ALS Emergency Department ED OR 268

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 329

ALS Emergency Department ED OR 329

Core EM

JANUARY 25, 2024

A study by Duniec et al. Here are a handful of these studies and their conclusions: Nomura et al., Here are a handful of these studies and their conclusions: Nomura et al., of scans conducted and in <5 minutes in 100% of scans Ferre et al., times more attempts when adjusted for BMI Gottlieb et al.,

ALS 246

ALS Critical Care OR 246

The Skeptics' Guide to EM

OCTOBER 21, 2023

Date: October 20, 2023 Reference: Cai et al. Date: October 20, 2023 Reference: Cai et al. Reference: Cai et al. Implementation of a Clinical Management Tool for Spinal Epidural Abscess Early Diagnosis. AEM October 2023. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals.

Emergency Department 338

Emergency Department ALS ED OR 338

The Skeptics' Guide to EM

FEBRUARY 11, 2023

Date: February 7, 2023 Reference: Cheskes et al. Date: February 7, 2023 Reference: Cheskes et al. Reference: Cheskes et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. first appeared on The Skeptics Guide to Emergency Medicine. Defibrillation Strategies for Refractory Ventricular Fibrillation.

Defibrillator 142

Defibrillator Medical Transportation OR CPR 142

The Skeptics' Guide to EM

JANUARY 6, 2024

Reference: Remick KE, et al. Reference: Remick KE, et al. Reference: Remick KE, et al. National Assessment of Pediatric Readiness of US Emergency Departments during the Covid-19 Pandemic. JAMA Netw Open. Pediatric Readiness of Emergency Departments first appeared on The Skeptics Guide to Emergency Medicine. JAMA Netw Open.

Emergency Department 343

Emergency Department Emergency Medical Services ALS ED 343

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

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

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The original term " benign early repolarization" has fallen out of favor since the seminal paper by Haïssaguerre et al. linking the finding with long term risk of idiopathic ventricular fibrillation. The link is quite modest, increasing the chance of VF from 3.4 per 100,000 to 11 per 100,000 [Rosso].

E-9-1-1 130

E-9-1-1 OR Coronary ACS 130

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Date: September 18, 2024 Reference: Dillon et al. Reference: Dillon et al. Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. JAMA Network Open. 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.

Naloxone 262

Naloxone NARCAN Overdose CPR 262

The Skeptics' Guide to EM

JANUARY 27, 2024

That 40-patient study by Ferguson et al did show a statistically significant increased likelihood of hypotension in RVMI patients who received nitrates, but to me, the study design was just plain weird. Fanaroff et al looked at the ACC/AHA guidelines from 2008-2018 [4]. In all comers with MI, the rate is probably closer to <3%.

Paramedic 317

Paramedic ALS EMS OR 317

The Skeptics' Guide to EM

JULY 27, 2024

Reference: Knack et al. A similar review by Sanders et al 2015 concludes that clinica. Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients. A randomized control trial (RCT) done in the prehospital setting enrolled 2,698 patients.

ICU 248

ICU ALS Ambulance OR 248

The Skeptics' Guide to EM

FEBRUARY 11, 2024

Reference: McLatchie et al and DAShED investigators. Reference: McLatchie et al and DAShED investigators. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. EMJ Nov 2023.

ED 330

ED Emergency Department ALS OR 330

The Skeptics' Guide to EM

JULY 6, 2024

Reference: Tjan et al. Reference: Tjan et al. Conflict in emergency medicine: A systematic review. AEM June 2024 Date: July 5, 2024 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate.

ED 242

ED ALS Emergency Department OR 242

FOAMfrat

SEPTEMBER 24, 2024

It’s probably safe to assume that your patient has a traumatic brain injury, so at what point in your treatment pathway do you reach for an antiepileptic drug (AED)? Are you carrying antiepileptics on your truck or aircraft? To give an AED or not to give an AED, that is the question. (Bet Bet you thought you left Shakespeare in high school).

OR 105

OR ALS 105

The Skeptics' Guide to EM

JANUARY 13, 2024

Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. Resuscitation 2023. Resuscitation 2023.

CPR 274

CPR Defibrillator First Responder Epinephrine 274

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 233

ICU Defibrillator CPR Paramedic 233

The Skeptics' Guide to EM

JULY 29, 2023

Date: July 21, 2023 Reference: McDonald et al. Date: July 21, 2023 Reference: McDonald et al. Reference: McDonald et al. Patterns of change in prehospital spinal motion restriction: a retrospective database review. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM.

Emergency Medical Services 246

Emergency Medical Services ALS EMS Emergency Department 246

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

Date: August 30, 2023 Reference: Griffey et al. Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. AEM August 2023 Guest Skeptic: Dr. Suchismita Datta. AEM August 2023 Guest Skeptic: Dr. Suchismita Datta.

ICU 276

ICU ED Critical Care ALS 276

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

NOVEMBER 6, 2023

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. This post will focus on the key parts of the guideline that affect ED evaluation and management. Top 10 Take Home Pearls 1.

Naloxone 116

Naloxone OR BLS Overdose 116

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

This Podcast Will Kill You

FEBRUARY 11, 2025

Now imagine that your tongue suddenly shriveled up and fell off and that in its place is a tongue-sized isopod aka rollie pollie aka pillbug. Just there, hanging out, forever. How are you feeling? Hey, we get it. But at least youll never be alone again. Believe it or not, this is not some bad creative writing exercise. This is a very real parasite.

E-9-1-1 97

E-9-1-1 ALS OR 97

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

The Skeptics' Guide to EM

JUNE 1, 2024

Reference: Tavender E, et al. Reference: Tavender E, et al. Triage tools for detecting cervical spine injury in paediatric trauma patients. Cochrane Database Syst Rev. Background: Pediatric cervical spine injuries (CSI), though rare, can have devastating consequences if missed. Imaging studies include X-rays, CT scans, and MRIs.

Emergency Medical Services 221

Emergency Medical Services Emergency Department EMS ALS 221

Pediatric EM Morsels

SEPTEMBER 22, 2023

Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues.

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

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%. Thus, the lumen observed may actually still be the same size as the original, normal lumen. Nor was there a challenge to look for coronary spasm.

Coronary 121

Coronary ACS OR EMR 121

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. T-waves are quite tall and possibly peaked (HyperK?), but potassium returned normal. What is the QT interval? In LBBB, the QT interval is partly prolonged by the wide QRS. Heart Rhythm [Internet].

Coronary 116

Coronary OR Defibrillator ALS 116

Core EM

JANUARY 25, 2024

Pfenning CL, Slovis CM: Electrolyte Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. Diagnosis and management of hypocalcaemia. link] Kelly A, Levine MA. Hypocalcemia in the critically ill patient. J Intensive Care Med 2013; 28:166. Louis, Mosby, Inc., Hypocalcemia.

Critical Care 246

Critical Care ED ALS OR 246

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 114

E-9-1-1 ACS OR Emergency Department 114

Pediatric EM Morsels

OCTOBER 27, 2023

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. Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. Krug 2007] What If the Child is Obese or Emaciated?

E-9-1-1 271

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