The Skeptics' Guide to EM

MAY 21, 2017

[display_podcast] Date: May 19th, 2017 Reference: Willman et al. Do heroin overdose patients require observation after receiving naloxone? display_podcast] Date: May 19th, 2017 Reference: Willman et al. Do heroin overdose patients require observation after receiving naloxone? Reference: Willman et al.

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The Skeptics' Guide to EM

APRIL 20, 2024

A clinical decision tool called the STUMBL score was derived and validated by Battle et al in 2014 [3]. An attempt was made to externally validate this tool in New Zealand by Murkerji et al 2021 [4]. These risks are particularly higher in the elderly [2]. It risks stratified older patients with blunt trauma.

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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.

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Overdose Critical Care EMS Emergency Department 215

Pediatric EM Morsels

OCTOBER 27, 2023

Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. 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. Zaritsky, A.,

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

ACEP Now

JULY 7, 2023

Xylazine is a veterinary sedative that has been increasingly implicated in overdose deaths throughout the United States. percent of all overdose deaths in 2020. 1 Known by street names such as “tranq,” “tranq-dope,” or “zombie drug,” xylazine is increasingly found in patients with opioid overdose. References Friedman J, et al.

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Overdose ALS Naloxone Emergency Department 98

The Skeptics' Guide to EM

AUGUST 27, 2022

Date: August 23rd, 2022 Reference: Schoenfeld et al. Date: August 23rd, 2022 Reference: Schoenfeld et al. Case: A 24-year-old male presents to the emergency department (ED) after a fentanyl overdose. Reference: Schoenfeld et al. He is successfully resuscitated using naloxone and is stable after an observation period.

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Emergency Department Naloxone Overdose ED 100

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. And it becomes impossible to treat multi-system injuries, such as doing chest compression (CPR) while trying to open an airway or control bleeding.

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BLS ALS Emergency Medical Technician Advanced Life Support 52

REBEL EM

JUNE 5, 2023

Background Information: Opioid overdose deaths have been increasing in the past twenty years. The national number of overdose deaths from any opioid has increased 62.5% In addition, buprenorphine has a lower risk of death from overdose when compared to methadone (2). Characteristics: Mean age 35.5 Homeless: 32.6%

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Naloxone ED Overdose Emergency Department 88

EMDocs

NOVEMBER 6, 2023

Opioid overdose remains the leading cause of cardiac arrest due to poisoning in North America. For a patient with suspected opioid overdose who has a definite pulse but no normal breathing or only gasping (ie, a respiratory arrest), in addition to providing standard BLS and/or ALS care, it is reasonable for responders to administer naloxone.

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Naloxone OR BLS Overdose 115

EMDocs

AUGUST 3, 2023

Massive acetaminophen overdose: effect of hemodialysis on acetaminophen and acetylcysteine kinetics. Bebarta VS, Kao L, Froberg B, et al. A multicenter comparison of the safety of oral versus intravenous acetylcysteine for treatment of acetaminophen overdose [published correction appears in Clin Toxicol (Phila). PMID: 27118496.

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Overdose E-9-1-1 OR ED 98

EMDocs

JANUARY 17, 2024

What are the treatment options for a benzonatate overdose? 7) Overdose literature review timeline: In 1986, the first two benzonatate fatalities were reported in the literature: a choking infant and an intentional overdose in a teenager. (8) There is no specific toxidrome or antidote for a benzonatate overdose.

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E-9-1-1 Overdose Emergency Medical Services Life Support 89

FOAMfrat

JUNE 3, 2024

Right as you’re making your bunk you get dispatched for a reported overdose with police enroute, no further information. We go into it with preconceptions of what to expect: “It’s a simple heroin overdose, we’ll wake them up and they’ll refuse, then we’ll go back to bed”. Iolascon A, Andolfo I, Russo R, et al. Hemasphere.

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Overdose Ambulance First Responder ALS 98

REBEL EM

JUNE 26, 2023

Click here for Direct Download of the Podcast Paper: Bouzat P et al. References: Bouzat P et al. PMID: 36942533 Innerhofer P et al. PMID: 28457980 Jehan F et al. PMID: 29664892 Zeeshan M et al. High-quality studies are needed to determine the utility of this intervention. Lancet Haematol 2017.

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FFP Frozen Plasma ALS Plasma 139

ACEP Now

MAY 8, 2023

Unfortunately, most cases are not so simple, with half of them being unintentional overdoses, many with a delayed presentation; some with delayed-release formulations, combined formulations, or co-ingestions, and some in patients with co-morbidities—all factors that make recognition and management more challenging. for death. for death.

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Overdose ALS OR EMS 52

ACEP Now

JANUARY 5, 2025

As it turns out, common sense likely rules the day when presented with patients whose low GCS is the result of a self-limited overdose toxidrome. References Gibbs KW, Semler MW, Driver BE, et al. Luo Z, Li Y, Li W, et al. Knack SKS, Scott N, Driver BE, et al. Escobar GJ, Liu VX, Schuler A, et al. N Engl J Med.

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ALS E-9-1-1 ED Emergency Department 40

Pediatric EM Morsels

JUNE 16, 2023

Sometimes this can be used to our advantage, like when we need to give subcutaneous fluids to a dehydrated patient without an IV, or when we need to give SQ medications for things like Sulfonylurea overdose , Hereditary Angioedema , or DVTs. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

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Overdose OR Critical Care ALS 154

EMDocs

SEPTEMBER 7, 2023

Elimination half-life data is not well established but increases in larger overdoses and as renal injury begins to occur. Metabolism of DEG adapted from Bessenhofer, et al. References: Abubukar et al. Nelson, et al. Conklin, Laura, et al. Nelson, et al. CDC’s Morbidity and Mortality Weekly Report.

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E-9-1-1 ALS Plasma Emergency Department 92

EMDocs

JANUARY 16, 2024

In our case, the patient had accidentally overdosed on drugs prior to being found. Carsten L, et al. Monika BM, Martin D, Balthasar E, et al. Forti A, Brugnaro P, Rauch S, et al. 2018.09.018 Romlin BS, Winberg H, Janson M, et al. Klein LR, Huelster J, Adil U, et al. The management of accidental hypothermia.

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Defibrillator CPR Epinephrine Life Support 109

Dr. Smith's ECG Blog

JULY 21, 2024

In such cases — radiofrequency ablation of ectopic beats triggering malignant ventricular arrhythmias was needed for control of arrhythmic storm because the antiarrhythmic medications tried were ineffective ( Marrouche et al — JACC 5;43(9): 1715-20, 2004 ). The most common side effects of Quinidine is hypotension and QTc prolongation.

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Defibrillator Coronary ALS STEMI 131

EMDocs

JUNE 5, 2024

doi:10.1016/0002-9343(89)90302-1 Guglielminotti J, Pascal Pernet, Maury É, et al. Negative anion gap and elevated osmolar gap due to lithium overdose. 061057 Wu AHB, McKay C, Broussard LA, et al. Ann Am Thorac Soc. 2014;11(4):671-674. doi:10.1513/annalsats.201401-033cc 201401-033cc Weisberg LS. Pseudohyponatremia: A reappraisal.

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Overdose ALS OR Emergency Department 98

REBEL EM

JULY 17, 2023

Click here for Direct Download of the Podcast Paper: Knack SKS et al. References: Knack SKS et al. It is possible that the induction agent used could play an important role on hemodynamic effects in critically ill adults. REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2;

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ED ICU Emergency Department Overdose 93

NAEMSP

APRIL 19, 2023

Current AHA guidelines do not recommend routine use of calcium in cardiac arrest (Panchal, et al., Calcium acts as a vasopressor and inotropic agent (Lindqwister, et al., risk ratio >1) was 4% for ROSC, 6% for 30 day survival, and 4% for survival with a favorable neurologic outcome at 30 days (Vallentin, et al.,

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E-9-1-1 Advanced Life Support Overdose CPR 52

EMDocs

APRIL 10, 2024

Poisoning & Drug Overdose. doi:10.1136/bcr-2019-233119 Neal JM, Barrington MJ, Fettiplace MR, et al. J Med Toxicol. 2008;4(3):184-191. doi:10.1007/BF03161199 Olson K, Smollin C, eds. McGraw Hill; 2022. Walters E, Wurster Ovalle V, Yin S, Dribin T. BMJ Case Rep. 2020;13(1):e233119.

E-9-1-1 111

E-9-1-1 Plasma Epinephrine Life Support 111

REBEL EM

SEPTEMBER 1, 2022

Paper: Vallentin MF et al. Although the results of both the short and long-term outcomes of the COCA trial do not support the use of calcium in all patients with OHCA, there are some populations that may still benefit from this treatment including patients with hyperkalemia, hypocalcemia, and calcium channel blocker overdose.

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Epinephrine Overdose ALS OR 52

ACEP Now

OCTOBER 3, 2023

Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented. References Lulla A, et al. Spaite DW, Bobrow BJ, Keim SM, et al. Prehosp Emerg Care. Accessed 2022, [link]. J Safety Res.

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Emergency Medical Services EMS OR Overdose 98

FOAMfrat

AUGUST 28, 2024

There are many underlying causes, such as stroke, central nervous system depression (opioid overdose, etc.), Hopkins, Erin, et al. For the purposes of this discussion, we’ll stick to the four basic types: o Respiratory acidosis results from inadequate alveolar ventilation leading to increased CO2 retention in the bloodstream.

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Critical Care Overdose OR ALS 98

EMDocs

JULY 30, 2024

3 When administered early after overdose, nicotinamide may decrease the severity of toxicity. doi: 10.1056/NEJM198001103020202 Buonvicino D, Mazzola F, Zamporlini F, et al. Activated charcoal can be used to prevent absorption in acute ingestions, presenting within an hour of exposure. A clinical study of 12 cases. N Engl J Med.

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Overdose ED Emergency Department OR 74

This Podcast Will Kill You

AUGUST 20, 2024

LoVecchio, Frank, et al. CDC: May 14, 2024 Drug Overdose Death Rates. Health care cost savings from Australian Poisons Information Centre advice for low risk exposure calls: SNAPSHOT 2. Clinical Toxicology , 58 (7), pp.752-757. “Poison control centers decrease emergency healthcare utilization costs.”

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Overdose ALS 52

This Podcast Will Kill You

AUGUST 13, 2024

LoVecchio, Frank, et al. CDC: May 14, 2024 Drug Overdose Death Rates. Health care cost savings from Australian Poisons Information Centre advice for low risk exposure calls: SNAPSHOT 2. Clinical Toxicology , 58 (7), pp.752-757. “Poison control centers decrease emergency healthcare utilization costs.”

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Overdose ALS 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

Common culprits in this situation are tricyclic overdose and cocaine toxicity (remember cocaine not only increases dopamine in central synapses, but is also a local anesthetic (-caine!) The data in the paper by Rangel et al. Lange RA, Cigarroa RG, Flores ED, et al. McCord J, Jneid H, Hollander JE, et al. Vittinghoff, E.

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E-9-1-1 Coronary Epinephrine Overdose 52

ACEP Now

JULY 7, 2023

Patients with opiate overdose get naloxone. References American College of Emergency Physicians Clinical Policies Subcommittee on the Adult Psychiatric P, Nazarian DJ, Broder JS, et al. Currier GW, Chou JC, Feifel D, et al. Zaman H, Sampson SJ, Beck AL, et al. Patients with sepsis get antibiotics. Ann Emerg Med.

Emergency Department 52

Emergency Department ED Naloxone ALS 52

ACEP Now

FEBRUARY 11, 2024

There have been documented cases of overdose, and of note, there is no known antidote. Sodhi M, Rezaeianzadeh R, Kezouh A, et al. Ahmann AJ, Capehorn M, Charpentier G, et al. Poison centers see nearly 1,500% increase in calls related to injected weight-loss drugs as people accidentally overdose. Bansal AB, Al Khalili Y.

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Overdose ACS Plasma ALS 52

Dr. Smith's ECG Blog

MAY 5, 2023

Krantz et al authored a State-of-the-Art Review on Cardiovascular Complications of Opioid Use ( JACC 77(2):205-223, 2021 ) — in which mechanisms from Opioid Overdose that detail arrhythmia production ( up to cardiac arrest ) are elucidated — thereby providing an explanation for the unusual arrhythmias in today's case.

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E-9-1-1 NARCAN Naloxone Overdose 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

This is pathognomonic of hyperkalemia (I suppose it could be due to a massive overdose of a sodium channel blocking drug, maybe). the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. She was in shock with thready pulses. A prehospital ECG was recorded: Limb leads: Precordial Leads What is the therapy?

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Plasma STEMI Defibrillator Overdose 40

EMDocs

JANUARY 4, 2024

Questions: What are the clinical manifestations of bupropion overdose? How is bupropion overdose treated? How long should a patient be observed after a bupropion overdose? 1 In addition to intentional overdoses, there are multiple case studies of abuse (ingestion, insufflation, injection). hours, SR 3 hours, XL 5 hours.

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Overdose E-9-1-1 ALS Emergency Department 92

The Skeptics' Guide to EM

AUGUST 18, 2018

[display_podcast] Date: August 16th, 2018 Reference: Hohl C et al. display_podcast] Date: August 16th, 2018 Reference: Hohl C et al. Reference: Hohl C et al. Prospective Validation of Clinical Criteria to Identify Emergency Department Patients at High Risk for Adverse Drug Events. AEM Aug 2018. AEM Aug 2018. AEM Aug 2018.

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Emergency Department Overdose ED ALS 130

Don't Forget the Bubbles

SEPTEMBER 6, 2023

The stepwise approach was guided by vital signs, presence of seizures or focal neurology, presence of trauma (including attempted hanging or cutting), overdoses and substance misuse, level of consciousness, medical complaints, history of alleged sexual assault/rape, and developmental delay. link] Radhakrishnan L, Leeb RT, Bitsko RH, et al.

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Emergency Department ED Overdose ALS 119