Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. A 12-year-old male is being transported by ambulance after a road traffic accident. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. Ann Emerg Med.

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E-9-1-1 Emergency Department ED CPR 135

ACEP Now

JANUARY 4, 2025

Clarke had begun an emergency medicine residency at what was then known as LA CountyUSC Hospital, Los Angeles. I was about two months into a family practice internship when I went to visit my uncle whose neighbor happened to be an ED resident, Dr. Clarke said. Firsthand Account An ambulance bay at the LA County-USC Hospital in 1978.

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ED Emergency Department Ambulance CPR 52

International Journal of Paramedicine

JULY 8, 2024

Methods: This is a retrospective cohort study of agitated patients with an initial Richmond Agitation-Sedation Scale (RASS) score of at least 3, who were sedated and transported by ambulance to Hartford Hospital. IM ketamine resulted in deeper sedation without increasing intubation rate.

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Emergency Department Ambulance ED OR 98

The Skeptics' Guide to EM

JANUARY 19, 2019

He is alert and oriented times three with normal vital signs by the time he arrives in the emergency department. They concluded: “For patients treated in the ED for opioid overdose, an observation period of one hour is sufficient if they ambulate as usual, have normal vital signs and a Glasgow Coma Scale of 15”.

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Naloxone Overdose Emergency Medical Services Emergency Department 130

ACEP Now

DECEMBER 6, 2024

His health care focus included hospital efficiency, physician and patient satisfaction, and emergency department (ED) wait times, as well as a host of nonhealth issues. Today, Dr. Morhaim is donating his time to a recently established Maryland commission focused on ED wait times. He got to be known as Dr. Dan.

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Emergency Department ED Ambulance OR 98

The Skeptics' Guide to EM

APRIL 24, 2021

Randomized Double-blind Trial Intramuscular Droperidol, Ziprasidone and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department. AEM April 2021 Case: You are sitting minding your own business charting on shift when you become aware of shouting and banging from your ambulance bay. Reference: Martel et al.

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Emergency Department ALS Ambulance ED 100

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage.

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E-9-1-1 ACS Emergency Department Coronary 139

ACEP Now

MAY 10, 2024

Patients often seek care in the emergency department (ED) setting when flares of pain affect their ability to ambulate, climb stairs, or even stand up from sitting. In our experience, patients have been able to ambulate comfortably with no motor deficits in approximately 30 minutes. J Emerg Med. Ragab, A.R.,

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Emergency Department Ambulance ED OR 92

The Skeptics' Guide to EM

JANUARY 7, 2023

Acute management of atrial fibrillation in congestive heart failure with reduced ejection fraction in the emergency department. Acute management of atrial fibrillation in congestive heart failure with reduced ejection fraction in the emergency department. Date: January 4th, 2023 Reference: Hasbrouck et al.

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OR Emergency Department ALS Ambulance 100

Dr. Smith's ECG Blog

MARCH 28, 2024

male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Here is the prehospital ECG: First ED ECG What do you think? SVT with aberrancy?

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OR Emergency Department Ambulance EMS 129

ACEP Now

OCTOBER 9, 2023

The other night I stood in the trauma bay, listening to rain patter against the automatic doors, awaiting an ambulance. Wearing a cut-up trauma sheet as a hijab, she walked out of our emergency department several hours later, intact and not traumatized. with a professional focus on the care of critically ill patients.

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Heart Attack Life Support Emergency Department Ambulance 126

EMDocs

JUNE 9, 2023

EMS Environment Ok, we’ve got the patient calmed down and gotten them into the ambulance. If you have restraints in your ambulance, are those restraints appropriately sized for pediatric patients? NASEMSO: Clinical care and restraint of agitated or combative patients by emergency medical service practitioners.

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Emergency Medical Services EMS Emergency Department Ambulance 98

AAEM RSA

MAY 7, 2021

Schreyer, MD CMQ FAAE Originally published: Common Sense January/February 2021 The advent and broad availability of ridesharing services, such as Lyft and Uber, are changing the way patients access medical services, and emergency departments (EDs) are taking notice. 5 The cost of transport is also an issue.

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EMR Emergency Medical Services Ambulance Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

His wife contacted the ambulance service after the patient experienced an episode of loss of consciousness. The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization. Those who make it to the ED usually have transient occlusions with reperfusion.

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Coronary ACS Emergency Department Defibrillator 128

ACEP Now

JUNE 14, 2024

Transferring patients from one ED to another hospital is an established part of emergency medicine practice. 1 As fresh challenges of the pandemic and hospital operations changed emergency medicine practice, one of the more challenging areas was the movement of admitted patients out of the first emergency department (ED).

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Emergency Department ED Ambulance OR 52

Don't Forget the Bubbles

JUNE 30, 2023

Grabbing a pristine white table napkin to apply pressure to the wound, Ranulf’s class teacher and expedition leader called the ambulance as chaos descended on the restaurant. All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. Back in ED with Ranulf, and pack two has gone through.

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E-9-1-1 FFP Plasma Emergency Department 139

The Good, The Bad & The Ugly Paramedic

SEPTEMBER 30, 2021

National industry insight reporting from the Australian Industry and Skills Committee suggests that, in 2019 alone, Australia wide, there were over 4,500 enrolments in ambulance and paramedic qualifications1. National Industry Insights: Ambulance and Paramedic. Journal of Emergencies, Trauma and Shock, 1 (2) 129-129. Shaban, R.

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Paramedic Paramedicine Paramedicine Ambulance 52

FOAMfrat

AUGUST 15, 2024

However, O- blood is always in such short supply that it is not feasible for it to be stocked in every ambulance, helicopter, and resuscitation bay. so I often overlook the simplistic act of turning on the heat in the ambulance, but it’s really important. Any emergency department has more blood availability than you.

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Plasma Ambulance ALS Emergency Department 69

FOAMfrat

JANUARY 23, 2024

Nevertheless, with their proliferation, new challenges have emerged - chief among them the growing threat of antibiotic resistance and life-threatening allergies. Having worked in the ED setting, I can attest that these skills can be extrapolated to a knowledgeable and experienced prehospital provider.

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EMS Emergency Department ALS Ambulance 52

NCOAE

SEPTEMBER 26, 2023

When you’re off the clock, focus on physical fitness, hobbies, family time, hanging out with friends — anything that takes you away from that ambulance and emergency department (ED) and puts you in a better frame of mind. Drink more water and less soda or energy drinks.

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EMS EMT EMT Allergic Reaction 52

Dr. Smith's ECG Blog

MARCH 6, 2023

Study idea: We should look at all OMIs who had a chest CT and compare to all patients with Non-OMI pathology who had a contrast chest CT and have radiologists blindly interpret the perfusion of the myocardium The cardiology fellow came down to the ED and said: "What are you worried about? This ST depression?" 2022.08.750 Section 5.2.2,

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OR STEMI ED Critical Care 52

ACEP Now

JULY 7, 2023

Case A 91-year-old Russian-speaking female on dual-antiplatelet therapy presented to the ED via ambulance with a left-sided nosebleed. EMS placed her on non-rebreather at 10 L per minute due to the significant amount of bleeding through the nose, and brought her to the ED. Acad Emerg Med. BioMed Res Int. 2015;2015:806243.

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Emergency Medical Services ALS EMS OR 45

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

It was a constant ache on the left side of his chest that forced him to stop cycling and call for an ambulance. The patient’s ECG on arrival at the emergency department is shown below. Figure-1: The initial ED ECG ( = E CG # 1) — with comparison to the patient’s baseline ECG done 4 years earlier ( = E CG # 3).

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E-9-1-1 Coronary STEMI Emergency Department 52

Don't Forget the Bubbles

NOVEMBER 1, 2023

This month, Bubble Wrap has teamed up with Sheffield Children’s Hospital Emergency Department to have a look at what’s new in paediatric literature. This group has developed a height-based guide for ETT insertion but recognise that measuring the height of a patient may not be feasible within an ED setting.

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Emergency Department ALS OR Ambulance 140

EMDocs

NOVEMBER 16, 2024

1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 10% of patient’s have an ED visit within 30 or 90 days following THA. An 80-year-old man with a history of hip arthroplasty presents by ambulance after falling at home.

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EMS E-9-1-1 Operating Room Emergency Department 98

The Skeptics' Guide to EM

DECEMBER 26, 2020

Mortality among patients with frequent emergency department use for alcohol-related reasons in Ontario: a population-based cohort study. CMAJ 2020 Guest Skeptic: Dr. Hasan Sheikh is an emergency and addictions physician in Toronto and a lecturer at the University of Toronto. Date: December 18th, 2020 Reference: Hulme et al.

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ED Emergency Department Emergency Medical Services ALS 130

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance.

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ED E-9-1-1 ALS OR 98

EMDocs

DECEMBER 18, 2023

F) in the ambulance. On arrival to the ED, her blood pressure is 84/36 mmHg with a heart rate of 110 beats per minute. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. The patient currently resides at a skilled nursing facility. She had a fever of 38.7 °C

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E-9-1-1 ALS Emergency Department Plasma 91

ACEP Now

JUNE 14, 2024

And, finally, patients with a history of COPD frequently present to the emergency department with dyspnea. Although dyspnea in this setting likely represents an AECOPD, other emergent differentials must be considered. Tintinalli JE, Stapczynski JS, Ma OJ, et al, eds. Ann Emerg Med. 8 Bronchodilators Albuterol 2.5-5

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ALS Coronary OR ED 52

EMDocs

SEPTEMBER 16, 2024

Author: Joshua Lowe, MD (EM Attending Physician, San Antonio, TX) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Manpreet Singh, MD (@MPrizzleER); Brit Long, MD (@long_brit) The fluorescent lights above cast a clinical pallor over the bustling ED. The symphony of sounds in the Emergency Department can be overwhelming.

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Heart Attack ED OR Emergency Department 94

ACEP Now

DECEMBER 7, 2024

As emergency departments (EDs) have become the focus of bottlenecks in the entire health care systemfrom insufficient inpatient beds leading to hospital boarding to dwindling access to primary carea siege atmosphere has developed. The majority do not require any additional resources on the part of the ED.

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Ambulance EMT EMT ED 98

ACEP Now

DECEMBER 8, 2024

The Centers for Disease Control and Prevention (CDC) estimates of emergency department (ED) visits for 2022 were recently released. This visit rate puts American EDs back on the data line it has followed since World War II. ED visit estimates and utilization rates for 2018 to 2022 are shown in Figure 1. and 8 a.m.

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ED Emergency Department Ambulance 52

FOAMfrat

NOVEMBER 21, 2024

Hypothermia Hypothermia, defined as core temperature less than 35oC (95oF) has been identified in up to 2/3 of trauma patients upon arrival to the emergency department. Increasing cabin temperatures in your aircraft or ambulance might be uncomfortable for you, but important to your patient’s survival. normal value is between 0.8

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ICU Emergency Department OR Ambulance 119

Don't Forget the Bubbles

NOVEMBER 27, 2024

C presents to your emergency department. FIDO was designed to assess the management of young febrile infants presenting to emergency departments in the UK and Ireland , report risk factors for IBI, and apply CDAs that do not exclusively rely on PCT testing. Imagine this – a six-week-old infant with a fever of 38.3⁰C

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E-9-1-1 Emergency Department Ambulance ED 81

Peter Canning

JANUARY 26, 2025

Robby), the senior attending in a busy Pittsburgh emergency department, who goes from patient to patient, emergency to emergency, overseeing a cast of younger doctors, nurses and other medical staff. Another EMT is made fun of for leaving the keys in the ambulance allowing unknowns to steal it.

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NARCAN Overdose EMT EMT 52

Dr. Smith's ECG Blog

DECEMBER 16, 2024

male who hasn't doctored in several years presented to the emergency department by ambulance for chief complaint of chest pain. An ED ECG was recorded: Very Similar Mild ST elevations in leads II, III, aVF with reciprocal changes in the lateral leads, along with ST elevation in V1 raising concern for RVMI. 29, 2024 ).

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STEMI Coronary Critical Care ED 105

ACEP Now

MARCH 10, 2025

You follow the recommended emergency department (ED) lab workup for hypertensive disorders of pregnancy, including urine protein/creatinine ratio, serum creatinine, platelet count, complete blood count, and renal liver function tests.

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ALS OR ED Emergency Department 52