First 10 EM

OCTOBER 21, 2024

Let’s see if I can get myself cancelled by a group of physicians that are definitely smarter than me.) I love toxicologists, but it’s time for someone to call them out. (I I also love ranting. I am sick of the anti-science rhetoric.

OR 110

OR 110

Critical Care Scenarios

SEPTEMBER 18, 2024

“Definitive” TRALI (there is no longer a less definite category) is defined as: * No evidence of lung injury prior to transfusion * Onset within 6 hours after end of transfusion * P/F ratio <300 or SaO2 <92% on room air * Radiographic evidence of bilateral infiltrates with n.

OR 152

OR 152

ALiEM

OCTOBER 28, 2024

Case Question: What is the definitive management for a nephroblastoma? The definitive management of a Wilms tumor is a multidisciplinary approach, with primary nephrectomy followed by a tailored chemotherapy regimen as the gold-standard treatment in the US. Pediatric abdominal structures commonly overlap.

ED 161

ED OR 161

Critical Care Scenarios

MAY 3, 2023

Reflections on the definition of a central line, whether it’s arbitrary, and the clinical implications of making the distinction. Reflections on the definition of a central line, whether it’s arbitrary, and the clinical implications of making the distinction.

100

100

The Skeptics' Guide to EM

NOVEMBER 16, 2024

One definition of AI is a computer system capable of performing tasks that typically require human intelligence, such as pattern recognition, decision-making, and language processing. The Chief of EM wants to be sure that any new system they introduce will enhance workflow and not add to clinicians’ cognitive burden.

ICU 211

ICU Emergency Department ALS EMS 211

Dr. Smith's ECG Blog

NOVEMBER 14, 2024

I responded: "Definite inferior OMI. The RV marginal branch must have a takeoff that is more distal than usual, as this is definitely an RV MI. The initial ECG shows definite ST-T wave abnormalities in 11/12 leads — with marked hyperacute T waves in lead III ( within the 1st RED rectangle in Figure-1 ). What do you think?

ED 120

ED Coronary Paramedic OR 120

The Skeptics' Guide to EM

NOVEMBER 30, 2024

The current evidence has not given a definitive answer as to which type of access is best for OHCAs. Recent randomized trials are now evaluating whether the speed and reliability of IO access provide significant benefits over the traditional IV route. Most EMS providers are choosing the proximal tibial as their go-to IO access.

Epinephrine 168

Epinephrine OR CPR Paramedic 168

Dr. Smith's ECG Blog

MAY 7, 2024

My response: "Definitely not polymorphic VT. Definitely atrial fibrillation. Here is the post cardioversion ECG: Definite pre-excitation (delta waves due to accessory pathway, "bypass tract"). Probably WPW but is very slow for atrial fib withWPW. I would just cardiovert electrically."

ALS 120

ALS OR 120

First 10 EM

SEPTEMBER 23, 2024

I definitely talk to people about smoking, but aside from brief counseling and occasionally prescribing nicotine replacement for […] The post Smoking cessation in the emergency department (The COSTED trial) appeared first on First10EM.

Emergency Department 86

Emergency Department OR EMS 86

The Skeptics' Guide to EM

NOVEMBER 23, 2024

Ultrasound is commonly used due to its non-invasive nature, while computed tomography (CT) scans, although more definitive, are often avoided in children due to radiation concerns [3]. Traditionally, diagnosis relies on a good history, followed by a directed physical examination and appropriate use of diagnostic tests (lab and imaging).

ED 187

ED Emergency Department ALS OR 187

Core Ultrasound

JANUARY 10, 2023

This is definitely not something that needs to be done all the time, but is a great adjunct in the appropriate clinical setting! Airway ultrasound is something that can be quite complex but at its most basic, it can be used to help determine if you have endotracheal versus endobronchial intubation.

130

130

Emergency Medicine Ireland

SEPTEMBER 30, 2024

As a reminder of the basics which I of course knew implicitly and definitely did not have to resort to wikipedia to check… Chyle is largely formed in the small intestine as the gut transports free fatty acids from the intestinal lumen. Chyle in the chest drain can be a yellowy milky thing or blood tinged.

Critical Care 98

Critical Care OR 98

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

This has led to variability in EMS protocols, with some agencies including naloxone in their cardiac arrest protocols while others do not specifically recommend it, highlighting a gap in definitive guidance [6].

Naloxone 238

Naloxone NARCAN Overdose CPR 238

REBEL EM

AUGUST 7, 2023

Background: Getting a definitive airway in a critically ill trauma patient can be a stressful situation. PMID: 37058727 Clinical Question: Does delayed sequence intubation decrease peri-intubation hypoxia in trauma patients requiring definitive airway control compared to rapid sequence intubation? Anesth Analg 2023.

ALS 98

ALS OR EMS 98

ALiEM

JUNE 10, 2024

High Risk (>12.1% risk of injury) -> Consider CT Altered mental status (GCS 3-8 or AVPU = U) Abnormal airway Breathing Circulation findings Focal neurological deficits Intermediate Risk (2.8% sensitivity and 99.9%

Emergency Department 317

Emergency Department ED OR 317

St. Emlyn's

APRIL 2, 2024

Anisa Jafar @EMergeMedGlobal takes us through why definitions really matter. St.Emlyn's - Emergency Medicine #FOAMed The ARC-H principle: re-defining global health & shifting the balance. The post The ARC-H principle: re-defining global health & shifting the balance. appeared first on St.Emlyn's.

89

89

Core Ultrasound

SEPTEMBER 18, 2023

Learn how to effectively perform the exam definitely within the reach of the non-radiologist clinician. Timely and accurate diagnosis is crucial for effective treatment. Bedside ultrasound has become a valuable tool for diagnosing pyloric stenosis quickly and non-invasively.

130

130

Don't Forget the Bubbles

JUNE 19, 2023

However, there are no agreed-upon definitions for growth restriction, and there are significant knowledge gaps. Refer to your local or national guidelines to decide whether a patient is SGA or not, but remember that, depending on which definition is used, both over- and underdiagnosis can occur. Literature list Beune IM et al.

ALS 143

ALS OR 143

Core EM

JULY 23, 2024

Hosts: Jonathan Kobles, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Agitation , psychiatry , Toxicology Show Notes Background/Epidemiology • Definition and Scope : Agitation encompasses behaviors from restlessness to severe altered mental states.

Emergency Department 233

Emergency Department OR 233

EMDocs

OCTOBER 19, 2024

2][3] Definitive diagnosis is made by laryngoscopy or bronchoscopy showing normal or mildly erythematous epiglottis and an erythematous, edematous trachea with thick mucopurulent exudates. [3] Labs and x-ray can be nonspecific, and definitive diagnosis is made with direct visualization. ampicillin-sulbactam).

EMS 87

EMS E-9-1-1 Epinephrine OR 87

Core EM

JULY 23, 2024

We review Acute Respiratory Distress Syndrome Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Critical Care , Pulmonary Show Notes Definition of ARDS: Non-cardiogenic pulmonary edema characterized by acute respiratory failure.

Critical Care 130

Critical Care OR 130

The Skeptics' Guide to EM

DECEMBER 7, 2019

Most of the definition is in the name itself. * The name was not reassuring and the definition was vague. The Journal of Pediatrics published a systematic review of literature regarding the Management of ALTE in 2013 and one of the findings was that there was very little agreement in the literature on how to apply the definition.

CPR 130

CPR ALS OR 130

Core EM

NOVEMBER 1, 2023

We discuss Electrical Storm (VT storm) and how to care for the very irritable heart.

OR 130

OR 130

ALiEM

NOVEMBER 1, 2024

This patient’s story was very consistent with a CHF exacerbation but POCUS allowed us to quickly identify a PE and get the patient on track to definitive management. Case Discussion Take-Home Points Point of care US is an essential tool for quickly assessing and appropriately treating patients.

ED 161

ED OR 161

Core EM

JANUARY 25, 2024

Definition: Catatonia: A behavioral motor dysregulation syndrome marked by an inability to move normally despite full physical capacity, which can occur in the context of many underlying psychiatric and general medical disorders [4].

MICU 246

MICU Emergency Department OR ED 246

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

What lowered my confidence in calling ECG #1 a definite OMI — was the finding of somewhat similar-appearing , upright T waves with slight-but-real J-point ST elevation in so many leads ( ie, leads I,II,aVF; V2-thru-V6 ). Once I identified leads V4 and V5 as definitely abnormal — I looked closer at neighboring leads.

OR 125

OR STEMI Coronary 125

Critical Care Scenarios

NOVEMBER 9, 2022

Reimbursers tend to like sepsis 3 definitions (qSOFA), core metrics may still use the older definitions. Many facilities may have their own policies on what definition to adopt. . * Spell out your findings and reasoning and you’ll get more grace on your diagnoses. Sepsis diagnoses are a mess.

OR 100

OR 100

Core EM

APRIL 1, 2024

We review Acute Respiratory Distress Syndrome Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Critical Care , Pulmonary Show Notes Definition of ARDS: Non-cardiogenic pulmonary edema characterized by acute respiratory failure.

Critical Care 130

Critical Care OR 130

Emergency Medicine Cases

JANUARY 4, 2022

What are the best strategies to efficiently get the patient in cardiogenic shock to definitive care, whether that be the cath lab or the operating room? In which patients would dobutamine be preferred over milrinone and vice versa? How can we best pick up occult cardiogenic shock before it floured shock kicks in?

Operating Room 130

Operating Room OR EMS 130

Emergency Medicine Cases

JUNE 29, 2021

Was CRASH-2 enough to be definitive, or does the classic EBM mantra of "we need more studies" remain true? Should we be using TXA for epistaxis, postpartum hemorrhage, hyphema or hemoptysis? Is it a miracle drug that stops all bleeding? Or has it been drastically overhyped?

OR 130

OR EMS 130

Dr. Smith's ECG Blog

JANUARY 27, 2024

Over the years — various definitions have been proposed for what should constitute a " significant " Q wave , based on width and/or depth of the Q wave. BOTTOM Line: In my opinion — there is no perfect definition for what constitutes a "significant" Q wave ( ie, a Q wave that indicates infarction has occurred at some point in time ).

STEMI 105

STEMI Coronary ACS ED 105

Core EM

JANUARY 25, 2024

Differentiating between the two is difficult as multiple proposed diagnostic criteria have yet to demonstrate sufficient sensitivity or specificity for a definitive diagnosis. The differential diagnosis for this patient includes Ventricular Tachycardia (VT) and Supraventricular Tachycardia (SVT) with aberrancy.

Coronary 246

Coronary Emergency Department ED OR 246

University of Maryland Department of Emergency Med

JUNE 9, 2023

Adhesive capsulitis aka frozen shoulder Definition: Gradual development of global limitation of both active and passive shoulde. Click to view the rest

79

79

Dr. Smith's ECG Blog

JUNE 15, 2023

Thus, this does NOT meet STEMI criteria (though, as of 2022, it is a formal "STEMI equivalent", assuming everyone agrees that this is de Winter morphology, for which there is currently no objective definition). Everywhere I'm aware of (only about 5 systems), the ECGs are not even recorded in the "STEMI database." What a farce.

STEMI 95

STEMI Coronary ACS OR 95

Dr. Smith's ECG Blog

MARCH 31, 2024

I simply texted back: "Definite posterior OMI." The person I was texting knows implicitly based on our experience together that I mean "Definite posterior OMI, assuming the patient's clinical presentation is consistent with ACS." The patient was a middle-aged female who had acute chest pain of approximately 6 hours duration.

STEMI 95

STEMI ACS ED 95

The Overrun Podcast

APRIL 23, 2024

However, this was an observational study and more research is needed to draw definitive conclusions. However, this was an observational study and more research is needed to draw definitive conclusions. The second study explores the use of nitroglycerin in right ventricular myocardial infarctions (MIs).

52

52

Pulsara

AUGUST 1, 2024

They've created a new protocol that allows them to bypass the ED and take qualified patients directly to definitive care. Teams in Arkansas are finding new ways to improve outcomes for pediatric behavioral health patients.

ED 91

ED 91