EMS 12-Lead

APRIL 28, 2022

Initial vital signs include: NIBP 99/58 HR 150-160 (trend) RR 10 (spontaneous, but shallow) SpO2 86 (RA) BBS CTA The initial rhythm strip is attached: Figure 1 There is a wide complex tachycardia of varying morphology, amplitude, and R-R cycle length. A prominent vertical scar, however, is noted at the sternum.

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EMDocs

MARCH 30, 2024

Comprehensive physical exam is unremarkable, but she does have pain at the T-12/L-1 region of her back. Her patellar reflexes are 1+ bilaterally, no ankle clonus is noted, and she denies any saddle anesthesia or bowel/bladder incontinence. CT of lower spine is ordered and shows the following: 1 What is the diagnosis?

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Don't Forget the Bubbles

JUNE 17, 2024

Introduction: Civility Matters Healthcare environments, particularly emergency departments, are characterised by high levels of Volatility, Uncertainty, Complexity, and Ambiguity ( VUCA ). The lack of consistent definitions in the literature makes it difficult to report its true prevalence and hampers efforts to combat it.

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EMDocs

NOVEMBER 18, 2023

A point of care ultrasound of the liver reveals the following: Image 1: Ultrasound of the liver showing abnormal hepatic artery flow and resistance index 1 Question: What is the diagnosis? Rosh Review Website Link References 1) Karmazyn B, Sağlam D, Rao GS, Jennings SG, Mangus RS. In: Molmenti E, Santibañes M, Santibañes E.

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Don't Forget the Bubbles

DECEMBER 16, 2024

Coverage of the 6-in-1 vaccine measured at 12 months of age in England for Q4 2023 to 2024 Source: ONS under the Open Government License v3.0 Young infants and immunosuppressed individuals are particularly at risk of severe disease, resulting in significant morbidity and associated mortality rates of 1-3 per 1,000 cases.

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EMDocs

FEBRUARY 26, 2024

1 While PJP gained significant recognition among HIV-positive adults during the early AIDS epidemic, the growing utilization of immunosuppressants has resulted in an increased incidence of the disease in individuals who are HIV-negative. 9 The signs and symptoms of PJP infection are non-specific. for detecting pulmonary opacities.

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Don't Forget the Bubbles

AUGUST 28, 2023

A biopsy is often ultimately required for a definitive diagnosis. Five-year-old Ginny presents to the Emergency Department with a syncopal episode. The median age at diagnosis was 47 months (range 1-173 months). 2014;9(9):S102-S109. 2019;43(1):98-103.doi:10.1097/RCT.0000000000000782 J Thorac Oncol.

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Emergency Management Emergency Manager E-9-1-1 Critical Care 97

REBEL EM

JULY 3, 2023

Impact of intravenous calcium with diltiazem for atrial fibrillation/flutter in the emergency department. Am J Emerg Med. What They Did: Researchers conducted a multicenter, retrospective cohort study in three community hospitals and two freestanding emergency departments. Article: Rossi N et al.

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Dr. Smith's ECG Blog

NOVEMBER 30, 2022

mm of ST segment elevation, V2 and V3 have 1 mm of elevation, v4 has 2 mm of elevation and v5 around 1.5 Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting." Note 1: Levels were significantly lower in takotsubo that presented with T-wave inversion.

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Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Clinical Course of Children 1 to 24 Months Old With Positive Urine Cultures Without Pyuria. 2024;24(1):111-118. Giannoni, E., Acad Pediatr. doi:10.1016/j.acap.2023.06.023 2023.06.023 What’s it about? Schlapbach, L.J., Hagenbuch, N.,

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ACEP Now

JANUARY 9, 2024

A 3-year-old male was brought to the emergency department (ED) by his mother, who reported the sudden onset of a rash (hives) covering his entire body, with no rash on his palms and soles. The next day, the patient’s mother was called to come to the emergency department with the patient due to abnormal labs.

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Dr. Smith's ECG Blog

APRIL 22, 2022

But these cases show the potential dangers of delayed recognition and treatment of inferior reperfusion Take away 1. ECG’s can be labeled as ‘normal’ by the computer (and confirmed by cardiology) even with diagnostic signs of occlusion or reperfusion References 1. JAMA Intern Med 2019 9. Am J Med [Internet] 2017;130(9):1076–83.e1.

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ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. A more practical definition of massive or life-threatening hemoptysis is that which causes signs of worsening respiratory distress, hemodynamic instability, abnormal gas exchange, or airway obstruction.

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E-9-1-1 ALS Emergency Department OR 52

Don't Forget the Bubbles

OCTOBER 19, 2023

Babie Junior, or Bee for short, was the definition of a cute, delightful baby. The bottom line is: Early high-flow nasal cannula oxygen started in the ED resulted in a longer length of hospital stay than standard oxygen therapy in children aged 1 – 4 with respiratory failure. days compared to 1.50 Watch this space.

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Dr. Smith's ECG Blog

MARCH 9, 2023

Sent by anonymous, written by Pendell Meyers A man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chest pain. Proven STEMI has an open artery in 19% to 36% of cases, depending on whether it is TIMI −1, −2, or −3 flow. Pol Arch Intern Med. 2017;127:401–411.

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REBEL EM

JANUARY 23, 2023

Patients were randomized in a 1:1 ratio. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Multicenter study of emergency department visits for insect sting allergies. 2005 Sep;116(3):643-9. Multicenter study of emergency department visits for food allergies. Schaefer P.

Allergic Reaction 52

Allergic Reaction ED E-9-1-1 Emergency Department 52

Don't Forget the Bubbles

JANUARY 10, 2024

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. A definitive trial was needed to help establish the best transfusion practices to prevent child mortality in LMICs. The study asked TWO questions: 1. Which children should receive blood?

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FOAMfrat

OCTOBER 20, 2023

As reported within the 6th edition Manual of Emergency Airway Management, there are cardiac arrest rates between 1% and 4%, with other complications (mostly hypoxemia and hypotension) as high as 30% in patients with first-pass success [1, pg 29; 4-10]. Why is Physiologic Optimization Important? Up to 44% per other sources [12].

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ACEP Now

MARCH 14, 2024

A 24-year-old male with history of quadriplegia and traumatic brain injury presents to the emergency department with hemorrhage in his oral cavity and blood from his tracheostomy tube. Tracheo-innominate fistula (TIF) is an unusual and frequently lethal complication of such definitive airway placement. 2005;128: 3906-9.

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E-9-1-1 ALS Operating Room OR 52

Dr. Smith's ECG Blog

JANUARY 10, 2020

Here is the parasternal short axis, performed by a real expert in emergency department point of care cardiac ultrasound: There does not appear to be an anterior wall motion abnormality. I was relieved to see this MRI result: MRI IMPRESSION 1) Mildly decreased LV function with no focal wall motion abnormalities. Pericarditis?

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Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Written by Destiny Folk MD, with edits by Meyers, peer reviewed by Smith and Grauer A woman in her late 20s with a past medical history of cervical cancer status post chemotherapy and radiation therapy presented to the emergency department for shortness of breath, chest tightness, and two episodes of syncope. 2013 Sep;26(9):965-1012.e15.

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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. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 2020 Sep 30;5(9):558-567. 10% of patients.

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

EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). However, ABGs have many drawbacks compared to VBGs.

Emergency Department 98

Emergency Department E-9-1-1 ED ICU 98

Dr. Smith's ECG Blog

APRIL 8, 2015

Approach to Syncope Syncope definition: Brief loss of consciousness with loss of postural tone and complete spontaneous recovery without medical intervention. Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. Palpitations preceding syncope (highest value on EGSYS score) 9.

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Emergency Department E-9-1-1 ED ALS 52

EMDocs

JULY 17, 2023

1 While less common than small bowel obstruction (SBO), obstruction of the large bowel is more likely to be a surgical emergency and is often associated with a serious underlying condition. 1 The most common causes of non-cancer-related LBO are cecal and sigmoid volvulus. He reports distension and the sensation of fullness.

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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

AAEM RSA

DECEMBER 3, 2020

1 His description of cases of life-threatening infections in the perineal, genital or perianal regions were thought to be idiopathic in previously healthy men. 3-5 Fournier gangrene is a type of necrotizing soft tissue infection, which can be categorized into four types based on the infectious organism involved and other features (Table 1).

Emergency Department 52

Emergency Department E-9-1-1 ALS EMT 52

Don't Forget the Bubbles

JULY 22, 2024

study from 200 9. A large proportion of the trials come from Finland (3) and The UK (2) and also from Australia (1) and the US (1), but only a small number took place in the ED. Castro-Rodriguez JA, Beckhaus AA, Forno E. Annals of Emergency Medicine. 2019 Aug;9(8):e028511. months to 40.9 Pediatr Pulmonol.

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EMDocs

OCTOBER 7, 2023

1-3 Common causes: Natural disasters such as tornadoes or earthquakes 4,5 Structure or building collapses from home fires or bombings. 6 Prolonged down time from falls, usually in the elderly Incidence is difficult to ascertain due to broad definition and that events that cause crush injuries are rather rare. 2016;20(1):135.

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EMDocs

JANUARY 6, 2024

1 Indications for transplant include: Non-ischemic cardiomyopathy (49%) Ischemic cardiomyopathy (35%) Restrictive cardiomyopathy (4%) Retransplantation following failed prior transplant (3%) Hypertrophic cardiomyopathy (3%) Congenital heart disease (3%) Valvular cardiomyopathy (3%) The median survival after heart transplant is over 12 years.

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EMDocs

MAY 29, 2023

Louis); Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 54-year-old female with a past medical history of rheumatoid arthritis presents to the emergency department (ED) with generalized fatigue. ESR and CRP are widely used in monitoring and detecting multiple inflammatory conditions.

ED 58

ED E-9-1-1 Emergency Department OR 58

ACEP Now

APRIL 5, 2024

writing for the advocacy organization Physicians for Human Rights note that “there is no clear or consistent definition, established etiology, or known underlying pathophysiology.” Published May 1, 2023. France E, Bourn S, et al. Colorado Department of Public Health & Environment website. [link]. West J Emerg Med.

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EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. 1 One study found that CTA head and neck was ordered for 2.5% 8 The VAN (vision, aphasia, neglect) score ( Figure 1 ), first proposed by Teleb et al. of patients with blunt multisystem trauma.

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E-9-1-1 ALS Emergency Department ED 105

REBEL EM

NOVEMBER 11, 2024

What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018. independence of the instrument from unmeasured confounders), which cannot be definitively proven in an observational study. vs. 52.2%). vs. 15.3%).

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REBEL EM

OCTOBER 26, 2023

1–4 Antimicrobial resistance is a global health crisis, underscoring the importance of antibiotic stewardship. Enrollment: Recruited patients from primary care offices, emergency departments, and inpatient wards at Children’s Hospital of Philadelphia and UPMC Children’s Hospital of Pittsburgh.

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Don't Forget the Bubbles

JULY 5, 2023

Figure 1: Clinical manifestations and long-term consequences of sickle cell disease Training and education on sickle cell disease: Training and education are crucial to improve morbidity and mortality. Investigations : Bloods show Hb of 8 g/L, White cell count 13x 10 9 /L, Platelets 570 x10 9 /L, CRP 35mg/L.

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EMDocs

JANUARY 25, 2025

Answer : Leukopenia Overview Leukopenia is defined as total WBC count < 4000/mm 3 Neutropenia is the most common subset of leukopenia and is defined on absolute neutrophil count: 1 Mild (1.01.5 10^9/L) Moderate (0.50.9 10^9/L) Severe (< 0.5 10^9/L) Generalized leukopenia (i.e. 10^9/L) Moderate (0.50.9

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