ALiEM

JUNE 10, 2024

A 10-year-old boy presents to the emergency department (ED) after a high-speed motor vehicle collision. The study enrolled 22,430 children, aged 0–17 years, presenting with blunt trauma across 18 PECARN-affiliated ED in the US. Case Scenario: What would you do? He complains of neck pain and is reluctant to move his head.

Emergency Department 317

Emergency Department ED OR 317

REBEL EM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Background: Hemmorhage is a major cause of preventable death in trauma patients. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. 2023;e2320850.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

EMS 12-Lead

APRIL 9, 2024

At the time of ED arrival he was alert, oriented, and verbalizing only a headache with a normalized BP. The ED activated trauma services, and a 12 Lead ECG was captured. This was deemed “non-specific” by the ED physicians. Thus, the ED admission ECG changes cannot be blamed on LVH. The fall was not a mechanical etiology.

Coronary 290

Coronary ACS CAD ED 290

The Skeptics' Guide to EM

NOVEMBER 16, 2024

With emergency department (ED) volumes rising, administrators are eager to explore AI-driven solutions to improve patient safety and reduce staff burnout. They want to know how CHARTWatch integrates with electronic health records (EHRs), whether it can adapt to their patient ED population, and how clinicians respond to using the tool.

ICU 142

ICU Emergency Department ALS EMS 142

EMDocs

JULY 17, 2023

Evaluation Imaging A definitive diagnosis of LBO requires imaging, most often a computed tomography (CT) scan with intravenous (IV) contrast. and is poorly tolerated by patients with obstruction, it should not be a routine part of the ED evaluation for LBO unless it is critical for another diagnosis on the differential.

E-9-1-1 76

E-9-1-1 ED Operating Room ALS 76

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. amiodarone or lidocaine).

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

He currently practices emergency medicine in New Mexico in the ED, in the field with EMS and with the UNM Lifeguard Air Emergency Services. Before attending medical school, he was a New York City Paramedic. Chris completed his emergency medicine residency and EMS fellowship at UNM. Your partner asks if you want to administer naloxone as well.

Naloxone 242

Naloxone NARCAN Overdose CPR 242

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain. The patient had no chest symptoms until he had been in the ED for many hours and had been undergoing management of his DKA. The patient was under the care of another ED physician. Another ECG was recorded: What do you think?

ED 102

ED Coronary CAD STEMI 102

Core EM

JANUARY 25, 2024

One week prior to ED arrival, the patient was becoming progressively despondent, less interactive with peers, exhibiting slow speech and movements, and was not eating. Patient Case: History: A 60-year-old male with history of schizophrenia and depression on multiple unknown antipsychotic medications presents with unresponsiveness x 1 day.

MICU 246

MICU Emergency Department OR ED 246

Core EM

JANUARY 25, 2024

The Case A 41-year-old male presents to the ED with constant palpitations for one day. Differentiating between the two is difficult as multiple proposed diagnostic criteria have yet to demonstrate sufficient sensitivity or specificity for a definitive diagnosis. Discussion Fascicular VT is a distinct subgroup of idiopathic VT.

Coronary 246

Coronary Emergency Department ED OR 246

Pediatric EM Morsels

AUGUST 23, 2024

Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. It does NOT have structural brain damage visible on standard neuroimaging. In the research setting, abnormalities can be found via functional, blood flow, or metabolic imaging.

Emergency Department 270

Emergency Department OR ED EMS 270

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" On arrival to the ED, while waiting for cath lab team, he obtained another ECG: You can now see the full voltage of the high-voltage QRS, likely with some degree of LVH. Both were awake and alert with normal vital signs.

OR 116

OR STEMI EMS ED 116

EMDocs

JUNE 3, 2023

Figure 1: The Young-Burgess classification of pelvic ring fractures (source: [link] 3 It is paramount to differentiate the definitions of “hemodynamically unstable” and “mechanically unstable” pelvic fractures. The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED.

ED 54

ED Operating Room ALS Frozen Plasma 54

The Skeptics' Guide to EM

DECEMBER 21, 2019

Outside of his academic duties, he works clinically in the adult ED at Spectrum Health in Grand Rapids, Michigan, the tertiary care center for Western Michigan. Only then would there be definitive evidence for the efficacy of parachutes. Date: December 17th, 2019 Reference: Reeves and Reynolds. It would be a cross over trial.

OR 100

OR ALS ED 100

REBEL EM

NOVEMBER 13, 2024

Obtain emergency orthopedics consultation for all open joints and administer antibiotics and update tetanus in all patients REBEL Core Cast 131.0 – Traumatic Arthrotomy Click here for Direct Download of the Podcast. cefazolin or cefuroxime) If risk factors for MRSA present, use agent with activity against MRSA (i.e.

ED 102

ED OR EMS 102

ALiEM

NOVEMBER 1, 2024

A 67-year-old male with a past medical history of CHF, MI, hypertension, and diabetes presented to the ED with complaints of headache, chest pain, and dyspnea for the past four days. He stated that he has been without his medications for the past few months due to cost. He denied any past surgical history. Eur Respir J. Epub 2016 Oct 6.

ED 161

ED OR 161

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3%

Allergic Reaction 145

Allergic Reaction Plasma ED Epinephrine 145

EMDocs

FEBRUARY 26, 2024

The ED clinician should inquire about a relevant history of HIV infection, malignancy, high-dose corticosteroid use, chemotherapy, organ transplant, or use of immunosuppressive drugs for other indications. She reports occasional central chest pain exacerbated by coughing. 0 C, and has no jaundice. of PJP patients with sensitivity of 86.5%

E-9-1-1 87

E-9-1-1 ED ALS OR 87

EMDocs

SEPTEMBER 25, 2023

Also known as Facilitated intubation (FI), the use of intubating with only a sedative was an accepted alternative intubation technique prior to those definitive studies in the late 1990s but quickly was abandoned for RSI in all emergent endotracheal intubations (ETI) (8,9).

ED 65

ED Emergency Department ALS Paramedic 65

EMDocs

NOVEMBER 6, 2023

This post will focus on the key parts of the guideline that affect ED evaluation and management. 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. COR Harm, LOE B-R.

Naloxone 93

Naloxone OR Overdose BLS 93

Dr. Smith's ECG Blog

NOVEMBER 10, 2024

Here is her ECG on arrival to the ED: Improved, but still some signal of posterior OMI. Angiogram was done rapidly after arrival to the ED: Culprit mid LCX 90% TIMI 3 flow, PCI performed with resultant TIMI 3 flow. Figure-1: Comparison between the initial EMS ECG and the repeat ECG in the ED. Just not yet. Very frustrating.

STEMI 81

STEMI OR ED EMS 81

Dr. Smith's ECG Blog

MARCH 13, 2023

An ED ECG, if recorded with pain, should show LAD OMI. So this ECG was immediately recorded: Indeed, as predicted, a patient with previous Wellens' waves who now definitely has chest pain has acute Occlusion, with new ST elevation in I, aVL, V2-V5. The Cath lab was activated.

ED 52

ED ACS Coronary Paramedic 52

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] Question: What’s the next step in your evaluation and treatment, and what is the potentially life-threatening diagnosis?

EMS 86

EMS E-9-1-1 Epinephrine OR 86

Pediatric EM Morsels

SEPTEMBER 22, 2023

Definition A series of hemodynamic changes related to autonomic denervation and loss of sympathetic tone. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues. Moral of the Morsel Anatomy Matters!

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

REBEL EM

JANUARY 23, 2023

Key Secondary Endpoints: 5 (3.9%) patients in the IV cetirizine group returned to any ED or clinic within 24 hours compared to 15 (11.1%) in the IV diphenhydramine group; P=0.04 7 (5.5%) patients in the IV cetirizine group returned to any ED or clinic within 48 hours compared to 19 (14.1%) in the IV diphenhydramine group; P=0.02

Allergic Reaction 52

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

Dr. Smith's ECG Blog

JANUARY 27, 2024

Figure-1: I've labeled the initial ECG in the ED. KEY Point: All patients who present to the ED for new CP should promptly have a triage ECG recorded, that is then immediately interpreted by the ED physician. In inferior aneurysm, we usually see QR-waves, whereas for anterior aneurysm, we see QS-waves (no R- or r-wave at all!).

STEMI 101

STEMI Coronary ACS ED 101

Core EM

OCTOBER 2, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3%

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

EMS 12-Lead

JULY 24, 2023

David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic (ret) @DidlakeDW Expert commentary and peer review by Dr. Steve Smith [link] @smithECGBlog A 57 y/o Female with PMHx HTN, HLD, DM, and current use of tobacco products, presented to the ED with chest discomfort. A 12 Lead ECG was captured on her arrival.

Coronary 130

Coronary ACS CAD ED 130

REBEL EM

FEBRUARY 15, 2024

Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications.

ICU 141

ICU ALS ED OR 141

EMDocs

DECEMBER 31, 2023

Without further ado, here is our list of top posts from 2023 based on viewership from you, the readers: Neurogenic Shock: Definition, Identification, and Management in the ED We start off the list with a clinical post from Kira Brayan and Jenny Beck-Esmay on diagnosing and managing neurogenic shock! This post from Mary E.

ED 73

ED EMS OR 73

Dr. Smith's ECG Blog

DECEMBER 29, 2018

The T-waves are not definitively hyperacute. There is definite v oltage for LVH. Clearly, more information is needed before a definite decision can be reached — but the “onus of proof” is on the clinician to rule out acute LAD occlusion. There is a small amount of STE in V2 and V3, with a very small amount of STD in V4-V6.

OR 52

OR STEMI Coronary ED 52

EMDocs

NOVEMBER 1, 2023

A 39-year-old male with history of achalasia with recent endoscopic dilation 24 hours prior presents to the ED for progressively worsening chest pain with radiation to his left shoulder. This series provides evidence-based updates to previous posts so you can stay current with what you need to know.

Critical Care 66

Critical Care ED EMS OR 66

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

The paramedic called the EM physician ahead of arrival and discussed the case and ECGs, and both agreed upon activating "Code STEMI" (even though of course it is not STEMI by definition), so that the acute LAD occlusion could be treated as fast as possible. So the cath lab was activated. Long term outcome is unavailable.

STEMI 116

STEMI EMS ACS ED 116

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

There is definite reperfusion. After discussing all of the above with ED staff, we have made a decision to get stat echocardiogram and assess overall LV function and wall motion abnormalities and defer cath lab activation at the time." There was definite evolution of the ECG. He had been smoking an opiate and suddenly collapsed.

Overdose 52

Overdose OR Coronary ACS 52

ACEP Now

AUGUST 14, 2024

Rate Versus Rhythm in the ED The 2023 AHA/ACC guideline doesn’t give explicit recommendations or preference regarding initial rate or rhythm control strategy for new-onset AF patients who are hemodynamically stable. based care of ED patients with AFRVR. The AHA/ACC cites a meta-analysis including five RCTs of 745 participants.

ALS 105

ALS Emergency Department ED OR 105

Dr. Smith's ECG Blog

JANUARY 31, 2024

Regarding Today's Initial ECG: Today's patient is a 60-something man who presented to the ED with CP ( C hest P ain ) that awakened him from sleep — but which quickly resolved, and was no longer present at the time ECG #1 was recorded. What can be said about ECG #1 — is that anterior MI has definitely occurred at some point in the past.

OR 99

OR ED 99

EMS 12-Lead

APRIL 2, 2022

1, 2] The most clinically useful definition to account for this entire constellation is intraventricular conduction delay. Upon arrival he was found alert and oriented, and without gross distress. He denied difficulty breathing, epigastric pain, or chest discomfort. He denied any chest discomfort, or difficulty breathing. Figure 1-2.

ALS 130

ALS STEMI Coronary OR 130