Pediatric EM Morsels

SEPTEMBER 22, 2023

To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Alpha 1 agonists are necessary to maintain appropriate blood pressure. Tenenbein M, Macias CG, Sharieff GQ, et al, eds.

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

EMDocs

MARCH 2, 2024

We’ll keep it short, while you keep that EM brain sharp. A 58-year-old female with a history of diabetes, hypertension, and chronic back pain presents to the ED with severe headache and nausea. Answer : Pneumocephalus 1-21 Background: Pneumocephalus is defined by the presence of air within the cranial cavity.

EMS 119

EMS E-9-1-1 OR ED 119

EMDocs

OCTOBER 19, 2024

We’ll keep it short, while you keep that EM brain sharp. to 1 case per 100,000 children. 2][3][9] Hypoxia, respiratory muscle retractions, fatigue, altered mental status, and decreased breath sounds are signs indicative of impending airway failure. [2] A 6-year-old girl presents to the ED with 1 day of fevers up to 104.1°F

EMS 110

EMS E-9-1-1 Epinephrine OR 110

REBEL EM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

ED 129

ED E-9-1-1 Emergency Department ALS 129

EMDocs

APRIL 13, 2024

We’ll keep it short, while you keep that EM brain sharp. A 24-year-old male presents to the ED from a mixed marital arts competition after being struck on the side of the right head by a fist earlier today. 1] Disposition: A 7-10 day course of prophylactic antibiotics is recommended due to limited vascular supply.[7]

EMS 104

EMS E-9-1-1 OR Emergency Department 104

EMDocs

MAY 25, 2024

We’ll keep it short, while you keep that EM brain sharp. A 70-year-old female with past medical history diabetes mellitus, hypertension, hyperlipidemia, dementia presents from nursing home with acute unilateral swelling along the left side of her face. Massaging the gland causes expression of purulent material. What is the diagnosis?

EMS 98

EMS E-9-1-1 OR ED 98

Pediatric EM Morsels

AUGUST 4, 2023

Let’s take a take a minute to review Superior Mesenteric Artery Syndrome presenting in the ED so we will be prepared when you see it! Oka, 2023) A systematic review linked SMA syndrome to the immediate post-operative period after surgery for scoliosis in pediatric patients, and found the mean days to onset of symptoms was 9.

E-9-1-1 246

E-9-1-1 ED OR EMS 246

EMDocs

MAY 11, 2024

We’ll keep it short, while you keep that EM brain sharp. A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. Vital signs include BP 168/89, HR 96, T 98.3,

EMS 110

EMS E-9-1-1 ALS OR 110

ALiEM

MARCH 7, 2024

Ultrasound probes from left to right: linear (nenoates), phased array (infants/younger children), and curvilinear (older children/adolescents) Pro tips for performing renal/bladder POCUS on a child [1] Addressing potential anxiety leads to a more efficient and comfortable examination. Estimated volume = 39.2

E-9-1-1 177

E-9-1-1 Emergency Department ALS ED 177

EMDocs

SEPTEMBER 7, 2024

We’ll keep it short, while you keep that EM brain sharp. A 70-year-old female with a past medical history of hypertension, coronary artery disease s/p 2x drug eluting stent placement one month ago, atrial fibrillation on apixaban presents to the ED with weakness and lightheadedness. Vital signs include BP 90/48, HR 122, T 98.3

EMS 97

EMS E-9-1-1 Operating Room OR 97

EMDocs

SEPTEMBER 23, 2023

We’ll keep it short, while you keep that EM brain sharp. A 36-year-old female presents to the ED after experiencing an episode of sudden syncope. Answer : Brugada Syndrome Epidemiology and Etiology Rare genetic disorder that affects approximately 1 in 5,000 individuals worldwide 1.

E-9-1-1 105

E-9-1-1 EMS ALS Defibrillator 105

Pediatric EM Morsels

AUGUST 9, 2024

Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Usually in 1st week of lif e Copious, white-ish drainage Teeming with spirochetes! gross ) Rash Occurs 1-2 weeks after rhinitis. Congenital Syphilis may still occur in patients presenting to your ED! 2024 Jan 16;17(1):e257694.

E-9-1-1 154

E-9-1-1 Plasma Emergency Department OR 154

EMDocs

JULY 29, 2023

We’ll keep it short, while you keep that EM brain sharp. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E.

E-9-1-1 96

E-9-1-1 EMS Emergency Department OR 96

EMDocs

JULY 13, 2024

We’ll keep it short, while you keep that EM brain sharp. A 37-year-old G2P2 female with no other past medical history presents to the ED with a 2-day history of intermittent fever and foul-smelling vaginal discharge. 1997 Mar;11(1):203-22. On pelvic exam, she has moderate thick, foul-smelling purulent discharge. 2000;8(2):77-82.

EMS 89

EMS E-9-1-1 Plasma OR 89

EMDocs

NOVEMBER 18, 2023

We’ll keep it short, while you keep that EM brain sharp. A 32-year-old female with a history of hypertension and autoimmune hepatitis status post liver transplant 6 weeks prior on tacrolimus and mycophenolate presents to the ED with abdominal discomfort. What are the complications of liver transplant that we see in the ED?

EMS 95

EMS E-9-1-1 ALS Emergency Department 95

EMDocs

NOVEMBER 4, 2023

We’ll keep it short, while you keep that EM brain sharp. He came to the ED because he now has a fever, chills, and nausea along with his testicular pain. A 54-year-old male with a history of diabetes presents with “pain in my groin” for the past two weeks. An ultrasound of the testes reveals the following: What is the diagnosis?

EMS 94

EMS E-9-1-1 Emergency Department ALS 94

EMDocs

FEBRUARY 26, 2024

Authors: Kamoga Dickson, MD (EM Resident Physician, Makerere University of Health Sciences); Jessica Pelletier, DO (EM Education Fellow, Washington University in St. They attach to type 1 pneumocytes, resulting in diffuse alveolar damage through the erosion of these pneumocytes. 0 C, and has no jaundice.

E-9-1-1 110

E-9-1-1 ED ALS OR 110

ALiEM

MAY 13, 2024

Her symptoms started 1 week ago as a scratch which progressively got more red and painful. Pediatric Soft Tissue POCUS Ultrasound Technique Figure 1. Cellulitis with cobblestoning Video 1. Abscess with irregular borders and surrounding cellulitis E. Superficial abscess with well-circumscribed borders Table 1.

E-9-1-1 161

E-9-1-1 ALS Emergency Department OR 161

Dr. Smith's ECG Blog

DECEMBER 19, 2023

[link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. EMS obtained the following vital signs: pulse 50, respiratory rate 16, blood pressure 96/49. cTnI drawn at the same was 0.011 ng/mL (ref.

E-9-1-1 127

E-9-1-1 Coronary ACS BLS 127

EMS 12-Lead

APRIL 28, 2022

David Didlake, NRP, APRN, ACNP-BC @DidlakeDW Expert analysis provided by Dr. Ken Grauer [link] @ekgpress EMS is called to the main reception area of a retirement center where an elderly female is found down, unconscious and unresponsive. Beats #1-thru-7 manifest the same morphology as we saw in the 12-lead tracing (A) for leads I and II.

E-9-1-1 130

E-9-1-1 ALS Coronary EMS 130

EMDocs

APRIL 10, 2024

Authors: Alex Rogers, MD (EM Resident Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX); J.D. 1-5] Since then, many more medications have been developed and deployed. 1-5] This post focuses on the identification and management of Local Anesthetic Systemic Toxicity (LAST).

E-9-1-1 111

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

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

EMDocs

FEBRUARY 15, 2024

1 These plants contain tropane alkaloids such as atropine (mixture of d-hyoscyamine and l-hyoscyamine) and scopolamine which are muscarinic receptor antagonists. 2 Jimson weed ( Datura stramonium, Figure 1) is one of several anticholinergic plants that if ingested can cause anticholinergic toxicity. 3 Figure 1. 3 Figure 1.

E-9-1-1 110

E-9-1-1 Overdose ED OR 110

Dr. Smith's ECG Blog

OCTOBER 1, 2024

== MY Comment , by K EN G RAUER, MD ( 8/30 /2024 ): == I was sent the ECG shown in Figure-1 — knowing only that the patient was being seen in the ED ( E mergency D epartment ). Figure-1: The initial ECG in today's case. After seeing ECG #2 — Can you explain: i ) Why no negative P wave was seen in lead V1 of ECG #1? —

E-9-1-1 113

E-9-1-1 STEMI ED OR 113

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

When EMS found her, she was dyspneic and diaphoretic. Here is lead I from ECGs 1 and 2 shown side-by-side to highlight the change in axis from borderline right to completely normal. Figure-1: I've labeled the initial ECG in today's case. She was out walking her dog when she developed sudden dizziness and light-headedness.

E-9-1-1 128

E-9-1-1 Coronary STEMI ALS 128

REBEL EM

MAY 27, 2024

Clinical Question: Does simultaneously performing the modified valsalva maneuver and administering intravenous adenosine, compared to either treatment alone, have greater success in achieving normal sinus rhythm in patients presenting to the ED with PSVT? 2010;17(1):44-49. Duration of Antiarrhythmic Effect: MVM group: 35.44

OR 137

OR E-9-1-1 ED ALS 137

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Here is the first ED ECG recorded, now pain free after sublingual Nitro: There is what appears to be a reperfusion T-wave in I and aVL. Learning Point: 1. For examples of such exceptions — See My Comment in the January 9, 2019 — August 22, 2020 — and June 30, 2023 posts in Dr. Smith's ECG Blog ).

E-9-1-1 116

E-9-1-1 Coronary EMS ED 116

Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. C Examination notable for diaphoresis, 1+ bilateral lower extremity edema, regular heart rate and rhythm, and no signs of respiratory distress with normal breath sounds. What do you think? In fact, Kosuge et al. Stein et al.

E-9-1-1 139

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

Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. A PEM Adventure Ranulf is a 14-year-old explorer.

E-9-1-1 139

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

ACEP Now

NOVEMBER 8, 2024

Emergency medical services (EMS) scope of practice is governed by the state, but national scope of practice guidelines are available for the four different EMS provider levels. 9 LMAs use an inflatable mask expanded using a similar technique to the endotracheal tube cuff. EMS Airway Management: System Considerations.

E-9-1-1 40

E-9-1-1 Emergency Medical Services Emergency Medical Technician AEMT 40

REBEL EM

AUGUST 30, 2023

Epidemiology 1 to 2.4 cases per 100,000 people ( Zimmerli 2010 ) More common in males with M:F of 3:1 Rate is also increasing due to increased number of spinal procedures Typically affects adults, with most cases occurring in patients over 50 years old. Other pathogens include: E. Often used interchangeably with osteomyelitis.

E-9-1-1 96

E-9-1-1 ALS ED OR 96

Broome Docs

DECEMBER 22, 2024

2024 Oct 9. PARAMEDIC 3 randomized 6,000 (but they were supposed to get to 15,000) patients with out of hospital arrest from multiple EMS agencies in the UK to either an IO or IV to start. There were no differences in survival (12% with IO vs 10% with IV) or neurologically intact survival (9% vs 8%). 2024 Nov 1.

E-9-1-1 52

E-9-1-1 ACS Paramedic Emergency Department 52

EMDocs

JANUARY 17, 2024

When emergency medical services (EMS) arrived, she was in asystole with an empty, recently full, bottle of benzonatate 100 mg capsules. She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). What are the treatment options for a benzonatate overdose?

E-9-1-1 89

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

EMDocs

OCTOBER 30, 2023

Pillai, MBBS (@sspillai01, EM Resident Physician, University of Kentucky) and Christopher N. ” – Musings of an American ED resident in July 2022 when US healthcare was affected simultaneously by supply chain issues from GE Healthcare (contrast media) and Abbott Laboratories (Similac baby formula). Authors: Saran S.

E-9-1-1 99

E-9-1-1 Emergency Department ALS CCT 99

EMDocs

MARCH 4, 2024

Authors: Amelia Campbell, MD (EM Resident Physician, Carl R. Darnall Army Medical Center) and Alec Pawlukiewicz, MD (EM Attending Physician, Carl R. Case: A 45-year-old woman presents to the emergency department (ED) with itching to bilateral palms. 9 How are cholestatic labs defined? How does cholestasis present?

Emergency Department 105

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

REBEL EM

SEPTEMBER 13, 2023

Features Urticaria and pruritis Rapid onset (1-2 hours) IgE Dependent (Type I Hypersensitivity) Reactions An allergen cross-links two or more IgE molecules on mast cells or basophils and initiates a signal cascade leading to degranulation. J Allergy Clin Immune Tract 2017; 5(5): 1402-9. In: UptoDate, Feldweg AM (ed.)

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

EMS 12-Lead

AUGUST 22, 2022

Question 1: What is the rhythm? Beat 1 : Sinus, narrow QRS complex. The assumption is that a premature complex discharged prior to Beat 1, which prolonged its respective refractory period in the same manner as Beat 5. We can, therefore, put down the defibrillation pads, set aside the amiodarone, and look further at the ECG.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130