ACEP Now

OCTOBER 9, 2023

emergencies, patient’s request). However, actual increases in available services in emergency departments based on prior state-level requirements have been mixed. The active role of interpreters in medical discourse – An observational study in emergency medicine. 2022;105(1):62-73. Annals of EM.

Emergency Department 64

Emergency Department E-9-1-1 ALS OR 64

EMDocs

MARCH 30, 2024

We’ll keep it short, while you keep that EM brain sharp. 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. Diagnosis includes imaging.

EMS 90

EMS E-9-1-1 Emergency Department Ambulance 90

EMDocs

SEPTEMBER 23, 2023

We’ll keep it short, while you keep that EM brain sharp. Answer : Brugada Syndrome Epidemiology and Etiology Rare genetic disorder that affects approximately 1 in 5,000 individuals worldwide 1. More common in males than females, with a male-to-female ratio of approximately 8:1 1.

E-9-1-1 84

E-9-1-1 EMS ALS OR 84

EMDocs

JULY 29, 2023

We’ll keep it short, while you keep that EM brain sharp. A 75-year-old male with past history of HTN, CVA, DM II presents to the emergency department with right facial swelling since last night. Other bacterial causes include anaerobic oral flora, Strep viridans, E.

E-9-1-1 71

E-9-1-1 EMS Emergency Department OR 71

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. The SB tube was created in 1950 in order to help tamponade variceal bleeds [1]. Pearl 1: Check the units of pressure being used. The conversion rate is: 1 cmH2O = 0.74

E-9-1-1 245

E-9-1-1 Emergency Department ICU OR 245

ALiEM

MAY 13, 2024

Case Introduction: Child with abdominal pain Wendy is a 7-year-old girl who comes into the emergency department with redness, swelling, and pain on her left calf. Her symptoms started 1 week ago as a scratch which progressively got more red and painful. Pediatric Soft Tissue POCUS Ultrasound Technique Figure 1.

E-9-1-1 161

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

EMDocs

NOVEMBER 4, 2023

We’ll keep it short, while you keep that EM brain sharp. A 54-year-old male with a history of diabetes presents with “pain in my groin” for the past two weeks. He reports approximately one month of dysuria, and around two weeks ago noticed a dull aching sensation in his testicles that has progressively gotten worse.

EMS 68

EMS E-9-1-1 Emergency Department ALS 68

EMDocs

NOVEMBER 18, 2023

We’ll keep it short, while you keep that EM brain sharp. 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? On exam the patient is tachycardic with RUQ pain to palpation and scleral icterus.

EMS 69

EMS E-9-1-1 ALS Emergency Department 69

Pediatric EM Morsels

FEBRUARY 2, 2024

2021 May; 8:1-16. While there is no “right” work up for these patients, hopefully this morsel will help illuminate your evaluation of Travel-Related Illness in Children: Travel-related Illness: Basics International travel has been significantly increasing since commercial airlines made travel much easier. References Abdel-Haq N, Asmar BI.

E-9-1-1 161

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

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.

E-9-1-1 139

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

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 90

E-9-1-1 Overdose ED OR 90

EMDocs

JUNE 27, 2024

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? 2022 Jul 5;328(1):57-68. C or 100.4 mg/kg, max 0.4

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

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.

E-9-1-1 77

E-9-1-1 ED ALS Operating Room 77

FOAMfrat

MAY 19, 2024

Many of us grew up in the age of EMS, which emphasized the need to memorize everything. While transporting to the emergency department, the patient’s mother informed me that PDCD affects less than 1 in 50,000 individuals and is more common in males than females. The reality is, nothing could be farther from the truth!

E-9-1-1 97

E-9-1-1 ALS Emergency Department EMT 97

EMDocs

JUNE 14, 2023

Patellar reflexes are 1+. 1, 2, 4, 9 Organophosphates are one of many types of insecticide and are used worldwide to manage crops. 1, 2 Symmetric sensorimotor axonopathy: leg cramping to extremity weakness and paralysis. 1, 2 Sensory > Motor neurons with predilection for long axons. Muscle tone is normal.

E-9-1-1 70

E-9-1-1 Emergency Department Plasma ED 70

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). Benzodiazepines are first-line therapy for seizures.

E-9-1-1 67

E-9-1-1 Overdose Emergency Medical Services Life Support 67

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. Orthopedic Emergencies 2015 May; 33(2) 311-26.

E-9-1-1 94

E-9-1-1 ALS ED OR 94

EMDocs

JUNE 7, 2023

1-5 Farmers also treat sheep for parasites using OPs and may become symptomatic after exposure, an illness called Dipper’s Flu. 8 Intermediate syndrome Occurs 1 to 5 days after acute exposure in up to 40% on individuals. 7, 9 Often have absence of excessive cholinergic stimulation. 7 May lead to respiratory failure.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

ACEP Now

JANUARY 14, 2024

Many common presentations to the emergency department (ED) are related to drug interactions that are commonly missed and largely preventable. 1-3 We may be unaware of potentially dangerous drug interactions when we order and prescribe medications in the ED. Acad Emerg Med. Ann Emerg Med. 2008;178:1563-9.

E-9-1-1 52

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

ACEP Now

AUGUST 29, 2023

9—Kickoff Party with a speakeasy theme at the Old Reading Terminal Oct. Check Out This New Opioids Education Series from E-QUAL ACEP’s Emergency Quality Network (E-QUAL) is serving up some fresh educational content as part of its Opioid Initiative. 10—Dine Around Dinners featuring the best of the Philly food scene Oct.

E-9-1-1 52

E-9-1-1 Naloxone Emergency Department EMS 52

ACEP Now

JULY 7, 2024

One night I found myself on the other side of the stretcher, as a patient waiting for a psychiatric assessment in an emergency department (ED). 9 By speaking out, I hope to once again find my calling in medicine. and her emergency medicine residency in Syracuse, N.Y., 2024;15(1):3-16. Muir-Cochrane E, Oster C.

E-9-1-1 52

E-9-1-1 First Responder ALS Emergency Department 52

EMDocs

SEPTEMBER 7, 2023

1 Clinical Questions: When should a clinician suspect diethylene glycol (DEG) toxicity? Toxicity typically evolves through three phases: 2,3,7,8,9 Phase 1: Gastrointestinal symptoms (e.g., 1 Of the 57 children, 96% had confirmed exposures to the acetaminophen-based teething medication.

E-9-1-1 66

E-9-1-1 ALS Emergency Department Plasma 66

EMDocs

AUGUST 22, 2024

1 However, we recognize that many patients prefer to speak a language other than English regardless of their English proficiency, and this does not indicate a deficiency. 9 Less likely to be satisfied with their care and have a lower understanding of their discharge instructions. Annals of Emergency Medicine. 45:446-458.

Emergency Department 82

Emergency Department ALS E-9-1-1 ED 82

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.

E-9-1-1 97

E-9-1-1 EMR Emergency Department ED 97

Don't Forget the Bubbles

SEPTEMBER 18, 2023

This blog post aims to help familiarise you with some of the most common reasons for prescribing antibiotics in the paediatric emergency department. Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review. Addo-Yobo E, Chisaka N, Hassan M, Hibberd P, Lozano JM, Jeena P, et al.

Emergency Department 142

Emergency Department E-9-1-1 ALS OR 142

EMDocs

JULY 3, 2023

Authors: Mikalah Ward, MD (EM Resident Physician, University of Kentucky); Susan Owens, MD (EM Attending Physician, University of Kentucky) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. 2022 Jan;39(1-2):35-48. His last known normal was 5 hours prior to ED presentation.

ED 85

ED E-9-1-1 ALS OR 85

Don't Forget the Bubbles

AUGUST 28, 2023

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). See their website for more: [link] References Carter BW, Marom EM, Detterbeck FC. 2014;9(9):S102-S109. 2019;43(1):98-103.doi:10.1097/RCT.0000000000000782

Emergency Management 96

Emergency Management Emergency Manager E-9-1-1 Critical Care 96

Broome Docs

OCTOBER 31, 2022

Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. 2022 Jan;48(1):78-91. PMID: 34904190 Not surprisingly, this paper has been covered by basically everyone who talks about research, so if you want to hear some other opinions, check out the SGEM , REBEL EM , or St. Emerg Med J.

E-9-1-1 52

E-9-1-1 Defibrillator ICU Critical Care 52

REBEL EM

JANUARY 30, 2023

PSA, also referred to as intravenous sedation in this paper, requires considerable resources, including 1:1 nursing observation, and burdens the emergency department (ED). weight of the entire meta-analysis, and 9/12 carried more than 8% weight. J Emerg Med. 1995 Jan-Feb;13(1):37-42. PMID: 7782623.

E-9-1-1 55

E-9-1-1 Emergency Department ED OR 55

EMDocs

AUGUST 7, 2023

Schnapp, MD, MEd (Associate Program Director, University of Wisconsin) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF), Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 36-year-old pregnant woman at 21 weeks gestation presents to the ED with chest pain.

E-9-1-1 69

E-9-1-1 ALS Plasma OR 69

Don't Forget the Bubbles

MAY 29, 2023

A study of teams over a 1-year period highlights that people witnessing incivility are also affected, which could lead to individuals feeling unsupported in their teams. 2021:36:1–2, NP448–NP473 Available at. Review of Cultivating Communities of Practice: A Guide to Managing Knowledge, by Wenger E, McDermott R, Snyder WM].

Critical Care 97

Critical Care E-9-1-1 Paramedicine Paramedicine 97

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

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.

E-9-1-1 52

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

Dr. Smith's ECG Blog

JULY 18, 2014

He had walked into the ED (did not use EMS). Although acute anterior STEMI frequently has narrow QR-waves within one hour of onset (1. He found 2 ECG patterns of atypical T-wave development in PIRP: 1) persistently positive (upright) T-waves 48 hours after AMI onset. Lessons : 1. J Am Coll Cardiol 53(17):1503-9.

STEMI 52

STEMI E-9-1-1 ALS Coronary 52

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. Acad Emerg Med. 1994 Jul;125(1):57-62. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. Paediatr Anaesth.

E-9-1-1 183

E-9-1-1 Operating Room Emergency Department ALS 183

EMDocs

JULY 15, 2023

We’ll keep it short, while you keep that EM brain sharp. aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. pneumoniae , S. pneumoniae , S. pneumoniae , S.

E-9-1-1 66

E-9-1-1 EMS OR ED 66

EMDocs

JANUARY 6, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University School of Medicine, St. Louis, MO); Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine, St. We’ll keep it short, while you keep that EM brain sharp. A 64-year-old male presents by EMS to the ED with shortness of breath.

EMS 63

EMS E-9-1-1 ACS Coronary 63