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.

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

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.

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

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.

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

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 91

EMS E-9-1-1 Emergency Department Ambulance 91

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 90

EMS E-9-1-1 ALS OR 90

REBEL EM

NOVEMBER 6, 2024

1998 Jan-Feb;6(1):15-23. PMID: 32644703 Robinson PM, Griffiths E, Watts AC. 2017 Jul;9(3):195-204. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. PMID: 29681420 Gottschalk HP, Eisner E, Hosalkar HS. 1999 Jan;13(1):58-9. 2022 Aug 2.

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E-9-1-1 ACS OR Emergency Department 118

EMDocs

APRIL 13, 2024

We’ll keep it short, while you keep that EM brain sharp. 1] In a survey of college wrestlers, the incidence of auricular hematoma was found to be 52% for those who do not wear headgear versus 26% who wore ear protection.[2] 1] Disposition: A 7-10 day course of prophylactic antibiotics is recommended due to limited vascular supply.[7]

EMS 83

EMS E-9-1-1 OR Emergency Department 83

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.

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E-9-1-1 EMS ALS Defibrillator 85

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.

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E-9-1-1 ACS Emergency Department Coronary 138

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.

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E-9-1-1 EMS Emergency Department OR 72

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.

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E-9-1-1 ALS Coronary EMS 130

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

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. She calls out her findings: A – OK B – 1 puncture mark to the anterior left chest wall, covered with a three-sided dressing. Actively oozing.

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

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 69

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

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 70

EMS E-9-1-1 ALS Emergency Department 70

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 91

E-9-1-1 Overdose ED OR 91

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.

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E-9-1-1 ALS ED OR 103

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!

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

REBEL EM

SEPTEMBER 13, 2023

patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01

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Frozen Plasma Allergic Reaction FFP Plasma 105

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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E-9-1-1 ED ALS Operating Room 78

REBEL EM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Recurrence of pneumothorax within 1 year. Pneumothorax recurrence within 1 year: 20% for aspirations, 27% for chest tubes. Panacek, E. Strange, C.,

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

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.

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E-9-1-1 ICU Emergency Department ED 84

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.

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E-9-1-1 Emergency Department Plasma ED 71

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

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E-9-1-1 ICU ACS EMS 76

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 68

E-9-1-1 Overdose Emergency Medical Services Life Support 68

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

EMDocs

OCTOBER 30, 2023

Pillai, MBBS (@sspillai01, EM Resident Physician, University of Kentucky) and Christopher N. 1 The shortage in supply posed difficulties for hospitals that significantly depend on GE Healthcare as their supplier, which encompassed approximately 50% of hospitals in the United States (US). 11 Table 1. 11 Table 1.

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E-9-1-1 Emergency Department ALS CCT 74

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.

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E-9-1-1 ED ALS OR 88

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 97

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

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al.

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

REBEL EM

FEBRUARY 21, 2024

Read More REBEL EM: The Ketorolac Analgesic Ceiling References Irizarry E et al. Acad Emerg Med 2021; 28(11): 1228-35. Can J Emerg Med 2007; 9(1): 30-2. NSAID use and efficacy in the emergency department: single doses of oral ibuprofen versus intramuscular ketorolac.

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E-9-1-1 Emergency Department ALS ED 63

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 98

Critical Care E-9-1-1 Paramedicine Paramedicine 98

ACEP Now

OCTOBER 11, 2024

Introduction Pediatric intubations in the emergency department (ED) occur at only a tenth the frequency of adult intubations. 1 Pediatric rapid sequence intubation (RSI) in the ED is associated with a higher frequency of failed first attempts and adverse effects than in adult patients. References Long E, Sabato S, Babl FE.

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E-9-1-1 Emergency Department Advanced Life Support ALS 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.

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

EMDocs

JUNE 1, 2023

Bradycardia: 18.8% Average ventilator days (8.3 Take Aways: The data do not suggest that targeted hypothermia improves neurological function, reduces death, or reduces hospital length of stay as compared to normothermia. Bradycardia: 18.8% Average ventilator days (8.3 Bradycardia: 18.8% Average ventilator days (8.3 Bradycardia: 18.8%

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E-9-1-1 Emergency Medical Services Emergency Department OR 61

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.

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

EMDocs

DECEMBER 6, 2024

1 The incidence of iron overdose and iron ingestion related deaths has significantly decreased over time, likely attributable to federal regulation. 1 Commercially available formulations of iron have varying elemental components. 1 Table 1: Iron content of various preparations. Be wary of this stage.

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E-9-1-1 Frozen Plasma Plasma Overdose 77