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. Pre-warmed ultrasound gel is helpful when available.

E-9-1-1 177

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

EMDocs

MARCH 4, 2024

Darnall Army Medical Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, (@long_brit) Disclaimer: The views expressed in this post are those of the authors and do not reflect the official policy or position of the Department of the Army, DoD, or the US Government.

Emergency Department 88

Emergency Department E-9-1-1 ALS OR 88

Pediatric EM Morsels

AUGUST 9, 2024

Neonates presenting to the Emergency Department often cause a lot of uncertainty. Let’s review how Congenital Syphilis may present to our Emergency Departments: Congenital Syphilis : Basics Occurs when the spirochete Treponema pallidum is transmitted from mother to fetus. Is this scalp swelling normal?

E-9-1-1 152

E-9-1-1 Plasma Emergency Department OR 152

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. ECG 1 What do you think?

E-9-1-1 115

E-9-1-1 OR Coronary ACS 115

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

DECEMBER 18, 2024

A 36-year-old male presents to the emergency department after being found down at home by his spouse. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. Per the mans wife, the patient is a heavy drinker often consuming two to three pints of vodka daily.

E-9-1-1 80

E-9-1-1 Emergency Department ICU ED 80

Pediatric EM Morsels

FEBRUARY 2, 2024

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. A study of swiss tourists found they compromised 53.4%

E-9-1-1 161

E-9-1-1 ED OR Emergency Department 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. 1.70) and 0.78 (0.46–1.35),

E-9-1-1 183

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

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 113

E-9-1-1 ACS OR Emergency Department 113

Broome Docs

SEPTEMBER 3, 2024

In a surprise to no one who reads First10EM, clinical judgment is better than all decision tools for sepsis Knack SKS, Scott N, Driver BE, Prekker ME, Black LP, Hopson C, Maruggi E, Kaus O, Tordsen W, Puskarich MA. Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients.

E-9-1-1 109

E-9-1-1 Emergency Department ICU ALS 109

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-9-1-1 136

E-9-1-1 ACS Emergency Department Coronary 136

Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. Intensive Care Research , 1 (3-4), pp.60-64. His name is Ben. While waiting, another call comes in.

E-9-1-1 135

E-9-1-1 Emergency Department ED CPR 135

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. RR 25-30. Actively oozing.

E-9-1-1 139

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

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 128

ED E-9-1-1 Emergency Department ALS 128

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.

E-9-1-1 130

E-9-1-1 ALS Coronary EMS 130

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

Don't Forget the Bubbles

SEPTEMBER 13, 2023

The parents of 18-month-old Susie brought her to the Emergency Department after she had a seizure at home. When considering tumours, 37 observation studies involving 2661 children found that 3% (95% CI 1-7%) had tumours. She has had two days of coryzal symptoms and fever. What is the evidence for avoiding imaging?

E-9-1-1 131

E-9-1-1 Emergency Department ALS OR 131

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 95

E-9-1-1 ALS ED OR 95

ACEP Now

DECEMBER 17, 2024

We deal with difficult and traumatizing situations daily, and nowhere is this more apparent than in the emergency department, where sickness, violence, and death are routine. 1 His tragic loss underscores the urgent need for mental health support for residents and fellows. Accessed December 9, 2024. died by suicide.

E-9-1-1 105

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

Broome Docs

MARCH 28, 2024

Until we see more science, it seems very reasonable to provide honey, jam, or sucralfate (which wasn’t studied here), every 10 minutes while arranging for that emergent scope. Am J Emerg Med. PMID: 34890894 Myth 1: Kayexalate is safe and useful. 2024 Jan 2;53(1):afad255. 2022 Feb;52:85-91. doi: 10.1016/j.ajem.2021.11.030.

E-9-1-1 107

E-9-1-1 ICU Emergency Department ALS 107

Don't Forget the Bubbles

JULY 17, 2023

You will find the list is broken down into four sections: 1.Reviews 2023 Jun 1. 2023 Jun 1;76(6):731-736 The Association Between Media-Based Exposure to Nonsuicidal Self-Injury and Emergency Department Visits for Self-Harm. 2023 Jun 9. 2023 Jun 6:1-11. 2023 Jun 9. Low yield from imaging after non -E.

E-9-1-1 98

E-9-1-1 ALS Emergency Department Emergency Medical Services 98

EMDocs

OCTOBER 8, 2024

Discharging a patient with abnormal vital signs has been linked to unanticipated death (1-4). Regarding emergent underlying causes, it may be helpful to think of etiologies of tachycardia as anything that could cause a need for increased cardiac output. At this point there are two large questions. #1. Am I missing anything? #2.

E-9-1-1 96

E-9-1-1 Emergency Department ED ALS 96

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

Frozen Plasma 104

Frozen Plasma Allergic Reaction FFP Plasma 104

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?

EMS 91

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

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. Population: Inclusion: Patients between 18–50 years of age.

E-9-1-1 103

E-9-1-1 ALS Emergency Department OR 103

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 ). Here are ten things to think about: 1. Churruca K, Pavithra A, McMullan R, Urwin R, Tippett S, Cunningham N, Loh E, Westbrook J.

E-9-1-1 105

E-9-1-1 Critical Care CPR ICU 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.

E-9-1-1 84

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

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 78

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

Don't Forget the Bubbles

JANUARY 17, 2024

Curious Ken is brought into your emergency department. Around 80% of those reported pass spontaneously, with another 10-20% requiring endoscopic removal and only 1% requiring surgical intervention. BMC Pediatrics , 21 (1), Jackson, J., Pediatric Emergency Care, 31 (8), pp.605-607. Image adapted from Mullens et al.,

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

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, 4, 9 Organophosphates are one of many types of insecticide and are used worldwide to manage crops. He has a glove and stocking pattern of numbness to his extremities.

E-9-1-1 71

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

FOAMfrat

MAY 19, 2024

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. Upon arrival in the pediatric emergency department, the patient was conscious and alert to her normal mental status, which included being nonverbal.

E-9-1-1 98

E-9-1-1 ALS Emergency Department EMT 98

EMDocs

SEPTEMBER 23, 2023

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. Type 1 “Brugada sign” The only type that is considered diagnostic.

E-9-1-1 85

E-9-1-1 EMS ALS Defibrillator 85

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 96

E-9-1-1 EMR Emergency Department ED 96

EMDocs

APRIL 13, 2024

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] 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]

EMS 83

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

Don't Forget the Bubbles

JULY 22, 2024

study from 200 9. However, there was no difference in LOS (83 minutes for placebo vs 79 minutes for prednisolone) in participants who were discharged straight from the ED ( 32% ). Compare this with the Panickar et al. The children were younger (10-72 months, mean 25 months) were younger.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

ACEP Now

FEBRUARY 13, 2024

A 77-year-old man presented to the emergency department (ED) with hip pain following a fall. A radiograph is shown (see figure 1). LEARN MORE The most common nerve blocks in this study are shown in Table 1. LEARN MORE The most common nerve blocks in this study are shown in Table 1. 2023 Sep 2;15(9):e44583.

E-9-1-1 52

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

EMDocs

JULY 29, 2023

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. Other bacterial causes include anaerobic oral flora, Strep viridans, E. RR 18, SpO2 97% on RA.

E-9-1-1 72

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