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

AUGUST 9, 2023

Child with Cough and Fever: Case Introduction A 6-year-old boy presents to the emergency department complaining of cough for 3 days and fever for the last day. Technique Positioning and Probe Figure 1: Younger children can sit in their parent’s lap and give a hug for lateral and posterior lung scanning.

E-9-1-1 246

E-9-1-1 Emergency Department ALS OR 246

ALiEM

APRIL 12, 2024

Traditionally large-bore tube thoracostomy has been the standard of care for treating many acute intrathoracic pathologies [1]. Pigtails provide a less invasive and often better tolerated alternative to traditional chest tubes and allow for adequate treatment of pneumothoraces and uncomplicated pleural effusions [1-5]. 1999;3(1):57-61.

E-9-1-1 183

E-9-1-1 ALS Critical Care Emergency Department 183

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 103

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

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-9-1-1 132

E-9-1-1 OR Coronary ACS 132

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

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

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-9-1-1 154

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

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

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-9-1-1 187

E-9-1-1 Operating Room Emergency Department ALS 187

ACEP Now

DECEMBER 7, 2024

1 A wide spectrum of severity exists in PE presentations, ranging from mild shortness of breath to cardiac arrest. Approximately 60,000 to 100,000 patients die from pulmonary embolism (PE) each year in the United States, and PE is the third leading cause of cardiovascular mortality.

E-9-1-1 52

E-9-1-1 ALS Critical Care OR 52

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-9-1-1 140

E-9-1-1 ACS Emergency Department Coronary 140

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

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 95

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

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

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-9-1-1 108

E-9-1-1 Overdose ED OR 108

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

Broome Docs

DECEMBER 22, 2024

2024 Oct 9. There were no differences in survival (12% with IO vs 10% with IV) or neurologically intact survival (9% vs 8%). There is a bunch more – so have a listen or watch us on Youtube feed below. You can read all the papers on the links in the show notes right here. doi: 10.1001/jama.2024.20424. 2024.20424. of the IV group).

E-9-1-1 52

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

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 125

ED E-9-1-1 Emergency Department ALS 125

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 104

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

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

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-9-1-1 105

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

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-9-1-1 102

E-9-1-1 EMS ALS Defibrillator 102

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 101

EMS E-9-1-1 OR Emergency Department 101

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 90

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

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 101

Frozen Plasma Allergic Reaction FFP Plasma 101

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 88

E-9-1-1 ALS ED OR 88

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

MAY 11, 2024

CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis? On exam, the patient opens eyes to voice, has extraocular movements intact, is unable to speak, and has 0/5 strength in all extremities. The patient was intubated for acute hypercapnic and hypoxic respiratory failure and airway protection.

EMS 107

EMS E-9-1-1 ALS OR 107

EMDocs

NOVEMBER 4, 2023

Answer : Testicular abscess Epidemiology Abscesses limited to scrotal wall are similar to other abscesses on areas of the body Local trauma can increase risk of infection, normally start as progressive swelling of a small pustule 2 Staph aureus is the most common cause in spontaneous skin abscesses 3,4 Intrascrotal abscesses can occur as a result of (..)

EMS 87

EMS E-9-1-1 Emergency Department ALS 87

EMDocs

NOVEMBER 18, 2023

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? She came today because her sister is a nurse who noticed her eyes were yellow. She denies fever or a new rash. LFTs are in the thousands.

EMS 89

EMS E-9-1-1 ALS Emergency Department 89

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

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 96

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

EMDocs

OCTOBER 30, 2023

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. Preparation 9 Hospitals had to prepare for the impending contrast shortage as soon as potential shortage news occurred.

E-9-1-1 92

E-9-1-1 Emergency Department ALS CCT 92

EMDocs

FEBRUARY 26, 2024

1 While PJP gained significant recognition among HIV-positive adults during the early AIDS epidemic, the growing utilization of immunosuppressants has resulted in an increased incidence of the disease in individuals who are HIV-negative. 9 The signs and symptoms of PJP infection are non-specific. 0 C, and has no jaundice.

E-9-1-1 106

E-9-1-1 ED ALS OR 106

EMDocs

JANUARY 17, 2024

She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). 1) There are a limited number of antitussives on the US market which include benzonatate, codeine, dextromethorphan, diphenhydramine, and hydrocodone.

E-9-1-1 81

E-9-1-1 Overdose Emergency Medical Services Life Support 81

Don't Forget the Bubbles

DECEMBER 16, 2024

Coverage of the 6-in-1 vaccine measured at 12 months of age in England for Q4 2023 to 2024 Source: ONS under the Open Government License v3.0 Young infants and immunosuppressed individuals are particularly at risk of severe disease, resulting in significant morbidity and associated mortality rates of 1-3 per 1,000 cases.

E-9-1-1 59

E-9-1-1 OR ALS Emergency Department 59