Core EM

JANUARY 25, 2024

7 86% of burn injuries are thermal burns (as opposed to chemical or electric), with 43% resulting from a direct exposure to fire, 34% from scalding liquid, and 9% from a hot object. 9 Apply a topical antimicrobial (eg. EM Cases – Burn and Inhalation Injuries: Ed Wound Care, Resuscitation and Airway Management.”

ED 246

ED E-9-1-1 First Aid OR 246

EMDocs

DECEMBER 1, 2024

We’ll keep it short, while you keep that EM brain sharp. A 52-year-old male with a history of essential hypertension presents to your South Texas ED for his second visit this week complaining of indolent fever, shortness of breath, pleuritic chest pain, and a rash on his trunk and extremities. .:

EMS 83

EMS E-9-1-1 OR ED 83

ALiEM

MAY 19, 2023

Esophageal Balloon Tamponade Devices – Linton-Nachlas, Sengstaken-Blakemore, Minnesota Tubes (image courtesy of Dr. Mark Ramzy at REBEL EM) What are esophageal balloon tamponade devices? The SB tube was created in 1950 in order to help tamponade variceal bleeds [1]. Pearl 1: Check the units of pressure being used.

E-9-1-1 245

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

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. 2024 Jan 16;17(1):e257694. 2024 Jan;24(1):e24-e35. 2024 Jan;24(1):e24-e35. 2013 Aug;20(4):337-9.

E-9-1-1 152

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

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

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 88

EMS E-9-1-1 Epinephrine OR 88

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 81

EMS E-9-1-1 OR ED 81

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

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

Pediatric EM Morsels

AUGUST 4, 2023

(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. PMID: 33905850 Ganss A, Rampado S, Savarino E, Bardini R. 15(1):74-78. Ann Vasc Surg. 76: 514-535. J Gastrointest Surg. 23(5):997-1005.

E-9-1-1 246

E-9-1-1 ED OR EMS 246

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.

E-9-1-1 85

E-9-1-1 EMS ALS Defibrillator 85

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-9-1-1 124

E-9-1-1 Coronary ACS BLS 124

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. PMID: 29681420 Gottschalk HP, Eisner E, Hosalkar HS. 1999 Jan;13(1):58-9. 2015 Jan;38(1):42-4. J Am Acad Orthop Surg. doi: 10.5435/00124635-199801000-00002. PMID: 9692937 Decker N, Norse A. 2022 Aug 2.

E-9-1-1 118

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

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

DECEMBER 18, 2024

Upon EMS arrival the male is noted to be anxious and tremulous with a GCS of 14. A 36-year-old male presents to the emergency department after being found down at home by his spouse. Per the mans wife, the patient is a heavy drinker often consuming two to three pints of vodka daily. What is the next step in evaluation and treatment?

E-9-1-1 73

E-9-1-1 Emergency Department ICU ED 73

EMDocs

SEPTEMBER 7, 2024

We’ll keep it short, while you keep that EM brain sharp. 1 Risk Factors: 1-4 Spontaneous Anticoagulants (Apixaban, Rivaroxaban, etc.) Older Age (median age of 70 years) 1 Abnormal vasculature/neoplasm of the kidney (e.g., 1 May need IR or surgical consultations for intervention. F, RR 16, SpO2 97% on room air.

EMS 75

EMS E-9-1-1 Operating Room OR 75

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

Pediatric EM Morsels

APRIL 5, 2024

Time from tick bite to onset of symptoms generally ranges from 1 week to 4 weeks but can start within 2 days (CDC 2022) Tick-Borne Encephalitis can also be transmitted in unpasturized dairy. These resolve within 1 week. 2004 Nov 15;39(10):1493-9. 2018 Mar; 3(1): 8. 2024 Jan 25;78(1):80-89. 2019 Apr:62:1-6.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

REBEL EM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 1, 4, 6 The overall incidence of VAP is somewhere around 5%-40% of all intubated patients, depending on the study and country from which it is reported. 4, 8 Paper: Dahyot-Fizelier, C.,

E-9-1-1 125

E-9-1-1 ICU ALS OR 125

Pediatric EM Morsels

NOVEMBER 17, 2023

Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. 1994 Jul;125(1):57-62. 2019 Sep;74(9):1186-1190. 2016 Feb;30(1):3-11. The post Cuffed Endotracheal Tubes for Children: ReBaked Morsel appeared first on Pediatric EM Morsels. Paediatr Anaesth. 2021 Jun;31(6):713-719. doi: 10.1111/pan.14185.

E-9-1-1 183

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

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 72

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.

E-9-1-1 130

E-9-1-1 ALS Coronary EMS 130

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Her husband called EMS when the patient experienced new onset seizures accompanied by micturition. The ECG below was recorded by EMS. ECG #1 Interpretation: ECG #1 shows sinus rhythm at a heart rate of 77 bpm. For clarity in Figure-1 — I've reproduced the initial ECG in today's case. What is your assessment?

E-9-1-1 112

E-9-1-1 ALS Defibrillator OR 112

EMDocs

JULY 13, 2024

We’ll keep it short, while you keep that EM brain sharp. 1997 Mar;11(1):203-22. 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. Infect Dis Obstet Gynecol. 2000;8(2):77-82. PMID: 10805361; PMCID: PMC1784665. Casey BM, Cox SM.

EMS 64

EMS E-9-1-1 Plasma OR 64

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-9-1-1 121

E-9-1-1 Coronary STEMI ALS 121

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

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

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.

E-9-1-1 139

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

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-9-1-1 140

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

REBEL EM

MAY 27, 2024

No significant differences in heart rate 1 minute after cardioversion were observed between the three groups. 2010;17(1):44-49. 4 patients were considered as failure to antiarrhythmic for recurrence within 5 min of conversion, 3 of them were converted with verapamil and one with amiodarone. seconds (SD = 7.73) Adenosine group: 24.24

OR 137

OR E-9-1-1 ED ALS 137

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-9-1-1 104

E-9-1-1 STEMI ED OR 104

REBEL EM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. The first evaluation of the patient was to be done within 1 hour of arrival to ED (Including the first POCUS). to −0.66) and −1.66 (95% CI −2.09

ED 129

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

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

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

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 ). Figure-1: Comparison between the first 3 ECGs in today's case. How Would YOU Interpret the Serial Tracings in Figure-1? EMS arrived — and recorded 2 ECGs.

E-9-1-1 112

E-9-1-1 Coronary EMS ED 112

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 94

E-9-1-1 Plasma Epinephrine Life Support 94