REBEL EM

MAY 27, 2024

No significant differences in heart rate 1 minute after cardioversion were observed between the three groups. The study lacks detailed information on recruitment and the randomization process, such as whether it was computer-generated or if patients were enrolled consecutively. Duration of Antiarrhythmic Effect: MVM group: 35.44

OR 137

OR E-9-1-1 ED ALS 137

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).

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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.

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E-9-1-1 Coronary EMS ED 116

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 128

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

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 99

FOAMfrat

MAY 19, 2024

Many of us grew up in the age of EMS, which emphasized the need to memorize everything. " The patient’s mother informed us that the patient suffers from PDCD and is generally non-verbal but interactive with limited motor function. The reality is, nothing could be farther from the truth! Absolutely! My brain is like, "ok!

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

REBEL EM

JULY 3, 2023

Critical information such as HR, SBP, drug administration times were occasionally missing. Investigators enrollend 660 patients in 9 years in 5 EDs; or approximately 6 patients per month; or 1 patient per /month for each ED. The study was dependent on EMR documentation which is prone to error.

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

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. PMID: 20696690 Baumann, M.

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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. 11 Unlikely to receive language assistance.

Emergency Department 104

Emergency Department ALS E-9-1-1 ED 104

REBEL EM

MAY 8, 2023

Paper: Smith JA, Secombe P, Aromataris E. Only 1 RCT and 1 cohort study had only mechanically ventilated patients. AUTHORS CONCLUSIONS: “ More evidence is required to fully inform the effectiveness of conservative management for occult pneumothoraces in mechanically ventilated patients. J Trauma Acute Care Surg.

E-9-1-1 58

E-9-1-1 Critical Care ICU OR 58

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). Researchers contacted authors of RCT trials for additional information and access to raw data when required. mean difference = − 0.04; 95% CI − 1.10

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E-9-1-1 Emergency Department ED OR 58

ACEP Now

AUGUST 29, 2023

Understanding how and why our biases work is an important first step in improving our decision-making, determining information we’re willing to trust, and building relationships. 9—Kickoff Party with a speakeasy theme at the Old Reading Terminal Oct. 8—NFL Watch Party featuring the Dallas Cowboys vs. the San Francisco 49ers Oct.

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

Dr. Smith's ECG Blog

AUGUST 9, 2018

It's important and useful to note that 1) Over 90% of healthy young men have up to 3mm ST elevation in one or more precordial leads normally (Atlas of Electrocardiography by K. My Comment , by K EN G RAUER, MD ( 8/9/2018 ): == Our thanks to Lou B for this insightful case. But there is clear ST elevation in lead aVL in Figure-1.

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E-9-1-1 STEMI Coronary Ambulance 52

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

Dr. Smith's ECG Blog

OCTOBER 23, 2022

EMS recorded these prehospital ECGs: Time 0: In V2-V4, there is ST elevation that does not meet STEMI "criteria," of 1.5 If you use something like the HEART score: 1. E EKG: a negative ECG (score = 0) 3. Learning Points : 1. They give extremely valuable information. These will often provide invaluable information.

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E-9-1-1 STEMI ED EMS 40

REBEL EM

DECEMBER 10, 2023

2022 Jan 1;92(1):44-48. What they did: Retrospective study performed at a level 1 trauma center of patients diagnosed with pneumothorax from 2018-2020. 2015 Jan;39(1):172-8. 2005 Sep;12(9):844-9. Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A. 2022 Jan 1;92(1):44-48. World J Surg.

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E-9-1-1 Emergency Department OR ALS 40

EMDocs

NOVEMBER 16, 2024

We’ll keep it short, while you keep that EM brain sharp. 1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 9=11 70% monomicrobial, 25% poly-microbial, 5% culture-negative. 2020 Sep 30;5(9):558-567. 10% of patients. Hip Pelvis.

EMS 97

EMS E-9-1-1 Operating Room Emergency Department 97

Pediatric EM Morsels

JULY 28, 2023

Rates of type 1 diabetes have increased since the COVID-19 pandemic. However, new information tells us that the hyperinflammatory state in DKA with cerebral hypoperfusion may play a big role. Insulin (in Bag #1) is for the Acidosis. 2010 Dec;1(2):103-20. Lesson = treat early! Then we’ve likely got DKA. PMID: 23499379.

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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. for detecting pulmonary opacities.

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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 105

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis [published online ahead of print, 2023 Aug 9]. References: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM.

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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?

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E-9-1-1 STEMI ED OR 113

EMDocs

MARCH 4, 2024

Authors: Amelia Campbell, MD (EM Resident Physician, Carl R. Darnall Army Medical Center) and Alec Pawlukiewicz, MD (EM Attending Physician, Carl R. A wide variety of conditions can result in either type of cholestasis (Figure 1). 9 How are cholestatic labs defined? hepatocellular pattern is by using the R factor.

Emergency Department 105

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

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. 1) There are a limited number of antitussives on the US market which include benzonatate, codeine, dextromethorphan, diphenhydramine, and hydrocodone.

E-9-1-1 89

E-9-1-1 Overdose Emergency Medical Services Life Support 89

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. If this EKG were handed to you to screen from triage without any clinical information, what would you think? found normal ECGs in only 3 of 50 patients with massive PE, and 9 of 40 with submassive PE. What do you think?

E-9-1-1 138

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

REBEL EM

AUGUST 21, 2023

Background Information: Cardiac arrest is a devastating event that imposes considerable human and financial burdens. Figure 2 : Extended Glasgow Outcome Scale (GOS-E) (credit: Doc_HG ) Secondary Modified Rankin Score Secondary outcomes included death within 6 months. These individuals are independent at home but dependent outside.

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E-9-1-1 Critical Care CPR ALS 97

REBEL EM

SEPTEMBER 26, 2022

It provides highly descriptive, real-time information on clot formation, clot strength, platelet function, and fibrinolysis, which is superior to traditional coagulation tests such as INR, aPTT, and platelet count. 2020;71(1):235-246. TEG analyzes the interaction between platelets and the coagulation cascade. Article: Kumar M et al.

FFP 52

FFP E-9-1-1 ICU ALS 52

ESO

DECEMBER 19, 2024

While its true that beating th e clock is vital , its only one of many factors to consider. The 2024 ESO Fire Service Index shows that: 67% of all calls are EMS-related, while 3% are fire-related. Tracking your departments data year after year helps you see where youre doing well and where theres room to improve. population.

E-9-1-1 52

E-9-1-1 NFPA Firefighter EMS 52

ACEP Now

OCTOBER 9, 2023

Have an initial plan for the conversation including what information you want to convey and specific questions you want to ask. 9 Being bilingual is often not enough to be a medical interpreter, which requires precision, experience, and knowledge of medical jargon, as well as culturally specific idioms and phrases. 2022;105(1):62-73.

Emergency Department 64

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

FOAMfrat

JULY 1, 2023

I also find the following information useful: Succinylcholine has an onset of approximately 45 seconds, whereas Rocuronium has an approximate onset of 60 to 90 seconds -- Depending on what book you read. mg/kg Rocuronium versus 1 to 1.5 mg/kg Rocuronium versus 1 to 1.5 mg/kg of Succinylcholine during RSI in an ED setting." [1]

E-9-1-1 52

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

Dr. Smith's ECG Blog

MAY 5, 2022

Submitted and written by Destiny Folk MD , peer reviewed by Meyers, Smith, Grauer, McLaren A man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. EMS arrived and found him awake and alert. Figure-1: I've reproduced the initial ECG in today's case.

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E-9-1-1 OR STEMI ED 52

EMDocs

FEBRUARY 12, 2024

Authors: Rachel Kelly, MD ( EM Resident Physician, Stony Brook University Hospital); Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. However, ABGs have many drawbacks compared to VBGs.

Emergency Department 98

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

Dr. Smith's ECG Blog

APRIL 8, 2015

Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. Palpitations preceding syncope (highest value on EGSYS score) 9. Abnormal ECG – looks for cardiac syncope. Syncope without a prodrome, no precipitating factors (EGSYS) 5. Hemoglobin less than 10 (SF rule) 6.

Emergency Department 52

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

EMDocs

NOVEMBER 13, 2023

Authors: Mary Hamblen, DO (EM Resident Physician, TX); Justin Hacnik, MD (EM Resident Physician, TX); Katherine Spencer, MD (EM Resident Physician, TX); J.D. 1 One study found that CTA head and neck was ordered for 2.5% 8 The VAN (vision, aphasia, neglect) score ( Figure 1 ), first proposed by Teleb et al.

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

REBEL EM

NOVEMBER 11, 2024

4 The 2023 ACORN Trial ( covered here on REBEL EM ) randomized 2,511 patients requiring antipseudomonal coverage to receive either cefepime or piperacillin-tazobactam. What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018.

E-9-1-1 108

E-9-1-1 ALS ICU Critical Care 108

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.

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REBEL EM

OCTOBER 26, 2023

1–4 Antimicrobial resistance is a global health crisis, underscoring the importance of antibiotic stewardship. After consent, children were randomized 1:1 to receive 5 additional days of antibiotics or 5 days of a matching placebo. 933 children did not receive 1 of the accepted antibiotics. 9 excluded after randomization.

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