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] The patient denies any loss of consciousness, neck pain, vomiting, or use of blood thinners.

EMS 82

EMS E-9-1-1 OR Emergency Department 82

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. Is this scalp swelling normal? May be on soles of feet !

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

EMDocs

JULY 13, 2024

We’ll keep it short, while you keep that EM brain sharp. 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.

EMS 64

EMS E-9-1-1 Plasma OR 64

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. ECG to evaluate for arrhythmia.

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E-9-1-1 EMS ALS Defibrillator 84

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 89

EMS E-9-1-1 ALS OR 89

Pediatric EM Morsels

JULY 19, 2024

Since tonsillectomy is one of the most common pediatric surgeries in the US (~500,000 per year) and the rate of post-tonsillectomy hemorrhage is about 1-5% , it is a good idea that we all are familiar with how to manage this issue! Get a hold of ENT early as OR management and/or admission are common. Set up suction x2 in the room!

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E-9-1-1 Epinephrine Emergency Department OR 286

Pediatric EM Morsels

OCTOBER 27, 2023

Initially tested in Johannesburg, South Africa: 1 month old to 12 years old Broselow predicted within 10% of weight in 63.6% Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. x exp[0.02

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E-9-1-1 Emergency Medical Services Life Support ALS 269

FOAMfrat

NOVEMBER 28, 2024

That said, complications tied directly to intubation in the field—like aspiration—tend to be more common due to the conditions EMS providers work under compared to the controlled environment of a hospital. "I’d say that EMS providers already do a phenomenal job managing complex airways in challenging conditions. Why is that?

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E-9-1-1 Critical Care ICU EMS 52

Pediatric EM Morsels

JUNE 30, 2023

References Dessole F, Virdis G, Andrisani A, Vitagliano A, Cappadona R, Dessole S, Cosmi E, Capobianco G. Leblanc C, Baron M, Desselas, E, Phan, MH, Rybak A, Thouvenin G, Lauby C, Irtan S. Dec: 9 (12): 1830. link] PMID: 36553274 The post Congenital Pulmonary Airway Malformation (CPAM) appeared first on Pediatric EM Morsels.

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E-9-1-1 ED EMS OR 281

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.

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E-9-1-1 EMS Emergency Department OR 71

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.

EMS 90

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

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. 4 Survival rate for all burn injuries is around 97%, which is a notable increase from 75% in the 1960’s.

ED 246

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

Pediatric EM Morsels

JULY 28, 2023

Rates of type 1 diabetes have increased since the COVID-19 pandemic. Kendra Jackson and Rebecca Raffler While we’ve gotten to snack on a Morsel on this subject before , new guidelines and research surrounding DKA and cerebral edema have come to light since the first go ‘round! Neuroimaging is NOT required. GCS score is not sensitive enough.

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E-9-1-1 ALS OR Critical Care 246

EMDocs

OCTOBER 29, 2024

Authors: Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA), Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

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E-9-1-1 ICU Epinephrine EMS 87

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? She came today because her sister is a nurse who noticed her eyes were yellow.

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

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.

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

Pediatric EM Morsels

SEPTEMBER 22, 2023

To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Alpha 1 agonists are necessary to maintain appropriate blood pressure. Never fear. Thought to be a “stunning” of the spinal cord.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

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.

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

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%

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

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

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.

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E-9-1-1 Coronary ACS BLS 121

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-9-1-1 106

E-9-1-1 ALS Defibrillator OR 106

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 102

EMDocs

NOVEMBER 6, 2024

Exam is notable for tremulous extremities. Shortly after labs are obtained, he yells and arches his back. He becomes rigid in all extremities and his abdomen. There is no convulsive activity or eye deviation, and the patient is yelling in pain. Questions: What is the differential diagnosis for toxicologic causes of severe muscle spasm and tetany?

E-9-1-1 78

E-9-1-1 ALS EMS OR 78

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.,

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E-9-1-1 ICU OR ALS 126

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? Other lung fields unremarkable. C or 100.4 mg/kg, max 0.4

E-9-1-1 76

E-9-1-1 ICU ACS EMS 76

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. Written by Willy Frick with edits by Ken Grauer A woman in her 70s with a history of hypertension presented with acute onset shortness of breath.

E-9-1-1 113

E-9-1-1 Coronary STEMI ALS 113

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. Clin Infect Dis.

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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.

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

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 90

E-9-1-1 Overdose ED OR 90

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

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

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

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 59

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

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-9-1-1 104

E-9-1-1 ALS ED OR 104

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. 1.70) and 0.78 (0.46–1.35), 1.35), p = 0.64 vs uncuffed 3.0-4.7%)

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