Core EM

JANUARY 25, 2024

The SQuID Protocol (Subcutaneous Insulin in Diabetic Ketoacidosis): Impacts on ED Operational Metrics. Fidelity was examined by the frequency of required q2h glucose checks, safety by seeing how many patients required rescue dextrose for hypoglycemia, and operational impacts including ED LOS and ICU admission. Image from cited article.

EMS 246

EMS ICU ED OR 246

Pediatric EM Morsels

MARCH 7, 2025

TXA has been mentioned previously on PEM Morsels in the following contexts: Post Tonsillectomy Hemorrhage , Hemophilia in the ED , Von Willebrand Disease , Epistaxis in Children , Hereditary Angioedema , Hemoptysis in Children , Hyphema , and even in Neonatal Subgaleal Hemorrhage. Kids get hurt. And they get sick. Its inevitable.

E-9-1-1 231

E-9-1-1 ALS OR EMS 231

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.

E-9-1-1 105

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

The Skeptics' Guide to EM

JANUARY 6, 2024

She is an executive lead for the EMS for Children Innovation and Improvement Center. She is the co-Principal Investigator for the EMS for Children Data Center. She is nationally known for her work as an EMS researcher and educator. July 2023 * Population: ED leadership across the United States. JAMA Netw Open.

Emergency Department 340

Emergency Department Emergency Medical Services ALS ED 340

The Skeptics' Guide to EM

NOVEMBER 25, 2023

Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. Upon EMS arrival, they find the patient is sweaty with normal vital signs. AEM November 2023. AEM November 2023.

Heart Attack 346

Heart Attack STEMI Emergency Medical Services Coronary 346

Medic Mindset

NOVEMBER 13, 2024

Dr. Casey Patrick is the EMS medical director of Montgomery County Hospital District (Texas). As an EM physician, he shares how he decides to care for his own patients in the ED who present with rapid atrial fibrillation. Here’s how. He shares with listeners how he came to the decision to remove Diltiazem from his service.

Paramedic 98

Paramedic Emergency Department EMS ED 98

EMS 12-Lead

APRIL 9, 2024

David Didlake @DidlakeDW EMS personnel responded to the residence of an 81 y/o Male with syncope. At the time of ED arrival he was alert, oriented, and verbalizing only a headache with a normalized BP. The ED activated trauma services, and a 12 Lead ECG was captured. This was deemed “non-specific” by the ED physicians.

Coronary 290

Coronary ACS CAD ED 290

The Skeptics' Guide to EM

APRIL 13, 2024

Case: A 70-year-old woman was brought into the emergency department by EMS after her family reported she was having trouble talking. When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago. When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago.

ALS 343

ALS Emergency Department OR EMS 343

NAEMSP

JANUARY 19, 2025

Literature Review Few case studies have touched on the subject of terminal extubation performed by EMS providers during the initial patient contact. More commonly, patients are transported to the Emergency Department (ED), where extensive conversations between ED providers and family occur.

EMS 52

EMS Emergency Department CPR ED 52

The Skeptics' Guide to EM

MARCH 2, 2024

Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Case: A 59-year-old man walks into your community emergency department (ED) complaining of chest pain.

Operating Room 329

Operating Room Emergency Department ALS ED 329

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Chris Root is an emergency medicine and emergency medicine service (EMS) physician at the University of New Mexico, Albuquerque. Chris completed his emergency medicine residency and EMS fellowship at UNM. Before attending medical school, he was a New York City Paramedic. Your partner asks if you want to administer naloxone as well.

Naloxone 260

Naloxone NARCAN Overdose CPR 260

Core EM

JANUARY 25, 2024

A narrow pulse pressure has been shown to predict the need for hemorrhage control in the ED setting but has not been assessed as a predictor in the prehospital setting. A narrow pulse pressure occurs due to compensatory increased systemic vascular resistance in the setting of decreased cardiac output.

Operating Room 246

Operating Room EMS ED ICU 246

REBEL EM

JULY 1, 2024

The AVAPS mode is as effective and safe as BPAP S/T in treating patients with hypercapnic respiratory failure in the ED.” Clinical Take Home Point: I n patients presenting to the ED with hypercapnic respiratory failure, AVAPS did lead to a faster improvement in pH and PaCO2 levels compared to BPAP S/T. AVAPS: 0.07 AVAPS: 10.20

ED 132

ED Emergency Department ALS OR 132

ALiEM

APRIL 14, 2023

Highlighted Quality Posts: Procedures Site Article Author Date Label Rebel EM Intra Articular Lidocaine vs Sedation in Shoulder Reductions Nordia Matthews, MD 30 Jan 2023 AIR EM Docs Video Laryngoscopy in the ED Cameron Jones, MD 8 Aug 2022 AIR First 10 EM Lacerations: Does closure technique matter?

EMS 246

EMS Emergency Department ED OR 246

EMS 12-Lead

MAY 15, 2024

Crew notifies the received ED of an incoming post-arrest patient and notes a sinus bradycardia on their monitor, as seen in Figure 2. On arrival at the ED, the leads are ripped off the patient and the pacemaker fires in non-demand mode for several minutes, as seen in Figure 7. Pacing was continued in the ED, with identical settings.

Epinephrine 331

Epinephrine Paramedic CPR EMT 331

The Skeptics' Guide to EM

JUNE 1, 2024

His research focuses on the pre-hospital care of children by EMS. He is the principal investigator for EMSC State Partnership in Washington, DC and is also involved in various multi-center EMS studies with the Pediatric Emergency Care Applied Research Network (PECARN). EMS placed him in a C-collar and brought him to you.

Emergency Medical Services 219

Emergency Medical Services Emergency Department EMS ALS 219

ACEP Now

JANUARY 5, 2025

A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. On exam, you see bright red blood trickling down her left tonsillar fossa.

Operating Room 98

Operating Room Epinephrine ALS ED 98

Emergency Medicine Cases

OCTOBER 13, 2020

In this podcast, Part 2 of our diabetic emergencies series with Melanie Baimel, Bourke Tillmann and Leeor Sommer, we dive into the recognition and ED management of Hyperglycemic Hyperosmolar State (HHS). Why is finding and treating the cause or trigger of HHS so important in the ED? How does fluid management differ in HHS from DKA?

ED 130

ED OR EMS 130

Pediatric EM Morsels

APRIL 19, 2024

Trauma season is at hand and like all other pediatric emergency departments in the country, we find our ED breaking ( pun intended ) at the seams with orthopedic injuries. We see all different flavors of upper extremity injuries. The minority of parents would have wanted clinic follow up (6%) and reimaging (14%).

ALS 290

ALS ACS Emergency Department ED 290

Dr. Smith's ECG Blog

MARCH 28, 2024

Per EMS report, patient believes he has been in atrial fibrillation for 5 days, since coming down with flu-like illness with rhinorrhea, productive cough, SOB. On EMS arrival, patient's oxygen saturation was in the high 80s and improved on 4L O2 via nasal cannula. Here is the prehospital ECG: First ED ECG What do you think?

OR 129

OR Emergency Department Ambulance EMS 129

EMDocs

JUNE 22, 2024

We’ll keep it short, while you keep that EM brain sharp. A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in.

EMS 111

EMS Ambulance FFP ICU 111

REBEL EM

MAY 27, 2024

Clinical Question: Does simultaneously performing the modified valsalva maneuver and administering intravenous adenosine, compared to either treatment alone, have greater success in achieving normal sinus rhythm in patients presenting to the ED with PSVT? This absence of detail leaves the study open to bias.

OR 137

OR E-9-1-1 ED ALS 137

Core EM

OCTOBER 16, 2024

To get a sense of how medical students feel about emergency medicine, we interviewed three students who are interested in EM: Nick, a graduating M4 pre-matched into EM residency, Charlotte, an M2 currently planning to pursue EM, and Annie, an M1 considering EM. What sparked your interest in emergency medicine?

ED 100

ED EMS Critical Care OR 100

Core EM

SEPTEMBER 24, 2024

To get a sense of how medical students feel about emergency medicine, we interviewed three students who are interested in EM: Nick, a graduating M4 pre-matched into EM residency, Charlotte, an M2 currently planning to pursue EM, and Annie, an M1 considering EM. What sparked your interest in emergency medicine?

ED 100

ED EMS Critical Care OR 100

Emergency Medicine Cases

SEPTEMBER 29, 2020

The post Ep 146 DKA Recognition and ED Management appeared first on Emergency Medicine Cases.

ED 130

ED OR EMS 130

EMDocs

MARCH 2, 2024

We’ll keep it short, while you keep that EM brain sharp. A 58-year-old female with a history of diabetes, hypertension, and chronic back pain presents to the ED with severe headache and nausea. The patient denies any trauma to the head, fevers, nuchal rigidity, changes in vision, focal weakness, paresthesia, or anticoagulation use.

EMS 119

EMS E-9-1-1 OR ED 119

Pediatric EM Morsels

AUGUST 23, 2024

Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. The post Return to Learn / Return to Sport after Concussion appeared first on Pediatric EM Morsels. It does NOT have structural brain damage visible on standard neuroimaging. Br J Sports Med. 2023 Jun;57(11):695-711.

Emergency Department 281

Emergency Department OR ED EMS 281

The Skeptics' Guide to EM

OCTOBER 3, 2021

Case: A 66-year-old woman is brought in by EMS from home with lethargy and hypotension. Some bench work, observational studies, and now two large, unblinded, cluster-randomized single-center trials ( SMART and SALT-ED ) suggested a benefit to using balanced crystalloids (i.e. Date: September 28th, 2021 Reference: Zampieri et al.

OR 130

OR Critical Care ICU Plasma 130

EMDocs

NOVEMBER 19, 2024

His roommate found an empty pill bottle on the floor next to him. The bottle contained 100 mg quetiapine tablets, and 50 tablets were unaccounted for. Second-generation antipsychotics (see Table 1 below) improve both positive and negative symptoms of schizophrenia and are less likely to be associated with EPS.

Overdose 111

Overdose EMS Emergency Medical Services OR 111

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 110

EMS E-9-1-1 ALS OR 110

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. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Never fear. 5 th Edition.

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

The Skeptics' Guide to EM

JULY 29, 2023

Emergency Medical Services (EMS) is called and on arrival the patient is walking but has obvious facial trauma and is complaining of some neck pain. As an EMS crew member, you are tasked with deciding what method of spinal motion restriction to use. He has a brief loss of consciousness (LOC) and then awakens and is ambulatory on scene.

Emergency Medical Services 246

Emergency Medical Services ALS EMS Emergency Department 246

The Skeptics' Guide to EM

APRIL 27, 2024

She is also the local director of the difficult airway EMS course at Washington State. Case: EMS arrives with a 58-year-old woman who suffered an out-of-hospital cardiac arrest (OOHCA). When emergency department (ED) staff roll her to remove her clothing her humeral intraosseous (IO) is dislodged. Prehospital Emergency Care.

ICU 231

ICU Defibrillator Paramedic CPR 231

EMDocs

OCTOBER 19, 2024

We’ll keep it short, while you keep that EM brain sharp. A 3-year-old male with no previous past medical history, born full term, and unvaccinated presents after 6 days of cough, fever, myalgias, and rhinorrhea. Question: What’s the next step in your evaluation and treatment, and what is the potentially life-threatening diagnosis?

EMS 110

EMS E-9-1-1 Epinephrine OR 110

EMDocs

DECEMBER 11, 2024

Heres another case from Medical Malpractice Insights Learning from Lawsuits , a monthly email newsletter for ED physicians. Facts : A 28-year-old female is seen in the ED of Hospital A for recurrent bouts of severe, intermittent abdominal pain. Doctor shopping at 3 different EDs with the same problem doesnt help.

ED 97

ED OR EMS 97

Pediatric EM Morsels

SEPTEMBER 8, 2023

The post Summer Penile Syndrome appeared first on Pediatric EM Morsels. J Emerg Med. 2014 Jan;46(1):e21-2. doi: 10.1016/j.jemermed.2013.08.081. 2013.08.081. Epub 2013 Nov 5. PMID: 24199728. Shah A, Sobolewski B, Mittiga MR. Summer Penile Syndrome. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e.

EMS 278

EMS ED OR 278

ALiEM

FEBRUARY 5, 2024

Take the AIR Toxicology Module at ALiEMU Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link. You will need to create a free, 1-time login account. Reference Lin M, Phipps M, Chan TM, et al.

Overdose 215

Overdose Critical Care EMS Emergency Department 215