ALiEM

SEPTEMBER 13, 2024

A 32-year-old male with no significant past medical history presented to the emergency department (ED) from an outside hospital for further management of right eye pain and vision loss sustained after he was struck by a metal wire while at work. He had no other complaints and denied any other trauma or loss of consciousness during the event.

Emergency Department 161

Emergency Department OR ED 161

The Skeptics' Guide to EM

APRIL 14, 2019

This is a warning to those listening to the podcast or reading […] The post SGEM#252: Blue Monday- Screening Adult ED Patients for Risk of Future Suicidality first appeared on The Skeptics Guide to Emergency Medicine. Date: April 11th, 2019 Reference: Brucker et al. This is a warning to those listening to the podcast or reading the blog post.

ED 130

ED Emergency Department ALS OR 130

International Journal of Paramedicine

JULY 8, 2024

However, ketamine may be associated with adverse clinical events including a higher intubation rate. The primary endpoint was incidence of endotracheal intubation occurring during transportation and within one hour after arrival to the emergency department (ED). versus 2.9%, respectively; p = 0.383).

Emergency Department 98

Emergency Department Ambulance ED OR 98

Core EM

JANUARY 25, 2024

We go over the essential and complex topic of vasopressors in the ED.

Epinephrine 246

Epinephrine Critical Care Emergency Department ED 246

The Skeptics' Guide to EM

MAY 2, 2020

This is Bob’s eleventh visit […] The post SGEM#291: Who’s Gonna Drive you to…the ED – with Lights & Sirens? July 2019 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Virginia. first appeared on The Skeptics Guide to Emergency Medicine. Date: April 24th, 2020 Reference: Watanabe et al.

ED 100

ED Ambulance Medical Transportation EMS 100

The Skeptics' Guide to EM

JULY 2, 2022

Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Case: You are working a shift in your local community emergency department (ED) when a 47-year-old male presents with chest pain.

Coronary 100

Coronary Heart Attack ACS CAD 100

Core EM

JANUARY 25, 2024

Three children (2.1%) had true hyperkalemia: one had known chronic renal failure and was referred to the ED due to concern for electrolyte abnormalities; the other 2 patients had diabetic ketoacidosis (DKA). mEq/L alone With insulin, ~1.2 mEq/L, additive effect Bicarbonate Controversy. mEq/L alone With insulin, ~1.2

Epinephrine 246

Epinephrine OR ED 246

EM Didactic

OCTOBER 22, 2018

Diplopia is one such complaint which we might come across in ED. Primary eye disorders or systemic diseases presenting as ophthalmologic complaints may present to the Emergency Department especially when symptoms are acute in onset. Key Questions when evaluating diplopia: 1. Is it Monocular or Binocular Diplopia? Associated pain?

ED 52

ED Emergency Department OR EMS 52

Pediatric EM Morsels

SEPTEMBER 22, 2023

Pathophysiology Primary injury happens at the time of the traumatic event or shortly after in the high cervical to mid-thoracic spine. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

EMDocs

SEPTEMBER 16, 2024

Author: Joshua Lowe, MD (EM Attending Physician, San Antonio, TX) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Manpreet Singh, MD (@MPrizzleER); Brit Long, MD (@long_brit) The fluorescent lights above cast a clinical pallor over the bustling ED. Stay Calm Under Pressure: The ED can be chaotic, and emotions can run high.

Heart Attack 68

Heart Attack ED OR Emergency Department 68

Chicago EMT Training

AUGUST 6, 2021

It's important to keep in mind that you are not functioning as an EMT when you're an ED Tech/Assistant. Standby EMS for events The company that comes to mind in Chicago is Event Medical Solutions. The biggest event they provide EMS for recently is Lollapalooza. It opens many doors in various industries.

EMT 130

EMT EMT Paramedic Ambulance 130

Dr. Smith's ECG Blog

MARCH 1, 2024

First responders found him to be very tachycardic , confused, perserverating and with no memory of the event. First ED ECG is Wellens' (pain free). There was tongue biting. Lightheadedness continued. The tachycardia was gone by the time paramedics arrived. He had a prehospital ECG: What do you think? Interpretation.

First Responder 99

First Responder ED Ambulance Paramedic 99

The Skeptics' Guide to EM

APRIL 2, 2022

Case: A 15-year-old male presents to the pediatric emergency department (ED) with right ankle pain sustained while twisting his ankle during dance practice. Background: Pediatric emergency department (ED) visits and related procedures can invoke pain and anxiety among children. The right ankle is swollen and tender.

Emergency Department 130

Emergency Department ALS ED OR 130

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Here is his ECG on arrival to the ED, still with active pain: ED1 at 0727 A baseline ECG was available from 1 month ago: First troponin was drawn before cath, which would soon return at 14 ng/L ( within normal limits ). Even before looking at the initial ECG — this patient is in a high prevalence group for having an acute event.

STEMI 95

STEMI EMS ACS ED 95

Core EM

JULY 23, 2024

Because most radiation injuries are not immediately life-threatening, patients with isolated radiation injuries will not require immediate attention in mass casualty events. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. Sources of Radiation Cosmic: Radiation generated by the sun and stars.

ALS 130

ALS OR Emergency Department ED 130

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. Here is the ED ECG (a photo of the paper printout) What do you think? The initial ECG in today's case was recognized as definitely abnormal — but the question arose as to whether this ECG indicated old infarction vs a new acute event.

EMS 108

EMS CPR ED Coronary 108

EMDocs

JUNE 22, 2024

A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in. The newborn is doing well, but the mother is complaining of shortness of breath and chest pain.

EMS 96

EMS Ambulance FFP ICU 96

The Skeptics' Guide to EM

NOVEMBER 1, 2022

AEM October 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: A 19-year-old man presents to the emergency department (ED) with his first time anterior should dislocation after trying to recreate one of his favourite scenes in the movie Lethal Weapon.

ALS 152

ALS Emergency Department OR ED 152

ESO

MARCH 7, 2024

of patients with open long bone fractures receive antibiotics within the critical first 60 minutes of ED arrival. A major benefit of the Trauma Index is that it not only examines this year’s performance, but also makes comparisons to the previous years’ data. Antibiotics and Open Long Bone Fractures: The 2023 Index points out that 67.3%

Operating Room 105

Operating Room ICU OR ED 105

Dr. Smith's ECG Blog

JUNE 27, 2024

By Sofiya Diurba MD, reviewed by Meyers, Grauer A woman in her 50s with PMH known RBBB and prior syncopal events presents to the ED for five syncopal events over the last 24 hours. Each event is associated with a prodrome of mild substernal CP, SOB, and “brain fog.” This is her first ECG in the ED: What do you see?

ED 122

ED OR Emergency Department Emergency Manager 122

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Here is the first ED ECG recorded, now pain free after sublingual Nitro: There is what appears to be a reperfusion T-wave in I and aVL. link] = My Comment by K EN G RAUER, MD ( 11/14 /2023 ): = One of the most helpful clinical clues in support that an acute cardiac event is ongoing — is the finding of " dynamic " ECG changes.

E-9-1-1 111

E-9-1-1 Coronary EMS ED 111

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

ECG 1 at time zero EARLY REPOLARIZATION ABNORMAL ECG ED final official overread: "early repol vs hyperacute T, minimal changes from previous (previous shown below)" What do YOU think? See these casese (and I have many others): First ED ECG is Wellens' (pain free). A 70-something y.o. male presents to triage with shortness of breath.

STEMI 116

STEMI ACS Critical Care OR 116

ACEP Now

JANUARY 14, 2024

Many common presentations to the emergency department (ED) are related to drug interactions that are commonly missed and largely preventable. 1-3 We may be unaware of potentially dangerous drug interactions when we order and prescribe medications in the ED. The resulting morbidity and mortality is significant.

E-9-1-1 52

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

REBEL EM

SEPTEMBER 21, 2023

There are other reasons aside from ACO for troponin elevations: Type 1: MI due to a spontaneous coronary atherosclerotic event. There are other reasons aside from ACO for troponin elevations: Type 1: MI due to a spontaneous coronary atherosclerotic event. This is a Type I myocardial infarction. Cardiol Rev.

Coronary 143

Coronary ACS ED OR 143

The Skeptics' Guide to EM

OCTOBER 10, 2020

Case: A 41-year-old man without a significant past medical history presents to the emergency department (ED) with a chief complaint of lower back pain that started 48 hours prior to the ED visits after attempting to move a couch in his house. Background: Pain is one of the most frequent reasons to attend an ED.

Emergency Department 130

Emergency Department ALS ED OR 130

Don't Forget the Bubbles

MAY 6, 2024

Arch Dis Child Fetal Neonatal Ed. It has a high rate of first-attempt failure and carries the risk of severe procedure-related adverse events. Secondary outcomes included tracheal intubation adverse events (TIAEs) or severe desaturation. This time, the PEM MSc team from QMUL, in association with DFTB, are taking over….

E-9-1-1 75

E-9-1-1 Emergency Department OR ALS 75

Don't Forget the Bubbles

NOVEMBER 29, 2023

Intubated, awake, and paralysed: a never event. Even though sedation after endotracheal intubation (ETI) reduces the risk of self-extubation, uncontrolled pain, and awakening awareness, several small single-centre studies demonstrate low rates of sedative drug administration after ETI in the emergency department (ED).

E-9-1-1 135

E-9-1-1 Emergency Department ED CPR 135

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. He presented tachycardic and hypotensive with a capillary refill time of 5 seconds. After 40ml/kg of IV 0.9% NaCl, his HR came down a little, but the effect was short-lived. He has an HR of 190/min, and his BP is 85/35 mmHg.

Advanced Life Support 143

Advanced Life Support ED ALS OR 143

Core EM

MARCH 12, 2024

Because most radiation injuries are not immediately life-threatening, patients with isolated radiation injuries will not require immediate attention in mass casualty events. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. Sources of Radiation Cosmic: Radiation generated by the sun and stars.

ALS 130

ALS OR Emergency Department ED 130

The Skeptics' Guide to EM

APRIL 10, 2021

JAMA Intern Med 2021 Case: A 60-year-old man presents to the emergency department (ED) after his wife found him to be drowsy and confused at home. On arrival to the ED his vitals are normal aside from a decreased level of consciousness and he is found to have a serum sodium concentration of 118 mmol/L.

Emergency Department 130

Emergency Department Coronary ED OR 130

The Skeptics' Guide to EM

NOVEMBER 19, 2022

Intimate partner violence (IPV) in the Emergency Department (ED). Intimate partner violence (IPV) in the Emergency Department (ED). She is the VP of Finance of a not-for-profit emergency education organization creating educational events for community emergency doctors.

Emergency Department 101

Emergency Department ED OR 101

Dr. Smith's ECG Blog

APRIL 17, 2023

One case sent by Dr. Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve Smith Take a look at these two ECGs below from two patients in the ED, first without any clinical context. CASE #2: I am more disturbed by learning of the events associated with the ECG in Case #2. Full case details and outcomes are below.

OR 52

OR STEMI ACS Emergency Department 52

Dr. Smith's ECG Blog

MAY 20, 2024

This was sent by an undergraduate (not yet in medical school, but applying now) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly. Edited by Smith He also sent me this great case. The undergraduate's analysis: This EKG shows J point elevation of about 0.5-1

CAD 127

CAD STEMI Coronary ACS 127

Don't Forget the Bubbles

MAY 24, 2023

A 5-year-old boy with a past medical history of Crouzon syndrome presents in the Pediatric ED. Airway complications are also more likely to occur in the emergency department (ED) than in the operating theatre. One large observational study found a 35-fold higher increase in events leading to death or brain damage in ED intubations.

Emergency Department 98

Emergency Department ED ALS OR 98

EMDocs

FEBRUARY 22, 2024

A 43-year-old male, with no significant medical history, presents to the ED for right eye pain. Evaluation Ask specifically about patients’ work environment, materials involved, and if they are aware of the inciting event Consider open globe in those with high-speed mechanism of injury (i.e. F oral, RR 14 bpm, SpO2 98% on room air.

ALS 77

ALS ED EMS OR 77

Don't Forget the Bubbles

AUGUST 23, 2023

This simple intervention aims to acknowledge the tragic and unexpected event humanely and respectfully. The Pause creates an opportunity for loved ones and healthcare workers to respectfully honour the patient and the significant event they have been involved in before moving on to the next task ahead. Our bodies primed for the fight.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

EMDocs

MAY 9, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Facts : A 24-year-old male is taken to the ED by his parents after “passing out” and being “unconscious for a few seconds.” The triage nurse records the event as a “seizure” lasting 7 minutes.

ED 82

ED EMS OR 82