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Awake, and Paralysed: A Never Event

Don't Forget the Bubbles

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
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Elder Male with Syncope

EMS 12-Lead

At the time of ED arrival he was alert, oriented, and verbalizing only a headache with a normalized BP. He denied any specific prodrome of gross palpitations, however did endorse feeling quite dizzy just before the event. The ED activated trauma services, and a 12 Lead ECG was captured. The fall was not a mechanical etiology.

Coronary 290
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Episode 188: Vasopressors

Core EM

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

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Cath Lab occupied. Which patient should go now (or does only one need it? Or neither?)

Dr. Smith's ECG Blog

He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon. He arrived to the ED by ambulance at 1529, only a half hour after the start of his chest pain around 1500 while eating. Patient 2 , EKG 1: What do you think? The patient had none of these conditions.

OR 104
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SGEM#445: Why Can’t We Be Friends – Conflict in Emergency Medicine

The Skeptics' Guide to EM

The emergency department (ED) evaluation reveals an unremarkable chemistry panel with normal renal function and a white blood cell count of 10,000. Background: We have discussed agitation in the ED on the SGEM several times. They are afebrile and tolerate oral intake. These conflicts can ultimately lead to moral injury [1,2,3].

ED 196
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The Modified Valsalva Maneuver: Practical Treatment or Pointless Trick?

REBEL EM

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
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SGEM#347: It Don’t Matter to Me – Balanced Solution or Saline

The Skeptics' Guide to EM

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. In the two large trials, this benefit was seen as a reduction in a composite outcome of major adverse kidney events within 30 days (MAKE-30).

OR 130