The Skeptics' Guide to EM

NOVEMBER 13, 2021

Guest Skeptic: Dr. Neil Dasgupta is an emergency physician and ED intensivist from Long Island, NY, and currently an assistant clinical professor and Director of Emergency Critical Care […] The post SGEM#350: How Did I Get Epi Alone? JAMA Sept 2021. He had been admitted the night before for a new diagnosis of rapid atrial fibrillation.

Epinephrine 100

Epinephrine Critical Care Life Support Emergency Department 100

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. More recent literature and guidelines support the use of lidocaine as an alternative agent, and currently both are included in standard advanced cardiovascular life support. 2023;163(5):1109-1119.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

Don't Forget the Bubbles

AUGUST 7, 2023

Heart rate (HR) and respiratory rate (RR) are THE major vital signs used in Advanced Paediatric Life Support ( APLS) guidance , sepsis guidelines , and Paediatric Early Warning Scores (e.g., Paediatric advanced life support Guidelines [Internet]. and two cohort studies, one performed in Australia by O’Leary et al.

Life Support 98

Life Support Advanced Life Support ALS Emergency Department 98

EMDocs

NOVEMBER 6, 2023

This post will focus on the key parts of the guideline that affect ED evaluation and management. High-dose insulin therapy is recommended early in the treatment of patients with life-threatening β-blocker and calcium channel blocker poisoning. Top 10 Take Home Pearls 1. COR 2a, LOE C-LD. COR 2a, LOE C-LD. COR 2a, LOE C-EO.

Naloxone 115

Naloxone OR BLS Overdose 115

ACEP Now

DECEMBER 6, 2024

Advanced cardiac life support protocol was initiated, and the patient was intubated. Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm. Dr. Rad is ED faculty at Wellstar Kennestone Regional Medical Center in Marietta, Ga.,

Coronary 98

Coronary Life Support ALS Emergency Department 98

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. Although historically used quite frequently, dopamine is no longer recommended by advanced life support guidelines for septic shock unless adrenaline/noradrenaline are unavailable. After 40ml/kg of IV 0.9%

Advanced Life Support 143

Advanced Life Support ED ALS OR 143

EMDocs

APRIL 10, 2024

These medications are a vital tool in the care of ED patients, from simple local analgesia for a laceration repair to regional analgesia for painful procedures. Supportive care includes: protecting the airway if necessary, supplemental oxygen if needed, and vasopressor support if the patient is hypotensive. 2022;59:42-48.

E-9-1-1 111

E-9-1-1 Plasma Epinephrine Overdose 111

Don't Forget the Bubbles

JUNE 30, 2023

She was intubated at the scene and transported to your ED, with cardiopulmonary resuscitation (CPR) performed en route. Extracorporeal life support rewarming rate is associated with survival with good neurological outcome in accidental hypothermia. Emergency Medical Services found her apneic and pulseless. Saczkowski, R.,

CPR 145

CPR Life Support Critical Care ALS 145

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). His blood sugar was normal en route to the ED, and his initial rhythm on the cardiac monitor was asystole. It is unclear how long he was down. doi: 10.1097/MAT.0000000000001518

Defibrillator 109

Defibrillator CPR Epinephrine Life Support 109

EMDocs

JUNE 22, 2024

A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. Treatment is supportive with respiratory therapy, critical care, inotropic therapy, and cardiac life support. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in.

EMS 111

EMS FFP Ambulance ICU 111

FOAMfrat

JULY 3, 2024

Advanced Hazmat Life Support Provider Manual (4th ed.). (F. Thomas, Eds.) -The Hazmat Medic References Borron, S. Bronstein, A. Fernandez, M. Walter, J. Schauben, R. Klein, & R. Tuscon, AZ: University of Arizona - Arizona Board of Regents. Centers for Disease Control. 2023, 02 07).

Life Support 105

Life Support ALS Emergency Response OR 105

NCOAE

AUGUST 12, 2022

Here, we present them in alphabetical order: ABC – Airway, Breathing and Circulation – “This is the Golden Rule of emergency medical professionals” AED – Automated External Defibrillator – The device that delivers electric shock to the heart of patients experiencing sudden cardiac arrest A-EMT – Advanced EMT ALS – Advanced Life Support Anaphylaxis— (..)

EMS 52

EMS EMT EMT Emergency Medical Technician 52

EMDocs

AUGUST 22, 2023

Capnography has several novel uses in other disease states commonly seen in the ED such as trauma, DKA, sepsis and obstructive lung disease. Capnography picks up hypoventilation faster than pulse oximetry. ETCO 2 correlates with blood pressure, lactate, and base excess in critically ill patients. Ann Emerg Med. 2017;70(5):758.

Emergency Department 94

Emergency Department ALS Life Support OR 94

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Case A 25-year-old-female presented to the ED in cardiac arrest. Summary This case exemplifies the value of POCUS in cardiac arrest patients in the ED. EKG RV strain. Tintinalli, J.E.

ED 98

ED NARCAN ALS OR 98

ESO

JANUARY 19, 2024

One of these areas is assessing patients with ED-diagnosed strokes. In order to overcome these disparities, it is incredibly important for the industry to recognize and monitor where the discrepancies lie. Closing the gap Through data, ESO is working to identify areas in which we can improve outcomes for all patients.

CPR 52

CPR Advanced Life Support Life Support STEMI 52

EMDocs

JANUARY 17, 2024

She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). Upon ED arrival, she had a heart rate (HR) of 160 and blood pressure (BP) of 80s/40s.

E-9-1-1 89

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

EMDocs

JANUARY 8, 2024

This post will focus on the key parts of the guideline that affect ED evaluation and management. 2023 American Heart Association Focused Update on Adult Advanced Cardiovascular Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation.

Epinephrine 98

Epinephrine Defibrillator Coronary CPR 98

Don't Forget the Bubbles

OCTOBER 7, 2024

In: Walls RM, ed. Advanced Paediatric Life Support [Internet]. If the hose is narrow, less water flows through (low current) References Electrocution and Electrical Injury – Emergency Management in Children; Children’s Health Queensland Hospital and Health Service Baird J. Electrical Injuries. Chen P, Bukhman AK. Culnan, D.M.,

ACS 80

ACS Life Support OR CPR 80

ACEP Now

DECEMBER 10, 2023

A middle-aged male with squamous cell carcinoma and extensive metastases is brought to the emergency department (ED) after being found unresponsive following a believed suicide attempt (SA) by methadone ingestion. 5 This cannot feasibly be performed in the ED as it requires a significant amount of time and a multi-disciplinary assessment.

Naloxone 52

Naloxone Life Support Paramedic ALS 52

REBEL EM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). The average time to control HR in the IV amiodarone was 1.7h, which is usually the average time for disposition from the ED. Paper: Mason JM, et al. Am J Emerg Med.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

The Good, The Bad & The Ugly Paramedic

SEPTEMBER 30, 2021

We equip them with a growing collection of skills to include everything from basic life support, right through to advanced care. The potential adverse patient effects of ambulance ramping, a relatively new problem at the interface between prehospital and ED care. Retrieved from [link] Paramedicine Board AHPRA.

Paramedic 52

Paramedic Paramedicine Paramedicine Ambulance 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

The patient was put on Extracorporeal Life Support in the ED 3 hours after initial resuscitation, the core temp was 30° C and the patient was defibrillated with a single attempt. This Transesophageal ED Echo was recorded: Cardiac POCUS.mov from Stephen Smith on Vimeo. Chest compressions and ventilation were begun.

CPR 40

CPR Defibrillator Life Support ED 40

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm. Electrical Injuries.

Operating Room 52

Operating Room ACS Critical Care Coronary 52

ACEP Now

OCTOBER 11, 2024

Introduction Pediatric intubations in the emergency department (ED) occur at only a tenth the frequency of adult intubations. 1 Pediatric rapid sequence intubation (RSI) in the ED is associated with a higher frequency of failed first attempts and adverse effects than in adult patients. Her breathing is irregular.

E-9-1-1 52

E-9-1-1 Emergency Department Advanced Life Support ALS 52

Dr. Smith's ECG Blog

MAY 19, 2020

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). For clarity — I’ll again show the initial ECG done in the ED in Figure-1. An elderly woman had sudden ventricular fibrillation. Figure-1: The initial 12-lead ECG in this case ( See text ).

Defibrillator 52

Defibrillator CPR Coronary CAD 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

This is a 30-something healthy patient presented with COVID pneumonia who presented to the ED. He was started on Extracorporeal Life Support ("VA ECMO") Here is the ECG on ECMO: Very low voltage On Day 3, the EF recovered (that seems quick!) He was moderately hypoxic. There is minimal, probably normal STE in V2-V6.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. What additional workup is necessary in the ED?

ED 98

ED E-9-1-1 ALS OR 98

Core EM

MARCH 5, 2025

The Pan American Health Organization also recommends screening anyone who was born in or lived longer than 6 months in a country with endemic Chagas as well as travelers with confirmed exposure to triatomines CD in the ED Most patients presenting with Chagas will be unaware of their infection status. EDs in the U.S. de Oliveira, E.C.

Defibrillator 130

Defibrillator Blood Donation OR Emergency Department 130

Don't Forget the Bubbles

FEBRUARY 5, 2025

Ali, a 12-year-old male, is pre-alerted by ambulance to ED. How would you prepare for the patient’s arrival to ED? Do I have emergency blood available in the ED? Lee, a 14-year-old male, is brought into the ED by his friends, stating he has been in a fight. Which investigations would you consider?

E-9-1-1 59

E-9-1-1 CPR Ambulance ED 59

Don't Forget the Bubbles

FEBRUARY 24, 2025

Because of their worsening respiratory acidosis, they were intubated in the ED, The initial chest-x ray shows a right-sided consolidation, in keeping with bronchopneumonia. This heightened risk underscores the need for vigilant supportive care and proactive management in these cases. What about ECMO?

ALS 59

ALS Critical Care OR Life Support 59