The Skeptics' Guide to EM

JANUARY 19, 2019

The EMS crew observes drug paraphernalia and suspect an intravenous (IV) opioid overdose. Background: There have been close to 400,000 deaths from an overdose involving any opioid (prescription and illicit opioids) between 1999 and 2017. [1] Wave 2: Rapid increase in overdose deaths involving heroin starting in 2010.

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Naloxone Overdose Emergency Medical Services Emergency Department 130

EMergucate

JULY 3, 2016

A 44 year old man presents to your ED after taking an overdose of paracetamol about 12 hours ago. His paracetamol nomogram is as follows:

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Overdose ED EMS 130

ALiEM

FEBRUARY 5, 2024

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Overdose Critical Care EMS Emergency Department 215

The Skeptics' Guide to EM

APRIL 20, 2024

Case: You are doing great things and helping many patients during your shift in the emergency department (ED) when you hear a trauma alert being called overheard. She is an Assistant Professor and Director of Research in the Department of Emergency Medicine at the NYU Grossman Long Island Hospital Campus.

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Emergency Department Overdose ALS ED 218

ESO

DECEMBER 18, 2024

In 2023, EMS clinicians responded to 236,000 calls for suspected opioid overdoses, representing nearly 2% of all EMS calls nationwide. The 2024 ESO EMS Index reveals that 82% of patients with suspected opioid overdoses received naloxone, a medication that can reverse opioid effects.

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Naloxone CPR Overdose Defibrillator 52

Emergency Medicine Cases

OCTOBER 9, 2018

In anticipation of EM Cases Episode 116 on Opioid Misuse, Overdose and Withdrawal, Dr. Michelle Klaiman, Addictions and Emergency Medicine specialist, tells her Best Case Ever exemplifying how we can positively impact the lives of ED patients for years to come - even when they present with simple, run-of-the-mill diagnoses - by thinking outside the (..)

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Overdose ED EMS Naloxone 130

Emergency Medicine Cases

JANUARY 3, 2017

One of the things we need to think about whenever we see a patient who’s going low and slow with hypotension and bradycardia is an overdose. And inevitably we’re gonna be faced with both intentional and unintentional overdoses from these drugs in the ED.

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Overdose ED EMS 100

REBEL EM

JULY 17, 2023

REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? PMID: Clinical Question: Does a single dose of ketamine or etomidate used for rapid sequence intubation (RSI) of critically adults in the ED impact the SOFA score within 3 days of hospitalization? Click here for Direct Download of the Podcast Paper: Knack SKS et al.

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ED ICU Emergency Department Overdose 98

EMergucate

APRIL 11, 2015

A 27 year old man is brought to your ED by ambulance after taking an overdose of a commonly used medication. He is tachypnoeic with a normal mental state and blood pressure. His ABG (RA) shows:

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The Skeptics' Guide to EM

AUGUST 27, 2022

Just give them a choice”: Patients’ perspectives regarding starting medications for opioid use disorder in the ED. Just give them a choice”: Patients’ perspectives regarding starting medications for opioid use disorder in the ED. Case: A 24-year-old male presents to the emergency department (ED) after a fentanyl overdose.

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Emergency Department Naloxone Overdose ED 100

EMergucate

JUNE 21, 2022

17 year old girl presented to ED with aspirin overdose. Her VBG showed the following: PH = 7.45 pCO2 = … Continue reading →

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Overdose ED 100

EMergucate

SEPTEMBER 30, 2019

18 year old man was brought to ED with an overdose of unknown medication. He was intoxicated and very agitated. He needed 4 security guards to restrain him so a medical officer can put a cannula an…

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Overdose ED 100

EMergucate

AUGUST 10, 2020

A 65 year old female is brought to ED via ambulance on a priority 1. According to the paramedics the patient has taken an overdose of benzodiazepines and alcohol. Her GCS is 3 and the team is prepa…

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Overdose Ambulance Paramedic ED 100

EMergucate

AUGUST 12, 2020

A 65 year old female is brought to ED via ambulance on a priority 1. According to the paramedics the patient has taken an overdose of benzodiazepines and alcohol. Her GCS is 3 and the team is prepa…

Overdose 100

Overdose Ambulance Paramedic ED 100

EMergucate

FEBRUARY 1, 2022

A 65 year old female is brought to ED via ambulance on a priority 1. According to the paramedics the patient has taken an overdose of benzodiazepines and alcohol. Her GCS is 3 and the team is prepa…

Overdose 100

Overdose Ambulance Paramedic ED 100

EMergucate

FEBRUARY 2, 2022

A 65 year old female is brought to ED via ambulance on a priority 1. According to the paramedics the patient has taken an overdose of benzodiazepines and alcohol. Her GCS is 3 and the team is prepa…

Overdose 100

Overdose Ambulance Paramedic ED 100

ALiEM

FEBRUARY 20, 2024

Managing cardiovascular collapse in severe flecainide overdose without recourse to extracorporeal therapy. Successful treatment of flecainide-induced cardiac arrest with extracorporeal membrane oxygenation in the ED. Am J Emerg Med. 2022 Jun;56:394.e1-394.e4. doi: 10.1016/j.ajem.2022.03.006. 2022.03.006. Epub 2022 Mar 9. J Med Toxicol.

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Life Support Overdose ED 183

The Skeptics' Guide to EM

AUGUST 18, 2018

Case: A 54-year-old female presents to the emergency department (ED) with abdominal pain and profuse non-bloody diarrhea for the past 24 hours. Background: Preventable adverse drug events (ADEs) are a common cause of ED visits, hospitalizations and death (Ref 1,2). Reference: Hohl C et al. AEM Aug 2018.

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Emergency Department Overdose ED ALS 130

EMDocs

AUGUST 3, 2023

Massive acetaminophen overdose: effect of hemodialysis on acetaminophen and acetylcysteine kinetics. A multicenter comparison of the safety of oral versus intravenous acetylcysteine for treatment of acetaminophen overdose [published correction appears in Clin Toxicol (Phila). Adverse reactions to acetylcysteine and effects of overdose.

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Overdose E-9-1-1 OR ED 98

EMDocs

JANUARY 17, 2024

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. What are the treatment options for a benzonatate overdose? Questions: What is benzonatate’s mechanism of action?

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

EMDocs

JANUARY 4, 2024

Questions: What are the clinical manifestations of bupropion overdose? How is bupropion overdose treated? How long should a patient be observed after a bupropion overdose? 1 In addition to intentional overdoses, there are multiple case studies of abuse (ingestion, insufflation, injection). hours, SR 3 hours, XL 5 hours.

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Overdose E-9-1-1 ALS Emergency Department 92

Pediatric EM Morsels

OCTOBER 27, 2023

Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS.

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E-9-1-1 Emergency Medical Services Life Support ALS 271

EMDocs

NOVEMBER 6, 2023

This post will focus on the key parts of the guideline that affect ED evaluation and management. Opioid overdose remains the leading cause of cardiac arrest due to poisoning in North America. Give naloxone for suspected opioid overdose and respiratory compromise/arrest. Top 10 Take Home Pearls 1. COR No Benefit, LOE C-LD.

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Naloxone OR BLS Overdose 115

Don't Forget the Bubbles

SEPTEMBER 6, 2023

14-year-old Katy presents to the paediatric Emergency Department (ED), alone, complaining of suicidal ideation. Mental health-related ED visits for children and young people are common and have been on the rise during the last decade. What is the problem? It can be difficult to diagnose and may require detailed investigation.

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Emergency Department ED Overdose ALS 119

EMDocs

FEBRUARY 15, 2024

7,10 Contraindications include asthma, chronic obstructive pulmonary disease (COPD), genitourinary or gastrointestinal obstruction, or if there is suspected or confirmed tricyclic antidepressant (TCA) overdose. His vitals also improve, and he is subsequently discharged from the ED. 9 Physostigmine dosing: 0.5-2 McGraw Hill; 2019.

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E-9-1-1 Overdose ED OR 111

Dr. Smith's ECG Blog

JULY 25, 2024

The patient was brought to the ED and had this ECG recorded: What do you think? After 1 mg of epinephrine they achieved ROSC. Total prehospital meds were epinephrine 1 mg x 3, amiodarone 300 mg and 100 mL of 8.4% sodium bicarbonate. And what do you want to do? The ECG shows severe ischemia, possibly posterior OMI.

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Defibrillator Coronary Epinephrine ACS 124

EMOttawa

MAY 23, 2024

The opioid epidemic is not new to ED providers across the country, but the true extent of harm is quite shocking. The North American opioid crisis is rapidly expanding, resulting in unprecedented levels of harm and strain on the healthcare system.

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ED Overdose 135

Dr. Smith's ECG Blog

MAY 8, 2014

The patient was restless, agitated, and nonverbal on arrival to ED, with elevated HR at 150. Here is the first ED ECG: What is the likely diagnosis? These findings are nearly pathognomonic of, or at least highly suspicious for, tricyclic antidepressant (TCA) overdose. More still on TCA overdose, from lifeinthefastlane.

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Overdose ICU EMS ED 52

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. doi:10.1007/BF03161199 Olson K, Smollin C, eds. Poisoning & Drug Overdose. 1-5] Since then, many more medications have been developed and deployed. 2022;59:42-48.

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ACEP Now

MAY 8, 2023

1,2 With such enormous popularity it is no surprise that each year there are 56,000 emergency department (ED) visits, 2,600 hospitalizations, and 500 deaths in the U.S. 1,2 With such enormous popularity it is no surprise that each year there are 56,000 emergency department (ED) visits, 2,600 hospitalizations, and 500 deaths in the U.S.

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Overdose ALS OR EMS 52

EMDocs

JUNE 2, 2023

The fourth episode in this series will shift gears and talk about safely transporting children to the ED via prehospital services. Haloperidol (Haldol) – 0.5-5 5 mg PO; 0.05-0.15 mg/kg IM (up to 5 mg/dose) Chlorpromazine (Thorazine) – 0.55 mg/kg/dose (PO/IM) Droperidol – 0.03-0.07 mg/kg/dose (PO/IM/IV) Midazolam – 0.25-0.5

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Emergency Department Emergency Medical Services Overdose ED 93

ACEP Now

JANUARY 5, 2025

The PREOXI trial compared oxygen mask pre-oxygenation versus noninvasive positive-pressure ventilation (NIPPV) in patients requiring intubation in emergency departments (EDs) and intensive care units. 2 This was not an ED trial but was performed in stable patients on the inpatient wards. The obvious winner was NIPPV, whose 9.1

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ALS E-9-1-1 ED Emergency Department 40

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

After discussing all of the above with ED staff, we have made a decision to get stat echocardiogram and assess overall LV function and wall motion abnormalities and defer cath lab activation at the time." On the other hand, stable EKG over an hour in the setting of ongoing acute coronary syndrome is again unusual.

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Overdose OR Coronary ACS 52

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

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Overdose ACS Critical Care OR 93

EMergucate

OCTOBER 10, 2017

56 year old male presents to ED after taking an unknown quantity of perindapril/indapamide combination 6 hours previously. He also … Continue reading →

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ED Overdose 100

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.

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Defibrillator CPR Epinephrine Life Support 109

EM Basic

MARCH 13, 2019

Today’s episode of the podcast is a myth busting on all the media reports about first responders overdosing by being exposed to fentanyl in the field by incidental contact. 100 micrograms is not enough to cause an overdose in an adult. Even if you were to try to overdose on fentanyl patches this is next to impossible.

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Naloxone Overdose First Responder NARCAN 52