Core EM

JANUARY 25, 2024

Patient Case: History: A 60-year-old male with history of schizophrenia and depression on multiple unknown antipsychotic medications presents with unresponsiveness x 1 day. One week prior to ED arrival, the patient was becoming progressively despondent, less interactive with peers, exhibiting slow speech and movements, and was not eating. Physical exam: Vital signs – febrile, tachycardic, hypertensive General – posturing with arms stretched out in front, eyes open without blinking, akinetic, no

MICU 246

MICU Emergency Department OR ED 246

EMOttawa

JANUARY 25, 2024

Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.

ICU 141

ICU ED OR Critical Care 141

Core EM

JANUARY 25, 2024

Prehospital Narrow Pulse Pressure Predicts Need for Resuscitative Thoracotomy and Emergent Intervention After Trauma J Surg Res., 2021 Background Prehospital trauma team activation criteria allow for prompt mobilization of personnel and resources. Prehospital hypotension is one of those criteria. Pulse pressure is the difference between systolic and diastolic blood pressure.

Operating Room 246

Operating Room EMS ED ICU 246

REBEL EM

JANUARY 25, 2024

Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. It can be used to distinguish between various conditions, including chronic obstructive pulmonary disease (COPD) exacerbation, acute heart failure (AHF), pleural effusion, pulmonary edema, pericardial effusion, pneumothorax, and pneumonia [2,3].

ED 130

ED E-9-1-1 Emergency Department ALS 130

Core EM

JANUARY 25, 2024

How and when to reverse anticoagulation in the bleeding EM patient. Hosts: Joe Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: Anticoagulation , Critical Care , Resuscitation Show Notes Coagulation Cascade: Algorithm for Anticoagulated Bleeding Patient in the ED: Indications for Anticoagulation Reversal: References: Baugh CW, Levine M, Cornutt D, et al.

Frozen Plasma 246

Frozen Plasma FFP Plasma Critical Care 246

Pulsara

JANUARY 25, 2024

With a new protocol and Pulsara, Metropolitan Emergency Medical Services can now transport eligible pediatric behavioral health patients directly to behavioral health facilities—resulting in a 44% decrease of pediatric behavioral health patients transported to the ED. Metropolitan Emergency Medical Services (MEMS) is a public, non-profit EMS entity serving Little Rock, Arkansas, and its surrounding counties.

Emergency Medical Services 109

Emergency Medical Services EMS STEMI Emergency Department 109

Core EM

JANUARY 25, 2024

Background & Pathophysiology: An inflammatory colitis caused by fecal impaction Marked distension and increased intraluminal pressure leads to ischemic pressure necrosis of the colonic wall and compromise of vascular supply and mucosal perfusion Risk of progression to colonic perforation and peritonitis Multiple areas of ulceration occur adjacent to the fecaloma; most commonly in the rectosigmoid colon Diagnosis: Lab findings are non-specific – may reveal increased WBC and/or acute phase rea

E-9-1-1 246

E-9-1-1 OR 246

Core EM

JANUARY 25, 2024

Background and Pathophysiology: Comorbidities, physiologic changes, and medication-associated effects leave elderly patients more susceptible to injury from “minor” mechanisms. Diminished functional reserves decrease compensatory ability for any injury, regardless of severity. 1 Despite adjustments for injury severity, significantly increased mortality occurs ≥70 years regardless of mechanism, compared to younger counterparts.

ALS 246

ALS ED ICU OR 246

Paramedics World

JANUARY 25, 2024

Burn injuries result from exposure to sources such as flames, hot surfaces, chemicals, or electricity that cause harm to both skin and underlying tissue. According to World Health Organization data,… The post Why It’s Essential to Find a Burn Injury Lawyer You Can Rely On appeared first on Paramedics World.

Paramedic 98

Paramedic OR 98

Core EM

JANUARY 25, 2024

Background: An update to our 2015 post on HIET for beta-adrenergic receptor and calcium channel antagonists overdose. Beta-adrenergic receptor antagonists (Beta blockers, BB) and calcium channel antagonists (calcium channel blockers) are common drugs that can produce profound cardiac depression and shock when taken in overdose. 2020 National Poison Data System report: 10,994 beta blocker overdoses 18 deaths 6,132 calcium channel blocker overdoses 45 deaths High case fatality rate, behind only ac

Overdose 246

Overdose ALS Epinephrine Critical Care 246

Paramedics World

JANUARY 25, 2024

Are you worried about your safety while riding a motorcycle? Well, you’re not alone. The NHTSA reports that out of 5,114 motorcycles in 2019, 2,811 (or 55%) were involved in… The post 7 Surefire Tips to Prevent Motorcycle Accidents appeared first on Paramedics World.

Paramedic 98

Paramedic OR 98

Core EM

JANUARY 25, 2024

Background: The lumbar puncture (LP or spinal tap) is a procedure that has been in the medical arsenal since first described in 1891 by German physician Heinrich Quincke. It can be both diagnostic and therapeutic, utilized in the diagnosis (meningitis, Guillain-Barre syndrome, subarachnoid hemorrhage) and symptomatic treatment (idiopathic intracranial hypertension, normal pressure hydrocephalus) of diseases of the central nervous system, respectively.

ALS 246

ALS Critical Care OR 246

SSCOR

JANUARY 25, 2024

It was the third vehicle crash of the shift. The first two were minor – low-speed fender benders with minor injuries. This one was different: a high-speed impact involving an unrestrained driver. The facial injuries were extensive.

97

97

Core EM

JANUARY 25, 2024

A quick primer on hypocalcemia in the ED. Hosts: Joseph Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: calcium , Critical Care , Endocrine Show Notes Swami’s CoreEM Post Hypocalcemia Repletion: IV calcium supplementation with 100-300 mg Ca2+ raises serum Ca2+ by 0.5 – 1.5 mEq For acute but mild symptomatic hypocalcemia: 200-1000mg calcium chloride IV or 1-2g IV calcium gluconate over 2 hours For severe hypocalcemia: 1g calcium chloride IV or 1-2g IV calcium gluc

Critical Care 246

Critical Care ED ALS OR 246

Dr. Smith's ECG Blog

JANUARY 25, 2024

A 40-something with severe diabetes on dialysis and with known coronary disease presented with acute crushing chest pain. Here is his ED ECG: What do you think? There is a flat and downsloping ST segment in V2 and V3. This could be due to posterior OMI. Is there an old ECG for comparison? Here is the most recent previous ECG: Indeed, there was some normal ST elevation in V2 and V3 , discordant to a relatively deep S-wave which could be due to some LVH.

Coronary 75

Coronary ED OR 75

Core EM

JANUARY 25, 2024

BACKGROUND: Necrotizing soft tissue infections are a rare but potentially lethal condition that can quickly lead to severe morbidity and mortality if not identified by clinical history and physical exam. It is a rapidly progressing infection that moves along fascial planes, often evading the immune system. This is a tricky diagnosis that can often be inconspicuous, so clinical gestalt is key.

E-9-1-1 246

E-9-1-1 Emergency Department OR 246

EMDocs

JANUARY 25, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives.

ED 72

ED ALS OR 72

Core EM

JANUARY 25, 2024

Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. While physical adjuncts like securing the tube, in line suctioning, and head positioning are part of general post intubation management, a better understanding of analgesics and sedatives have offered newer approaches and improved outcomes down the line during the patient’s hospital stay.

ICU 246

ICU Emergency Department Critical Care ALS 246

FirstNet Authority

JANUARY 25, 2024

The game-changing benefits of push-to-talk for the fire service Blog joseph.rey@fir… Thu, 01/25/2024 - 09:38 By Gary McCarraher, Senior Public Safety Advisor, First Responder Network Authority Learn more about how FirstNet is transforming public safety communications — contact your local FirstNet Authority Public Safety Advisor and sign up for our discipline newsletters.

Public Safety 59

Public Safety First Responder OR 59

Core EM

JANUARY 25, 2024

Written By: Kaitlynn Tracy, MD Edited By: Sean Schnarr, MD and Gregg Chesney, MD Definition/Background: Burns are classified as being major, moderate, or minor in severity. The American Burn Association classifies a burn as “minor” if it meets the following criteria: 2 Partial thickness < 15% BSA in a patient between the ages of 10-50 Partial thickness < 10% BSA in a patient younger than 10 or older than 50 Full thickness < 2% BSA In general, a “minor” burn should also be without a

ED 246

ED E-9-1-1 First Aid OR 246

Life in the Fastlane

JANUARY 25, 2024

Mark Corden and Neil Long Funtabulously Frivolous Friday Five 357 Funtabulously Frivolous Friday Five 357 - Just when you thought your brain could unwind, enter the medical trivia of FFFF.

52

52

Core EM

JANUARY 25, 2024

Written by: Samantha Kerester, MD Naillid Felipe, MD Edited by: Gregg Chesney, MD Jonathan Kobles, MD Background: Thrombotic thrombocytopenic purpura (TTP) is a hematologic disorder caused by platelet aggregation and thrombus formation in the microvasculature, resulting in severe thrombocytopenia, hemolytic anemia, and multi-organ ischemia. Annual incidence of approximately 2-4 cases/million/year (Kappler, 2017), with 90% of cases occurring in adulthood.

Plasma 246

Plasma Frozen Plasma Emergency Department FFP 246

Paramedics World

JANUARY 25, 2024

Sometimes, medical issues strike, and your primary care provider is unavailable. Before heading to the ER, consider whether an urgent care facility would suffice. At urgent care centers, you can… The post Navigating Urgent Care Costs: What You Need to Know appeared first on Paramedics World.

Paramedic 52

Paramedic 52

Core EM

JANUARY 25, 2024

The SQuID Protocol (Subcutaneous Insulin in Diabetic Ketoacidosis): Impacts on ED Operational Metrics. Academic Emergency Medicine, 2023 Background Diabetic ketoacidosis (DKA) is an endocrine emergency. The standard of care of treating DKA is fluid resuscitation, electrolyte management, and intravenous insulin infusion in the intensive care unit (ICU) setting for close glucose and electrolyte monitoring.

EMS 246

EMS ICU ED OR 246

Paramedics World

JANUARY 25, 2024

Artificial intelligence (AI) and virtual assistants are altering worldwide healthcare systems and are being incorporated across the industry in many exciting ways. One area seeing incredible evolution is the utilization… The post AI And Healthcare: How Virtual Assistants Are Improving Patient Outcomes appeared first on Paramedics World.

Paramedic 52

Paramedic 52

Core EM

JANUARY 25, 2024

We discuss the diagnosis and management of septic arthritis in the pediatric population. Hosts: Brian Gilberti, MD Ellen Duncan, MD [link] Download Leave a Comment Tags: Infectious Diseases , Pediatrics Show Notes General Pain in joint for pediatric patient has a broad differential, including transient synovitis and septic arthritis Transient synovitis, also known as toxic synovitis, is a common condition affecting kids aged 3-10 and often occurs after a viral infection.

OR 246

OR 246

Life in the Fastlane

JANUARY 25, 2024

Ciselle Meier and Mike Cadogan Elmer McKesson Elmer Isaac “Ira” McKessen (1881-1935) was an inventor, physician and engineer.

52

52

Core EM

JANUARY 25, 2024

Written by: Sadakat Chowdhury MD Edited by: Mak Sarich MD, Jay Lin MD, Jonathan Kobles MD Background: Ultrasound (US) guided nerve blocks offer an applicable option for achieving analgesia in the emergency department. As an alternative to parenteral or oral analgesia, nerve blocks have the potential for improved pain control, decreased risk of harm (hypoventilation, compromised airway or perfusion, potential for addiction), and decreased length of hospital stay. 1 2 3 4 This article will focus o

Epinephrine 246

Epinephrine ED OR Emergency Department 246

Core EM

JANUARY 25, 2024

The Case A 41-year-old male presents to the ED with constant palpitations for one day. The patient's medical history is notable for a congenital bicuspid aortic valve, four months post aortic valve replacement with a post-surgical ejection fraction of 30%. The following ECG is obtained: EKG Show Details EKG Characteristics Rate Fast Rhythm Wide complex tachycardia Intervals Wide complex QRS (146 ms) Axis Left axis deviation ST Segments Non-specific Additional Features Right bundle branch block m

Coronary 246

Coronary Emergency Department ED OR 246

Core EM

JANUARY 25, 2024

We go over the essential and complex topic of vasopressors in the ED. Hosts: Brian Gilberti, MD Catherine Jamin, MD [link] Download Leave a Comment Tags: Critical Care Show Notes Introduction Host: Brian Gilberti, MD Guest: Catherine Jamin, MD Associate professor of Emergency Medicine at NYU Langone Health Vice Chair of Operations Triple-boarded in Emergency Medicine, Internal Medicine, and Critical Care Medicine Topic: Vasopressors: Essential agents for supporting critically ill patients in the

Epinephrine 246

Epinephrine Critical Care Emergency Department ED 246

Core EM

JANUARY 25, 2024

Diagnostic accuracy of the physical examination in emergency department patients with acute vertigo or dizziness: A systematic review and meta-analysis for GRACE-3 Academic Emergency Medicine, 2023 Background GRACE Background The GRACE guidelines – “Guidelines for Reasonable and Appropriate Care in the Emergency Department” – are a Society for Academic Emergency Medicine (SAEM) program designed to “ reduce wasteful testing, provide explicit criteria to reduce foreseeable risk, and de

EMS 246

EMS Emergency Department OR ED 246

Core EM

JANUARY 25, 2024

We revisit the topic of Hyperkelamia to update our prior episode from 2015 (pre-Lokelma) Hosts: Brian Gilberti, MD Jonathan Kobles, MD [link] Download Leave a Comment Tags: Renal Colic Show Notes Introduction Background Physiology : Normal range and the significance of deviations (>5.5 mEq/L) Epidemiology : Prevalence of hyperkalemia in the ER ESRD missed HD → ECG, monitor Causes / Risk Factors Causes Kidney Dysfunction, Medications, Cellular Destruction, Endocrine Causes, Pseudohyperkalem

Epinephrine 246

Epinephrine OR ED 246

Core EM

JANUARY 25, 2024

Relevance: In 07/2021, the CDC released the first updates to their guidelines in 5 years on the treatment of sexually transmitted infections (STIs). These are consensus guidelines meant to provide an approach for those providers treating suspected and documented sexually transmitted infections, especially in the setting of increasing antibiotic resistance and globalization resulting in increasing prevalence of STIs previously seen mostly abroad.

OR 246

OR ALS ED 246