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Date: October 20, 2023 Reference: Cai et al. Implementation of a Clinical Management Tool for Spinal Epidural Abscess Early Diagnosis. AEM October 2023. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: You are in your group meeting and have heard about a case at a nearby emergency department (ED) where the […] The post SGEM#418: I Ain’t Missing You – Spinal Epidural Abscess first appeared on The Skeptics Guide to Emergency Medicine.
A 26-year-old male with no significant past medical history presented to the ED after slipping on wet pavement and hitting his head on the ground three hours prior. He endorsed a constant, achy 7/10 headache accompanied by nausea and photophobia. He denied vomiting, dizziness, diplopia, loss of consciousness, or seizures. Nothing made it better or worse.
Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Dr. James Broselow, a family medicine-turned-emergency medicine physician from Hickory, North Carolina , recognized that his team spent a lot of time trying to calculate doses of medications rather than spending their mental energy on the actual medical decisions for the resuscitation.
In this month's EM Quick Hits podcast: Sarah Reid on an approach to Infant Vomiting, Brit Long on Orbital Cellulitis essentials, Justin Morgenstern on the PATCH trial - Prehospital TXA in Trauma, Christina Shenvi on Prevention and Treatment of Delirium, Jason Hines on Procedural Skills Decay, Aaron Billin on Altitude Sickness. The post EM Quick Hits 52 Infant Vomiting, Orbital Cellulitis, Prehospital TXA in Trauma, Prevention and Treatment of Delirium, Procedural Skills Decay, Altitude Sickness
Read between the lines. No matter where we are or what type of medicine we practice, it is likely that we all were told at one point that we were expected to be lifelong learners. This is important as medical knowledge is constantly evolving. Dr. David Sackett, the father of evidence-based medicine, once said: I The traditional way to stay current is by reading the relevant scientific literature.
In patients with trauma and critical bleeding who require activation of a major haemorrhage protocol, does the empiric administration of 3 pools of cryoprecipitate (6g fibrinogen) within 90 minutes of randomisation (and no more than 3 hours after injury) improve survival, compared to standard care?
Date: October 26, 2023 Reference: Jones et al. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial placebo-controlled trial. Lancet July 2023 Guest Skeptic: Dr. Sergey Motov is an Emergency Physician in the Department of Emergency Medicine, Maimonides Medical Center in New York City. He is also one of the world’s leading researchers […] The post SGEM#419: Welcome Back – To Another Episode on Back Pain first appeared on The Skeptics Guide
A 32-year-old man with a history of traumatic globe rupture from a stab wound two months ago, status post repair, presented to the emergency department for worsening right eye pain and green malodorous drainage for the past three days. These symptoms started when he got a fleck of sawdust in the right eye about four days prior to presentation, which he was able to brush out with his finger.
A 32-year-old man with a history of traumatic globe rupture from a stab wound two months ago, status post repair, presented to the emergency department for worsening right eye pain and green malodorous drainage for the past three days. These symptoms started when he got a fleck of sawdust in the right eye about four days prior to presentation, which he was able to brush out with his finger.
A 70 something male presented in severe respiratory distress. The patient had altered mental status and so he was prepared for intubation. Before intubation, he became hypotensive. On the monitor patient had wide-complex tachycardia. The following 12-lead was obtained: What do you think? Differential is ventricular tachycardia versus supraventricular tachycardia with aberrancy versus sinus tachycardia with a aberrancy.
In this ECG Cases blog Dr. Jesse McLaren guides us through 10 cases, driving home the points that sepsis is a common cause of rapid Afib and diffuse ST depression with reciprocal ST elevation in aVR, myo/pericarditis is a diagnosis of exclusion, endocarditis or lyme carditis can cause AV block, PE can cause low grade fever and ECG signs of acute RV strain and that fever can unmask Brugada syndrome.
The CHRISTUS Health-Texas A&M Spohn Emergency Medicine Residency Program announced Friday that its program will close in June 2026 after the current emergency medicine residents complete their training. An official reason for the closure was not immediately available from the hospital administration, but residents there said they were told the surprise move was likely because of financial reasons.
FOR IMMEDIATE RELEASE Contact: Amanda Riordan 703-615-4492 ariordan@ambulance.org EMS Heroes To Be Honored in Washington, DC as 2023 Stars of Life Washington, DC—Next week, the American Ambulance Association (AAA) will […] The post Release | EMS Heroes Honored in Washington, DC as 2023 Stars of Life appeared first on American Ambulance Association.
Reference: Brennan L et al. Time to change the reference ranges of children’s physiological observations in emergency care? A prospective study. J Paediatr Child Health. March 2023 Date: July 12th, 2023 Guest Skeptic: Dr. Vicki Currie is a paediatric emergency medicine registrar in the West Midlands in the United Kingdom. She is also a member […] The post SGEM #417: Everybody’s Changing…the Reference Ranges for Pediatric Vital Signs first appeared on The Skeptics Guide to Emergency Medicine.
What is the most common primary cause of death from ingesting the pictured marine animal? Acute liver failure Acute renal failure Coagulopathy and DIC Respiratory failure Status epilepticus [Image from Canstockphoto] Reveal the Answer 4. Respiratory Failure The pufferfish, considered a delicacy in multiple countries, contains tetrodotoxin which causes sodium channel blockade and can lead to muscle paralysis, respiratory failure, and death.
Written by Michael Doyle DO and Timothy Palmieri MD. Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. The described rhythm was an irregular, wide complex rhythm. By EMS report, open pill bottles were found nearby at the scene, including quetiapine, fluoxetine, hydroxyzine, and gabapentin.
We chat with Janelle Bludorn (@JanelleRBlu), former emergency medicine PA, Assistant Professor and Academic Coordinator at the Duke PA program, about transitioning from clinical work into teaching and academia. Find us on Patreon here! Buy your merch here! Resources We chat with Janelle Bludorn ( @JanelleRBlu ), former emergency medicine PA, Assistant Professor and Academic Coordinator at the Duke PA program, about transitioning from clinical work into teaching and academia.
The American Ambulance Association is proud to announce the winners of the 2023 AAA Legislative Awards. Each Member of Congress is being recognized for their strong advocacy for emergency medical services […] The post 2023 AAA Legislative Awards appeared first on American Ambulance Association.
Some folks on twitter asked my thoughts on AMIKINHAL trial, so I thought I'd jot them here. AMIKINHAL is a multi-center RCT that evaluated the ability of inhaled amikacin to prevent VAP (ventilator-associated pneumonia) among patients who had been intubated for three days. It's available here at NEJM. It was a positive trial, which is […] EMCrit Project by Josh Farkas.
What potential terrorism agent could be treated with the pictured antidote? Anthrax Botulism Dioxin Ricin Soman Reveal the Answer 5. Soman The pictured autoinjector is a MARK-1 kit containing 2 mg of atropine and 600 mg of pralidoxime. This kit has historically been issued to US service members for treating nerve agent toxicity from agents such as soman, sarin, tabun, and VX, all of which are organophosphates and cause a cholinergic toxidrome.
This is a re-post of an excellent case from 2021. See it again now, along with our new Queen of Hearts functionality. We've come a long way in 2 years! And the pace only quickens. A man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. He called EMS who brought him to the ED.
Case Your patient is bleeding. A lot. Their vital signs are abnormal. They look very sick. (I am being intentionally vague, because the post is going to look at massive hemorrhage in general, rather than getting into the specifics of any one condition.) This post is a condensed clinical summary of appropriate actions in the […] The post Massive hemorrhage: The clinical approach appeared first on First10EM.
The National EMS Advisory Council (NEMSAC) will host a hybrid meeting on Wednesday and Thursday, November 15-16, 2023, from 1:00 pm – 4:15 PM ET. Join us for national EMS program […] The post National EMS Advisory Council Meeting November 15-16, 2023 appeared first on American Ambulance Association.
Each time she moved her hand it caught my eye: the glint of her bejeweled fingers sharply contrasting with the spare gurney and paper-thin blanket. The fat heaviness of her rings seemed startling against her bony fingers, as if they should have shrunk in parallel with her collagen and fat. She fought against the technician removing her belongings while her protestations melded with my trauma survey.
Welcome to the AIR Respiratory Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to related to respiratory diseases in the Emergency Department. 6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board.
Background: Hemorrhage is the leading cause of trauma related mortality. The initial injury is often complicated by multifactorial coagulopathy that can exacerbate bleeding. Fibrinogen is the precursor to fibrin and a major component of stable clot formation. Fibrinogen and fibrin are often depleted during major trauma as a result of consumption, breakdown, and dilution.
More guidelines! Today we'll walk through some interesting bits of the new IDSA/SCCM guideline on evaluation of new fever in the adult ICU patient (available free here). how should temperature be evaluated? This is frankly a mess. Bladder catheter or esophageal probe are best, but usually not used. Rectal temperature is 2nd best, but unwieldy […] EMCrit Project by Josh Farkas.
Highlighting Key Commitments to Diversity, Equity, Inclusion and Accessibility With this reinforced dedication, FICEMS can better achieve and enhance the EMS mission for all persons. FICEMS’ newly released Diversity, Equity, […] The post FICEMS DEIA Statement Now Available appeared first on American Ambulance Association.
Maryland enacted the first “prudent layperson standard” (PLP) in state law in 1993 (see related timeline). The PLP standard they devised protected a patient’s access to emergency medical services, including on-call services, if the medical condition of the patient manifests itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson could reasonably expect that the absence of immediate medical attention could result in serious jeopardy to the health of t
Dr. Garcia is a freshly minted faculty member at Big Name University Medical Center. She’s excited to have finally finished residency and dive into her career as a full time (and fully paid) attending. After spending her first year acclimating to the new department and achieving board certification, Dr. Garcia finds herself at a bit of a crossroad.
A 3-year-old girl presents with acute onset convergent strabismus. Fundoscopy examination reveals papilloedema. What are the next steps in the management of their daughter? First thoughts – is this a space-occupying lesion? If you haven’t seen it already, please check out HeadSmart. It details presentations commonly associated with a brain tumour in each age group.
Written by Sean Trostel MD, peer reviewed by Meyers, Smith, Grauer, etc. A man in his 60s with a history of severe alcohol use disorder and epidural abscess on long-term ciprofloxacin presented to the emergency department after an episode of syncope while standing in line at a grocery store. He did not have chest pain. Here is his triage ECG: What do you think?
Today on the emDOCs cast, we have a guest piece by Rob Orman, MD. Emergency Physician and founder of Orman Physician Coaching Host of the Stimulus Podcast Learn more at roborman.com If you want to hear the coaching session where Brit and Rob deconstructed his shift and came up with this strategy, it’s here. Episode 87: Conquering Mid-Shift Overwhelm Mid-shift in an emergency department is a special beast.
FOR IMMEDIATE RELEASE Contact: Amanda Riordan 703-615-4492 ariordan@ambulance.org EMS Heroes To Be Honored in Washington, DC as 2023 Stars of Life Washington, DC—This November, the American Ambulance Association (AAA) will […] The post Release | EMS Heroes To Be Honored in Washington, DC as 2023 Stars of Life appeared first on American Ambulance Association.
Hello fellow nerds, let's take a look at the new American Association of Neurology (AAN) brain death guidelines. Instead of a tweetorial, I'll jot my thoughts here, so they're accessible to everyone. Disclaimer: the following discussion applies only to adult medicine. Most of these guidelines are consistent with the 2020 World Brain Death Project, so […] EMCrit Project by Josh Farkas.
The Problem: Emergency Medicine (EM) in Pakistan has moved from developing to developed stage in the last decade [1]. As the specialty evolves in Pakistan and other countries, there is a need to improve and assimilate novel learning methods to elevate education standards. The COVID-19 pandemic catalyzed the routine use of video-conference platforms such as Zoom.
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