October, 2024

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Sudden Cardiac Arrest Awareness Month

High Performance EMS

October is Sudden Cardiac Arrest Awareness month, so High Performance EMS and PulsePoint are encouraging everyone to locate and register Automated External Defibrillators (AEDs). By doing so you’re helping to build this network of life-saving devices. Every minute that a victim of Sudden Cardiac Arrest (SCA) goes without potential defibrillation, the chances of a responding EMS crew finding a shockable rhythm decrease between 7 and 10%.

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Congressman Mike Bost Honored with Legislative Recognition Award

American Ambulance Association

FOR IMMEDIATE RELEASE Contact: Tristan North tnorth@ambulance.org October 10, 2024 Congressman Mike Bost Honored with Legislative Recognition Award from the American Ambulance Association Washington, D.C. — The American Ambulance […] The post Congressman Mike Bost Honored with Legislative Recognition Award appeared first on American Ambulance Association.

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SGEM#455: Harmony 5000 – Prehospital Detection of Large Vessel Occlusion Strokes

The Skeptics' Guide to EM

Date: October 2, 2024 Reference: Paxton et al. Headpulse measurement can reliably identify large-vessel occlusion stroke in prehospital suspected stroke patients: Results from the EPISODE-PS-COVID study. AEM Sept 2024 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the UMass Chan Medical School – Baystate.

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ECG Cases 51 – ECGs falsely labeled “normal”

Emergency Medicine Cases

In this ECG Cases blog we look at 5 cases of ECGs falsely labeled 'normal'. Can you spot the critical abnormality? Written by Jesse McLaren; Peer Reviewed and edited by Anton Helman. October 2024 Five patients presented with ECGs labeled ‘normal’. Can you use systematic ECG interpretation to identify the [.] The post ECG Cases 51 – ECGs falsely labeled “normal” appeared first on Emergency Medicine Cases.

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Episode 80: Implementing the A-F bundle with Kali Dayton

Critical Care Scenarios

We discuss the practical barriers to implementing the A-F ICU liberation bundle, with Kali Dayton, ACNP-BC (@HomeIcu), host of the Walking Home from the ICU podcast, and consultant to ICUs working on these issues. Learn more at the Intensive Care Academy! Find us on Patreon here! Buy your merch here! We discuss the practical barriers to implementing the A-F ICU liberation bundle, with Kali Dayton, ACNP-BC ( @HomeIcu ), host of the Walking Home from the ICU podcast, and consultant to ICUs working

ICU 208
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SAEM Clinical Images Series: When Needles Go Beyond Sewing and Acupuncture

ALiEM

A 64-year-old male with a history of bipolar 1 disorder, PTSD, anxiety, depression, obsessive-compulsive disorder, GERD, and HTN presented to the ED with the chief complaint of foreign body and self-injury. He reported years of sticking sewing needles into his right arm, most recently yesterday. He explained that inserting needles makes him feel better with mild associated pain.

ED 177
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Lab case 451 interpretation

EMergucate

This VBG was from a young girl with sever gastroenteritis (Vomiting and diarrhoea) for 3 days. PH = 7.52, that is moderate alkalaemia. pCO2 = 21 mmHg. So, we have respiratory alkalosis.

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SGEM #456: We are Young…but we can still Understand

The Skeptics' Guide to EM

Reference: Ma K et al. A national survey of children’s experiences and needs when attending Canadian pediatric emergency departments. PLoS One. June 2024 Date: Oct 1, 2024 Guest Skeptic: Dr. Andrew (Andy) Tagg is an Emergency Physician with a special interest in education and lifelong learning. He is the co-founder of website lead of Don’t Forget the Bubbles (DFTB).

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EM Quick Hits 60 Post-Tonsillectomy Hemorrhage, Post-CABG Infections, Bougie Tips, Pelvic Fracture Bleeds, Debriefing: Why, When & How

Emergency Medicine Cases

On this month's EM Quick Hits podcast: Kevin Wasko on post-tonsillectomy hemorrhage management, Brit Long on assessment and management of post-CABG surgical incision infections, Anand Swaminathan on evidence, pitfalls and tips on using Bougies, Leah Flannigan on when to suspect vascular injury in patients with low energy mechanism pelvic fractures, Andrew Petrosoniak on debriefing after cases: why, when and how.

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Lightning rounds 46: Nick Ghionni on combating cognitive bias

Critical Care Scenarios

We chat with Nick Ghionni, pulm/crit attending at MedStar Baltimore Hospital, about identifying and combating cognitive biases in our clinical decision-making. Check out the Intensive Care Academy here! Find us on Patreon here! Buy your merch here! We chat with Nick Ghionni, pulm/crit attending at MedStar Baltimore Hospital, about identifying and combating cognitive biases in our clinical decision-making.

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Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

‘Dope’ is no longer heroin in an increasing number of our communities. The biggest change has been the gradual replacement of diacetylmorphine (heroin) by fentanyl and other synthetic opioids. Due in large part to the proliferation of anonymous chemical factories able to produce industrial volumes of inexpensive synthetic opioids without opium or other controlled precursors, fentanyl spilled into the United States, Canada, and Europe, heroin soon fell to market forces [1, 2].

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Weakness and Palpitations. What’s “long” with this ECG?

Core EM

The Case A 24-year-old man with no past medical or surgical history presented to the emergency department with 5 days of progressively worsening bilateral leg cramping, paresthesias, and multiple falls. The following ECG is obtained: EKG Show Details EKG Characteristics Rate 88 Rhythm Sinus Rhythm with PAC's Intervals Normal PR and QRS interval, Prolonged QTc interval (619 ms) Axis Normal ST Segments Normal Additional Features Diffuse, prominent, prolonged T-waves Diagnosis Diagnosis : Hypokalem

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Senator Stabenow Receives Inaugural EMS Legacy Award

American Ambulance Association

FOR IMMEDIATE RELEASE Contact: Tristan North tnorth@ambulance.org October 10, 2024 Senator Debbie Stabenow Receives Inaugural EMS Legacy Award from the American Ambulance Association Washington, D.C. — Senator Debbie Stabenow […] The post Senator Stabenow Receives Inaugural EMS Legacy Award appeared first on American Ambulance Association.

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SGEM#457: Inhale – Nebulized or IV Ketamine for Acute Pain?

The Skeptics' Guide to EM

Date: October 7, 2024 Reference: Nguyen et al. Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial. Annals of EM 2024. Guest Skeptic: Dr. Brendan Freeman is an emergency medicine physician, assistant professor of emergency medicine, and medical education fellow at Staten Island University Hospital.

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Ep 198 Understanding and Improving Culture in Emergency Medicine: Key Insights

Emergency Medicine Cases

In this EM Cases podcast Anton chats with Dr. Peter Brindley and Dr. Leon Byker who have a deep interest in the Culture of Medicine to explore what culture in medicine is, why culture is so important, and then drive home 10 strategies to improving the culture in our departments emphasizing the importance of human connection, empathy, open communication, and a willingness to learn from mistakes in creating a positive and fulfilling work environment, so that we love our work, we love our departmen

EMS 137
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ECG 16 October

EMergucate

An 80yr male presents with 2 weeks increasing shortness of breath, he has a history of CABG. What can be seen on the ECG: If these were new findings what might you be concerned about?

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SAEM Clinical Images Series: Not Your Average Ear Infection

ALiEM

A 5-year-old generally healthy fully immunized boy presented to the ED with worsening left ear redness, swelling, and tenderness that his family noticed the day before presentation. His family had also recently noticed an abrasion over that ear. The patient was on amoxicillin for strep throat, which was diagnosed a week before the onset of his symptoms and was improving.

ED 169
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Transfusion Reactions

Core EM

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% Febrile Non-hemolytic (FNHTR) – 1% Transfusion-associated circulatory overload (TACO) – 1% Transfusion-related acute lung injury (TRALI) – <0.01% Anaphylaxis/ABO incompatibility –

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Congressman Ryan Zinke Honored with Legislative Recognition Award

American Ambulance Association

FOR IMMEDIATE RELEASE Contact: Tristan North tnorth@ambulance.org October 10, 2024 Congressman Ryan Zinke Honored with Legislative Recognition Award from the American Ambulance Association Washington, D.C. — The American Ambulance […] The post Congressman Ryan Zinke Honored with Legislative Recognition Award appeared first on American Ambulance Association.

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Lightning rounds 45: Noelia Bischoff on transitioning nursing roles

Critical Care Scenarios

We chat with Noelia Bischoff, recently off orientation in the medical ICU at Johns Hopkins as a nurse practitioner, about the transition from her role as a bedside ICU nurse. Check out the Intensive Care Academy here! Find us on Patreon here! Buy your merch here! We chat with Noelia Bischoff, recently off orientation in the medical ICU at Johns Hopkins as a nurse practitioner, about the transition from her role as a bedside ICU nurse.

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FirstNet Authority Welcomes New, Returning Board Members

FirstNet Authority

FirstNet Authority Welcomes New, Returning Board Members Press Releases michelle.fordi… Wed, 10/30/2024 - 13:08 The First Responder Network Authority (FirstNet Authority) is an independent authority within the U.S. Department of Commerce National Telecommunications and Information Administration. Established in 2012, the FirstNet Authority’s mission is to ensure the building, deployment, and operation of the nationwide broadband network that equips first responders to save lives and protect U.S.

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ECG of the Week 30 Oct 24

EMergucate

Today’s ECG is a 45yr male who presents to ED with a 12hr history of epigastric pain and diaphoresis. He is an ex smoker, no other cardiac risk factors.

ED 130
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SAEM Clinical Images Series: Wilma, Take a Look at This!

ALiEM

A 2-year, 11-month-old female with a history of constipation was brought to the ED by her mother for abdominal pain. The mother noticed that the patient’s abdomen had been enlarging for months. When they visited the pediatrician several months ago, the pediatrician also noticed a mildly enlarged abdomen but the patient was asymptomatic at that time.

ED 161
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Episode 201: Migraines

Core EM

We discuss migraines with one of the authorities in the field. Hosts: Benjamin Friedman, MD of Montefiore Brian Gilberti, MD [link] Download Leave a Comment Tags: Neurology Show Notes Initial Approach to Diagnosing Migraines: Differentiating between primary headaches (migraine, tension-type, cluster) and secondary causes (e.g., subarachnoid hemorrhage).

ED 130
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Senator Jon Tester Honored with Legislative Recognition Award

American Ambulance Association

FOR IMMEDIATE RELEASE Contact: Tristan North tnorth@ambulance.org October 7, 2024 Senator Jon Tester Honored with Legislative Recognition Award from the American Ambulance Association Washington, D.C. — The American Ambulance Association […] The post Senator Jon Tester Honored with Legislative Recognition Award appeared first on American Ambulance Association.

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Is there a Precedence for Precedex in the ED?

EMOttawa

Precedex (dexmedetomidine) is an alpha-2 adrenergic agonist increasingly used in critical care environments for sedation and anxiolysis. It offers a unique profile of sedation without respiratory depression, making it an attractive option in various clinical scenarios. Historically, it has been used more frequently in the ICU than in Emergency Departments, likely due to provider comfort. […] The post Is there a Precedence for Precedex in the ED?

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See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Dr. Smith's ECG Blog

Written by Magnus Nossen The patient in today's case is a male in his 70s with hypertension and type II diabetes mellitus. His wife contacted the ambulance service after the patient experienced an episode of loss of consciousness. The syncope lasted about 2-3 minutes according to his wife. He woke up alert and with chest pain which he also had experienced intermittently over the previous few days.

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Lab case 452

EMergucate

17-year-old boy with wrist fracture. This patient became blue during manipulation of the fracture under bier’s block anaesthetic effect.

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SAEM Clinical Images Series: Doubly Double Vision

ALiEM

A 52-year-old female with a past medical history of hypertension and prediabetes presented to the emergency department with double vision that started one day prior to arrival. She stated that her double vision improved when she closed one eye. She denied trauma, headache, neck pain, dizziness, dysphagia, numbness, tingling, weakness, or gait instability.

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Episode 201: Migraines

Core EM

We discuss migraines with one of the authorities in the field. Hosts: Benjamin Friedman, MD of Montefiore Brian Gilberti, MD [link] Download Leave a Comment Tags: Neurology Show Notes Initial Approach to Diagnosing Migraines: Differentiating between primary headaches (migraine, tension-type, cluster) and secondary causes (e.g., subarachnoid hemorrhage).

ED 130
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2024 AAA Legislative Awards

American Ambulance Association

The American Ambulance Association is proud to announce the winners of the 2024 AAA Legislative Awards. Each Member of Congress is being recognized for their strong advocacy for emergency medical […] The post 2024 AAA Legislative Awards appeared first on American Ambulance Association.

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Delirium revisited

EMOttawa

Delirium is a medical emergency. It is characterized by acute disturbance of consciousness, with changes in perceptual disturbances and fluctuation of symptoms. Delirium is often the initial manifestation of an underlying acute illness and can be present before fever, tachypnea, tachycardia, or hypoxia. There is an ED prevalence ranging from 7-24%, with increased mortality rates […] The post Delirium revisited appeared first on EMOttawa Blog.

ED 111
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Adrenal Crisis and Addison’s Disease: What EMS Needs to Know

NAEMSP

Author: Joshua Stilley, MD FACEP FAEMS This article was written in collaboration with the National Adrenal Diseases Foundation Background: Adrenal crisis occurs when the adrenal glands are unable to produce enough endogenous steroids under stress. This is often due to primary adrenal insufficiency, also known as Addison’s disease, or secondary causes like chronic exogenous steroid use leading to adrenal suppression.

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Imaging Case of the Week 606 Answer

EMergucate

The chest x-ray shows streaky lucency outlining the great vessels of the neck (tubular artery sign) & air in the … Continue reading →

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SAEM Clinical Images Series: A Blistery Mystery

ALiEM

A 76-year-old female presented with a lingering cough and an oral lesion to the left lower cheek. She reported ten days of improving flu-like symptoms but had a persistent cough and nasal congestion. On the day of presentation, she developed a painful, intermittently bleeding “blood blister” to the left lower cheek that had increased in size, as well as new red spots on her arms and legs.

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NVFC Receives Federal Grant to Support Emergency Responder Hazmat Response Training

NVFC

The National Volunteer Fire Council (NVFC) is pleased to announce it has received a $740,000 Supplemental Public Sector Training (SPST) grant from the U.S. Pipeline and Hazardous Materials Safety Administration. The SPST program provides funding to national nonprofit fire service organizations, which then train instructors to provide training to public-sector hazmat responders or those tasked with responding to accidents and incidents involving hazardous materials.

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SBA Informational Session on OSHA Emergency Response Rule

American Ambulance Association

As many of you are aware, OSHA has published the NPRM titled the Emergency Response Rule. This rule will have substantial impacts on EMS and Fire Emergency Service Organizations should […] The post SBA Informational Session on OSHA Emergency Response Rule appeared first on American Ambulance Association.