ALiEM

MAY 29, 2023

Massive epistaxis is considered a medical emergency that requires immediate attention. Symptoms of massive epistaxis include sudden and heavy bleeding from the nose, difficulty breathing, dizziness, and a rapid heartbeat. If left untreated, it can lead to significant blood loss, shock, airway obstruction, and even death. We report a case of a 50-year-old man with end stage renal disease with massive nasal bleeding from the left nostril, shortness of breath, and confusion.

E-9-1-1 246

E-9-1-1 Epinephrine Emergency Department 246

Emergency Medicine Cases

MAY 23, 2023

In this part 2 of our 2-part series on STIs with Dr. Catherine Varner and Dr. Robyn Shafer we answer such questions as: Why should we care about making the diagnosis of pelvic inflammatory disease (PID) in the ED? What combination of clinical features and lab tests should trigger a presumptive diagnosis and empiric treatment of PID? Which patients with PID require admission to hospital?

ED 130

ED EMS 130

EMergucate

MAY 29, 2023

56 year old man with background of type 2 DM. Presented after a fall at home. He was presyncopal with blood pressure of 60/50 and pulse rate of 50/ min. (Normal sinus rhythm).

130

130

The Skeptics' Guide to EM

MAY 20, 2023

Date: May 10, 2023 Reference: Harhay MO, et al. A bayesian interpretation of a pediatric cardiac arrest trial (THAPCA-OH). NEJM Evidence. 2023. Guest Skeptic: Dr. Kat Priddis is a paediatric emergency medicine consultant and trauma director at Watford General Hospital. She is part of the Don’t Forget the Bubbles team and faculty at Queen Mary […] The post SGEM #404: Sitting on the Dock of the Bay-esian Interpretation of Therapeutic Hypothermia for Pediatric Cardiac Arrest first appeared on The S

CPR 130

CPR ALS Emergency Department EMS 130

Pediatric EM Morsels

MAY 12, 2023

We all know that Gravity Works ! While this fact can adversely affect anyone, it offers the greatest challenge for those who cannot protect themselves , like children less than 3 months of age ! We last pondered this in 2011 Morsel , just a couple years after PECARN head injury data was published. Since that time there have been several studies externally validating the PECARN rule in all age groups and in multiple different countries.

OR 130

OR EMS 130

High Performance EMS

MAY 11, 2023

I am pleased to announce the availability of my latest paperback book. As a consultant working with agencies across the nation that are representative of many distinct models of service, as well as being an EMS provider and a chief fire officer myself, I feel highly invested in the process to improve strategic dispatch and deployment decisions. It is my unique collective experience gained over more than 13 years of consultation and experimentation that is shared through these pages.

Ambulance 130

Ambulance Paramedic EMS OR 130

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood right in front of you. You intubate the patient and initiate the massive transfusion protocol, but everything you pour into him seemingly comes right back out.

E-9-1-1 245

E-9-1-1 Emergency Department ICU OR 245

Core Ultrasound

MAY 8, 2023

At long last, Core Ultrasound Image Review episode #20! In this episode, we discuss median nerve blocks, fibroids, pneumonia, pleural effusions, CRAO, AAA, abscesses, endocarditis, DVTs, CVC confirmation and gallstones. Check out the YT for the full video! CUIR #19 CUIR #18 CUIR #17 The post Core Ultrasound Image Review, Episode 20! first appeared on Core Ultrasound.

130

130

EMergucate

MAY 5, 2023

The neck x-ray shows Prevertebral soft tissue swelling, raising suspicion for a retropharyngeal inflammatory process (cellulitis/abscess).

130

130

Pediatric EM Morsels

MAY 5, 2023

Our world has become inundated with the newest food and diet crazes. It seems like every social media persona provides “expert” opinions on the best way to nourish our bodies. Adults are one thing, but how does that translate to our growing, developing pediatric patients? Today we are focusing on vegan diets in children , and which nutritional deficiencies we need to remain vigilant to spot!

E-9-1-1 130

E-9-1-1 OR EMS 130

REBEL EM

MAY 29, 2023

Background: Sepsis can induce numerous physiologic derangements. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e. septic shock). Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications.

ICU 145

ICU ALS Epinephrine OR 145

ALiEM

MAY 24, 2023

A young boy is brought to the pediatric emergency screaming at the top of his lungs by his parents. His penile skin is trapped in the zipper of his jeans. On a busy shift, you want a simple way to handle zipper injuries that minimizes pain, doesn’t require resource-intensive procedural sedation, and is quick. Background The 4 most common types of zippers are nylon coil zip, plastic mold zip, metal zip, and invisible zip.

ED 233

ED OR 233

Emergency Medicine Cases

MAY 9, 2023

In this Part 1 or our two-part podcast series on STIs we discuss a general approach to cervicitis, vulvovaginitis and urethritis, elucidate some key historical features, debate who needs a pelvic exam in the ED, understand who needs what testing, debate self swabs vs physician taken swabs, dig into some specific under-recognized organisms like Mycoplasma Genitalium, figure out who needs what kind of empiric treatment, sexual partner treatment and which discharge instructions are key.

ED 130

ED OR EMS 130

Core Ultrasound

MAY 8, 2023

At long last, Core Ultrasound Image Review episode #20! In this episode, we discuss median nerve blocks, fibroids, pneumonia, pleural effusions, CRAO, AAA, abscesses, endocarditis, DVTs, CVC confirmation and gallstones. Check out the YT for the full video!

130

130

Don't Forget the Bubbles

MAY 31, 2023

What’s the relationship between COVID-19 and diabetes? May saw the e-publication of the DIMPLES study. Let’s take a deep dive into this paper and its implications for PEM internationally. Ponmani C, Nijman RG, Roland D, Barrett M, Hulse T, Whittle V, Lyttle MD on behalf of PERUKI. Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study.

Emergency Department 135

Emergency Department ED OR ALS 135

EMergucate

MAY 9, 2023

The chest x-ray is from a patient with severe dyspnoea. Patient has a past history of chronic airway obstruction.

EMS 130

EMS 130

REBEL EM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. In the initial management of trauma resuscitation there are 4 key principles that should be followed: Control bleeding Restore tissue perfusion Minimize iatrogenic injury from resuscitation itself Promote hemostasis In this blog post I will summarize the lecture and the evidence for each of these principles… MINIMIZE IATROGENIC INJURY PERMISSIVE HYPOTENSION Maintaining a lower blood pressure than physiol

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

ALiEM

MAY 17, 2023

The 2023 Emergency Medicine Match was an unprecedented year that took many of us in the education community by surprise. There were 132 (46%) EM residency programs with at least one unfilled PGY-1 position, and there were 554 (18.4%) overall unfilled EM positions. Dr. Sara Krzyzaniak (EM program director at Stanford) hosts this important episode with Dr.

EMS 130

EMS ALS 130

Emergency Medicine Cases

MAY 9, 2023

In this Part 1 or our two-part podcast series on STIs we discuss a general approach to cervicitis, vulvovaginitis and urethritis, elucidate some key historical features, debate who needs a pelvic exam in the ED, understand who needs what testing, debate self swabs vs physician taken swabs, dig into some specific under-recognized organisms like Mycoplasma Genitalium, figure out who needs what kind of empiric treatment, sexual partner treatment and which discharge instructions are key.

ED 130

ED OR EMS 130

Core Ultrasound

MAY 4, 2023

In this 5 Minute Sono video, we’ll guide you through the process of using ultrasound imaging to identify and diagnose inguinal and femoral hernias. Hernias can be difficult to identify with physical examination alone (and may actually be missed on CT!), but with ultrasound imaging, healthcare professionals can detect hernias at the bedside with greater accuracy and confidence.

130

130

The Skeptics' Guide to EM

MAY 6, 2023

Date: April 25, 2023 Reference: Walsh et al. Revisiting “Excited Delirium”: Does the Diagnosis Reflect and Promote Racial Bias? WJEM 2023 Guest Skeptic: Dr. Brooks Walsh is a former paramedic, and is currently an emergency physician in the Bridgeport Hospital, Yale-New Haven Health in Connecticut. This is an SGEM Xtra episode. Brooks reached out to me recently to see […] The post SGEM Xtra: I’m So Excited – But Don’t Call It Excited Delirium first appeared on The Skeptics Guide to Emergency Medi

Emergency Medical Services 101

Emergency Medical Services Paramedic ALS EMS 101

EMergucate

MAY 28, 2023

The chest x-ray shows cardiomegaly & 3rd Mogul Sign due to enlargement of the left atrial appendage.

EMS 130

EMS 130

Critical Care Scenarios

MAY 24, 2023

We chat with Scott Weingart of Emcrit about the use of crash VA ECMO for the cardiac arrest patient. Check out the REANIMATE course here! Listen to the ED ECMO podcast on ECPR here Find us on Patreon here! Buy your merch here! Takeaway lessons We chat with Scott Weingart of Emcrit about the use of crash VA ECMO for the cardiac arrest patient. Check out the REANIMATE course here!

CPR 100

CPR ED EMS OR 100

Medgadget

MAY 3, 2023

Researchers at MIT have developed a printer that can create large numbers of microneedle patch-style vaccines in places where they are needed quickly. Moreover, the printed patches can deliver thermostable mRNA vaccines, whereby the mRNA therapeutic is encapsulated in lipid nanoparticles before printing to enhance its shelf-life at room temperature and avoid the need for cold storage and transport.

OR 114

OR 114

Emergency Medicine Cases

MAY 10, 2023

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life. The post ECG Cases 42 – Approach to ECG Interpretation in Patients with Chest Pain: OMI, False Positive & Negative STEMI & Other Causes appeared first on Emergency Medicine Cases.

STEMI 130

STEMI EMS 130

Core Ultrasound

MAY 1, 2023

In this Five Minute Sono video, Paul Khalil (with the help of Rob Farrow), walks us through the bedside diagnosis of testicular torsion. This disease is quite important to diagnose as early as possible and using this tool may dramatically increase the chance of testicular salvage. Hydronephrosis Bladder Vol. Meas.

130

130

The Skeptics' Guide to EM

MAY 13, 2023

Date: April 12, 2023 Reference: Edlow et al.Guidelines for Reasonable and appropriate care in the emergency department 3 (GRACE-3): Acute dizziness and vertigo in the emergency department. AEM May 2023 Guest Skeptic: Dr. Jonathon Edlow has practiced emergency medicine for nearly 40 years and is a Professor of Emergency Medicine at Harvard Medical School.

Emergency Department 100

Emergency Department ED OR 100

EMergucate

MAY 8, 2023

PH = 7.395, that is within normal range. pCO2 = 42 mmHg, Normal for venous blood gases ( Normal pCO2 is 40 mmHg for arterial blood and 48 mmHg for venous). HCO3 = 25 mmol/L.

100

100

Critical Care Scenarios

MAY 17, 2023

Understanding the causes of doubled vent breaths, including premature/short cycling and reverse triggering, plus a basic approach to managing them. Understanding the causes of doubled vent breaths, including premature/short cycling and reverse triggering, plus a basic approach to managing them.

100

100

Medgadget

MAY 1, 2023

Researchers at Northwestern University and the University of Texas at Austin have developed a thin and flexible graphene “tattoo” that can be affixed to the outside of the heart, and which can monitor heart rhythms and apply corrective electrical impulses to treat arrhythmias. The patch is optically clear, allowing the researchers to also use light to monitor and stimulate the heart.

Defibrillator 111

Defibrillator 111

REBEL EM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. These patients can have a vasodilated vascular bed and the initial use of fluids is hypothesized to serve two purposes: Augmenting the macrovascular system (stroke volume and cardiac output) and augmenting the microvascular perfusion (capillary blood flow).

OR 105

OR ICU EMS ED 105

Core Ultrasound

MAY 17, 2023

Thoracic ESB Intro to NB Serratus Anterior block

130

130

EMCrit Project

MAY 4, 2023

My attempt to model my empirical experience with Burnout EMCrit Project by Scott Weingart, MD FCCM.

137

137

EMergucate

MAY 2, 2023

The following left knee x-rays are from a 60 year old with mild knee pain following a fall.

EMS 130

EMS 130

Critical Care Scenarios

MAY 10, 2023

Bryan and Brandon share their favorite podcasts, blogs, social media, and other online channels for medical education. Podcasts Blogs/websites Twitter accounts So, with Twitter, we could post all day and still leave a bunch of people out. Here are a few…the best way to find good Twitter followers is to start with these and see … Continue reading "Lightning rounds #27: Our favorite FOAM" Bryan and Brandon share their favorite podcasts, blogs, social media, and other online channels for medical ed

Critical Care 100

Critical Care ICU Life Support 100

Medgadget

MAY 12, 2023

Researchers at Northwestern University have trailed an implanted ultrasound device in patients, which is used in combination with microbubbles to transiently open pores in the blood brain barrier, allowing chemo drugs to enter. We have reported on this technique before as a lab-based concept (see flashbacks below), but this is the first time that it has actually been trialed in human patients, in this case patients with glioblastoma, a difficult to treat brain cancer.

109

109

Don't Forget the Bubbles

MAY 24, 2023

A 5-year-old boy with a past medical history of Crouzon syndrome presents in the Pediatric ED. He is febrile and tachypnoeic, with low blood pressure and a capillary refill time of 4 seconds. His oxygen saturations are 86% in air, and he has a GCS of 8/15. His notes suggest that he was a difficult intubation in the neonatal intensive care unit. While you prepare the difficult airway cart, a young trainee asks about cannot intubate cannot oxygenate scenarios.

Emergency Department 98

Emergency Department ED ALS OR 98