Pediatric EM Morsels

JUNE 30, 2023

I’m sure you can recall at least several parents who bring their children into the ED for concern of recurrent pneumonias. Often the parents focus on a possible underlying immunodeficiency. Fortunately, most commonly these pneumonias are due to viral infections, and we can often offer reassurances to the parent. The differential could also include aspiration , asthma , and bronchiectasis depending on the patient’s history.

E-9-1-1 281

E-9-1-1 ED EMS OR 281

ALiEM

JUNE 5, 2023

Which of the following is the most likely explanation for this skin lesion in a worker handling sheep hides? Bacillus anthracis Group A streptococcus Pseudomonas aeruginosa Staphylococcus aureus (Photo credit: CDC/ James H. Steele, Public domain via Wikimedia Commons) Reveal the Answer Answer: 1. Bacillus anthracis This patient has cutaneous anthrax.

ALS 256

ALS OR ED 256

Emergency Medicine Cases

JUNE 6, 2023

In this ECG Cases blog we look at 10 patients with shortness of breath, and discuss how the ECG can be used to help diagnose cardiac, respiratory and metabolic emergencies. We discover that for STEMI/OMI vs subendocardial ischemia, we should look for STEMI(-)OMI, subacute OMI, and OMI in the presence of LBBB and RBBB, and consider the differential for diffuse ST depression with reciprocal ST elevation in aVR.

STEMI 241

STEMI EMS 241

The Skeptics' Guide to EM

JUNE 3, 2023

Date: June3, 2023 Reference: Kotani et al. Etomidate as an induction agent for endotracheal intubation in critically ill patients: A meta-analysis of randomized trials. Journal of Critical Care April 2023 Guest Skeptic: Dr. Amber Gombash is an emergency physician in Concord, NC. Case: You have a critically ill patient that you are preparing to intubate and wonder […] The post SGEM#405: We’re Off To Never-Never Land – But Should We Use Etomidate for the Rapid Sequence Intubation?

Critical Care 247

Critical Care ALS Paramedic 247

Core Ultrasound

JUNE 14, 2023

I’m so proud to be living my truth and sharing my story with you all! Join me in this special episode where I share just a little bit of my journey of coming out to the rest of the world as a transgender woman. Also, there are 5 other reasons to watch: I’ll share with you my favorite ultrasound cases of the past few months. I hope you enjoy this wide-ranging talk on some pretty important and amazing topics!

130

130

High Performance EMS

JUNE 12, 2023

During the height of the COVID pandemic, shortages led to many operational challenges that required creative solutions. One of the more challenging issues that has become as endemic as the disease itself is the recruitment and retention of EMS professionals. This shortage has disproportionally impacted paramedics, as evidenced in the NAEMT survey results published in May of 2022.

BLS 130

BLS UHU Paramedic ALS 130

Pediatric EM Morsels

JUNE 2, 2023

Rare diseases are not confined to the pages of a textbook or computer screen. Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! Today we are talking about a rare disease called FPIES (food protein induced enterocolitis syndrome) and how you might encounter these patients in the Pediatric Emergency Department.

Emergency Department 189

Emergency Department ALS EMS OR 189

Emergency Medicine Cases

JUNE 6, 2023

On this month's EM Quick HIts podcast: Anand Swaminathan on EVT for large vessel occlusion strokes, Sarah Reid on picking up intussusception, Andrew Petrosoniak on 5 Penetrating Trauma Tips, Peter Toth on using a slit lamp to manage skin foreign body hack, Nour Khatib and Jonathan Wallace on CT Radiation Risk and Matt Poyner on setting up an emergency fund.

EMS 202

EMS 202

The Skeptics' Guide to EM

JUNE 24, 2023

Date: June 16, 2023 Reference: Reed et al. Pilot Testing Fentanyl Test Strip Distribution in an Emergency Department Setting: Experiences, Lessons Learned, and Suggestions from Staff. AEM June 2023 Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate.

Overdose 187

Overdose Emergency Department ALS ED 187

EMergucate

JUNE 20, 2023

The neck x-rays are from a patient with neck pain following fall onto their back. X-rays were done as the patient had tenderness over mid c-spine. What can be seen?

EMS 130

EMS 130

Don't Forget the Bubbles

JUNE 30, 2023

A PEM adventure It’s time for another PEM adventure. Join us on another journey (with an inbuilt time travel machine) in managing Elsa, a 2-year-old girl who is a HUGE fan of the Disney movie, Frozen. Elsa was found face down in the family pool 20 minutes after last visual contact and was picked up without resuscitation. Emergency Medical Services found her apneic and pulseless.

CPR 145

CPR Life Support Critical Care ALS 145

Pediatric EM Morsels

JUNE 16, 2023

The subcutaneous space is a vast region of potential space where things can collect. Sometimes this can be used to our advantage, like when we need to give subcutaneous fluids to a dehydrated patient without an IV, or when we need to give SQ medications for things like Sulfonylurea overdose , Hereditary Angioedema , or DVTs. Sometimes, however, these deeper layers of the subcutaneous space can collect dangerous infections , like Necrotizing Fasciitis.

Overdose 152

Overdose OR Critical Care ALS 152

ALiEM

JUNE 1, 2023

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? If not, you probably should be. Another old drug for a new indication, right? Well not exactly. Phenobarbital is indeed an older and relatively cheap drug (less than $20 per loading dose) that has gained some press recently for the treatment of acute alcohol withdrawal [1-3].

Emergency Department 246

Emergency Department ICU ED OR 246

Emergency Medicine Cases

JUNE 27, 2023

We miss potentially dangerous and even lethal drug interactions in EM more often than we realize. In this main episode EM Cases podcast with Dr. David Juurlink and Dr. Walter Himmel we review the common categories of drugs, the high risk patients and the key drug interactions that we need to know about in Emergency Medicine. The post Ep 184 Must Know Drug Interactions in Emergency Medicine appeared first on Emergency Medicine Cases.

EMS 186

EMS 186

The Skeptics' Guide to EM

JUNE 17, 2023

Date: June 15, 2023 Reference: Rees CA et al. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. American Journal of Hematology Jan 2023 Guest Skeptic: Dr. Amy Drendel is a pediatric emergency medicine physician and physician scientist at Children’s Wisconsin. […] The post SGEM#406: Homeward Bound…after a dose of Intranasal Fentanyl for Sickle Cell Vaso-occlusive

Emergency Department 182

Emergency Department ALS ED OR 182

REBEL EM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? This stemmed a lot of discussion in the background between Swami, myself, and Scott. We felt it was worthwhile to record this as a podcast to better flush out some nuanced points. Below you will find some of the points we discussed.

CPR 145

CPR ICU EMS ALS 145

Don't Forget the Bubbles

JUNE 30, 2023

A PEM adventure Meet Polly, a 6-year-old girl with a penchant for shopping. Besides a few febrile convulsions when she was two, she’s a healthy 6-year-old. Having just bought the most gorgeous pair of red ballet pumps that would go delightfully with the red bow she bought in Harrods last week, she was skipping down Regent’s Street with her nanny. As they crossed the front of Liberty, a huge letter L came plummeting down, crashing in front of her.

E-9-1-1 145

E-9-1-1 OR ALS Critical Care 145

Pediatric EM Morsels

JUNE 9, 2023

When we think of severe hemorrhage in children, we typically think about trauma. Maybe injuries to the spleen or kidney come to mind. Perhaps thoughts of pelvic injuries or severe head injury dominate our considerations. Of course, we all have a healthy respect for post-tonsillectomy hemorrhage and we like to talk about Damage Control Resuscitation.

OR 152

OR Critical Care EMS 152

ALiEM

JUNE 7, 2023

The venom from this pictured snail shares a primary mechanism of action with what other deadly toxin? Alpha-latrotoxin Botulinum toxin Bufotoxin Tetanus toxin Sarin Reveal the Answer Answer: 3. Botulinum toxin The cone snail contains alpha-conotoxin which is a potent nicotinic receptor antagonist similar to botulinum toxin and can cause muscular paralysis.

ALS 130

ALS OR 130

Emergency Medicine Cases

JUNE 26, 2023

With increasing forest fires, heat waves, floods, storms, vector-borne illnesses and heat waves, the emergency department is uniquely positioned to declare sentinel events, advocate on behalf of vulnerable populations and lead by example. Dr. Matt Douglas-Vail explains the need for Increased education on climate change and planetary health, Increased resource allocation in emergency departments for climate-related pathologies and increased disaster planning for climate-related emergencies on thi

EMS 164

EMS Emergency Department 164

The Skeptics' Guide to EM

JUNE 10, 2023

Date: June 6th, 2023 Reference: Pines, Raja, Bellollo and Carpenter. Evidence-Based Emergency Care: Diagnostic Testing and Clinical Decision Rules 3rd Edition Guest Skeptic: Dr. Jesse Pines is the Chief Clinical Innovation at US Acute Care Solutions and a Clinical Professor and George Washington University and Professor of Emergency Medicine at Drexel University.

Emergency Department 178

Emergency Department ED OR 178

REBEL EM

JUNE 26, 2023

Background: Hemorrhage is the leading cause of mortality in trauma patients. Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy.

FFP 145

FFP Frozen Plasma ALS Plasma 145

The Bottom Line

JUNE 19, 2023

In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?

145

145

Don't Forget the Bubbles

JUNE 12, 2023

I remember how I felt when. I first watched “ Just a Routine Operation “, – the story of the events that led to the tragic death of Elaine Bromiley. Elaine Bromiley went into hospital for a routine operation. Despite an appropriate pre-operative assessment, the anaesthetists tasked with intubating Elaine found themselves in a Can’t Intubate, Can’t Oxygenate scenario, though they failed to recognise it at the time.

ICU 145

ICU ED OR 145

EMergucate

JUNE 26, 2023

The chest x-ray shows features of right middle lobe pneumonia. There is air space opacity silhouetting the right heart border.

EMS 130

EMS 130

First 10 EM

JUNE 19, 2023

The internet is alive with rumors of a simple, cheap, low-risk cure for long COVID. Sound too good to be true? That’s because it almost certainly is. Let’s talk about this COVIT-OUT trial and what it says about metformin. The paper Bramante CT, Buse JB, Liebovitz DM, et al. Outpatient treatment of COVID-19 and incidence […] The post No, metformin is probably not the cure for long COVID appeared first on First10EM.

ALS 134

ALS EMS 134

Medgadget

JUNE 6, 2023

Researchers at the University of California San Diego have created a wearable ultrasound system that can monitor deep tissues, as far as 16.5 cm (6.5 inches) below the surface of the body. Moreover, the team employed a machine learning algorithm to reduce the noise associated with movement, helping to obtain reliable readings while the wearer goes about their day.

OR 125

OR 125

REBEL EM

JUNE 22, 2023

Background: The COVID-19 pandemic has been the focus of massive research efforts over the last three years. Our understanding of the disease and effective treatments to reduce mortality have progressed rapidly during this time. However, the medical community is only just starting to understand long-COVID (WHO Definition: the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation).

ALS 145

ALS OR EMS ED 145

Critical Care Scenarios

JUNE 28, 2023

The value of performing chart checks to see how your patients are doing after your care. The value of performing chart checks to see how your patients are doing after your care.

100

100

Don't Forget the Bubbles

JUNE 19, 2023

You are asked to see a baby boy in the labour ward. He was born at 38 weeks and 5 days gestational age and weighs 2600 grams. His mother is healthy, but she does mention that her first-born daughter was also small. She weighed 2570 grams at 39 weeks and is now perfectly healthy. The parents are of South-Asian descent. There were no issues during the pregnancy, and estimated fetal growth by ultrasound was constant.

ALS 143

ALS OR 143

EMergucate

JUNE 6, 2023

Neonate with increased work of breathing. What can be seen on the chest x-ray? Answer will be posted later.

EMS 130

EMS 130

First 10 EM

JUNE 12, 2023

Can herbs cure sepsis? The EXIT-SEP trial was just published, and demonstrated a decrease in all cause mortality from xuebijing – a product manufactured by a pharmaceutical company from a combination of Carthamus tinctorius flowers (Honghua in Chinese), Paeonia lactiflora roots (Chishao), Ligusticum chuanxiong rhizomes (Chuanxiong), Angelica sinensis roots (Danggui), and Salvia miltiorrhiza roots (Danshen). […] The post Finally, a cure fore sepsis: Herbs appeared first on First10EM.

EMS 128

EMS 128

Chicago EMT Training

JUNE 20, 2023

We've recently uploaded a public study guide on our website. We've been toying with the idea of creating a database for mentors and we'd like to open it to anyone that would be interested! This role is strictly remote and unpaid. Students could be reaching out for advice, study tips, difficult topics, career advice Here's the application: Let us know if you have any questions or concerns!

EMT 100

EMT EMT OR 100

REBEL EM

JUNE 14, 2023

Anaphylactic Shock is an acute, life-threatening hypersensitivity disorder, with a generalized, rapidly evolving, multi-systemic allergic reaction (IgE-mediated disorder). If not treated rapidly can become fatal. Scott Weingart, MD put together a manual titled the Resuscitation Crisis Manual , which in short, is composed of two-page protocols for various situations that involve crashing patients.

Allergic Reaction 145

Allergic Reaction Epinephrine OR EMS 145

Critical Care Scenarios

JUNE 21, 2023

Bryan puts Brandon through the paces, discussing the nuts and bolts of managing a code. Find us on Patreon here! Buy your merch here! Takeaway lessons Bryan puts Brandon through the paces, discussing the nuts and bolts of managing a code. Find us on Patreon here! Buy your merch here! Takeaway lessons * Managing a room is less about asserting authority and more about leading by example.

Coronary 100

Coronary 100

Don't Forget the Bubbles

JUNE 30, 2023

A PEM Adventure Ranulf is a 14-year-old explorer. He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. Whilst you were busy managing head injuries and drownings, Ranulf had been out with a group of boys from school this evening. They had been enjoying a celebratory dinner following their safe return from a trip to the Amazon rainforest.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

EMergucate

JUNE 5, 2023

32 year old asthmatic lady presented to the emergency department with shortness of breath for few days.

Emergency Department 130

Emergency Department 130