The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. He is also a fully-fledged ultrasonographer. Casey currently splits his time […] The post SGEM#415: Buckle Down for some Ultrasound to Diagnosis Distal Forearm Fractures first appeared on The Ske

Critical Care 310

Critical Care ALS ED Emergency Department 310

Pediatric EM Morsels

SEPTEMBER 22, 2023

To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Never fear. As our fearless leader likes to say: “children are not aliens, but they are a special population with unique anatomy and physiology.” Children compensate for blood and volume loss very well… until they don’t.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

Emergency Medicine Cases

SEPTEMBER 12, 2023

In this ECG Cases blog Dr. Jesse MacLaren guides us through 10 cases of patients who present with generalized weakness or acute neurologic symptoms and discusses how to look for ECG signs of dysrhythmias, electrolyte emergencies, acute coronary occlusion, and demand ischemia in patients with generalized weakness and in patients with neurologic symptoms, to consider predisposing factors like LVH; seizure-like activity from cardiac syncope; TIA/CVA embolic sources like atrial fibrillation or LV th

Coronary 296

Coronary OR EMS 296

ALiEM

SEPTEMBER 29, 2023

A 49-year-old male was triaged to the Fast Track area with complaints of an abrasion to the neck following an assault. The patient was attending a party with his family when “someone started shooting.” The patient believes some stucco or stone fragment from a brick wall struck him in the neck during the initial incident, but his primary concern was for his more seriously wounded family members.

ALS 177

ALS OR 177

American Ambulance Association

SEPTEMBER 27, 2023

This content is for AAA members only. Please either Log In or Join! The post Impact of Partial Government Shutdown on Healthcare appeared first on American Ambulance Association.

Ambulance 130

Ambulance OR 130

Critical Care Scenarios

SEPTEMBER 27, 2023

We chat with Leon Chen about his work setting up infrastructure for clinical POCUS at Memorial Sloan Kettering. Leon is an Adult/Gerontology Acute Care Nurse Practitioner in the ICU, Clinical Program Manager of Research and Simulated Learning, and an Associate Professor at Columbia University School of Nursing. Find us on Patreon here! Buy your merch … Continue reading "Lightning rounds #32: Creating a POCUS system with Leon Chen" We chat with Leon Chen about his work setting up infrastructure f

ICU 130

ICU Critical Care 130

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. AEM August 2023 Guest Skeptic: Dr. Suchismita Datta. She is an Assistant Professor and Director of Research in the Department of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. This is the last show for […] The post SGEM#414: The SQuID Protocol first appeared on The Skeptics Guide to Emergency Medicine.

ICU 201

ICU ED Critical Care ALS 201

Emergency Medicine Cases

SEPTEMBER 26, 2023

I had the enormous honour of interviewing Dr. Ben McKenzie, EM physician and a PhD candidate at the University of Melbourne studying the topic of resuscitation algorithms in anaphylaxis and asthma. The tragic death of his son Ben McKenzie at the age 15 from hypoxic respiratory arrest as a result of anaphylaxis and asthma in 2021 has led Dr. McKenzie on a mission to prevent deaths from anaphylaxis and asthma by educating emergency providers around the world using his AMAX4 algorithm as a framewor

EMS 279

EMS 279

ALiEM

SEPTEMBER 27, 2023

What well-known adverse reaction results from ingestion of the pictured mushroom? Acute hepatitis Disulfiram-like reaction with ethanol consumption Pneumonitis from inhalation of spores Seizures from glutamate agonist activity [Image from Canstockphoto] Reveal the Answer 2. Disulfiram-like reaction with ethanol consumption Coprinus atramentarius or Ink Cap mushroom is well known to cause a disulfiram-like reaction when it is consumed prior to ethanol.

ALS 169

ALS OR ED 169

American Ambulance Association

SEPTEMBER 29, 2023

Jarlicia Islandriana Scott Paramedic Pafford Emergency Medical Services Clarksdale, MS Share on Instagram | Facebook | Twitter | LinkedIn How did you come to be in EMS? I found myself […] The post EMS Profiles | Meet Jarlicia Islandriana Scott appeared first on American Ambulance Association.

EMS 130

EMS Emergency Medical Services Ambulance Paramedic 130

Critical Care Scenarios

SEPTEMBER 13, 2023

We discuss the nuts and bolts of urinary infection with an obstructing stone with Ashley Winter (@AshleyGWinter), board certified urologist with a fellowship in male and female sexual medicine, and chief medical officer of Odela Health. Find us on Patreon here! Buy your merch here! Takeaway lessons We discuss the nuts and bolts of urinary infection with an obstructing stone with Ashley Winter ( @AshleyGWinter ), board certified urologist with a fellowship in male and female sexual medicine, and

OR 130

OR 130

EMergucate

SEPTEMBER 18, 2023

Question 1: PH = 7.32 ( less than 7.35) so, we have mild acidaemia. PCO2 = 48 mmHg ( on arterial blood gas > 40), so we have respiratory acidosis.

130

130

First 10 EM

SEPTEMBER 18, 2023

Transfusion seems like the simplest intervention in medicine. The patient is losing blood, so let’s put some back in. Not much more complicated than an oil change. Sure, you need to use a specific brand, but as long as the system is topped up, everything should run just fine. Therefore, when someone (to be left […] The post Massive hemorrhage: a very deep dive appeared first on First10EM.

145

145

Emergency Medicine Cases

SEPTEMBER 12, 2023

On this month's EM Quick Hits podcast: Anand Swaminathan on the role of methylene blue in septic shock, Nour Khatib on jaw dislocation reduction techniques, Hans Rosenberg on a phenotypic approach to Crohn's disease emergencies, Gil Yehudaiff on evidence based analgesics in renal colic, Brit Long on the importance of inhaled steroids for asthma, and Andrew Petrosoniak on the "lethal diamond" in polytrauma patients and the current state of hypocalcemia in bleeding trauma patients.

EMS 217

EMS 217

ALiEM

SEPTEMBER 1, 2023

A 65-year-old male presented with chest and abdominal pain for three weeks. He endorsed a poor appetite and a weight loss of 16 kilograms in the last month. He denied fever, vomiting, diarrhea, and tarry stools and described having his usual bowel movements. Additional Images Physical Exam Vitals : BP 172/71; HR 127; T 35.9°C; O2 Sat 100% General : In acute distress Cardiovascular : Regular rate and rhythm; no murmur; bilateral upper extremity and lower extremity pulses palpable Gastrointestin

161

161

American Ambulance Association

SEPTEMBER 23, 2023

Jameson Fernandez Emergency Medical Technician Cataldo Ambulance Somerville, Massachusetts Share this on Instagram | Facebook | X / Twitter | LinkedIn How did you come to be in EMS? The […] The post EMS Profiles | Meet Jameson Fernandez appeared first on American Ambulance Association.

Emergency Medical Technician 130

Emergency Medical Technician EMS Ambulance 130

REBEL EM

SEPTEMBER 21, 2023

Bottom Line Up Top: Troponins should not be routinely sent in patients presenting with SVT. Rarely, they may be necessary if the patient has concerning ischemic symptoms that persist after conversion to sinus rhythm. Clinical Scenario: A 44-year-old man presents with palpitations that started 45 minutes ago. He has no medical problems and denies any prior similar symptoms.

Coronary 143

Coronary ACS ED OR 143

EMergucate

SEPTEMBER 26, 2023

The pelvic x-ray is from a 12 year old with hip pain following a fall onto left side while doing a cartwheel. What can be noticed?

EMS 130

EMS 130

First 10 EM

SEPTEMBER 25, 2023

Introduced to the world by our friend Scott Weingart, delayed sequence intubation (DSI) is often summarized as procedural sedation for the procedure of preoxygenation. (Weingart 2011, Weingart 2015) It is a brilliant concept, makes a ton of sense on paper, and anecdotally has seemed to help a number of my patients. However, any long time […] The post Delayed sequence intubation: An RCT appeared first on First10EM.

EMS 138

EMS 138

Emergency Medicine Cases

SEPTEMBER 26, 2023

The EM Cases Quiz Vault is now on Anki flashcards to help you solidify knowledge of Emergency Medicine Cases podcasts. Herein lies a guide to optimize EM Cases Anki decks, download links and more. The post EM Cases Quiz Vault on Anki appeared first on Emergency Medicine Cases.

EMS 130

EMS 130

ALiEM

SEPTEMBER 25, 2023

66 year-old-male with a history of type 2 diabetes and hypertension presented as a transfer for rapid progression of lower extremity pain, swelling, and blue-purple discoloration of the entire limb with concern for a possible necrotizing infection. His symptoms began earlier in the day and progressed over just a few hours. He had no known thromboembolic risk factors.

OR 152

OR 152

American Ambulance Association

SEPTEMBER 18, 2023

Press Release from the Prehospital Blood Transfusion Initiative Coalition PREHOSPITAL BLOOD TRANSFUSION INITIATIVE COALITION BEING FORMED Contact: Bill Skillman bskillman@veli.co 781 315 7537 In cities, towns and rural communities across […] The post Prehospital Blood Transfusion Initiative appeared first on American Ambulance Association.

Ambulance 130

Ambulance 130

REBEL EM

SEPTEMBER 28, 2023

Background: Primary PCI is the recommended reperfusion strategy in patients with STEMI and should be initiated within 2 hours after first medical contact. In non-PCI-capable hospitals this goal is not always achievable due to delays in transfer. In these cases, thrombolysis is recommended to improve morbidity and mortality. The STREAM-1 trial found that for [2] patients with STEMI presenting within 3 hours of symptom onset and unable to attain PCI within 1 hour of first medical contact, a phar

STEMI 138

STEMI Allergic Reaction Coronary Ambulance 138

EMergucate

SEPTEMBER 24, 2023

The abdominal x-ray shows a radio opaque density in the right lower quadrant of the abdomen. This is an appendicolith.

EMS 130

EMS 130

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Case submitted by anonymous. Written by Smith. Ken's piece at the bottom is excellent. A 50-something presented with s udden onset palpitations 8 hrs prior while sitting at desk at work. He had concurrent sharp substernal chest pain that resolved, but palpitations continued. Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest.

Coronary 136

Coronary OR EMS ED 136

Don't Forget the Bubbles

SEPTEMBER 23, 2023

This talk, from Clare Skinner, on music, medicine and leadership , comes from our 2022 DFTB conference in Brisbane. [link] Years ago, before I became a medical student, I heard Professor Michael Field , Associate Dean of Medical Curriculum at the University of Sydney, nephrologist, and an accomplished flautist, being interviewed about his love of music on ABC Classic FM.

OR 136

OR Emergency Department ED 136

ALiEM

SEPTEMBER 15, 2023

A 64-year-old Caucasian male with a history of alcohol use disorder and tobacco use disorder presents with painless bilateral hand contractures that have been worsening for the past several months. He denies any recent trauma, fever, chills, or decreased sensation. The patient works as a construction worker. Physical Exam Vitals : BP 143/83 ; HR 94; RR 18; T 98.6°F; O2 saturation 98% on room air Musculoskeletal : He has bilateral palmar contractures proximal to the fourth digits.

OR 152

OR 152

American Ambulance Association

SEPTEMBER 8, 2023

This content is for AAA members only. Please either Log In or Join! The post CRS Issues Overview of Select No Surprises Act Litigation appeared first on American Ambulance Association.

Ambulance 130

Ambulance OR 130

REBEL EM

SEPTEMBER 14, 2023

Background: Cardiogenic shock develops in up to 10% of patients with acute myocardial infarction (AMI) and carries a 30 day mortality rate around 50%. Revascularization of the culprit lesion remains one of the few established treatments though there are numerous other unproven modalities including extracorporeal life support (ECLS). Many centers have attempted ECLS to achieve hemodynamic stabilization in this group of patients.

Life Support 137

Life Support Coronary CPR ICU 137

EMergucate

SEPTEMBER 12, 2023

The abdominal x-ray is from an adult with severe epigastric pain. Erect chest x-ray shows no air under the diaphragm.

EMS 130

EMS 130

EMCrit Project

SEPTEMBER 3, 2023

In many countries, pulmonary and critical care are commonly bundled together. Consequently, a single person will often be responsible for both inpatient ICU management as well as inpatient pulmonary consultation. Honestly, I have some doubts about whether this is an ideal system. As both pulmonology and critical care medicine become increasingly complex, it's becoming impossible […] EMCrit Project by Josh Farkas.

Critical Care 133

Critical Care ICU 133

Don't Forget the Bubbles

SEPTEMBER 13, 2023

The Choosing Wisely ® campaign is an initiative that promotes collaborative conversations between clinicians and families to safely avoid unnecessary and potentially harmful tests. The American Academy of Paediatrics Section on Emergency Medicine (AAP SOEM) created a list of five key recommendations for Paediatric Emergency Medicine after a structured review process and expert consensus opinion.

E-9-1-1 131

E-9-1-1 Emergency Department ALS OR 131

ALiEM

SEPTEMBER 11, 2023

A 29-year-old female with a past medical history of migraine headaches presented to the emergency department (ED) for several hours of bilateral eye pain, redness, and decreased visual acuity. The patient is a contact lens wearer. The night prior to presentation at 18:00, the patient inserted her contacts that she had washed and soaked in a hydrogen peroxide (H2O2) cleaning solution.

Emergency Department 152

Emergency Department ED OR 152

American Ambulance Association

SEPTEMBER 1, 2023

This content is for AAA members only. Please either Log In or Join! The post VA Final Rule on Ambulance Services Update appeared first on American Ambulance Association.

Ambulance 130

Ambulance OR 130

REBEL EM

SEPTEMBER 7, 2023

BACKGROUND: intracerebral hemorrhage (ICH) makes up 10-15% of all strokes and significantly contributes to overall stroke-related morbidity and mortality ( Hostettler 2019 ). Levetiracetam is frequently used to prevent seizures in patients with conditions such as ICH, traumatic brain injury (TBI), supratentorial neurosurgery, and subarachnoid hemorrhage (SAH).

OR 133

OR ALS EMS 133

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant. More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior.

Defibrillator 130

Defibrillator Coronary STEMI CPR 130

EMergucate

SEPTEMBER 19, 2023

The following chest x-ray is from an adult with chest pain. What can be seen? Answer will be posted later.

EMS 130

EMS 130