The Skeptics' Guide to EM

FEBRUARY 11, 2024

Reference: McLatchie et al and DAShED investigators. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. EMJ Nov 2023. Date: February 11, 2024 Guest Skeptic: Nirdosh Ashok Kumar, Emergency Medicine Specialist – Aga Khan University Hospital, Karachi, Pakistan. […] The post SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Sy

ED 303

ED Emergency Department ALS OR 303

Emergency Medicine Cases

FEBRUARY 13, 2024

In this month's ECG Cases blog Dr. Jesse McLaren reviews interpretation of the pre-arrest ECG: identifying high risk ECGs requiring empiric treatment like calcium for hyperkalemia, magnesium for long QT, or reperfusion for Occlusion MI; the intra-arrest ECG: identifying pseudo-PEA; and post-arrest ECG: the importance of serial ECGs to reduce false positive STEMI, role of POCUS to help with the differential of diffuse ST depression with reciprocal ST elevation in aVR, and identifying signs of Occ

STEMI 277

STEMI OR EMS 277

ALiEM

FEBRUARY 9, 2024

How do we best use high-sensitivity cardiac troponin (hs-cTn) to risk stratify patients with symptoms concerning for an acute myocardial infarction (AMI)? The 2022 American College of Cardiology (ACC) pathway provides timely guidance [1]. We help you translate this to your clinical practice, by illustrating with a case. Time to know your hs-cTn better.

E-9-1-1 276

E-9-1-1 ED Coronary ALS 276

American Ambulance Association

FEBRUARY 8, 2024

This content is for AAA members only. Please either Log In or Join! The post OHSA Notice of Proposed Rule Making (NPRM) Emergency Response Standard appeared first on American Ambulance Association.

Emergency Response 246

Emergency Response Ambulance OR 246

Pediatric EM Morsels

FEBRUARY 2, 2024

There have been many times I have encountered a triage note which states “ patient recently returned from … (insert awesome foreign country) … ” Not only does this leave me daydreaming about my future travel adventures, but has often caused me to take pause. Thoughts of what endemic illnesses could this child potentially have been exposed to in their travels?

E-9-1-1 161

E-9-1-1 ED OR Emergency Department 161

EMergucate

FEBRUARY 26, 2024

The following ECG is from a 40-year-old man who presents overnight with left sided sharp chest pain which has woken him from sleep. He describes the pain as radiating into his left arm.

130

130

The Skeptics' Guide to EM

FEBRUARY 24, 2024

Reference: Li, T., & Gal, D. (2023). Consumers prefer natural medicines more when treating psychological than physical conditions. Journal of Consumer Psychology 2023, Date: February 23, 2024 Guest Skeptic: Ethan Milne is a Marketing PhD student at the Ivey Business School (Western University). He researches how moral outrage and status-seeking personalities motivate social media aggression, and how […] The post SGEM#341: You Make Me Feel Like a Natural Treatment first appeared on The Skeptics G

Emergency Department 174

Emergency Department OR 174

ALiEM

FEBRUARY 5, 2024

Welcome to the AIR Toxicology 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 toxicology in the Emergency Department. 8 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

American Ambulance Association

FEBRUARY 26, 2024

The Ambulance Open Door Forum has been rescheduled from March 14th to NEW DATE date, April 11th at the same time of 2:00pm-3:00pm ET. Thank you. Register Here Overview: The […] The post CMS Ambulance Open Door Forum: Rescheduled appeared first on American Ambulance Association.

Ambulance 130

Ambulance 130

Core EM

FEBRUARY 23, 2024

The Case A 71-year-old male with a history of chronic obstructive pulmonary disease, hyperlipidemia, and peptic ulcer disease presents to the emergency department with substernal chest pain radiating down the right arm and dyspnea that began acutely while “running” up the stairs from the subway. The following ECG is obtained upon arrival to the emergency department.

STEMI 130

STEMI Coronary Emergency Department OR 130

EMergucate

FEBRUARY 23, 2024

Proton Pump Inhibitor Use and Risk of Serious Infections in Young Children Marion Lassalle, PharmD, PhD1; Mahmoud Zureik, MD, PhD1,2; Rosemary Dray-Spira, MD, PhD1 August 14, 2023 doi:10.1001/jamapediatrics.2023.

130

130

The Skeptics' Guide to EM

FEBRUARY 3, 2024

Reference: Curry SD, et al. Systematic Review of CT Angiography in Guiding Management in Pediatric Oropharyngeal Trauma. Laryngoscope. March 2023 Date: January 30, 2024 Guest Skeptic: Dr. Alexandra (Ali) Espinel is an Associate professor of pediatrics and otolaryngology at Children’s National Hospital and George Washington University. She is also the director of the Pediatric Otolaryngology […] The post SGEM #429: It’s CT Angio, Hi.

ALS 165

ALS Emergency Department OR ED 165

Emergency Medicine Cases

FEBRUARY 13, 2024

In order fix EM, each of us needs to understand systems issues and systems thinking, and advocate for a better system based on sound systems principles and specific solutions. In this main episode EM Cases podcast Anton is joined by Dr. Alecs Chochinov and Dr. Davie Petrie, two systems thinkers and leaders in EM. They discuss solutions for how to fix EM in 5 spheres: having a coordinated mission, optimizing access points, accountability, disaster preparedness and adaptation/evolution.

EMS 201

EMS ED 201

ALiEM

FEBRUARY 26, 2024

An 18-day-old male presented for a rash on his face for two days. The patient was born via spontaneous vaginal delivery full term without complications to a mom who has a history of genital HSV but without active lesions at delivery and on acyclovir. The patient presented with a vesicular rash on his face including around his eyes. He had conjunctival discharge noted by mom.

195

195

American Ambulance Association

FEBRUARY 23, 2024

Dave and Kelly’s Inspiring Journey Meet Dave Raymond, a dedicated firefighter EMT, and his wife, Kelly, who has been on a courageous four-year quest to find a kidney donor. In […] The post EMS Gives Life | EMT Dave and Wife Kelly Need Your Help appeared first on American Ambulance Association.

EMT 130

EMT EMT EMS Firefighter 130

Critical Care Scenarios

FEBRUARY 14, 2024

A roundup of opinions from attendees at SCCM’s 2024 Critical Care Congress in Phoenix on strategies for rescuing the patient stuck in a loop of deep sedation and agitation. Thanks to Pat Posa, Martha Roberts, Juliana Barr, Kelly Drumright, and Ben Lassow for their input. Resources A roundup of opinions from attendees at SCCM’s 2024 Critical Care Congress in Phoenix on strategies for rescuing the patient stuck in a loop of deep sedation and agitation.

ICU 136

ICU Critical Care 136

EMergucate

FEBRUARY 4, 2024

A police recruit doing a 20 km pack hike. Collapsed. GCS on arrival was 7. His temperature was 39.2 on arrival. His venous blood gases showed the following: PH = 7.

130

130

REBEL EM

FEBRUARY 15, 2024

Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits.

ICU 141

ICU ALS ED OR 141

Dr. Smith's ECG Blog

FEBRUARY 22, 2024

Written by Pendell Meyers A woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed: What do you think? Extremely wide complex monomorphic rhythm just over 100 bpm. The QRS is so wide and sinusoidal that the only real possibilities left are hyperkalemia or Na channel blockade.

EMS 136

EMS STEMI ED OR 136

ALiEM

FEBRUARY 20, 2024

What agent would most likely be responsible for these ECG findings? Cyclobenzaprine Digoxin Flecainide Sotalol Reveal the Answer 3. Flecainide Background [1-3] Flecainide is a class IC antiarrhythmic that binds to the voltage-gated sodium channel of the myocardium, slowing depolarization and prolonging phase 0 of the action potential. In toxicity, bradydysrhythmias, AV nodal blockade, ventricular tachycardia, and rate-dependent QRS widening occur.

Life Support 183

Life Support Overdose ED 183

American Ambulance Association

FEBRUARY 22, 2024

From GoAEROprize.com Heroes who look past danger to help people in need, Heroes to step in to be the difference between triumph and tragedy, And Heroes who use their minds to […] The post GoAERO Competition + Informational Webinar Details appeared first on American Ambulance Association.

Ambulance 130

Ambulance 130

Critical Care Scenarios

FEBRUARY 7, 2024

How to document your ultrasound findings. Find us on Patreon here! Buy your merch here! How to document your ultrasound findings. Find us on Patreon here! Buy your merch here!

117

117

EMergucate

FEBRUARY 20, 2024

The following ECG is from a 60 year old lady with chest pain and dyspnoea a few hours after finishing a triathlon. At the scene she was hypothermic at 32 degrees.

ED 130

ED 130

REBEL EM

FEBRUARY 19, 2024

Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. Historically the administration of vasopressors was restricted to central venous catheters (CVC) due to concerns for local tissue injury resulting from vasoconstriction if extravasation occurred from a peripheral IV.

ICU 137

ICU EMS ALS OR 137

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

Written by Pendell Meyers First try to interpret this ECG with no clinical context: The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. After an initially narrow QRS, there is a very large abnormal extra wave at the end of the QRS complex. These are Osborn waves usually associated with hypothermia. There is also large T wave inversion and long QT.

ICU 132

ICU OR ALS ED 132

ALiEM

FEBRUARY 2, 2024

An 18-year-old-female with no known past medical history presented with a lesion on her back that had been present and enlarging for five months. It was not painful unless she touched it, and then only mildly tender. She denied any known cause, wound, prior rash, or other lesions. Her review of systems and past medical history were negative. Additional Images Physical Exam Vitals : Normal Skin : An erythematous lenticular, or biconvex, lesion with distinct borders is noted at the left posterior

Emergency Department 169

Emergency Department OR 169

American Ambulance Association

FEBRUARY 20, 2024

The Centers for Medicare & Medicaid Services (CMS) released a new “Reporting for Rural and Super-Rural Organizations Tip Sheet” on February 16, 2024. This guide assists ground ambulance organizations in […] The post CMS Releases New GADCS Tip Sheet for Rural, Super Rural Services appeared first on American Ambulance Association.

Ambulance 130

Ambulance 130

Critical Care Scenarios

FEBRUARY 21, 2024

How I make patients poop. Find us on Patreon here! Buy your merch here! How I make patients poop. Find us on Patreon here! Buy your merch here!

124

124

EMergucate

FEBRUARY 25, 2024

Answers: PH = 7.39, that is within normal range/ pCO2 = 48 mmHg, that is slightly elevated (Can be considered normal for venous blood) HCO3 = 29 mmol/L.

130

130

NVFC

FEBRUARY 13, 2024

On December 21, the Occupational Safety and Health Administration (OSHA) announced that it will issue a Notice of Proposed Rulemaking (NPRM) to modernize the agency’s “Fire Brigades” standard. This standard was first published and last updated in 1980. This proposed updated standard would issue several new requirements that would be very burdensome, and in many cases impossible, for volunteer fire departments to comply with.

Emergency Response 131

Emergency Response 131

FirstNet Authority

FEBRUARY 29, 2024

Update on February 22 Network Outage Blog joseph.rey@fir… Thu, 02/29/2024 - 13:49 By Joe Wassel, Executive Director and CEO, First Responder Network Authority Learn more about how FirstNet is transforming public safety communications — contact your local FirstNet Authority Public Safety Advisor and sign up for our discipline newsletters. Follow us on Twitter , Facebook , Instagram , and LinkedIn for the latest FirstNet Authority updates.

Public Safety 128

Public Safety First Responder OR 128

ALiEM

FEBRUARY 16, 2024

An 86-year-old man with a past medical history of coronary artery disease, hypertension, hyperlipidemia, chronic kidney disease, COPD, choledocholithiasis requiring ERCP and sphincterotomy 2 years ago presented with five days of feeling unwell. History was limited due to cognitive impairment. His daughter had reported to staff he had been feeling unwell for five days, intermittently having nausea and generalized abdominal pain, subjective fevers, chest pain, and shortness of breath.

Coronary 161

Coronary OR 161

American Ambulance Association

FEBRUARY 19, 2024

HHS Announces New Cybersecurity Performance Goals to Enhance Cybersecurity The U.S. Department of Health and Human Services (HHS), through the Administration for Strategic Preparedness and Response (ASPR), announced on January […] The post EMS.gov | HHS Announces New Performance Goals to Enhance Cybersecurity appeared first on American Ambulance Association.

Ambulance 130

Ambulance 130

Dr. Smith's ECG Blog

FEBRUARY 16, 2024

Written by Pendell Meyers A teenager was playing basketball when he suddenly developed palpitations and lightheadedness. He presented soon afterward at the Emergency Department with ongoing symptoms. Mentation and blood pressure were normal. He had no chest pain or shortness of breath. Heart rates on the monitor fluctuated from 180-250 bpm. Here is his triage ECG: What do you think?

Emergency Department 127

Emergency Department OR 127

EMergucate

FEBRUARY 27, 2024

The following ankle x-ray is from a 13 year old with severe ankle pain & swelling post twisting injury to … Continue reading →

EMS 130

EMS 130

REBEL EM

FEBRUARY 29, 2024

Background: Ventilator-associated pneumonia (VAP), or what the CDC recently renamed infection-related ventilator-associated complication (IVAC), is defined as a nosocomial pneumonia occurring on day 3 of mechanical ventilation that was preceded by 2 days of stable or decreasing ventilator requirements. 1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 3, 4 It is the most common nosocomial infection in patients on m

E-9-1-1 126

E-9-1-1 ICU OR ALS 126

Critical Care Scenarios

FEBRUARY 28, 2024

We discuss the medications typically used after organ transplant, their impact on critical illness, and how to manage them when these patients show up sick—with Olivia Philippart, transplant clinical pharmacist specializing in liver and kidney transplant at University of Kentucky HealthCare. Find us on Patreon here! Buy your merch here! Takeaway lessons References From: Fishman … Continue reading "Episode 71: Transplant medications with Olivia Philippart" Photo by Tim Webb We discuss the medicat

ICU 100

ICU OR 100