ALiEM

NOVEMBER 22, 2023

The toxin from the golden poison dart frog most resembles which of the following in its mechanism of action? Botulinum toxin Bufotoxin Grayanotoxin Palytoxin Tetrodotoxin Photo adapted from Wilfried Berns (Wikimedia Commons) Reveal the Answer 3. Grayanotoxin – a sodium channel opener Background The golden poison dart frog ( Phyllobates terribilis ), often considered one of the most poisonous animals on the planet, secretes onto its skin the lipophilic alkaloid batrachotoxin , which irreversibly

ALS 284

ALS ED OR 284

The Skeptics' Guide to EM

NOVEMBER 25, 2023

Date: November 22, 2023 Reference: Stopyra et al. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. AEM November 2023. Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. She is the cofounder of FOAMcast and a […] The post SGEM#421: I Think I’d Have a Heart Attack – Maybe Not in a Rural Area?

Heart Attack 278

Heart Attack STEMI Emergency Medical Services Coronary 278

Emergency Medicine Cases

NOVEMBER 28, 2023

On this month's EM Quick Hits podcast: Anand Swaminathan on update to ED management of postpartum hemorrhage, Nour Khatib on serotonin syndrome and its mimics, Katie Lin on an approach to recognition and management of severe TBI and brain herniation syndromes, Hans Rosenberg on the ED management of ulcerative colitis, Heather Cary on pediatric c-spine immobilization controversies and techniques, Navpreet Sahsi on the difference between humanitarian and development work The post EM Quick Hits 53

EMS 276

EMS ED 276

Pediatric EM Morsels

NOVEMBER 3, 2023

Imported Malaria , like all imported tropical illnesses, is a Tale of Two Cities. The infection was unknowingly obtained while enjoying a delightful holiday and then brought back in transit to a country where it is not endemic. In these non-endemic countries, we need to always be attentive to patient’s history of recent travel to correctly identify any concerns related to their recent travel.

ALS 278

ALS Critical Care EMS OR 278

EMergucate

NOVEMBER 27, 2023

Answers: PH = 7.479, that is mild acidaemia. HCO3 = 30 mmol/L (that is high). So, we have metabolic alkalosis. Next we check the respiratory compensation for metabolic alkalosis.

130

130

American Ambulance Association

NOVEMBER 27, 2023

Input Requested: EMS Education Agenda 2050 NHTSA plans community-lead revision of 1996 Education Agenda, tackling education to clinicians The National Highway Traffic Safety Administration (NHTSA) is seeking public comment regarding the upcoming revision […] The post EMS.gov | Input Requested: EMS Education Agenda 2050 appeared first on American Ambulance Association.

EMS 130

EMS Ambulance 130

ALiEM

NOVEMBER 17, 2023

A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. The grandmother first noted blood in the patient’s underwear the previous morning when she was helping the patient wipe and she noticed it again prior to arrival, this time saturating the patient’s underwear.

Emergency Department 250

Emergency Department OR 250

Emergency Medicine Cases

NOVEMBER 7, 2023

You diagnose uncomplicated appendicitis in the ED. The on call General Surgery team wants to wait until the next morning to perform an appendectomy. Is your patient at risk for appendiceal perforation with a delay to surgery? Dr. Rohit Mohindra and Dr. Shelley McLeod analyze the latest RCT that attempts to answer this question, the PERFECT study, on this EM Cases Journal Club.

EMS 258

EMS ED 258

Pediatric EM Morsels

NOVEMBER 17, 2023

While doing literature review for my scholarly project it dawned on me that it might be time to dust off a classic morsel from the bottom of the cookie jar. On this 10 year anniversary, we chose to throw this one back in the oven to include some even more delicious data on cuffed endotracheal tube (ETT) use. No matter whether you have the wisdom of many years of practice ( old doc like Dr.

E-9-1-1 183

E-9-1-1 Operating Room Emergency Department ALS 183

Core EM

NOVEMBER 15, 2023

The Case A 62-year-old male with a history of Hypertension, Hyperlipidemia, Coronary Artery Disease with stents, Pulmonary Embolism on Eliquis, presents with sudden onset, severe, mid-sternal chest pain that started 15 minutes prior to arrival. He arrived initially with diaphoresis and pallor which have self-resolved following arrival to the ED. EKG Show Details EKG Characteristics Rate 95 BPM Rhythm Normal Sinus Rhythm Intervals PR 164, QRS 82, QT/QTc 360/452 (normal) Axis Normal Additional Fea

Coronary 130

Coronary STEMI ED 130

American Ambulance Association

NOVEMBER 27, 2023

Emergency Medicine in Rural America | OAS Episode 198 NOVEMBER 19TH, 2023 | 36:56 | E198 SHARE EMBED RECAST SUBSCRIBE DOWNLOAD MP3 EPISODE SUMMARY Two experts in emergency medical services joined the podcast […] The post NCSL Podcast | Emergency Medicine in Rural America appeared first on American Ambulance Association.

Emergency Medical Services 130

Emergency Medical Services Ambulance 130

ALiEM

NOVEMBER 3, 2023

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

Critical Care 211

Critical Care EMS Emergency Department ALS 211

Critical Care Scenarios

NOVEMBER 8, 2023

We learn about pancreaticoduodenectomy (the Whipple) with Michael Cavnar (@DrMikeCavnar), surgical oncologist at University of Kentucky, with a fellowship in Complex General Surgical Oncology from Sloan Kettering. He specializes in GI surgical oncology (liver, pancreas, stomach, etc), with ongoing research in GI stromal tumors and hepatic artery infusion pump chemotherapy.

ICU 130

ICU OR 130

Emergency Medicine Cases

NOVEMBER 7, 2023

Key principles and approach to management of both non-massive and massive hemoptysis with Dr. Scott Weingart and Dr. Bourke Tillmann, who answer questions such as: What are the factors to consider in the decision to intubate patients with massive hemoptysis? How can one reliably distinguish hemoptysis from pseudohemoptysis? What is the evidence for tranexamic acid in patients with hemoptysis?

ED 230

ED EMS 230

Chicago EMT Training

NOVEMBER 7, 2023

The class usually starts out optimistic and hopeful with how the rest of the semester will play out. Not unlike when I applied to Malcolm X College years ago, we try to forewarn the amount of time it takes to truly understand the material in this class. It's not inherently difficult but rather the volume of content that is overwhelming. We all have something going in outside of the EMT class.

EMT 130

EMT EMT OR 130

Core EM

NOVEMBER 13, 2023

The primary survey in trauma management is a critical initial assessment to identify and address life-threatening conditions. It follows the ABCDE approach: Airway maintenance with cervical spine protection, Breathing and ventilation, Circulation with hemorrhage control, Disability (neurological status), and Exposure/Environmental control. This systematic method ensures prompt identification and immediate treatment of urgent medical issues, enhancing the chances of survival and recovery in traum

130

130

American Ambulance Association

NOVEMBER 27, 2023

The next public meeting of the National Biodefense Science Board (NBSB) will be held virtually on Thursday, November 30, 2023, from 12:30 to 4:00 p.m. ET. Advanced registration is required. To register […] The post National Biodefense Science Board (NBSB) Public Meeting on November 30, 2023 appeared first on American Ambulance Association.

Ambulance 130

Ambulance 130

ALiEM

NOVEMBER 13, 2023

A 57-year-old female college counselor living in the northeastern United States with no PMH presented for evaluation of rash, joint pain, and dyspnea for the past three weeks. The patient first noticed the rash on her upper back, describing it as being itchy. The rash then spread to her face, scalp, and thighs. Two weeks ago, she noticed swelling in her hands and had a gradual onset of dyspnea on exertion.

OR 200

OR 200

The Skeptics' Guide to EM

NOVEMBER 4, 2023

Reference: Roland D, Munro A. Time for paediatrics to screen out sepsis “screening.” BMJ. June 2023 Date: Sept 12, 2023 Guest Skeptic: Dr. Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Professor for the University of Leicester’s SAPPHIRE group. He specializes in Paediatric Emergency Medicine and is a passionate […] The post SGEM Xtra: Say What You Need to Say…but Don’t Say “Sepsis Screening” first appeared on The Skeptics Guide to Emergency Medicine.

OR 133

OR 133

Emergency Medicine Cases

NOVEMBER 7, 2023

Dr. Navpreet Sahsi outlines 5 core ethical principles in choosing and participating a global health project on EM Cases' Global EM blog. The post Global EM 5 Is it Ethical? 5 Core Principles When Choosing a Global Health Project appeared first on Emergency Medicine Cases.

EMS 134

EMS 134

Chicago EMT Training

NOVEMBER 8, 2023

We occasionally get an inquiry asking to become a paramedic. It's encouraging to hear that there is still interest in becoming first responders! A quick breakdown on the differences between an EMT-B(asic) and an EMT-P(aramedic) Basic Life Support (BLS) vs Advanced Life Support (ALS) So there it is. The two main levels of care you would probably see in the prehospital setting.

Advanced Life Support 130

Advanced Life Support BLS EMT EMT 130

Core EM

NOVEMBER 1, 2023

We discuss Electrical Storm (VT storm) and how to care for the very irritable heart. Hosts: Brian Gilberti, MD Reed Colling, MD [link] Download Leave a Comment Tags: Cardiology Show Notes Background/Overview of VT: Definition: What makes it a storm Three or more sustained episodes of VF, VT, or appropriate ICD shocks in a 24-hour period Pathophysiology: Understanding the origin and mechanism Sympathetic drive/adrenergic surge Underlying pathology: Sodium channelopathies, infiltrative disease li

OR 130

OR 130

American Ambulance Association

NOVEMBER 22, 2023

This content is for AAA members only. Please either Log In or Join! The post California Human Resources | Changes to CA Paid Sick Leave Law appeared first on American Ambulance Association.

Ambulance 130

Ambulance OR 130

ALiEM

NOVEMBER 6, 2023

A 55-year-old female with a history of hyperlipidemia presents after a syncopal episode. She had mild nausea and diarrhea on the morning of presentation but otherwise had no prodromal symptoms before suddenly losing consciousness in a grocery store. Of note, she recalls a similar syncopal episode in the remote past, also preceded by gastrointestinal symptoms at that time.

OR 195

OR 195

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. He presented tachycardic and hypotensive with a capillary refill time of 5 seconds. After 40ml/kg of IV 0.9% NaCl, his HR came down a little, but the effect was short-lived. He has an HR of 190/min, and his BP is 85/35 mmHg. The CRT is unchanged.

Advanced Life Support 143

Advanced Life Support ED ALS OR 143

EMergucate

NOVEMBER 21, 2023

28 days old boy brought by his parents for multiple vomiting episodes. His venous gases showed the following: PH = 7.

130

130

Broome Docs

NOVEMBER 17, 2023

This is another lecture by the always amazing Dr Justin Morgenstern from the series of talks he delivered on his tour of Perth in September 2023. In this talk I challenged Justin to go on a very deep dive into the literature around the modern management of the massively bleeding trauma patient. What is the best way to resuscitate and replace all those blood products in these severely unwell people?

FFP 138

FFP OR 138

Critical Care Scenarios

NOVEMBER 29, 2023

Explaining the ultimate expression of prognosis: Morbidity = (Severity x Duration)/Reversibility Explaining the ultimate expression of prognosis: Morbidity = (Severity x Duration)/Reversibility

100

100

American Ambulance Association

NOVEMBER 22, 2023

Hot off the press! The Department of Veteran’s Affairs has announced a one year delay of the VA Final Rule. This delay pushes implementation of the final rule to February […] The post VA Final Rule Delayed One Year appeared first on American Ambulance Association.

Ambulance 130

Ambulance 130

ALiEM

NOVEMBER 29, 2023

Which of the following agents, when injected along with heroin, is associated with the skin changes pictured? Cocaine Fentanyl Methamphetamine Xylazine Photo by Dr. Matthew Salzman Reveal the Answer 4. Xylazine Background Xylazine is a synthetic substance approved by the U.S. Food and Drug Administration for veterinary use, specifically for its muscle relaxant, sedative, and analgesic effects [1].

Naloxone 169

Naloxone Overdose ALS Epinephrine 169

Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. A 12-year-old male is being transported by ambulance after a road traffic accident. His name is Ben. Ben has a possible skull fracture and has been intubated, but his oxygen requirement is minimal. While waiting, another call comes in. Ben suddenly woke up and accidentally self-extubated.

E-9-1-1 135

E-9-1-1 Emergency Department ED CPR 135

EMergucate

NOVEMBER 28, 2023

70 year old man presented with reduced level of consciousness. His venous blood gas showed the following: PH = 7.

130

130

First 10 EM

NOVEMBER 27, 2023

Evidentiary amnesia is a term I use to describe the phenomenon I frequently encounter in which evidence seems to be forgotten over time. When I hear people lecture about the management of intracranial hemorrhage, and even when I invite incredibly smart people to write about neurologic emergencies, blood pressure management is always recommended. But why?

EMS 125

EMS 125

Critical Care Scenarios

NOVEMBER 15, 2023

Which site should you select for your central line placement? A discussion of some considerations. Which site should you select for your central line placement? A discussion of some considerations.

100

100

American Ambulance Association

NOVEMBER 21, 2023

Federal Interagency Committee on EMS to Hold Virtual Meeting on December 6 Advanced public comment period open until Wednesday, November 29 The Federal Interagency Committee on EMS (FICEMS) was established […] The post Register Now: FICEMS Meeting on December 6 appeared first on American Ambulance Association.

Ambulance 130

Ambulance EMS 130

ALiEM

NOVEMBER 15, 2023

What toxin is found in bitter apricot kernels? Cardiac glycoside Cyanogenic glycoside Dinitrophenol Lysergic Acid Reveal the Answer 2. Cyanogenic glycoside Background Apricot kernels contain a cyanogenic glycoside called amygdalin which is hydrolyzed to hydrogen cyanide in the gastrointestinal tract [1]. There are over 2,000 species of cyanogenic glycoside producing plants, including apricots, almonds, peaches, and cassava [2].

OR 169

OR ED 169

Don't Forget the Bubbles

NOVEMBER 22, 2023

One-liner… Although commonly used, Propofol can have severe adverse effects. Propofol Infusion Syndrome (PRIS) can lead to significant morbidity and mortality in children. What is Propofol? Commonly referred to as “the milk of amnesia”, propofol is a drug used for induction and maintenance of general anaesthesia and for procedural sedation. Propofol is prepared in a lipid emulsion, giving it a characteristic milky white appearance, and due to its ability to dissolve in fats, it is rapidly redist

E-9-1-1 126

E-9-1-1 Critical Care Operating Room ALS 126