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Reference: Gibbons et al. The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol): A multicenter, prospective, observational study. AEM February 2024. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. He is the Vice Chair of the Emergency Department at Nassau University […] The post SGEM#432: SPEED, Give Me What I Need – To Diagnose Acute Aortic Dissections first appeared on Th
TCP In Transit: A case reviewing transcutaneous pacing, false electrical capture, and re-arrest. Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the first installment of a blog series showing how transcutaneous pacing (TCP) can be difficult, and how you can improve your skills. We will be using redacted information from different cases where paramedics attempted TCP in the field.
A 30-year-old female with a past medical history of Crohn’s Disease presented to the ED for evaluation of an acutely bruised right 4th finger. She stated she was typing on a computer keyboard approximately 10 minutes prior to presentation and she noticed a sudden popping sensation at the base of her right ring finger. After the popping sensation, she noticed a cool sensation of the finger and numbness to the entire finger.
Often our job requires us to consider the presence of needles of significant illness in the haystack of nonspecific symptoms. With the help of our favorite geneticist , Dr. Liz Baker, we will dive into the haystack headfirst and find those needles. Hopefully, without getting poked. Let’s consider Inborn Errors of Metabolism Presenting in the ED : Inborn Errors of Metabolism: Basics Common Presentations, Uncommon Kiddos For the child with lethargy, vomiting, acidosis, hypoglycemia , organom
In this part 1 of our 2-part podcast series on Asthma Management we explore a systematic approach to managing patients presenting to the ED with asthma exacerbations. Our discussion will emphasize the critical role of a thorough history and physical examination in effectively stratifying patient risk and guiding treatment/disposition decisions. Additionally, we'll examine the importance of providing comprehensive discharge medications and instructions to mitigate both mortality and morbidity ass
There is plenty of data in the world, the key to improving performance is to discover the right information and make an appropriate decision, based on facts, in time to change outcomes for the better. Computers are quite useful in aggregating and processing data to distill information in support of the decision-making process, but artificial intelligence and machine-learning has increased our expectations of cyber assistance.
FOR IMMEDIATE RELEASE Contact: Samantha Hilker Director of Strategic Initiatives shilker@ambulance.org American Ambulance Association Announces 2024 Vanguard Award Winners Washington D.C. – The American Ambulance Association (AAA) is proud to […] The post 2024 Vanguard Award Winners Announced appeared first on American Ambulance Association.
Date: March 6, 2024 This is an SGEM Xtra created from a lecture I gave for the Rural Ontario Medical Program (ROMP) ICE Camp Retreat in Collingwood, Ontario last month. ROMP helps Ontario medical students & residents arrange core & elective rotations in rural Ontario. An old friend, Dr. Matt De Stefano invited me to […] The post SGEM Xtra: A Philosophy of Emergency Medicine first appeared on The Skeptics Guide to Emergency Medicine.
Date: March 6, 2024 This is an SGEM Xtra created from a lecture I gave for the Rural Ontario Medical Program (ROMP) ICE Camp Retreat in Collingwood, Ontario last month. ROMP helps Ontario medical students & residents arrange core & elective rotations in rural Ontario. An old friend, Dr. Matt De Stefano invited me to […] The post SGEM Xtra: A Philosophy of Emergency Medicine first appeared on The Skeptics Guide to Emergency Medicine.
Old IVC Vid (2021) TEE VTI Here are Dr. Spiegel’s Notes: 1. The discussion of what an IVC tells you is a fairly nuanced discussion but essentially it is telling you the difference in the RA pressure compared to the intra-abdominal pressure. It is our job as clinicians to interpret what that means. I find if you teach IVC US from that perspective than all the variability in techniques make a whole lot of sense.
We encounter seizures commonly in the Emergency Department. While they can be dramatic and devastating, we have learned to become comfortable with the wide variety that may present in children. From the simple febrile seizure to the complex seizure, we know how to stabilize and how to evaluate. While fortunately most seizure activity is short lived, we also know that status epilepticus can be difficult to manage, and persistent seizures should make us consider specific etiologies (ex.
In this Waiting to Be Seen blog Dr. Howard Ovens outlines 4 key learnings from his extensive career in EM leadership: Be a good clinician, get substantial real-world experience, take a long-term view of benefits and risks and get along with your counterparts in the leadership dyad. The post WTBS 29 Four Key Learnings from a Career in Emergency Medicine Leadership appeared first on Emergency Medicine Cases.
Read this tutorial on the use of point of care ultrasonography (POCUS) for pediatric renal and bladder ultrasonography. Then test your skills on the ALiEMU course page to receive your PEM POCUS badge worth 2 hours of ALiEMU course credit. Take the ALiEMU Quiz: Pediatric Renal and Bladder Ultrasound Module Goals List the indications for performing a pediatric renal/bladder point-of-care ultrasound (POCUS) Describe the technique for performing renal/bladder POCUS Identify hydronephrosis and its
We review Nitrous Oxide Toxicity: Symptoms, diagnosis, and treatment overview Hosts: Stefanie Biondi, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Toxicology Show Notes Patient Case Illustration Hypothetical case: 21-year-old male with no previous medical history, experiencing a month of progressively worsening numbness, tingling, and weakness.
We talk about working in critical care APP leadership positions, with Jason Wieland, PA, Lead Pulmonary & Critical Care APP at WakeMed Health System in Raleigh, NC. Find us on Patreon here! Buy your merch here! We talk about working in critical care APP leadership positions, with Jason Wieland, PA, Lead Pulmonary & Critical Care APP at WakeMed Health System in Raleigh, NC.
Reference: Marx et al. Simple Aspiration versus Drainage for Complete Pneumothorax: A Randomized Noninferiority Trial. Am J Respir Crit Care Med. 2023 Date: March 22, 2024 Guest Skeptic: Dr. Richard Malthaner holds the prestigious position of Chair/Head of the Division of Thoracic Surgery and serves as the Director of the Thoracic Robotic Program at Western […] The post SGEM#433: Breathe – Simple Aspiration vs.
We have digested many Morsels regarding various pulmonary complaints. While some are very rare (ex, Pulmonary Embolism , Pulmonary Hypertensive Crisis , Negative Pressure Pulmonary Edema , CPAM ) others are commonly encountered (ex, Croup , Bronchiolitis , Sinusitis ). It is pneumonia , however, that often generates the most conversations. When should I consider a CXR ?
Posterior circulation ischemia accounts for approximately 20-25% of all ischemic strokes and is a significant cause of patient disability. The diagnosis can be extremely challenging as findings are often not typically focal. Posterior strokes are misdiagnosed more than 3x more often than anterior circulation strokes.1 Similar to anterior circulation strokes, posterior strokes are most commonly […] The post Posterior Circulation Strokes appeared first on EMOttawa Blog.
A 53-year-old woman with no significant past medical history presented to the emergency department with a 3-day history of double vision on leftward gaze. She initially presented to urgent care with a chief complaint of chest heaviness and concern that her blood pressure was too high, but was sent to the emergency department for further cardiac and neurological evaluation after her urgent care provider noticed abnormal eye movement.
The Hamilton T1 is quickly becoming one of the most prominent ventilators in the transport environment. While initially, all the bells and whistles can be intimidating, some high points make the learning curve slightly less steep. My goal for this blog is to highlight some "hacks" that are actually just strategies you should know and common misconceptions.
Date: March 16, 2024 This is an SGEM Xtra episode. Yes, that is two back-to-back SGEM Xtra episodes. The critical appraisal that was lined up for this week’s episode got delayed due to some scheduling problems with clinical responsibilities. You can access all the slides for this episode from this LINK and see the presentation […] The post SGEM Xtra: The Matrix – Social Media for Knowledge Translation first appeared on The Skeptics Guide to Emergency Medicine.
New Resources Address Important EMS Issues The Latest Updates on Highway Safety Regulations, Rural EMS Education and Special Pathogens Updating the Highway Safety Improvement Program The Federal Highway Administration has […] The post EMS.gov | New Resources Address Important EMS Issues appeared first on American Ambulance Association.
A 69 y.o. male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Per EMS report, patient believes he has been in atrial fibrillation for 5 days, since coming down with flu-like illness with rhinorrhea, productive cough, SOB.
A 28-year-old male presented to the ED for evaluation of an injury to his right eye. While working out with an exercise band, it snapped back, hitting the patient in the right eye. He experienced blurry vision and excess eye tearing immediately after the incident occurred. The patient also developed gross blood over the front of the eye. Physical Exam Vitals : Temp 98°F, HR 73, BP (135/77), RR 16, SpO2 99% HEENT : Gross blood in the anterior portion of the right eye (grade I).
Author: Mallika Singh, MD Editor: Jonathan Kobles, MD Background Unintentional or intentional exposure to radiological material represents a potential threat to human health on the individual to mass-casualty scale. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. Due to their availability, iridium-192, Cesium-137, and Cobalt-60 are often viewed as the substances posing the greatest threat for intentional radiation exposure.
Eyelid opening apraxia refers to a specific inability to open the eyelids. This may result from non-dominant hemispheric strokes. On superficial examination it will mimic unconsciousness, but upon further examination the patient is awake and able to respond to stimuli with their extremities. I've seen a similar phenomena of eyelid opening apraxia a few times […] EMCrit Project by Josh Farkas.
New Resources Address Important EMS Issues The Latest Updates on Highway Safety Regulations, Rural EMS Education and Special Pathogens Updating the Highway Safety Improvement Program The Federal Highway Administration has […] The post EMS.gov | New Resources Address Important EMS Issues appeared first on American Ambulance Association.
Looking back, I am somewhat surprised I never published a First10 approach to sympathetic crashing pulmonary edema. I guess it never felt necessary, as it was the first ever EMCrit post, and therefore felt well covered in the FOAMed community. However, a full 15 years after that first EMCrit podcast (congrats on the decade and […] The post High dose nitroglycerin is correct dose nitroglycerin appeared first on First10EM.
A 24-year-old female with no pertinent PMHx presents to the ED with a chief complaint of eye pain. She reported a 10-day history of worsening right eye pain following being punched in that eye. She had been managing her pain with ice and had not taken any OTC medications. Her mom convinced her to go to the ED and she first went to an outside hospital, but was referred to come to our institution.
A young man presented with a gunshot wound to the right chest, with hemo-pneumothorax and hemorrhagic shock. He got a chest tube and intubation and massive transfusion and stabilized. CT of chest showed the bullet path through his right lung but nowhere near his heart. But he did get an EKG: What is this? There were times when it would be usurped by sinus tachycardia, then return to this rhythm.
St.Emlyn's - Emergency Medicine #FOAMed Is mechanical CPR associated with improved or worse outcomes in in-hospital cardiac arrest. #FOAMed @stemlyns The post Is mCPR associated with better outcomes for in-hospital cardiac arrest? St Emlyn’s appeared first on St.Emlyn's.
Yesterday was a proud day for EMS! Yesterday, Dr. @ed_racht of @AMR_social and former @NAEMT_ President @mattzavadsky provided testimony at a House Ways & Means field hearing on the challenges […] The post EMS Testifies at House Ways & Means Field Hearing appeared first on American Ambulance Association.
There is little doubt that the use of testing has increased dramatically in emergency medicine during my career. Between 2001 and 2010 the use of CT in emergency departments increased 3-fold (and the use of MRI increased 9-fold, but for some reason it is still almost impossible for me to get one done.) (Carpenter 2015) […] The post Overdiagnosis: Would we better better off not looking?
In July 2022, a 32-year-old male with a past medical history of HIV (on antiretroviral therapy, CD4 390, viral load undetectable) presented to the emergency department with constitutional symptoms and a rash for 4-5 days. His symptoms included malaise, body aches, subjective fevers, a sore throat, tender, swollen neck glands, body rash, and irritation of his left eye.
Find us on Patreon here! Buy your merch here! We discuss the phenomenon of CPR-induced consciousness (i.e. patients demonstrating awakeness during resuscitation) with Jack Howard, Intensive Care Paramedic at Ambulance Victoria in the northern suburbs of Melbourne, Australia, and first author on a recent literature review and Delphi-derived expert guideline on CPRIC management.
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