The Skeptics' Guide to EM

JULY 2, 2023

Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Prehospital Tranexamic Acid for Severe Trauma. NEJM 2023. Guest Skeptic: Dr. Salim Rezaie is a community emergency physician in San Antonio, TX. He is the Creator and founder of REBEL EM, a free, critical appraisal blog that tries to cut down knowledge translation gaps of […] The post SGEM#408: Hey, I, Oh I’m Still Alive – Is it due to TXA?

Emergency Medical Services 311

Emergency Medical Services EMS Paramedic 311

Pediatric EM Morsels

JULY 28, 2023

Authors: Drs. Kendra Jackson and Rebecca Raffler While we’ve gotten to snack on a Morsel on this subject before , new guidelines and research surrounding DKA and cerebral edema have come to light since the first go ‘round! Thankfully, Dr. Fox wasn’t too “ salty” when we asked to rehydrate this topic. Rates of type 1 diabetes have increased since the COVID-19 pandemic.

E-9-1-1 245

E-9-1-1 ALS OR Critical Care 245

ALiEM

JULY 22, 2023

You have a severely dehydrated patient with a peripheral IV line, requiring urgent fluid resuscitation. However, the crystalloid fluids are not flowing freely. Multiple attempts were made to place this line with the latest having a flash of blood return and a smoothly flowing saline flush. You can not seem to find your pressure infusion cuff to squeeze the IV bag and accelerate fluid administration.

Emergency Department 241

Emergency Department OR Critical Care 241

Emergency Medicine Cases

JULY 18, 2023

On this month's EM Quick Hits podcast David Carr on differential diagnosis of normal unenhanced CT renal colic, Leeor Sommer on recognition and management of perichondritis and auricular abscess, Suzanne Schuh on IV magnesium sulphate for pediatric asthma, Jess McLaren on Occlusion MI ECG interpretation requiring cath lab activation and Justin Morgenstern on update on steroids for pneumonia.

EMS 221

EMS ACS STEMI 221

American Ambulance Association

JULY 20, 2023

This content is for AAA members only. Please either Log In or Join! The post Perez and Finstad Push Medic to Paramedic Provision appeared first on American Ambulance Association.

Paramedic 130

Paramedic Ambulance OR 130

EMS 12-Lead

JULY 30, 2023

David Didlake, FF/EMT-P, AG-ACNP @DidlakeDW An elder female presented to the ED with worsening shortness of breath. She was known to have a history of poorly controlled COPD, AFib, and multivessel coronary disease. Specific to the latter, she was previously deemed not appropriate for CABG (complex rationale) with preference for optimized medical management, instead.

EMT 130

EMT EMT ACS Coronary 130

The Skeptics' Guide to EM

JULY 8, 2023

Date: July 6, 2023 Reference: Hanula R et al. Evaluation of oseltamivir used to prevent hospitalization in outpatients with influenza: a systematic review and meta-analysis. JAMA Int Med 2023. Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at Staten Island University Hospital. Managing editor of EM:RAP and Associate Editor at REBEL EM.

ALS 239

ALS Emergency Department EMS ED 239

ALiEM

JULY 20, 2023

Welcome to the AIR Infectious Disease Module! After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to related to infectious diseases in the Emergency Department. 6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board.

Emergency Department 188

Emergency Department EMS OR 188

Emergency Medicine Cases

JULY 18, 2023

You are working the ambulatory section of your ED and evaluating a 6-year boy with a possible distal radius injury. He lives with autism spectrum disorder and is uncomfortable in X-ray rooms, and you wonder if there is a role for PoCUS to help exclude a fracture. With expert clinical commentary by Dr. Arun Sayal and Research Methodology Hot Take by Dr.

OR 130

OR ED EMS 130

American Ambulance Association

JULY 24, 2023

Register Now: National EMS Advisory Council Meeting August 9-10 The National EMS Advisory Council (NEMSAC) will host a hybrid meeting on Wednesday, August 9, 2023, at 1:00 pm ET, […] The post NEMSAC | Meeting August 9-10 appeared first on American Ambulance Association.

Ambulance 130

Ambulance EMS 130

EMS 12-Lead

JULY 24, 2023

David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic (ret) @DidlakeDW Expert commentary and peer review by Dr. Steve Smith [link] @smithECGBlog A 57 y/o Female with PMHx HTN, HLD, DM, and current use of tobacco products, presented to the ED with chest discomfort. She described it as tightness, centralized, and associated with both dyspnea and diaphoresis.

Coronary 130

Coronary ACS CAD ED 130

The Skeptics' Guide to EM

JULY 29, 2023

Date: July 21, 2023 Reference: McDonald et al. Patterns of change in prehospital spinal motion restriction: a retrospective database review. AEM July 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM.

Emergency Medical Services 203

Emergency Medical Services ALS EMS Emergency Department 203

EMergucate

JULY 19, 2023

Characteristics Associated With Serious Self-Harm Events in Children and Adolescents Mert Sekmen,a,b Carlos G.

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183

ALiEM

JULY 24, 2023

Dr. Sara Krzyzaniak (EM program director at Stanford) hosts this episode with Dr. Michelle Lin (ALiEM/UCSF) featuring all-star guests Dr. Alexis Pelletier-Bui (EM associate program director at Cooper University Hospital) and Dr. Elizabeth Werley (EM program director at Penn State Hershey). Both our guests serve as key representatives on behalf of the EM specialty on the AAMC ERAS Supplemental Application Working Group and provide you with a sneak peek behind what is coming for the totally revamp

EMS 130

EMS 130

Critical Care Scenarios

JULY 26, 2023

The dilemma of lung-protective ventilation in patients with strong spontaneous breathing. The dilemma of lung-protective ventilation in patients with strong spontaneous breathing.

100

100

American Ambulance Association

JULY 20, 2023

This content is for AAA members only. Please either Log In or Join! The post CMS Releases Advance Copy of CY 2024 Physician Fee Schedule Proposed Rule appeared first on American Ambulance Association.

Ambulance 130

Ambulance OR 130

REBEL EM

JULY 5, 2023

Take Home Points Provider assessment of how the patient looks is extremely important. If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately. POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations. Isolated elevation in aVR with diffuse ST depressions can be a sign of Left Main occlusion.

Coronary 119

Coronary STEMI EMS ED 119

The Skeptics' Guide to EM

JULY 22, 2023

Date: July 21, 2023 Reference: Prekker et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. NEJM 2023 Guest Skeptic: Dr. Jeff Jarvis is the Chief Medical Officer and System Medical Director for the Metropolitan Area EMS Authority in Fort Worth, Texas, also known as MedStar. He is board certified in both Emergency Medicine […] The post SGEM#410: Do You See What I See?

Emergency Medical Services 180

Emergency Medical Services Defibrillator CPR EMS 180

EMergucate

JULY 31, 2023

50-year-old man with history of type II diabetes and colorectal cancer. He is on Metformin and other anti-diabetic medications.

130

130

ALiEM

JULY 17, 2023

The Study In an Annals of Emergency Medicine paper , Preiksaitis et al. sought to identify program factors associated with unfilled post-graduate year 1 (PGY-1) emergency medicine (EM) positions in the 2023 Match [1]. The authors completed a cross-sectional, observational study using National Residency Matching Program (NRMP) data and examined 9 variables as potential predictors of unfilled PGY1 positions using regression analyses [2].

EMS 130

EMS ALS Emergency Department ED 130

Critical Care Scenarios

JULY 19, 2023

We dive into when to initiate renal replacement therapy, the modalities, settings, and physics involved, troubleshooting problems, and more, with Dr. Paul Adams, a dual-trained nephrologist and intensivist at the University of Kentucky. Find us on Patreon here! Buy your merch here! Takeaway lessons We dive into when to initiate renal replacement therapy, the modalities, settings, and physics involved, troubleshooting problems, and more, with Dr.

ICU 100

ICU OR 100

American Ambulance Association

JULY 20, 2023

Washington, DC— While the Centers for Medicare & Medicaid Services (CMS) has decided to end the Emergency Triage, Treat, and Transport (ET3) Model two years early on December 31, 2023, […] The post AAA Encourages CMS to Consider Revised Innovation Model for Treatment in Place appeared first on American Ambulance Association.

Ambulance 130

Ambulance 130

Don't Forget the Bubbles

JULY 24, 2023

Discitis is an inflammatory condition involving the intervertebral discs and end plates of vertebral bodies. It encompasses a spectrum of conditions that includes discitis , spondylodiscitis , and vertebral osteomyelitis. Discitis is uncommon. However, there is a bimodal peak in children, those under 6 years and adolescents. Neonates can also be affected.

ALS 98

ALS OR 98

The Skeptics' Guide to EM

JULY 15, 2023

Date: 15 June 2023 Guest Skeptic: Dr. Samina Ali is a pediatric emergency medicine physician, clinician scientist, and Professor of Pediatrics and Emergency Medicine at the University of Alberta in Edmonton. Her research focuses on improving assessment and treatment of pain in children. She is an executive member of Pediatric Emergency Research Canada (PERC), pain […] The post SGEM Xtra: Hurts so Good…but does it Have to?

Emergency Department 130

Emergency Department ED EMS 130

EMergucate

JULY 27, 2023

The chest x-ray shows presence of pneumomediastinum as indicated on the image. There is no obvious pneumothorax.

EMS 130

EMS 130

REBEL EM

JULY 24, 2023

Background: Rapid Sequence Intubation (RSI) is a procedure fraught with potential complications including hypotension which, in turn, can result in cardiovascular collapse. While there are numerous potential causes of hypotension peri-RSI, induction medications represent an important, modifiable variable. Over the last decade, airway experts have advocated for reduced induction agent dosing to lessen the risk of hypotension particularly in at risk patients.

ALS 98

ALS Emergency Department OR EMS 98

Critical Care Scenarios

JULY 12, 2023

5 things you pretty much must be doing if you want to be excellent at critical care. See also on the blog: The ten laws of critical care Practicing medicine like an adult 5 things you pretty much must be doing if you want to be excellent at critical care.

Critical Care 100

Critical Care 100

American Ambulance Association

JULY 19, 2023

From CMS on July 19, 2023 The next CMS Ambulance Open Door Forum scheduled for: Date: Thursday, July 27, 2023 Start Time: 2:00pm-3:00pm PM Eastern Time (ET); Please dial-in at […] The post 7/27 CMS Ambulance Open Door Forum appeared first on American Ambulance Association.

Ambulance 130

Ambulance 130

Don't Forget the Bubbles

JULY 12, 2023

4-year-old Mark presents with lethargy, jaundice, and abdominal pain after eating one portion (40g) of broad beans. Could he have G6PD deficiency? G6PD , short for glucose-6-phosphate dehydrogenase, is an enzyme active in all cell types and is key to protecting red blood cells from oxidative damage and early destruction. A child with reduced G6PD enzyme activity has increased red blood cell breakdown – haemolysis – when exposed to specific triggers.

OR 98

OR 98

ACEP Now

JULY 8, 2023

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

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98

EMergucate

JULY 27, 2023

The frontal chest x-ray shows a cavity with fluid level projected over the right dome of diaphragm.

EMS 130

EMS 130

First 10 EM

JULY 17, 2023

I have written about the resuscitation of anaphylaxis and asthma before. However, I was forwarded the AMAX4 algorithm for the patient with asthma or anaphylaxis who is either unconscious or requiring assisted ventilation, and I think it is an important addition for our sickest patients. The heartbreaking backstory to this algorithm and website, created by […] The post Critical anaphylaxis and asthma: The AMAX4 algorithm appeared first on First10EM.

OR 98

OR 98

Critical Care Scenarios

JULY 5, 2023

We chat with Callie Tennyson, DNP, ACNP-BC, AACC, CHSE, assistant professor from the Duke University School of Nursing, about the use of the internet and social media for medical education: trends, challenges, and principles for doing it right. Bluejacket_headshot Download We chat with Callie Tennyson, DNP, ACNP-BC, AACC, CHSE, assistant professor from the Duke University School of Nursing, about the use of the internet and social media for medical education: trends, challenges, and principles f

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100

American Ambulance Association

JULY 18, 2023

This content is for AAA members only. Please either Log In or Join! The post Rule Expanding Electronic Submission Requirements for Injury & Illness Data for High Hazard Employers appeared first on American Ambulance Association.

Ambulance 130

Ambulance OR 130

The Bottom Line

JULY 1, 2023

In critically ill adults undergoing tracheal intubation, does the use of a videolaryngoscope (VL) compared to a direct laryngoscope (DL) improve the first-pass success rate?

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98

ACEP Now

JULY 7, 2023

CASE A 30-year-old woman presents to the emergency department with left arm pain from a chronic wound. She notes that the wound has been present for greater than a year and it becomes malodorous and painful and oozes intermittently. She reports fevers up to 103 degrees Fahrenheit. She endorses a one-year history of near-syncopal episodes associated with shortness of breath, headache, and neck pain.

Overdose 98

Overdose ALS Naloxone Emergency Department 98

EMergucate

JULY 3, 2023

Answers: PH = 7.56, that is moderate alkalaemia We have low pCO2 (34 mmHg) and high HCO3 (30 mmol/L), both these values can lead to alkalosis. Most likely combined alkalosis.

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100