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 302

Emergency Medical Services EMS Paramedic 302

Pediatric EM Morsels

JULY 21, 2023

In emergency medicine, we often use illness scripts and protocols to help drive our decision-making. I recall a shift I had with Dr. Fox while I was early in fellowship ( not so many years ago ). We had just received a young child from EMS who was post-ictal with decreased mentation. Dr. Fox asked me what I wanted to do next to care for the child, and as I calculated his GCS… 7 at the time… I felt somewhat obligated to say that I should intubate the child. “ Less than 8, intubate!

Critical Care 246

Critical Care ALS OR Life Support 246

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 222

EMS ACS STEMI 222

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 237

ALS Emergency Department EMS ED 237

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 193

Emergency Medical Services ALS EMS Emergency Department 193

Pediatric EM Morsels

JULY 7, 2023

In the past, we have discussed several causes of Knee Pain in children. Some of those causes are benign (ex, Osgood Schlatter’s Disease ) while others are scary (ex, osteosarcoma ). Evaluating the limping child , though, requires us to ponder not only the common (ex, Toddler’s Fracture ), but also to be vigilant for the severe (ex, Septic Arthritis ).

OR 141

OR EMS 141

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

EMergucate

JULY 19, 2023

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

183

183

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 144

Coronary STEMI EMS ED 144

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 172

Emergency Medical Services Defibrillator CPR EMS 172

Don't Forget the Bubbles

JULY 5, 2023

Topic Sickle Cell Disease Author Beatrice Zanetti Duration Up to 2 Hours Facilitator Level ST4+ Learner Level Most useful for those in experience seeing paediatric patients regularly. From FY1 + and 5+ nurses on Equipment Required None Outline Pre-reading Basics Case 1: Salmonella osteomyelitis Case 1: Discussion Case 2: Acute painful crisis and Priapism Case 2: Discussion Advanced Case 1: Acute chest syndrome Advanced Case 1: Discussion Advanced Case 2: Stroke in sickle cell disease patient Adv

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

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

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

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

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

REBEL EM

JULY 27, 2023

Background: Current stroke guidelines recommend IV alteplase for patients with acute ischemic stroke presenting within 4.5hrs of symptom onset based on the NINDS and ECASS III publications. Both NINDS and ECASS III excluded patients with mild stroke symptoms but failed to clearly define a threshold for mild stroke. Many patients, however, will have minor strokes (defined as an NIHSS score ≤5).

ALS 98

ALS OR EMS 98

Don't Forget the Bubbles

JULY 31, 2023

With millions of journal articles published yearly, it is impossible to keep up. Our team have scoured what’s new (well, mostly new!) in the paediatric literature. One reviewer has returned to an oldie but a goodie to answer a clinical question! Article 1: Does rapid diagnostic testing for Malaria work? Bird C, Hayward GN, Turner PJ, Merrick V, Lyttle MD, Mullen N, Fanshawe TR.

Emergency Department 98

Emergency Department OR ED ALS 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.

98

98

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

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

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

REBEL EM

JULY 26, 2023

Take Home Points Methylxanthines are a drug class that includes caffeine, theophylline, and theobromine. The three main mechanisms that account for the clinical presentation of methylxanthine toxicity are: catecholamine release, adenosine antagonism, and phosphodiesterase inhibition. Beta agonism will lead to hyperlactatemia, hypokalemia, hyperglycemia, and tachycardia.

OR 98

OR EMS 98

Don't Forget the Bubbles

JULY 26, 2023

Topic Cardiology & the ECG Author Anna McCorquodale Duration 1-2 hours Facilitator Level ST4+ level used to seeing children acutely Learner level Anyone involved in initial assessment of children with cardiac symptoms; paediatric trainees, emergency trainees, foundation doctors Outline Pre-reading Basics Case 1 Case 1: Discussion Case 2 Case 2: Discussion Advanced Case 1 Advanced Case 1: Discussion Advanced Case 2 Advanced Case 2: Discussion Quiz Take Home Points Basics (15 mins) with sharin

ALS 98

ALS ED OR CPR 98

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. 2,3 In general, patients who develop cardiac arrest with an initial r

Defibrillator 98

Defibrillator OR ALS Epinephrine 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

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

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

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

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