Critical Care Scenarios

JANUARY 31, 2024

We discuss assessing patients prior to intubation or other airway management, including both elective and emergent circumstances, with Dr. Jed Wolpaw, anesthesiologist and intensivist from Johns Hopkins, anesthesiology residency program director, and host of the ACCRAC podcast. Find us on Patreon here! Buy your merch here! Takeaway lessons References We discuss assessing patients prior to intubation or other airway management, including both elective and emergent circumstances, with Dr.

OR 286

OR 286

Pediatric EM Morsels

JANUARY 19, 2024

If you have ever talked with a pediatric emergency medicine physician about some basic tenets of their practice, one of them will inevitably be, “ Never trust a neonate. ” The first few months of life outside the womb can elucidate a myriad of problems that were previously hidden during the prenatal state. We have previously touched on congenital issues like Congenital Adrenal Hyperplasia , Congenital Pulmonary Airway Malformation , Neonatal Leukemia , and of course there is always the Inconso

Plasma 269

Plasma OR EMS ED 269

Emergency Medicine Cases

JANUARY 23, 2024

Olivia Ostrow on the management of button battery ingestions, Brit Long on C difficile infection, Jesse McLaren on an approach to ECG's in the tox patient, Joe Mullally on the identification and treatment of bed bug bites, Andrew Petrosoniak on fibrinogen replacement in bleeding trauma patients, Justin Morganstern on Cold Air for Croup. The post EM Quick Hits 54 Button Battery Ingestion, C. difficile, ECG in Tox, Bed Bugs, Fibrinogen in Trauma, Cold Air for Croup appeared first on Emergency Medi

EMS 260

EMS 260

The Skeptics' Guide to EM

JANUARY 6, 2024

Reference: Remick KE, et al. National Assessment of Pediatric Readiness of US Emergency Departments during the Covid-19 Pandemic. JAMA Netw Open. July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC. Her research focuses on prehospital care of children with anaphylaxis. […] The post SGEM #425: Are You Ready for This?

Emergency Department 261

Emergency Department Emergency Medical Services ALS ED 261

Core EM

JANUARY 25, 2024

Patient Case: History: A 60-year-old male with history of schizophrenia and depression on multiple unknown antipsychotic medications presents with unresponsiveness x 1 day. One week prior to ED arrival, the patient was becoming progressively despondent, less interactive with peers, exhibiting slow speech and movements, and was not eating. Physical exam: Vital signs – febrile, tachycardic, hypertensive General – posturing with arms stretched out in front, eyes open without blinking, akinetic, no

MICU 246

MICU Emergency Department OR ED 246

ALiEM

JANUARY 26, 2024

An 88-year-old female presented to the ER with a chief complaint of cough, vague abdominal pain, and a rash. The patient stated that she was started on Cipro eyedrops 1 or 2 days prior to presentation for a possible eye infection. A day prior to presentation she developed a purple purpuric rash on her lower extremities that gradually progressed up her legs, and was present on her buttocks thighs, and lower legs.

EMS 183

EMS OR 183

American Ambulance Association

JANUARY 24, 2024

From EMS.gov on January 24, 2024 Recent Announcements TODAY: Rural Emergency Medical Service (EMS) Training Grant Pre-Application Webinar The Substance Abuse and Mental Health Services Administration (SAMHSA) is hosting a webinar […] The post Recent Announcements and New Resources on EMS.gov appeared first on American Ambulance Association.

Mental Health Services 130

Mental Health Services Emergency Medical Services Ambulance EMS 130

Emergency Medicine Cases

JANUARY 2, 2024

Based on a blend of number of listens, feedback from listeners, website visits and personal faves, EM Cases Best of 2023 Top 10. The post EM Cases Best of 2023 Top 10 appeared first on Emergency Medicine Cases.

EMS 260

EMS 260

The Skeptics' Guide to EM

JANUARY 13, 2024

Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. Resuscitation 2023. Date: January 11, 2024 Guest Skeptic: Dr. Chris Root is an EMS fellow in the Department of Emergency Medicine at the University of New Mexico Health […] The post SGEM#426: All the Small Things – Small Bag Ventilation Masks in Out of Hospital Cardiac Arrest first appeared on The Skeptics Guide to Emergency Me

CPR 223

CPR Defibrillator First Responder Epinephrine 223

Core EM

JANUARY 25, 2024

Prehospital Narrow Pulse Pressure Predicts Need for Resuscitative Thoracotomy and Emergent Intervention After Trauma J Surg Res., 2021 Background Prehospital trauma team activation criteria allow for prompt mobilization of personnel and resources. Prehospital hypotension is one of those criteria. Pulse pressure is the difference between systolic and diastolic blood pressure.

Operating Room 246

Operating Room EMS ED ICU 246

ALiEM

JANUARY 5, 2024

Dr. Sara Krzyzaniak (podcast host and Stanford University PD) and Dr. Michelle Lin (ALiEM Founder/UCSF) are joined by Dr. Aaron Kraut (University of Wisconsin PD) in this insightful, rapid-fire, practical episode through the lens of experienced residency program directors. What does the Electronic Residency Application Service (ERAS) preliminary data show just far for the 2024 residency application season?

EMS 177

EMS ALS OR 177

American Ambulance Association

JANUARY 22, 2024

Statement from Global Medical Response Air Evac Lifeteam is heartbroken to report that three crew members have perished in an incident that occurred on Saturday, January 20. At 11:23 pm […] The post In Memory of the Crew of Air Evac Lifeteam N295AE appeared first on American Ambulance Association.

Ambulance 130

Ambulance 130

EMergucate

JANUARY 20, 2024

The abdominal x-ray shows Dilated central small bowel loops. Branching gas pattern over the liver indicating the presence of pneumobilia.

EMS 130

EMS 130

Emergency Medicine Cases

JANUARY 2, 2024

Triquetrum chip fractures, scapholunate injuries, hook of the hamate fractures, and of course, scaphoid fractures can be easily missed with serious consequences for our patients. In this part 2 of our 2-part podcast series on wrist injuries we highlight the "Big 4" most commonly missed and mismanaged carpal bone injuries, elucidating the key historical, physical exam and x-ray findings, as well as management strategies.

EMS 130

EMS 130

The Skeptics' Guide to EM

JANUARY 20, 2024

Reference: Zaoutis T, et al. Short-course Therapy for Urinary Tract Infections in Children: the SCOUT randomized clinical trial. JAMA Pediatr. Aug 2023 Date: October 30, 2023 Guest Skeptic: Dr. Ellie Hill is a pediatric emergency medicine physician at Children’s National Hospital in Washington, DC and Assistant Professor of Pediatrics and Emergency Medicine at George Washington University […] The post SGEM #427: I Want a Treatment with a Short Course…for Pediatric Urinary Tract Infections first

Emergency Department 179

Emergency Department ALS ICU OR 179

Core EM

JANUARY 25, 2024

How and when to reverse anticoagulation in the bleeding EM patient. Hosts: Joe Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: Anticoagulation , Critical Care , Resuscitation Show Notes Coagulation Cascade: Algorithm for Anticoagulated Bleeding Patient in the ED: Indications for Anticoagulation Reversal: References: Baugh CW, Levine M, Cornutt D, et al.

Frozen Plasma 246

Frozen Plasma FFP Plasma Critical Care 246

ALiEM

JANUARY 29, 2024

A 59-year-old male with no known past medical history other than an incidental abdominal aortic aneurysm presented with sudden onset, painless vision loss in his left eye. The patient was watching TV two days prior when he saw a “brightness” in his left eye and then progressive blurriness until his vision faded away, all occurring within the span of a minute.

ALS 161

ALS ED OR 161

American Ambulance Association

JANUARY 17, 2024

January 17, 2024 – Irving, TX We didn’t need emergency warning devices to get where we were going – a motor vehicle crash without serious injuries. We tried to change […] The post Enhancing EMS Safety: Outcomes of the Lights and Siren Collaborative appeared first on American Ambulance Association.

EMS 130

EMS Ambulance 130

EMOttawa

JANUARY 25, 2024

Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.

ICU 140

ICU ED OR Critical Care 140

EMergucate

JANUARY 23, 2024

This ECG represents fever induced Brugada syndrome. Needs aggressive treatment of the fever and Cardiology referral for ICD.

130

130

REBEL EM

JANUARY 29, 2024

Background: Massive pulmonary embolism defined as sustained hypotension (SBP <90mmHg) has a high mortality which is why early recognition and thrombolytic therapy is typically recommended (AHA Class IIA; ESC Class IB) [1]. However, full-dose thrombolytic therapy (Alteplase 100mg (IV) is associated with an increase in bleeding [2]. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety

ALS 137

ALS ACS OR CPR 137

Core EM

JANUARY 25, 2024

Background & Pathophysiology: An inflammatory colitis caused by fecal impaction Marked distension and increased intraluminal pressure leads to ischemic pressure necrosis of the colonic wall and compromise of vascular supply and mucosal perfusion Risk of progression to colonic perforation and peritonitis Multiple areas of ulceration occur adjacent to the fecaloma; most commonly in the rectosigmoid colon Diagnosis: Lab findings are non-specific – may reveal increased WBC and/or acute phase rea

E-9-1-1 246

E-9-1-1 OR 246

ALiEM

JANUARY 22, 2024

A 40-year-old male, tailor by occupation, was brought to the Emergency Department with complaints of high-grade fever for the past 11 days. Fever was documented to be 102°F and was not associated with any chills or rigors. The patient also complained of shortness of breath for one week associated with a dry cough, as well as an altered sensorium for one day.

Emergency Department 161

Emergency Department OR 161

American Ambulance Association

JANUARY 15, 2024

The US Fire Administration (USFA) and Fire Safety Research Institute (FSRI) have announced the commencement of a national engagement period for the National Emergency Response Information System (NERIS) Draft Data Framework. This period will end on January […] The post EMS.gov | National Engagement Open Now for NERIS Draft Data Framework appeared first on American Ambulance Association.

Emergency Response 130

Emergency Response Ambulance 130

First 10 EM

JANUARY 15, 2024

We are once again buried in a wave of viral respiratory illnesses, and much of the burden of illness is still COVID. I did a pretty thorough review of all COVID antiviral therapies in 2022, both on First10EM and on the EMCases Journal Jam, but that was 2 years ago. I think most of us […] The post Paxlovid evidence: still very little reason to prescribe appeared first on First10EM.

137

137

EMergucate

JANUARY 10, 2024

61-year-old non-English speaking lady from India. Presented with chest pain for few hours. What is the spot diagnosis?

130

130

REBEL EM

JANUARY 18, 2024

Background: Sepsis remains one of the leading causes of morbidity and mortality. It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Time to antibiotic therapy (from triage, not from onset of infection) has become a quality metric to improve the time to administration of these medications. In an effort to administer antibiotics earlier, many studies have attempted to give antibiotics in the prehospital setting but the benefit of this int

ICU 132

ICU ALS EMS 132

Core EM

JANUARY 25, 2024

Background and Pathophysiology: Comorbidities, physiologic changes, and medication-associated effects leave elderly patients more susceptible to injury from “minor” mechanisms. Diminished functional reserves decrease compensatory ability for any injury, regardless of severity. 1 Despite adjustments for injury severity, significantly increased mortality occurs ≥70 years regardless of mechanism, compared to younger counterparts.

ALS 246

ALS ED ICU OR 246

ALiEM

JANUARY 8, 2024

A 49-year-old female with a past medical history of recurrent diverticulitis initially presented with one month of shortness of breath and a minor nonproductive cough for which she was started on doxycycline by her primary care provider. She then developed a rash on her chest, upper back, and face. Antibiotics were switched to amoxicillin and azithromycin.

ED 152

ED OR 152

American Ambulance Association

JANUARY 12, 2024

This content is for AAA members only. Please either Log In or Join! The post Final Rule Governing the Classification of Independent Contractors appeared first on American Ambulance Association.

Ambulance 130

Ambulance OR 130

Life in the Fastlane

JANUARY 15, 2024

Sheralyn Guilleminot and Mike Cadogan Real-World Applications of Artificial Intelligence in Medicine Interview with critical care clinician, and AI enthusiast, Dr Sameer Shaikh on the many ways to use AI to save time and increase efficiency in healthcare

Critical Care 126

Critical Care 126

EMergucate

JANUARY 29, 2024

The following shoulder x-ray is from an adult who is complaining of shoulder pain following MVA. What can be seen?

EMS 130

EMS 130

REBEL EM

JANUARY 25, 2024

Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. It can be used to distinguish between various conditions, including chronic obstructive pulmonary disease (COPD) exacerbation, acute heart failure (AHF), pleural effusion, pulmonary edema, pericardial effusion, pneumothorax, and pneumonia [2,3].

ED 130

ED E-9-1-1 Emergency Department ALS 130

Core EM

JANUARY 25, 2024

Background: An update to our 2015 post on HIET for beta-adrenergic receptor and calcium channel antagonists overdose. Beta-adrenergic receptor antagonists (Beta blockers, BB) and calcium channel antagonists (calcium channel blockers) are common drugs that can produce profound cardiac depression and shock when taken in overdose. 2020 National Poison Data System report: 10,994 beta blocker overdoses 18 deaths 6,132 calcium channel blocker overdoses 45 deaths High case fatality rate, behind only ac

Overdose 246

Overdose ALS Epinephrine Critical Care 246

ALiEM

JANUARY 12, 2024

A 42-year old Bengali man with a history of hyperlipidemia presented to the Emergency Department with facial swelling, diffuse rash, renal insufficiency and proteinuria after receiving his COVID-19 vaccine (Moderna) booster dose. There were no adverse events with the first two doses of the vaccine except for mild transient sore throat and cough after the 2nd dose.

Emergency Department 130

Emergency Department EMS ED 130

American Ambulance Association

JANUARY 10, 2024

Dear ground ambulance providers and suppliers, Starting January 1, 2024, selected ground ambulance organizations in Year 3 and Year 4 are required to report cost, utilization, revenue, and other information to CMS. Organizations that […] The post Medicare Ground Ambulance Data Collection System Overview Webinar – January 18 appeared first on American Ambulance Association.

Ambulance 130

Ambulance 130

EMCrit Project

JANUARY 22, 2024

background: ANTHARTIC trial Prophylaxis against VAP (ventilator associated pneumonia) has is already supported by a few studies in the literature, perhaps most notably the ANTHARTIC trial. That was a multi-center RCT evaluating 48 hours of therapy with ampicillin-sulbactam for patients intubated following cardiac arrest. Antibiotic therapy reduced early-onset VAP, with a trend towards more ventilator-free […] EMCrit Project by Josh Farkas.

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