ALiEM

JUNE 1, 2023

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? If not, you probably should be. Another old drug for a new indication, right? Well not exactly. Phenobarbital is indeed an older and relatively cheap drug (less than $20 per loading dose) that has gained some press recently for the treatment of acute alcohol withdrawal [1-3].

Emergency Department 246

Emergency Department ICU ED OR 246

Pediatric EM Morsels

JUNE 2, 2023

Rare diseases are not confined to the pages of a textbook or computer screen. Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! Today we are talking about a rare disease called FPIES (food protein induced enterocolitis syndrome) and how you might encounter these patients in the Pediatric Emergency Department.

Emergency Department 189

Emergency Department ALS EMS OR 189

EMergucate

MAY 29, 2023

56 year old man with background of type 2 DM. Presented after a fall at home. He was presyncopal with blood pressure of 60/50 and pulse rate of 50/ min. (Normal sinus rhythm).

130

130

REBEL EM

JUNE 1, 2023

Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC. Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. Identification of the underlying cause of the cardiac arrest is a critical area of focus in post-arrest care. Although myocardial infarction, dysrhythmias and pulmonary emboli are common pathologies to consider, there are a host of other causes including subarachnoid hemorrhage, trauma and electroly

Coronary 145

Coronary Defibrillator CPR ALS 145

ALiEM

MAY 29, 2023

Massive epistaxis is considered a medical emergency that requires immediate attention. Symptoms of massive epistaxis include sudden and heavy bleeding from the nose, difficulty breathing, dizziness, and a rapid heartbeat. If left untreated, it can lead to significant blood loss, shock, airway obstruction, and even death. We report a case of a 50-year-old man with end stage renal disease with massive nasal bleeding from the left nostril, shortness of breath, and confusion.

E-9-1-1 246

E-9-1-1 Epinephrine Emergency Department 246

Don't Forget the Bubbles

MAY 31, 2023

What’s the relationship between COVID-19 and diabetes? May saw the e-publication of the DIMPLES study. Let’s take a deep dive into this paper and its implications for PEM internationally. Ponmani C, Nijman RG, Roland D, Barrett M, Hulse T, Whittle V, Lyttle MD on behalf of PERUKI. Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study.

Emergency Department 135

Emergency Department ED OR ALS 135

EMergucate

MAY 28, 2023

The chest x-ray shows cardiomegaly & 3rd Mogul Sign due to enlargement of the left atrial appendage.

EMS 130

EMS 130

Critical Care Scenarios

MAY 31, 2023

A brief overview and call to arms around the key concepts of ICU liberation. A brief overview and call to arms around the key concepts of ICU liberation.

OR 100

OR ICU 100

Medgadget

JUNE 1, 2023

Researchers at Penn State have developed a low-cost, wearable sensor using pencil-on-paper technology. This approach involves depositing graphite (pencil ‘lead’) on paper that has been treated with sodium chloride, to create a conductive, low-cost sensor. Previously, these researchers had developed such sensors to detect moisture and even used them to develop a smart diaper ( yes, really ).

OR 103

OR 103

EMergucate

MAY 28, 2023

The chest x-ray shows bilateral skin folds simulating pneumothoraces.

EMS 130

EMS 130

Don't Forget the Bubbles

MAY 29, 2023

You are working with your colleagues to assist an 8-year-old with multiple injuries following a high-impact traffic collision. You’re thinking about the next steps and voicing the options; you hear an impatient voice saying, “Are up for this? Should I do it?” from one of the team. What does incivility look like? Whilst not a new concept, incivility is still a widely reported concern within healthcare.

Critical Care 98

Critical Care E-9-1-1 Paramedicine Paramedicine 98

EMCrit Project

MAY 27, 2023

My dear pulmonologists, I have some bad news. Santa Claus isn't real. Neither is “ARDS.” “ARDS” has traditionally been conflated with a specific histopathological form of lung injury: diffuse alveolar damage (DAD). Lectures, chapters, and articles typically juxtapose these two entities, promoting the concept that they're one and the same.

93

93

Medgadget

MAY 30, 2023

Researchers at MIT have developed smart sutures with a hydrogel coating that contains sensing and drug delivery components, and could even be used to implant therapeutic cells. The sutures are made using pig tissues that have been decellularized with detergents to reduce the possibility that they could provoke an immune reaction. The surrounding hydrogel layer contains microparticles that can release peptides when enzymes involved in inflammation are present, and other microparticles that allow

OR 84

OR 84

EMergucate

MAY 29, 2023

Answers: PH = 7.56, that is moderate alkalaemia HCO3 = 38.4 mmol/L, so we have metabolic alkalosis. Next, we will calculate the compensation.

100

100

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. His prehospital ECG was diagnostic of inferior posterior OMI. The patient was in clinical shock with a lactate of 8. BP was 108 systolic (if a cuff pressure can be trusted) but appeared to be maintaining BP only by very high systemic vascular resistance. He appeared gray in color, with cool skin.

E-9-1-1 82

E-9-1-1 STEMI Coronary OR 82

EMCrit Project

JUNE 1, 2023

Optimization of Emergency Medicine Teams EMCrit Project by Scott Weingart, MD FCCM.

129

129

EMDocs

MAY 31, 2023

Author: Walid Malki, MD ( @Wandering_ER ) // Reviewed by: Brit Long, MD (@long_brit); Alex Koyfman, MD (@EMHighAK) Welcome the Visual Wednesdays, a series that provides focused EM updates with infographics. Please follow us on Instagram to see past, current and future infographics! The post Visual Wednesdays: Septic Shock Management appeared first on emDOCs.net - Emergency Medicine Education.

EMS 81

EMS 81

EMergucate

MAY 28, 2023

The chest x-ray shows pneumomediastinum.

EMS 130

EMS 130

Dr. Smith's ECG Blog

MAY 31, 2023

I received the following text message with these 3 EKGs (providers text me ECGs all day every day; most are false positives; many are subtle true positives): "Hi Steve, here are 3 EKGs for you (my colleague's case). A 67 yo f developed chest pain this morning." EKG #1 Followed 15 minutes by this #2 EKG: Then the patient received aspirin and Dilaudid (hydromorphone, same effect as morphine) and the pain went away and there was this 3rd ECG: Smith comment: hydromorphone will make any pain go away

STEMI 81

STEMI Coronary ACS OR 81

Medgadget

JUNE 1, 2023

Researchers at Florida State University have developed a 3D model that examines how the bacterium Helicobacter pylori moves through viscous fluids. H. pylori can cause gastrointestinal ulcers and even cancer, moving through the intestinal mucus layer to reach the wall of the gut. Using antibiotics can cause side-effects and can contribute to drug resistance, so these researchers are studying how the bacterium navigates through mucus in an effort to find new therapeutic targets with which to disr

79

79

EMDocs

JUNE 2, 2023

Original podcast posted on PEM Currents – Hosted by Brad Sobolewski ( @PEMTweets ) and co-authored by Dennis Ren ( @DennisRenMD ) This podcast series by PEM Currents is a co-production with the Emergency Medical Services for Children Innovation and Improvement Center (EMSC IIC), whose mission is to minimize morbidity and mortality of acutely ill and injured children across the emergency continuum.

Emergency Department 66

Emergency Department Emergency Medical Services Overdose ED 66

ACEP Now

JUNE 1, 2023

Recently, large language models (LLMs), like ChatGPT and Med-PaLM, have generated a lot of buzz in the press and among emergency physicians. LLM’s are designed to process large amounts of data, synthesize information, generate text, and even translate it to other languages. These abilities are similar to those performed by emergency physicians. Our specialty is a fast-paced, dynamic medical field that demands rapid decision-making and adaptability.

Emergency Department 52

Emergency Department OR 52

Dr. Smith's ECG Blog

JUNE 2, 2023

Written by Pendell Meyers A woman in her 30s with minimal past medical history presented simply stating she was "feeling unwell." Her symptoms started suddenly about 48 hours ago, but had continued to worsen, including epigastric discomfort, nausea, cough, and dyspnea and lightheadedness on exertion. She denied chest pain and denied feeling any palpitations, even during her triage ECG: What do you think?

ED 79

ED OR ALS CAD 79

Medgadget

MAY 30, 2023

Researchers at UMass Chan Medical School have developed a small interfering RNA (siRNA) technology that is stable enough for inhalation into the lungs, where it can potentially treat diseases as diverse as asthma, pulmonary fibrosis, and viral infections such as COVID-19. siRNA is not typically stable enough to survive for long in the lungs, but the researchers chemically modified the constituent nucleotides to stabilize the molecules and help them to evade immune destruction.

OR 73

OR 73

EMDocs

JUNE 1, 2023

Welcome back to the “52 in 52” series. This collection of posts features recently published must-know articles. This week we cover the POLAR RCT on hypothermia for neuroprotection in those with severe TBI. Author: Christiaan van Nispen, MD (Resident, Emergency Medicine Physician, San Antonio, TX); B rannon Inman, MD (Chief Resident, Emergency Medicine Physician, San Antonio, TX) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Effect of Early Sustained Prophylactic Hypot

E-9-1-1 61

E-9-1-1 Emergency Medical Services Emergency Department OR 61

NHCPS Save a Life

MAY 30, 2023

Immense value resides within advanced life support training courses. While these courses are traditionally reserved for health professionals, more people are turning to advanced life support training to improve their career outlook and save lives. According to the International Liaison Committee on Resuscitation (ILCOR), cardiac arrest statistics appear to be increasing.

Advanced Life Support 52

Advanced Life Support Life Support 52

Ambulance Driver Files

MAY 29, 2023

Today is Memorial Day. Normally, most of us would have spent the weekend grilling burgers and visiting with relatives, or lounging on a beach somewhere, or watching a baseball game in an opulent stadium, overpriced beer and hot dog in hand, but let’s not forget the meaning of the day. So when you partake in.

OR 52

OR 52

University of Maryland Department of Emergency Med

MAY 28, 2023

We hope that you enjoy your Memorial Day! Don't forget your Sandy Beach Sign vs Barcode Sign of Lung Ultrasound: Normal lung wi.

59

59

EMDocs

MAY 27, 2023

We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: And the Best Shoulder Reduction Award Goes to… Spoon Feed This meta-analysis found Boss-Holzach-Matter/Davos and FARES had the most favorable value for success rates, while both FARES and modified external rotation

ED 57

ED OR 57

Silk City Blog

MAY 31, 2023

Point-of-Care Ultrasound (POCUS) in Detecting Aortic Aneurysms By: Dr. Shani Tal & Dr. Doris Ilic Faculty Reviewer: Dr.

Emergency Department 52

Emergency Department ED 52

Ambulance Driver Files

MAY 31, 2023

One of the most egregious disservices to EMS students is what passes for medicolegal education in EMT or Paramedic school. Far too often, students are subjected to myth, dogma and outright b t from instructors who have at best a superficial understanding of the subject, most of whom have never had their lessons taught or vetted.

EMT 40

EMT EMT Paramedic EMS 40

University of Maryland Department of Emergency Med

JUNE 2, 2023

The authors of this study retrospectively compared the 10-day mortality rates of patients who were triaged to levels 3-5 on the Scandinavian Ra.

62

62

EMCrit Project

JUNE 1, 2023

The slides are not the problem. EMCrit Project by Scott Weingart, MD FCCM.

52

52

EMDocs

MAY 29, 2023

Authors: Rachel Kelly, MD (EM Resident Physician, Stony Brook University Hospital) and Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Louis); Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case A 54-year-old female with a past medical history of rheumatoid arthritis presents to the emergency department (ED) with generalized fatigue.

ED 53

ED E-9-1-1 Emergency Department OR 53

University of Maryland Department of Emergency Med

MAY 31, 2023

Calcium channel blocker (CCB) overdose can lead to severe shock/hypotension. A small study was conducted to compare the hemodynamic effects of.

Overdose 53

Overdose 53

University of Maryland Department of Emergency Med

MAY 29, 2023

Background: In general practice, platelets are typically transfused for invasive procedures when the platelet count falls below 50 x 109/.

53

53

University of Maryland Department of Emergency Med

JUNE 1, 2023

Some things are easy, even reflexive, and one of those things is putting oxygen on cyanotic patients. Usually, this is a great thing. Blue = bad. Occasion.

48

48