Emergency Medicine Cases

JUNE 18, 2024

Dr. Jesse McLaren illustrates the paradigm shift from STEMI to Occlusion MI (OMI) through 9 cases, and drives home the points that if there is STEMI criteria, consider false positives (eg. secondary and proportional to LVH or BER); if there is no STEMI criteria, consider false negatives and look for other signs of occlusion (eg. acute Q waves or loss of R waves, hyperacute T waves, or reciprocal STD/TWI) and if the ECG is nondiagnostic, consider other OMI signs including clinical (refractory isc

STEMI 288

STEMI OR EMS 288

High Performance EMS

JUNE 20, 2024

Sadly, this is not an adventure story of heroic first responder actions on the scene of an emergency incident but rather about how current EMS operations are failing us and their missions. Across the country, a quarter of positions in the dispatch center , the folks we rely on to keep resources coordinated, are going unfilled. Recent annual surveys also show that over 10% of EMS clinicians will leave the field entirely each year.

EMS 240

EMS First Responder Emergency Response OR 240

The Skeptics' Guide to EM

JUNE 15, 2024

Reference: Jansen et al. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. JAMA. 2023 Date: June 10, 2024 Guest Skeptic: Dr. Rob Leeper is an intensivist, trauma surgeon, and general surgeon at Western University where he also serves as the director of the Royal College Surgical Foundations program.

Life Support 225

Life Support Emergency Department ALS 225

Pediatric EM Morsels

JUNE 21, 2024

The management of pediatric thermal burns always seems to be a hot topic , whether we are caring for a little future chef who splashed a scalding microwaved noodle cup on himself, or a toddling youngster who pulled a pot of boiling water on herself. Or maybe you have the adventurous adolescent who was a little too aggressive with the lighter fluid before igniting the campfire.

ALS 169

ALS OR EMS 169

Emergency Medicine Cases

JUNE 18, 2024

In this month's EM Quick Hits podcast: Megan Landes on the importance of diagnosing HIV in the ED, Jesse McLaren on the failed paradigm of STEMI criteria and ECG tips to identify acute coronary occlusion, Anand Swaminathan on evidence for non-invasive airway management in the poisoned patient, Brit Long and Hans Rosenberg on the identification, workup and management of spontaneous bacterial peritonitis, Matt Pointer on the most lucrative side-gig, DIY investing.

STEMI 169

STEMI EMS Coronary ED 169

American Ambulance Association

JUNE 20, 2024

CMS recently posted an updated Medicare Ground Ambulance Data Collection System (GADCS) webinar on Public Safety Organizations on their Ambulance Events webpage. The post CMS GADCS: Public Safety Webinar Recording appeared first on American Ambulance Association.

Public Safety 130

Public Safety Ambulance 130

EMergucate

JUNE 18, 2024

The following ECG is from a 38-year-old type 1 diabetic who has come by ambulance with epigastric pain, dyspnoea and feeling generally unwell. What are the key ECG features?

Ambulance 130

Ambulance 130

EMCrit Project

JUNE 17, 2024

introduction Bilevel Sequence Intubation (BSI) refers to initiation of noninvasive bilevel positive pressure ventilation with a backup rate prior to intubation (either using a BiPAP machine or a full-featured mechanical ventilator). BSI is distinct from traditional rapid sequence intubation (RSI), since BSI involves the delivery of machine-initiated, pressure-controlled breaths following administration of sedation and paralytics. […] EMCrit Project by Josh Farkas.

OR 132

OR 132

Don't Forget the Bubbles

JUNE 19, 2024

Why is this study needed? Cervical spine injuries are a rare but serious finding following blunt trauma, affecting around 1-2% of presentations. In adult trauma cases, there has been significant research to help decide which patients require X-ray or CT imaging for possible cervical spine injuries, leading to the development of the National Emergency X-Ray (NEXUS) prediction rule and the Canadian C-Spine Rule (CCR).

CPR 124

CPR Operating Room OR Emergency Department 124

EMergucate

JUNE 18, 2024

The following chest x-ray is from an elderly patient with chest pain & hypotension. What can be seen?

EMS 130

EMS 130

NVFC

JUNE 18, 2024

Practical tips for diversity, equity, and inclusion in your community Source: FEMA Office of Community and Faith Partnerships The Human Rights Campaign Foundation has reported that an estimated 20 million adults in the U.S. identify as lesbian, gay, bisexual, or transgender (LGBT). June is recognized nationally as Pride Month, commemorating the struggles and progress of people who identify as LGBTQ+.

Firefighter 111

Firefighter First Responder Emergency Response Emergency Management 111

SSCOR

JUNE 20, 2024

After successful intubation, your patient is mechanically ventilated with a patent airway and his vital signs stabilize. Then, while transporting your patient, you notice a sawtooth pattern to the ventilator waveform. The patient’s cough is not “junky” and his oxygen saturation remains stable.

109

109

FOAMfrat

JUNE 21, 2024

Alaina Martini, a flight nurse at Allegheny Life Flight, shares her expertise in transporting patients with external ventricular drains (EVDs). She explains the indications for EVD insertion, such as aneurysmal subarachnoid hemorrhage and obstructive hydrocephalus. Alaina discusses the importance of assessing the color and texture of the cerebrospinal fluid (CSF) to detect changes and potential rebleeding.

Ambulance 105

Ambulance OR Critical Care 105

Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line. The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU.

E-9-1-1 105

E-9-1-1 Critical Care CPR ICU 105

NVFC

JUNE 18, 2024

On June 4, the National Volunteer Fire Council (NVFC) testified before the House of Representatives Homeland Security Committee’s Subcommittee on Emergency Management and Technology regarding the impact that the Occupational Safety and Health Administration’s (OSHA) proposed Emergency Response Standard will have on volunteer fire departments. OSHA published a Notice of Proposed Rulemaking on February 5 to replace their Fire Brigade Standard with the proposed Emergency Response Standard.

Emergency Response 105

Emergency Response Firefighter Emergency Management Emergency Manager 105

St. Emlyn's

JUNE 18, 2024

St.Emlyn's - Emergency Medicine #FOAMed Does the use of non invasive ventilation prior to intubation of critically ill patients improve outcomes? The post Noninvasive Ventilation for Preoxygenation during Emergency Intubation appeared first on St.Emlyn's.

106

106

Pulsara

JUNE 19, 2024

Patient tracking during MCIs and pre-planned events is a complex operation with many moving parts. Every incident is different and requires different resources, making planning for and preparing for incidents challenging. To set ourselves up for success, we need to practice the same way we respond. That's why a panel of experts from California, Colorado, and Texas believe that the answer lies in using the same tools to manage and track patients during a crisis as you do for everyday response.

89

89

EMCrit Project

JUNE 18, 2024

REVISE is the latest multicenter RCT on the use of PPIs for GI prophylaxis in critical illness. I would view this as the triquel following SUP-ICU and PEPTIC. In order to understand REVISE in context, let's briefly review SUP-ICU and PEPTIC trials, before discussing REVISE. Part I: SUP-ICU (2018) This was a large multicenter RCT […] EMCrit Project by Josh Farkas.

ICU 121

ICU 121

ACEP Now

JUNE 18, 2024

ACEP Now is looking for its next resident to join our editorial team. The position is open to any emergency medicine resident physician in an ACGME-accredited program who will be PGY2–4 during the July 2024–July 2025 Resident Fellow term. Responsibilities include: Regularly promote ACEP Now articles via social media, including Twitter and Facebook. Author or curate 4 Resident Voice columns during the 12-month position.

OR 85

OR 85

St. Emlyn's

JUNE 20, 2024

St.Emlyn's - Emergency Medicine #FOAMed Learn about Sudden Arrthymic Death Syndrome in children. Listen to the podcast recorded live at the Premier Conference 2024. The post Podcast – Sudden Cardiac Death Syndrome appeared first on St.Emlyn's.

105

105

EMDocs

JUNE 15, 2024

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: PREOXI RCT – Preoxygenation with Noninvasive Ventilation vs. Non-rebreather Mask Spoon Feed Noninvasive ventilation (NIV) was superior to a standard non-rebreather (NRB) oxygen mask for preoxygenation of critically

ICU 74

ICU Emergency Department ED OR 74

First 10 EM

JUNE 17, 2024

Maximizing your productivity and impact is hard. The A.D.D. framework: Automate, Deprecate, and Delegate, identifies strategies that can be implemented to scale your impact in research and beyond. This is a guest post by Dr. Ross Prager, which was also posted on his blog at resub.app, but that I should would be useful to readers […] The post Improving Productivity: Implementing the A.D.D. framework appeared first on First10EM.

73

73

Dr. Smith's ECG Blog

JUNE 21, 2024

A patient in the ICU with significant underlying cardiac disease [HFrEF 30%, non-ischemic cardiomyopathy, LBBB s/p CRT-D (biventricular pacer), AVNRT s/p ablation a few yrs ago, hx sinus tachycardia while on max tolerated BB therapy] went into a regular wide-complex tachycardia after intubation for severe COPD exacerbation. Here is the ECG: Regular Wide Complex Tachycardia at a rate of 166 bpm.

ICU 71

ICU OR 71

EMOttawa

JUNE 20, 2024

This case report demonstrates the utility of point-of-care ultrasound (POCUS) to identify complicated gallbladder disease. In this case, the patient presented with abdominal pain and a known history of cholelithiasis. POCUS demonstrated signs of small bowel obstruction and subsequently guided the decision to pursue radiology-performed imaging. Subsequently, the rare complication of Bouveret syndrome was identified. […] The post A Rolling Stone Without a Home: Bouveret Syndrome on PoCUS ap

EMS 66

EMS 66

EMCrit Project

JUNE 18, 2024

All the literature goodness for June 2024 EMCrit Project by Scott Weingart, MD FCCM.

95

95

NVFC

JUNE 21, 2024

Reprinted from the 2024 issue of Firefighter Strong For those just beginning the fire service journey, the path ahead can seem daunting. Seeking advice and assistance from mentors and those with more experience can help ease the adjustment and form a solid foundation for what is to come. With that spirit in mind, we asked instructors from the 2024 NVFC Training Summit to provide their best tips, advice, and words of wisdom to those starting out in the fire service.

Firefighter 52

Firefighter Public Safety OR 52

Dr. Smith's ECG Blog

JUNE 19, 2024

This is another case sent by the undergraduate (who is applying to med school) who works as an EKG tech. Case An 82 year old man with a history of hypertension presented to the ED with chest pain at 1211. He described his chest pain as pleuritic and reported that it started the day prior while swinging a golf club. An EKG for chest pain was obtained right away: For an 82 year old, this is a good looking EKG, with sinus rhythm at a rate of 70 BPM.

STEMI 60

STEMI Coronary CAD ED 60

Stem EMS

JUNE 21, 2024

Next 22 June the 160th anniversary of the Red Cross will be celebrated with a torchlight procession from Solferino that will retrace the steps of the first rescuers during the […] L'articolo The Red Cross celebrates 160 years: its values always relevant proviene da Stem Ems.

EMS 52

EMS 52

Life in the Fastlane

JUNE 21, 2024

Pramod Chandru Network Five: Emergency Medicine Conversations Network Five Emergency Medicine Conversations Episode 30 with Dr Setthy Ung - an inspiring discussion about developing paediatric emergency care, systems change and balance!

OR 52

OR 52

Firefighters and EMS Fund

JUNE 20, 2024

Firefighters are in the business of saving lives, even at the cost of their safety. This is often taken for granted: We’ve all seen the heroic scenes of first responders walking into a burning building to protect others. Should anything happen during the fire, firefighters can at least rely on prompt medical help and protection […] The post Status Report: Presumptive Cancer Coverage for Firefighters in Illinois appeared first on Firefighters and EMS Fund.

Firefighter 52

Firefighter First Responder EMS 52

Paramedics World

JUNE 18, 2024

Welcome to the ultimate guide on hyperlipidemia – a mouthful term for something that affects millions of people worldwide. If you’ve ever wondered how those lipids in your blood can… The post Your Ultimate Guide to Understanding and Managing Hyperlipidemia appeared first on Paramedics World.

Paramedic 52

Paramedic 52

NAEMSP

JUNE 18, 2024

Article Summary by Sarah Fabiano, MD, FACEP, FAAEM Sobieraj DM, Martinez BK, Miao B, et al. Comparative effectiveness of analgesics to reduce acute pain in the prehospital setting. Prehosp Emerg Care 2020 Mar-Apr;24(2):163-74. doi: 10.1080/10903127.2019.1657213. Epub 2019 Sep 23. PMID: 31476930. Background This study compared the effectiveness/harms of opiates versus non-opiates for moderate and severe acute pain in the prehospital setting.

ALS 52

ALS OR 52

Life in the Fastlane

JUNE 18, 2024

Kyle Cunningham MD and Michael Gibbs MD Abdominal Imaging: Diaphragm Abdominal Imaging: Diaphragm and Diaphragmatic injuries with Kylee Brooks MD, Parker Hambright MD, Alexis Holland MD, and William Lorenz and EMGuidewire

52

52

NVFC

JUNE 18, 2024

Applications are being accepted through 5pm ET on July 12 for Stage 1 of the U.S. Department of Transportation’s Strengthening Mobility and Revolutionizing Transportation (SMART) Grants. Established by the Bipartisan Infrastructure Law, the program provides $100 million for funding to public-sector agencies, including EMS, for projects that focus on using technology interventions to solve real-world challenges facing communities.

EMS 52

EMS 52

Paramedics World

JUNE 18, 2024

Welcome to the ultimate guide on hyperlipidemia – a mouthful term for something that affects millions of people worldwide. If you’ve ever wondered how those lipids in your blood can… The post Your Ultimate Guide to Understanding and Managing Hyperlipidemia appeared first on Paramedics World.

Paramedic 52

Paramedic 52

EMOttawa

JUNE 18, 2024

Methodology: 3/5 Usefulness: 1.5/5 Le Cornec C, e al. JAMA Netw Open. 2024 Jan 2;7(1):e2352844. Question and Methods: This was a multicenter, single-blind, noninferiority RCT, to assess the noninferiority of intravenous ketamine vs intravenous morphine for pain relief in adults with out-of-hospital traumatic pain. Findings: In this RCT including 251 patients, the ketamine group had […] The post Ketamine Compared With Morphine for Out-of-Hospital Analgesia for Patients With Traumatic Pain:

ALS 52

ALS 52

Stem EMS

JUNE 17, 2024

Eurosatory 2024, the International Exhibition for Terrestrial, Airborne and Security Defence, is expected to take place from 17 to 21 June in Paris. Also visiting the event is STEM ‘MEDEVAC’, […] L'articolo Military Medical Transport: STEM is also at Eurosatory 2024 proviene da Stem Ems.

Medical Transportation 52

Medical Transportation EMS 52