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

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

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

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

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 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 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

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

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 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 & 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

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.

123

123

EMergucate

JANUARY 23, 2024

58-year-old lady with history of COPD presented with fever. Her venous blood gases showed the following: PH = 7.

130

130

Dr. Smith's ECG Blog

JANUARY 20, 2024

Written by Pendell Meyers A man in his late 30s with history of hypertension, tobacco use, and obesity presented to the Emergency Department for acute chest pain which started approximately 3 hours prior to arrival, in the setting of a very stressful situation. The pain radiated down both arms, 10/10 in severity. He stated it did not feel like his prior episodes of reflux.

STEMI 114

STEMI CAD ED ALS 114

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

First 10 EM

JANUARY 22, 2024

Over the last few years, I have seen a steady increase in the number of non-inferiority trials being published. This makes some sense, as they generally require fewer participants, and are therefore cheaper and easier to run. However, it presents a problem, as most of us (including myself) don’t really understand the statistics being performed, […] The post You don’t understand non-inferiority trials (and neither do I) appeared first on First10EM.

115

115

EMergucate

JANUARY 23, 2024

Wrist x-ray from a patient with FOOSH injury. What can be seen? Answer will be posted later.

EMS 130

EMS 130

NVFC

JANUARY 24, 2024

Fire and emergency service leaders have many responsibilities, from recruiting and managing personnel, to budgeting and administration, to community relations, to setting the culture and ethical tone for the department, and much more. Whether new or established, leaders are constantly needing to learn and grow in their roles. The National Volunteer Fire Council (NVFC) has released a new Leadership training track in the Virtual Classroom, designed specifically for fire and EMS department leaders,

Firefighter 111

Firefighter First Responder EMS OR 111

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

Don't Forget the Bubbles

JANUARY 24, 2024

Going beyond the algorithm, what can we do when a child is still fitting despite appropriate treatment? Four-year-old Fern is a previously healthy girl who presents with a febrile illness and seizures. Seizure activity did not respond to either first or second-line treatments, so she needed rapid sequence induction and transfer to PICU for ongoing anaesthesia and management.

Critical Care 111

Critical Care ALS OR 111

EMergucate

JANUARY 22, 2024

Answers PH = 7.507, that is alkalaemia pCO2 = 28 mmHg. So, we have respiratory alkalosis.

130

130

Pulsara

JANUARY 25, 2024

With a new protocol and Pulsara, Metropolitan Emergency Medical Services can now transport eligible pediatric behavioral health patients directly to behavioral health facilities—resulting in a 44% decrease of pediatric behavioral health patients transported to the ED. Metropolitan Emergency Medical Services (MEMS) is a public, non-profit EMS entity serving Little Rock, Arkansas, and its surrounding counties.

Emergency Medical Services 109

Emergency Medical Services EMS STEMI Emergency Department 109

Core EM

JANUARY 25, 2024

Background: The lumbar puncture (LP or spinal tap) is a procedure that has been in the medical arsenal since first described in 1891 by German physician Heinrich Quincke. It can be both diagnostic and therapeutic, utilized in the diagnosis (meningitis, Guillain-Barre syndrome, subarachnoid hemorrhage) and symptomatic treatment (idiopathic intracranial hypertension, normal pressure hydrocephalus) of diseases of the central nervous system, respectively.

ALS 246

ALS Critical Care OR 246

EMOttawa

JANUARY 22, 2024

Methodology: 3.5/5 Usefulness: 4/5 Friedman BW, et al. Neurology. 2023 Oct 3;101(14):e1448-e1454. Question and Methods: This double-blinded RCT of 209 patients presenting to the ED with moderate to severe migraines compared high- to low- dose dexamethasone (16 mg vs 4 mg) on sustained headache relief 48 hours post discharge. Findings: There was no significant difference in sustained […] The post Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to

ALS 106

ALS ED 106

EMergucate

JANUARY 23, 2024

71 y old male is coming with palpitations, haemodynamically stable.

130

130

Critical Care Scenarios

JANUARY 24, 2024

Arterial lines are resuscitative tools. Arterial lines are resuscitative tools.

124

124

Core EM

JANUARY 25, 2024

A quick primer on hypocalcemia in the ED. Hosts: Joseph Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: calcium , Critical Care , Endocrine Show Notes Swami’s CoreEM Post Hypocalcemia Repletion: IV calcium supplementation with 100-300 mg Ca2+ raises serum Ca2+ by 0.5 – 1.5 mEq For acute but mild symptomatic hypocalcemia: 200-1000mg calcium chloride IV or 1-2g IV calcium gluconate over 2 hours For severe hypocalcemia: 1g calcium chloride IV or 1-2g IV calcium gluc

Critical Care 246

Critical Care ED ALS OR 246

Paramedics World

JANUARY 25, 2024

Many people today have oral herpes and don’t know it. They never show symptoms, so they aren’t tested for it. This viral infection may affect the lips, mouth, or gums.… The post Oral Herpes: The 5 Key Takeaways appeared first on Paramedics World.

Paramedic 98

Paramedic OR 98

SSCOR

JANUARY 25, 2024

It was the third vehicle crash of the shift. The first two were minor – low-speed fender benders with minor injuries. This one was different: a high-speed impact involving an unrestrained driver. The facial injuries were extensive.

97

97

EMDocs

JANUARY 23, 2024

Today on the emDOCs cast we cover BRASH syndrome and what you need to know regarding diagnosis and treatment. Episode 93: BRASH syndrome Background: Brash syndrome has 5 components: bradycardia, renal failure, AV nodal blocker, shock, hyperkalemia. Patients at risk of renal insufficiency are the primary population, as well as those on certain medications: AV nodal blockers : any of this class but specifically atenolol, nadolol, labetalol ACE-I and ARBS : increase risk of hyperkalemia and renal d

Epinephrine 87

Epinephrine Overdose OR 87

Core EM

JANUARY 25, 2024

BACKGROUND: Necrotizing soft tissue infections are a rare but potentially lethal condition that can quickly lead to severe morbidity and mortality if not identified by clinical history and physical exam. It is a rapidly progressing infection that moves along fascial planes, often evading the immune system. This is a tricky diagnosis that can often be inconspicuous, so clinical gestalt is key.

E-9-1-1 246

E-9-1-1 Emergency Department OR 246

Paramedics World

JANUARY 25, 2024

Burn injuries result from exposure to sources such as flames, hot surfaces, chemicals, or electricity that cause harm to both skin and underlying tissue. According to World Health Organization data,… The post Why It’s Essential to Find a Burn Injury Lawyer You Can Rely On appeared first on Paramedics World.

Paramedic 98

Paramedic OR 98

Dr. Smith's ECG Blog

JANUARY 23, 2024

This was written by Magnus Nossen The patient is a female in her 50s. She presented with a one week hx of «dizziness» and weakness. She was feeling fine prior to the last seven days. There was no chest pain. She did admit to shortness of breath on exertion. She had no known heart condition. Other than being overweight and having an elevated cholesterol she was healthy.

Coronary 84

Coronary OR Defibrillator ALS 84

EMDocs

JANUARY 25, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians and reduce the cost and stress of medical malpractice lawsuits. To opt in to the free subscriber list, click here. Stories of med mal lawsuits can save lives.

ED 72

ED ALS OR 72

Core EM

JANUARY 25, 2024

Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. While physical adjuncts like securing the tube, in line suctioning, and head positioning are part of general post intubation management, a better understanding of analgesics and sedatives have offered newer approaches and improved outcomes down the line during the patient’s hospital stay.

ICU 246

ICU Emergency Department Critical Care ALS 246