The Skeptics' Guide to EM

JUNE 17, 2023

Date: June 15, 2023 Reference: Rees CA et al. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. American Journal of Hematology Jan 2023 Guest Skeptic: Dr. Amy Drendel is a pediatric emergency medicine physician and physician scientist at Children’s Wisconsin. […] The post SGEM#406: Homeward Bound…after a dose of Intranasal Fentanyl for Sickle Cell Vaso-occlusive

Emergency Department 182

Emergency Department ALS ED OR 182

EMergucate

JUNE 20, 2023

The neck x-rays are from a patient with neck pain following fall onto their back. X-rays were done as the patient had tenderness over mid c-spine. What can be seen?

EMS 130

EMS 130

REBEL EM

JUNE 22, 2023

Background: The COVID-19 pandemic has been the focus of massive research efforts over the last three years. Our understanding of the disease and effective treatments to reduce mortality have progressed rapidly during this time. However, the medical community is only just starting to understand long-COVID (WHO Definition: the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation).

ALS 145

ALS OR EMS ED 145

The Bottom Line

JUNE 19, 2023

In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?

145

145

Don't Forget the Bubbles

JUNE 19, 2023

You are asked to see a baby boy in the labour ward. He was born at 38 weeks and 5 days gestational age and weighs 2600 grams. His mother is healthy, but she does mention that her first-born daughter was also small. She weighed 2570 grams at 39 weeks and is now perfectly healthy. The parents are of South-Asian descent. There were no issues during the pregnancy, and estimated fetal growth by ultrasound was constant.

ALS 143

ALS OR 143

First 10 EM

JUNE 19, 2023

The internet is alive with rumors of a simple, cheap, low-risk cure for long COVID. Sound too good to be true? That’s because it almost certainly is. Let’s talk about this COVIT-OUT trial and what it says about metformin. The paper Bramante CT, Buse JB, Liebovitz DM, et al. Outpatient treatment of COVID-19 and incidence […] The post No, metformin is probably not the cure for long COVID appeared first on First10EM.

ALS 134

ALS EMS 134

Critical Care Scenarios

JUNE 21, 2023

Bryan puts Brandon through the paces, discussing the nuts and bolts of managing a code. Find us on Patreon here! Buy your merch here! Takeaway lessons Bryan puts Brandon through the paces, discussing the nuts and bolts of managing a code. Find us on Patreon here! Buy your merch here! Takeaway lessons * Managing a room is less about asserting authority and more about leading by example.

Coronary 100

Coronary 100

Broome Docs

JUNE 20, 2023

Hi All, we are back with another instalment of the Journal Club with Justin Morgenstern. Big news this month is that Justin has just been invited to visit my home shop as the honorary WG Smith Fellow and deliver a series of EBM lectures to the local teams in Western Australia. So we are planning to take this show on th eraod and do some live sessions later in 2023.

Emergency Department 132

Emergency Department ALS 132

EMergucate

JUNE 20, 2023

26 year old woman presented exacerbation of her asthma for 3 months. She also complained of weight loss in the last few months. Her blood gases showed the following: PH = 7.

100

100

ACEP Now

JUNE 21, 2023

U.S. emergency medicine (EM) residency training length has been a decades-long dilemma: four vs. three years. Two important questions befall educators and residents. First, is three years enough time to become an EM physician? Second, does an additional year add sufficient value to justify the time and expense? To date, the debate has been lively yet largely conceptual.

EMS 114

EMS ALS Emergency Medical Services OR 114

REBEL EM

JUNE 19, 2023

Background: Injuries are a major cause of death worldwide. Hemorrhage accounts for about 1/3 of all trauma deaths and as such, it should be our goal to find treatments to decrease death from hemorrhage. Our bodies have a finely tuned system that allows blood to flow freely and not clot too easily while also allowing the body to form clots when needed.

Emergency Medical Services 105

Emergency Medical Services EMS Paramedic OR 105

Dr. Smith's ECG Blog

JUNE 21, 2023

Sent by Magnus Nossen MD, written by Pendell Meyers A man in his 50s, previously healthy, developed acute chest pain. EMS was called, and they recorded the following ECG on scene at 13:16: What do you think? Below is the version standardized by PM Cardio app Meyers interpretation: Findings are specific for posterior (and also likely inferior) wall transmural acute infarction, most likely due to acute coronary occlusion (OMI).

STEMI 97

STEMI Coronary Defibrillator EMS 97

EMergucate

JUNE 19, 2023

Repeat for lab case 351, Question 1: PH = 7.53, that is mild alkalaemia pCO2 = 25 mmHg, that is low (<40), so we have respiratory alkalosis.

100

100

The Bottom Line

JUNE 19, 2023

In patients resuscitated from out-of-hospital cardiac arrest (OOHCA) does targeted mild hypercapnia compared to targeted normocapnia improve 6-month neurological outcomes?

98

98

EMDocs

JUNE 22, 2023

Author: Taylor Webb, MD (Emergency Medicine Resident, University of Mississippi Medical Center) // Reviewed by: Brit Long, MD (@long_brit) I am a third year Emergency Medicine chief resident at the University of Mississippi Medical Center (UMMC) and want to share one of my experiences to all medical residents and providers. Remember that while mistakes in resuscitation are often dissected and analyzed, it is equally crucial to acknowledge and celebrate the moments of impeccable execution, where

ED 96

ED Paramedic OR EMS 96

Medgadget

JUNE 19, 2023

Researchers at Rockefeller University have developed a cell culture platform in which to grow ‘lung buds’ from human embryonic stem cells. The tiny structures are similar to the lung buds that form during fetal development, and they contain tiny airways and alveoli. The researchers create the structures in a bio-reactor style device that is furnished with microfluidic chips in which the lung buds grow.

89

89

EMergucate

JUNE 21, 2023

Question 1: PH = 7.17, that is moderate acidaemia. HCO3 = 14 (less than 24). So, we have metabolic acidosis.

100

100

University of Maryland Department of Emergency Med

JUNE 18, 2023

It is difficult to diagnosis a ruptured AAA with POCUS. However, based on one systematic review and meta-analysis, POCUS has a sensitivity of.

96

96

EMDocs

JUNE 17, 2023

Author: Jackie Nguyen, MD (EM Resident Physician, UTSW – Dallas, TX); Joshua Kern, MD (Assistant Professor of EM/Attending Physician, UTSW – Dal las, TX) // Reviewed by: Sophia Görgens, MD (EM Resident Physician, Zucker-Northwell NS/LIJ, NY); Cassandra Mackey, MD (Assistant Professor of Emergency Medicine, UMass Chan Medical School); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Welcome to EM@3AM, an emDOCs series designed to foster your working knowledge by providing an expedited re

EMS 71

EMS OR Emergency Department ALS 71

Medgadget

JUNE 19, 2023

Researchers at the University of Pennsylvania have developed nanorobots that can travel to the site of a fungal infection under the influence of an external magnetic field, bind to the fungal cells, and then release reactive oxygen species to completely destroy the fungus. The tiny particles are an example of catalytic nanoparticles, which the researchers have dubbed ‘nanozymes’.

ED 78

ED OR 78

Dr. Smith's ECG Blog

JUNE 23, 2023

A 50-something male with unspecified history of cardiomyopathy presented in diabetic ketoacidosis (without significant hyperkalemia) with a wide complex tachycardia and hypotension. Bedside echo showed "mildly reduced" LV EF. Here is the ED ECG: What do you think? Analysis: there is a wide complex tachycardia. It is regular. There are no P-waves. The morphology is of RBBB and LAFB.

OR 52

OR ED 52

University of Maryland Department of Emergency Med

JUNE 21, 2023

Between 2010 and 2020, there were 279 fatalities related to ambulance accidents. In up to 50% of accidents, EMS is not at fault. The use.

Ambulance 68

Ambulance EMS 68

The Overrun Podcast

JUNE 21, 2023

For our 100th episode, we sat down with a friend of the show Dr. Mark Merlin of MD1 to discuss how far EMS has come in the last 5 years and where EMS might go in the next 5 years. Dr. Merlin talks about his 2009 study using the MAR method to estimate blood loss as well as the recent Emergency Medicine Match dilemma. Take a listen and let us know what you think.

EMS 52

EMS 52

EMT Training Station

JUNE 18, 2023

Welcome to an in-depth exploration of the cardiovascular system and its significance in the field of emergency medical services. As an Emergency Medical Technician (EMT), your knowledge of this intricate system, the conditions that can arise, and the interventions necessary to save lives is fundamental to your role. This comprehensive guide titled ‘The Cardiovascular System: EMT Interventions for Heart Conditions’ is designed to deepen your understanding and equip you with the practi

EMT 52

EMT EMT Heart Attack Emergency Medical Technician 52

Dr. Smith's ECG Blog

JUNE 19, 2023

Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen Smith A 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. Here is his triage ECG which was obtained at 20:34 during active pain. What do you think?

STEMI 52

STEMI ACS Coronary Defibrillator 52

EMCrit Project

JUNE 20, 2023

More on the CLOVERS trial from the lead author EMCrit Project by Scott Weingart, MD FCCM.

73

73

University of Maryland Department of Emergency Med

JUNE 23, 2023

How much screen time after concussion? Adolescents spent more than 7 hours daily on screen time during the pandemic. Historically.

64

64

The FllightBridge ED

JUNE 20, 2023

Introduction A crew responds to a motor vehicle collision involving a passenger vehicle into a tree.

52

52

Dr. Smith's ECG Blog

JUNE 17, 2023

Written by Pendell Meyers A middle aged man called EMS for acute chest pain. EMS recorded this ECG during active symptoms and transmitted it to the ED: I had no information when I was shown the ECG. I said "Not OMI. Some probably thought the inferior leads showed findings of OMI, but that's a fake." Others probably thought lead V4 has a hyperacute T wave.

OR 52

OR STEMI ALS EMS 52

EMS 20/20

JUNE 21, 2023

In a Lucky Charms fueled rage, Chris shares his thoughts on what it takes to be a Paramedic before the guys try and figure why a patient is so short of breath. Is it bronchoconstriction? Pulmonary Edema? Heart problems? Listen and find out! In a Lucky Charms fueled rage, Chris shares his thoughts on what it takes to be a Paramedic before the guys try and figure why a patient is so short of breath.

Paramedic 40

Paramedic 40

University of Maryland Department of Emergency Med

JUNE 17, 2023

Click to view the rest

65

65

Don't Forget the Bubbles

JUNE 21, 2023

You are asked to come to the labour ward and examine a baby girl, Mantre, born at 41 weeks and two days. Her mom has poorly controlled gestational diabetes. Mantre weighs 4280 grams. You wonder: is this weight too much for the gestational age? Is this because of maternal diabetes? And what should I do next? What is large for gestational age? It is impossible to practice neonatology without coming across babies that are large for gestational age (LGA).

ALS 119

ALS OR 119

EMDocs

JUNE 21, 2023

Today on the emDOCs cast with Brit Long, MD ( @long_brit) , we discuss traumatic arthrotomy, also known as an open joint. Episode 80: Traumatic Arthrotomy What is traumatic arthrotomy (TA)? TA occurs when a wound disrupts a joint capsule and exposes the intra-articular surface of a joint to contamination and potentially infection. May lead to significant morbidity Typical presentation: Males in their 20s and 30s are most commonly affected Mechanisms include any potential injury, but GSW and MVCs

ALS 68

ALS OR ED 68