ALiEM
NOVEMBER 17, 2023
A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. The grandmother first noted blood in the patient’s underwear the previous morning when she was helping the patient wipe and she noticed it again prior to arrival, this time saturating the patient’s underwear.
The Skeptics' Guide to EM
NOVEMBER 11, 2023
Date: November 2, 2023 Reference: Coventry et al. Which clinical features best predict occult scaphoid fractures? A systematic review of diagnostic test accuracy studies. Emerg Med J. Aug 2023 Guest Skeptic: Dr. Matt Schmitz is an Orthopaedic Surgeon who sub-specializes in adolescent sports and hip preservation. He will soon be transitioning out of the US military after […] The post SGEM#420: I get knocked down, but I get up again – do I have a scaphoid fracture?
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Pediatric EM Morsels
NOVEMBER 17, 2023
While doing literature review for my scholarly project it dawned on me that it might be time to dust off a classic morsel from the bottom of the cookie jar. On this 10 year anniversary, we chose to throw this one back in the oven to include some even more delicious data on cuffed endotracheal tube (ETT) use. No matter whether you have the wisdom of many years of practice ( old doc like Dr.
American Ambulance Association
NOVEMBER 15, 2023
This content is for AAA members only. Please either Log In or Join! The post CMS Finalized CY 2024 Ambulance Fee Schedule Add-Ons and Adopts Helpful Modifications to Ground Ambulance Data Collection System appeared first on American Ambulance Association.
ALiEM
NOVEMBER 13, 2023
A 57-year-old female college counselor living in the northeastern United States with no PMH presented for evaluation of rash, joint pain, and dyspnea for the past three weeks. The patient first noticed the rash on her upper back, describing it as being itchy. The rash then spread to her face, scalp, and thighs. Two weeks ago, she noticed swelling in her hands and had a gradual onset of dyspnea on exertion.
Core EM
NOVEMBER 15, 2023
The Case A 62-year-old male with a history of Hypertension, Hyperlipidemia, Coronary Artery Disease with stents, Pulmonary Embolism on Eliquis, presents with sudden onset, severe, mid-sternal chest pain that started 15 minutes prior to arrival. He arrived initially with diaphoresis and pallor which have self-resolved following arrival to the ED. EKG Show Details EKG Characteristics Rate 95 BPM Rhythm Normal Sinus Rhythm Intervals PR 164, QRS 82, QT/QTc 360/452 (normal) Axis Normal Additional Fea
Broome Docs
NOVEMBER 17, 2023
This is another lecture by the always amazing Dr Justin Morgenstern from the series of talks he delivered on his tour of Perth in September 2023. In this talk I challenged Justin to go on a very deep dive into the literature around the modern management of the massively bleeding trauma patient. What is the best way to resuscitate and replace all those blood products in these severely unwell people?
Paramedicine Now brings together the best content for paramedicine professionals from the widest variety of thought leaders.
ALiEM
NOVEMBER 15, 2023
What toxin is found in bitter apricot kernels? Cardiac glycoside Cyanogenic glycoside Dinitrophenol Lysergic Acid Reveal the Answer 2. Cyanogenic glycoside Background Apricot kernels contain a cyanogenic glycoside called amygdalin which is hydrolyzed to hydrogen cyanide in the gastrointestinal tract [1]. There are over 2,000 species of cyanogenic glycoside producing plants, including apricots, almonds, peaches, and cassava [2].
Core EM
NOVEMBER 13, 2023
The primary survey in trauma management is a critical initial assessment to identify and address life-threatening conditions. It follows the ABCDE approach: Airway maintenance with cervical spine protection, Breathing and ventilation, Circulation with hemorrhage control, Disability (neurological status), and Exposure/Environmental control. This systematic method ensures prompt identification and immediate treatment of urgent medical issues, enhancing the chances of survival and recovery in traum
Critical Care Scenarios
NOVEMBER 15, 2023
Which site should you select for your central line placement? A discussion of some considerations. Which site should you select for your central line placement? A discussion of some considerations.
American Ambulance Association
NOVEMBER 17, 2023
This content is for AAA members only. Please either Log In or Join! The post CMS Ambulance Open Door Forum 11/30 appeared first on American Ambulance Association.
EMergucate
NOVEMBER 13, 2023
The chest x-ray is from an elderly patient with septic delirium. What can be noticed?
Dr. Smith's ECG Blog
NOVEMBER 17, 2023
I was texted this ECG just as I was getting into bed. It is of an elderly woman who complained of shortness of breath and had a recent stent placed. I was told that the Queen of Hearts had called it OMI with high confidence. What do you think? Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema.
REBEL EM
NOVEMBER 15, 2023
Take Home Points: Dose your RSI meds correctly. Reach for post-intubation sedation at the same time you are asking for your induction agent and paralytic. Propofol is a great choice for post-intubation sedation, and if your patient becomes hypotensive do not be afraid of adding on a pressor! REBEL Core Cast 112.0 – Awareness During Paralysis [“[link] Click here for Direct Download of the Podcast Awareness during paralysis is real.
American Ambulance Association
NOVEMBER 16, 2023
Yesterday, November 15, Congresswoman Marie Gluesenkamp Perez (D-WA) and Congressman Brad Finstad (R-MN) introduced the Preserve Access to Rapid Ambulance Emergency Medical Treatment (PARA-EMT) Act (H.R. 6433). H.R. 6433 is […] The post Gluesenkamp Perez and Finstad Introduce EMS Workforce Shortage Bill appeared first on American Ambulance Association.
EMergucate
NOVEMBER 12, 2023
Answers: PH = 7.415, this is within normal range. slightly more to the alkelaemic side. pCO2 = 34 mmHg, that is slightly low, this patient is hyperventilating.
Dr. Smith's ECG Blog
NOVEMBER 14, 2023
In the last post, we saw how important old ECGs are in assessing the current ECG in a patient without atypical presentation (in this previous case, the patient had no chest pain, and the apparent inferior OMI did not have reciprocal ST depression in lead aVL). Here is that last post: A 90-something with acute stroke. She has no chest symptoms. What is the diagnosis?
First 10 EM
NOVEMBER 13, 2023
After a recent talk entitled “Mastering Diagnosis”, Casey Parker and I sat down to discuss a few of the key points I was trying to make. Although this might be one of the nerdiest talks I have ever given, based entirely around math, I think it is one of the most important, because we cause […] The post Mastering Diagnosis VodCast appeared first on First10EM.
Don't Forget the Bubbles
NOVEMBER 15, 2023
One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. Background Prescribing maintenance fluids can seem like a straightforward tick-off from the to-do list for many of us. However, considering human mass is composed of 60% water ( 70% for term neonates), we must get this right.
EMergucate
NOVEMBER 13, 2023
The knee x-ray shows a Segond fracture with knee effusion.
Dr. Smith's ECG Blog
NOVEMBER 15, 2023
A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest. She said this was midsternal and felt like a tightness.
University of Maryland Department of Emergency Med
NOVEMBER 17, 2023
This small study suggests using reverse shock index times the Glasgow Comma Scake score may give a prognostication on pediatric trauma seve.
EMDocs
NOVEMBER 11, 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: ACORN RCT – Piperacillin-Tazobactam or Cefepime? Spoon Feed In this randomized control trial of patients receiving cefepime or piperacillin-tazobactam, there was no difference in risk of acute kidney injury between
EMergucate
NOVEMBER 13, 2023
The frontal chest x-ray shows a dislocated left shoulder.
Dr. Smith's ECG Blog
NOVEMBER 11, 2023
A 90-something year old woman presented with an acute mild stroke. She had a routine ECG as part of her workup: What do you think? This was shown to me in real time. I thought it had to be an inferior-lateral-posterior OMI. But the patient had no symptoms. Later, she did admit to some vague chest discomfort, but that could be due to the power of suggestion.
Don't Forget the Bubbles
NOVEMBER 13, 2023
Should we use ultrasound to diagnose distal forearm fractures in children and adolescents? Distal forearm fractures are common in children and adolescents, but the best method for diagnosing them is still debatable. X-ray (radiography) is the standard imaging technique used in emergency departments. However, ultrasound is gaining popularity due to its portability, affordability, and lack of ionising radiation.
FOAMfrat
NOVEMBER 16, 2023
How do you talk to a patient experiencing suicidal ideation? What if you're the one having these thoughts? We're interviewing James Boomhower from Stay Fit 4 Duty in this episode. We discuss suicidal ideation, therapeutic communication, and verbal de-escalation. Podcast: [link] We're not able to adequately measure suicidal ideation and mental health crises in terms of vital signs or a physical assessment, so our communication skills need to be honed to reach these patients - it takes a different
EMergucate
NOVEMBER 12, 2023
21 year old man presented to ED with fatigue and weakness. His blood gases showed the following: PH = 7.
ACEP Now
NOVEMBER 16, 2023
U.S. emergency medicine (EM) residency training length has been a decades-long dilemma: four versus 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.
Pulsara
NOVEMBER 15, 2023
Editor's Note: On July 21st, 2023, EMS1, Fitch & Associates, and the National EMS Management Association released their annual EMS Trend Report, proudly sponsored by Pulsara. Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Read, enjoy, share, and take to heart the following information brought to you by the most prestigious thought leaders in EMS.
Ambulance Driver Files
NOVEMBER 13, 2023
Broke 100 laps in the pool again today. Did 103 laps in 90 minutes. Even better, that average heart rate was down to 92 in one minute, and 72 in ten minutes. That’s pretty damned good cardiovascular recovery for an athlete, much less a fat guy trying to get in shape.Weighed in at 348.7 pounds.
EMT Training Station
NOVEMBER 12, 2023
Updated: Nov 2023 Hi, I am Mike I am a veteran EMT with more than a decade of experience, and I want to help you pick the best pair of EMS boots for your career as an EMT or paramedic. In my experience, the best and most reliable pair of boots are the 5.11 A.T.A.C Shield Boot. In brief, the shield boots are affordable, comfortable, and meet industry safety standards.
ACEP Now
NOVEMBER 16, 2023
Case A 74-year-old man presents with vomiting of blood for two days. He has a history of daily alcohol and tobacco use. Vital signs are: blood pressure, 88/50; heart rate, 120; respiratory rate, 36. He is actively vomiting coffee ground emesis. His abdomen is soft with voluntary guarding. What is the best management of this condition? Upper gastrointestinal bleeding (UGIB) is a significant problem in the U.S., with 350,000 hospitalizations annually and a mortality rate of five to 10 percent. 1,2
University of Maryland Department of Emergency Med
NOVEMBER 16, 2023
Pediatric patients treated at pediatric specific trauma centers have improved mortality. However, it is estimated that only 57% of.
EMCrit Project
NOVEMBER 13, 2023
Brian Johnson talks about his new book, Arete EMCrit Project by Scott Weingart, MD FCCM.
The EMS Show
NOVEMBER 17, 2023
Mike and Ritu welcome Dr. Frank Guyette to the show! Dr. Guyette is a Professor of Emergency Medicine, University of Pittsburgh Medical Director - STAT MedEVAC as well as the Principal Investigator for the ongoing PACT Trial. We took some time to get to know Dr. Guyette and talk some EMS Research!
ACEP Now
NOVEMBER 15, 2023
The emergency medicine workforce is an important issue with ramifications for physicians relocating or retiring, medical students considering the specialty, and graduating residents seeking their first jobs. In August 2021, an article published in the Annals of Emergency Medicine projected a surplus of more than 7,800 emergency physicians in 2030 based on multiple scenarios, including patterns of supply and demand for emergency physicians at that time. 1 The workforce in emergency medicine is co
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