The Skeptics' Guide to EM

DECEMBER 25, 2021

Case: An EMS crew arrives at the home of a 68-year-old suffering from a witnessed out-of-hospital cardiac arrest (OHCA). Intraosseous access is quickly obtained, and a dose of epinephrine is provided. The patient is transported to the emergency department with vital signs absent (VSA).

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REBEL EM

JUNE 8, 2023

1-4 The PDPs, phenylephrine and epinephrine, result in vasoconstriction and increased cardiac contractility. They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine.

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The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Audrey Marcotte are Chief Residents from the Royal College of Emergency Medicine Program at McGill University. Alongside his EM residency, he is doing a PhD in epidemiology. Outside of medicine, Audrey likes […] The post SGEM#301: You Can’t Stop GI Bleeds with TXA first appeared on The Skeptics Guide to Emergency Medicine.

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The Skeptics' Guide to EM

SEPTEMBER 16, 2017

Guest Skeptic: Dr. Anand Swaninathan is an Assistant Professor of Emergency Medicine at NYU/Bellevue Hospital in the Department of Emergency Medicine. Guest Skeptic: Dr. Anand Swaninathan is an Assistant Professor of Emergency Medicine at NYU/Bellevue Hospital in the Department of Emergency Medicine.

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The Skeptics' Guide to EM

MARCH 2, 2019

JAMA 2018 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a physician assistant practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program. They had a difficult time getting a definitive airway pre-hospital.

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REBEL EM

APRIL 29, 2024

One may speculate that the US-guided CVC placement would have a higher first-pass success rate with fewer complications, however, this may potentially add time to the procedure depending on the operator and institution’s use of ultrasound during emergencies and maintaining sterile technique with the US probe. Ong MEH, Chan YH, Oh JJ, et al.

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The Skeptics' Guide to EM

APRIL 20, 2019

Talk Trauma is a two-day conference for nurses, allied health and EMS professionals involved in providing care for the adult and paediatric trauma patient. Case: A 52-year-old man presents to the emergency department via EMS after a motor vehicle collision while driving home from the city.

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REBEL EM

SEPTEMBER 13, 2023

patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 Angioedema in the Emergency Department: An Evidence Based Review. Emergency Medicine Practice. of people who take NSAIDs ( Nzeako 2010 ).

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ACEP Now

NOVEMBER 6, 2024

A gravid woman presents to your emergency department (ED). mg/kg IV epinephrine, or 0.05–0.1 3 Dr. Turner , originally trained at the Medical University of South Carolina, is an EM intern at Hershey Medical Center in Hershey, Pa. Dr. Sandelich is a pediatric emergency physician at Hershey Medical Center in Hershey, Pa.

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EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. N Engl J Med.

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ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2 Standard management for VT and VF involves the use of electrical defibrillation, high-quality chest compressions, and epinephrine. Adult cardiac arrest in the emergency department – A Swedish cohort study.

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EMDocs

MAY 26, 2023

Avoid Trying to Reason With Them When agitated, a child’s prefrontal cortex is suppressed by the cortisol and epinephrine induced fight-or-flight reaction. Emerg Med Clin North Am. Structured team approach to the agitated patient in the emergency department. Emerg Med Australas. Deaths due to physical restraint.

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REBEL EM

JULY 18, 2022

When simple maneuvers fail, we proceed to topical agents such as lidocaine with epinephrine, oxymetazoline, anterior nasal packing, and electrical or chemical cauterization. TXA has become the standard practice in the ED based on small RCTs, though larger trials have not demonstrated the same benefit ( REBEL EM review ).

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NCOAE

NOVEMBER 13, 2021

What an EMT Must Learn While nearly anyone can attempt to become an EMT, in order to qualify to take and pass the National Registry of Emergency Medical Technicians certification exam, candidates must first complete an approved EMS education program. Many fire departments require that all of their firefighters also be EMTs.

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REBEL EM

JANUARY 23, 2023

Noninferiority trials, covered here on REBEL EM , are helpful when the experimental treatment offers a distinct advantage over the standard treatment. Multicenter study of emergency department visits for insect sting allergies. Multicenter study of emergency department visits for food allergies. PMID: 16159637.

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ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. Bourke Tillmann and Scott Weingart for their expertise on the EM Cases podcast that inspired this column. Dr. Helman is an emergency physician at North York General Hospital in Toronto.

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NAEMSP

APRIL 19, 2023

After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. Association between calcium administration and outcomes during adult cardiopulmonary resuscitation at the emergency department. Turkish Journal of Emergency Medicine, 22 , 67-74. Wongtanasarasin, W., Namsongwong, N.,

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FOAMfrat

OCTOBER 20, 2023

Epinephrine should be considered as the vasopressor of choice in patients with decreased myocardial function. Dr. Jarvis of The EMS Lighthouse Project podcast also covers this paper in detail here: [link] ^^^ I highly recommend listening! Intern Emerg Med. Acad Emerg Med. Now, what is the resuscitation end goal?

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EMDocs

DECEMBER 18, 2023

Today, she would not get out of bed, prompting the facility to call EMS. 1 The rationale for the shift away from normal saline in 2021 derived from multiple trials, including the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) and Saline Against Lactated Ringer’s or Plasma-Lyte in the Emergency Department (SALT ED).

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EMDocs

JANUARY 4, 2024

Other Norepinephrine or epinephrine are preferred vasopressors when needed. Case Follow-up: The patient required a dose of lorazepam in the emergency department. Consider lidocaine for associated dysrhythmias. 8 Consider intravenous lipid emulsion (ILE) for cardiotoxicity not responsive to other treatments.

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ACEP Now

OCTOBER 28, 2024

Holy Foley A Rare Case of Iatrogenic Obstruction by Adam Heilmann, MD; Jessica Pelletier, DO; Jennifer Reyes Lin, MD, MPH Our patient is a 33-year-old male with spastic quadriparesis due to cerebral palsy with chronic indwelling suprapubic catheter (SPC) who presented to the emergency department (ED) due to concern for Foley catheter obstruction.

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ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. EMS physicians report he was found in ventricular fibrillation. Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. Simon EM, Tanaka K. Emmerson AC, Whitbread M, Fothergill RT. Resuscitation.

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REBEL EM

DECEMBER 19, 2022

At REBEL EM, we’ve done an extensive write up that details some of the different types of DED and the electrophysiology behind it. Within the United States, due to paramedic shortages, this dual-medic setup does not exist in many EMS systems. That write up was for the DOSE-VF pilot trial done in March 2020 and can be found here.

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Dr. Smith's ECG Blog

DECEMBER 22, 2010

After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. Emergency Department Two-Dimensional Echocardiography in the Diagnosis of Nontraumatic Cardiac Rupture. Annals of EM 23(6):1333-1342; June 1994. She collapsed and 911 was called; she was found pulseless. Plummer D et al.

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EMDocs

JANUARY 20, 2024

We’ll keep it short, while you keep that EM brain sharp. Takotsubo syndrome is often exceedingly difficult to distinguish from acute myocardial infarction in the emergency department, as there is significant overlap in many clinical and diagnostic features. Vital signs show T of 99.0°F 2010;55(22):2514-2516. J Neurosurg.

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FOAMfrat

NOVEMBER 25, 2024

Earlier in the summer, I wrote a blog discussing the challenges, intricacies, and educational pitfalls of postpartum hemorrhage in EMS. In the standard care of anaphylactoid reactions, we administer Epinephrine, Diphenhydramine, steroids, and bronchodilators. I even know of cases that my colleagues have managed!

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ACEP Now

OCTOBER 29, 2024

EMS found the patient pulseless and apneic, with an initial rhythm showing ventricular fibrillation (see figure 1). He was defibrillated twice and received two doses of epinephrine, with return of spontaneous circulation. Figure 1: The EMS rhythm strip. There was no family history of syncope or sudden death. Click to enlarge.)

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