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. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S.

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The Skeptics' Guide to EM

NOVEMBER 13, 2021

Neil Dasgupta is an emergency physician and ED intensivist from Long Island, NY, and currently an assistant clinical professor and Director of Emergency Critical Care at Nassau University Medical Center. Case: A code blue is called for a 71-year-old male in-patient that is boarding in the emergency department (ED).

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Core EM

JANUARY 25, 2024

Written by: Sadakat Chowdhury MD Edited by: Mak Sarich MD, Jay Lin MD, Jonathan Kobles MD Background: Ultrasound (US) guided nerve blocks offer an applicable option for achieving analgesia in the emergency department. Blocks with larger volumes of anesthetic carry higher risk of LAST. mL/kg over 1 min, then 0.25

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The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services at Tacoma Community College. Case: During a busy emergency department (ED) shift the paramedic phone rings.

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The Skeptics' Guide to EM

SEPTEMBER 16, 2017

Though they are relatively safe, upper airway angioedema is one of the life-threatening adverse effects that we see frequently in the Emergency Department. epinephrine, histamine blockers, corticosteroids) the underlying mechanism of action predicts that these medications will not work. Reference: Sinert et al.

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The Skeptics' Guide to EM

FEBRUARY 25, 2023

Case: A 6-month-old boy presents to the emergency department (ED) with three days of worsening cough, cold symptoms, and fever. 1] The SGEM has covered the use of epinephrine, vasopressin, methylprednisolone, and calcium for cardiac arrest in SGEM#238 , SGEM#350 , and SGEM#353. . * Pediatric Crit Care Med.

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REBEL EM

APRIL 29, 2024

Over the years emergency and critical care physicians have tried many ways to establish IV access in emergencies including the “crash” or “dirty” central line. The IO can actually be your “GO-TO” emergency line or your second choice after failed PIV access.

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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 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

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ACEP Now

DECEMBER 6, 2024

Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm. This case report documents the first known instance of using NTG during an emergency department resuscitation to treat a patient in cardiac arrest due to severe coronary artery vasospasm.

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Coronary Life Support ALS Emergency Department 98

Dr. Smith's ECG Blog

OCTOBER 4, 2010

He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. He arrived in the emergency department hemodynamically stable. On his bib it stated that he had a congenital heart disorder. His initial ECG is shown here.

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Don't Forget the Bubbles

MAY 8, 2024

A silent scream in the pediatric emergency department: child abuse and neglect. Emergency department discharge practices for children with acute wheeze and asthma: a survey of discharge practice and review of safety netting instructions in the UK and Ireland. Eur J Pediatr. 2024 Apr;183(4):1543-1553. Toniutti M, et al.

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NCOAE

NOVEMBER 13, 2021

Depending on where you live, you may see them every day or just when there’s a fire, police, or medical emergency where you are. Regardless of the frequency with which you see them, you may be wondering — what exactly does an EMT (Emergency Medical Technician) do? Many EMTs work on a 911 emergency response ambulance.

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REBEL EM

JANUARY 23, 2023

PMID: 32653333 What They Did Multi-center, double-blind, randomized, phase 3 clinical trial with a parallel-group, active-controlled, non-inferiority design. Patients were randomized in a 1:1 ratio. Exclusion: Presented with acute anaphylaxis, and their acute anaphylactic symptoms had not yet been treated. in the IV cetirizine group and 2.1

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Allergic Reaction ED E-9-1-1 Emergency Department 52

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. Initial interventions include local pressure, ice, and forward head positioning for persistent bleeds. Essentially, it increases blood clot stability.

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ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. Out-of-hospital cardiac arrest unfortunately occurs relatively commonly and emergency physicians must be equipped to diagnose and treat this rapidly.

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Defibrillator E-9-1-1 ALS Epinephrine 52

NAEMSP

APRIL 19, 2023

After several cycles of defibrillation, epinephrine, and amiodarone, the patient remains in cardiac arrest. The medic on scene calls on-line medical control to ask for advice, and specifically asks if calcium can be given, as she has “seen it work before” to get pulses back as a “last ditch effort.” mEq/L (OR: 51.11; 95% CI: 3.12−1639.16;

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Broome Docs

APRIL 6, 2023

A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments. Epinephrine metered-dose inhaler for pediatric croup. Acad Emerg Med. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023 Jan 21. doi: 10.1056/NEJMoa2212663. Epub 2022 Dec 7.

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REBEL EM

DECEMBER 19, 2022

trying harder and longer knowing they are enrolled in this study) Use of two different models of defibrillators may negatively impact the internal validity of this pilot study Certain baseline characteristics were not balanced, such as: prehospital intubation and Epinephrine administration.

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FOAMfrat

DECEMBER 26, 2024

IF YOU OR A LOVED ONE NEEDS HELP, CALL 988 OR SEEK CARE AT A LOCAL EMERGENCY DEPARTMENT. TRIGGER WARNING: TOPICS OF SUICIDE MAY BE HARD FOR SOME PEOPLE TO READ ABOUT. THIS ARTICLE IS COVERING THE MEDICAL ASPECTS OF CHEMICAL SUICIDES. REMEMBER, IF YOU ARE TREATING A SUICIDE ATTEMPT SURVIVOR, DO NOT PASS JUDGMENT.

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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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ALiEM

NOVEMBER 29, 2023

Xylazine is an alpha-2 agonist similar to clonidine that inhibits the release of norepinephrine and epinephrine resulting in decreased vascular tone and heart rate [4]. Opioid overdoses involving xylazine in emergency department patients: a multicenter study. How does xylazine toxicity present? 2022;14(8):e28160.

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Naloxone Overdose Epinephrine ALS 169

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization. On arrival in the emergency department, invasive blood pressure was 35/15mmHg and the patient was in profound cardiogenic shock with severe confusion secondary to brain hypoperfusion. The below ECG (ECG #4) was recorded.

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Coronary ACS Emergency Department Defibrillator 128

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest. We were trying to answer the question: Do all patients presenting to the emergency department with chest pain need to be placed on cardiac monitoring or could some be safely removed?

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EMDocs

MAY 26, 2023

But what about the patient who is agitated, and is a potential danger to themselves or to the ED staff? Do we Redirect? Patient that are agitated should always be treated with dignity and respect. This entails utilizing the least invasive non-pharmacologic means of assisting them, before moving to physical or chemical restraints.

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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 Before you can obtain any history, she gives birth in your waiting room. The neonate is apneic and has a heart rate of 48. How do you stabilize this patient? each year will require at least some intervention. ET tube size should be 2.5

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EMDocs

DECEMBER 18, 2023

In addition to clinical screening methods, many biomarkers have emerged over the years as potential adjuncts for early diagnosis of sepsis. The patient currently resides at a skilled nursing facility. Per staff, she has been acting progressively more tired, confused, and less interactive over the last three days.

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E-9-1-1 ALS Emergency Department Plasma 95

The Skeptics' Guide to EM

APRIL 20, 2019

Case: A 52-year-old man presents to the emergency department via EMS after a motor vehicle collision while driving home from the city. Alison picked the song “ It’s A Man’s World “ by James Brown for this paper on gender bias in academia and medicine. You suspect he has been drinking.

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Epinephrine ALS Emergency Department EMS 100

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch.

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EMDocs

JANUARY 4, 2024

The patient’s mother believes the patient thought the pills were acetaminophen, and she was taking them for abdominal pain. Bupropion lowers the seizure threshold and even at therapeutic doses patients can have seizures. 6 Severe toxicity: Seizures: It is unclear if seizures are caused by bupropion or the active metabolite, hydroxybupropion.

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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. A more practical definition of massive or life-threatening hemoptysis is that which causes signs of worsening respiratory distress, hemodynamic instability, abnormal gas exchange, or airway obstruction.

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Dr. Smith's ECG Blog

OCTOBER 20, 2013

With ventilations and epinephrine, she regained a pulse. Data collected included demographics, initial rhythm, EKG, emergency department (ED) CT and outcomes. A middle-age woman with h/o hypertension was found down by her husband. Medics found her apneic and pulseless, began CPR, and she was found to be in asystole.

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STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury.

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FOAMfrat

OCTOBER 20, 2023

In addition to this consensus paper, I utilize the above considerations for stepwise hemodynamic strategies found in the most recent print of The Manual of Emergency Airway Management (staying within my company's guidelines, or course ). Of note, in the paper by Russotto et al., How Do I Predict Physiologically Difficult Airways?

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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. What do you think? Just another NSTEMI.

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AAEM RSA

AUGUST 27, 2020

However, the decade since the original Hypothermia after Cardiac Arrest trial had seen significant advances in pre-hospital, emergency department, and critical care that may have contributed to these outcomes. Enrollees were then assigned to either TTM of 33ºC or 36ºC for 36 hours.

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ECG & Echo Learning

JANUARY 18, 2023

IIa C Pre-hospital logistics Management Recommendation Level of evidence The pre-hospital care of STEMI patients should be organized regionally (including all components from the emergency medical dispatch to catheterization laboratory) in order to provide reperfusion therapy as early as possible. I C Pain Titrated i.v.

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Don't Forget the Bubbles

DECEMBER 5, 2023

Data was collected at 2 emergency departments in America and included assessment by both clinicians and patients for a total of 31 patients. The device was assessed by the clinicians (emergency medicine doctors) using it on ease of use, speed of use and the appearance of the closed wound. Br J Gen Pract. doi: 10.3399/BJGP.2023.0006.

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