ALiEM

JUNE 10, 2024

Emergency physicians often face the challenge of deciding whether to proceed with imaging, given the potential risks associated with ionizing radiation from CT scans. High Risk (>12.1% sensitivity and 99.9% High Risk (>12.1% sensitivity and 99.9%

Emergency Department 317

Emergency Department ED OR 317

Emergency Medicine Cases

JUNE 18, 2024

Jesse McLaren illustrates the paradigm shift from STEMI to Occlusion MI (OMI) through 9 cases, and drives home the points that if there is STEMI criteria, consider false positives (eg. secondary and proportional to LVH or BER); if there is no STEMI criteria, consider false negatives and look for other signs of occlusion (eg.

STEMI 295

STEMI OR EMS 295

EMS 12-Lead

APRIL 9, 2024

No 12 Lead ECG was captured, but telemetry did reveal the following: The spouse offers a pertinent medical history to include HTN and HLD, and furthermore states that he hasn’t previously complained of any chest discomfort, or shortness of breath. He awoke earlier that morning in his usual state of health. The CXR demonstrated no pulmonary edema.

Coronary 290

Coronary ACS CAD ED 290

ALiEM

FEBRUARY 9, 2024

Low-risk patients do not routinely require stress testing in the ED. Intermediate-risk patients may be further stratified based on recent stress testing or coronary angiogram findings plus a modified HEART or Emergency Department Assessment of Chest Pain (EDACS) score. That’s because these values are assay specific. She does not smoke.

E-9-1-1 276

E-9-1-1 ED Coronary ALS 276

Emergency Medicine Cases

SEPTEMBER 12, 2023

The post ECG Cases 45 ECG in Weakness and Neurological Symptoms appeared first on Emergency Medicine Cases.

Coronary 303

Coronary OR EMS 303

The Skeptics' Guide to EM

DECEMBER 2, 2023

We don’t routinely perform sinus aspiration on children, but it is thought that the most common pathogens involved in sinusitis include Streptococcus pneumoniae Hemophilus influenzae, or Moraxella catarrhalis. Untreated sinusitis is associated with complications such as pre septal cellulitis, orbital cellulitis.

Emergency Department 292

Emergency Department ALS OR ED 292

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. He is also a fully-fledged ultrasonographer.

Critical Care 305

Critical Care ALS ED Emergency Department 305

Pediatric EM Morsels

JANUARY 19, 2024

[CDC 2023] In 2021, there were over 2800 cases of congenital syphilis, tripled from 2017. CDC 2023] Pseudoparalysis of Parrot – Presentation and Exam Infant presents with lack of movement of one or both upper extremities, and will cry with palpation. However , the musculoskeletal complaints may be the first presenting symptom !

Plasma 269

Plasma OR EMS ED 269

ALiEM

OCTOBER 27, 2023

He denied vomiting, dizziness, diplopia, loss of consciousness, or seizures. Nothing made it better or worse. Additional Images Physical Exam Vitals : BP 101/63; HR 76; RR 14; T 36.7°C Most cases of MCM are found during prenatal ultrasonography. Adults with isolated MCM are typically asymptomatic and found incidentally on radiographic imaging.

OR 278

OR ED 278

Pediatric EM Morsels

AUGUST 23, 2024

It does NOT have structural brain damage visible on standard neuroimaging. In the research setting, abnormalities can be found via functional, blood flow, or metabolic imaging. Mild traumatic brain injury also includes a larger group of injuries that may have evidence of structural injury.

Emergency Department 270

Emergency Department OR ED EMS 270

Dr. Smith's ECG Blog

OCTOBER 8, 2024

This was sent to me by a reader who wishes to remain anonymous. A lady in her 60s came to the ER with chest discomfort and shortness of breath. She had a history of previous anterior MI treated by primary PCI to the proximal LAD. The first EKG is from 2:30 PM on the day of presentation to the ER.

OR 116

OR STEMI ICU Coronary 116

Core EM

JANUARY 25, 2024

Written By: Kaitlynn Tracy, MD Edited By: Sean Schnarr, MD and Gregg Chesney, MD Definition/Background: Burns are classified as being major, moderate, or minor in severity. 4 Survival rate for all burn injuries is around 97%, which is a notable increase from 75% in the 1960’s.

ED 246

ED E-9-1-1 First Aid OR 246

Pediatric EM Morsels

MARCH 29, 2024

Let’s consider Inborn Errors of Metabolism Presenting in the ED : Inborn Errors of Metabolism: Basics Common Presentations, Uncommon Kiddos For the child with lethargy, vomiting, acidosis, hypoglycemia , organomegaly, or cardiopulmonary arrest remember to consider Inborn Errors of Metabolism (IEM) on your DDx. Kid with Known diagnosis?

ED 294

ED Plasma OR EMS 294

Pediatric EM Morsels

APRIL 19, 2024

Pediatric Buckle and Greenstick Forearm Fractures: Basics The junction of the metaphysis and diaphysis in pediatric long bones is an area of biomechanical transition (Light, 1984) Thin metaphyseal cortex meets the thick cortex of the diaphysis Or in Emergency Medicine terms, “ Thick bone meet thin bone.”

ALS 286

ALS ACS Emergency Department ED 286

Emergency Medicine Cases

APRIL 2, 2024

In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. They explain complementary diagnostic insights into pericardial effusion and cardiac tamponade, occlusion MI and RV strain.

Emergency Department 312

Emergency Department OR STEMI EMS 312

Emergency Medicine Cases

NOVEMBER 12, 2024

We discuss indications and timing of intubation, penetrating neck trauma, the head injured patient, the agitated patients and the soiled airway. The critical question is: when should we deviate from, delay or modify RSI, and how do we navigate the unique challenges presented by trauma airways and airway trauma? and many more.

EMS 270

EMS OR 270

Pediatric EM Morsels

MAY 10, 2024

Ask about suicidal ideation : Let’s not miss a caustic ingestion… Ask about birth control : Teens may be on OCPs and at increased risk for PE and their parents don’t know it Ask about drugs : Does your patient smoke, vape, or use cocaine? Have you ever had chest pain or shortness of breath in exercise? Cardiac Murmurs, gallops or rubs? Equal pulses?

E-9-1-1 268

E-9-1-1 OR EMS 268

Core EM

JANUARY 25, 2024

Treat aggressively with IVF, antibiotics (covering gram negative and anaerobic organisms), and rapid transfer to the OR to resect the affected colon A 32-60% mortality rate has been reported when stercoral colitis is associated with perforation! Stercoral Colitis.

E-9-1-1 246

E-9-1-1 OR 246

Core EM

JANUARY 25, 2024

Definition: Catatonia: A behavioral motor dysregulation syndrome marked by an inability to move normally despite full physical capacity, which can occur in the context of many underlying psychiatric and general medical disorders [4]. Epidemiology : Who typically suffers from catatonia? Who typically suffers from malignant catatonia?

MICU 246

MICU Emergency Department OR ED 246

Pediatric EM Morsels

JULY 26, 2024

While it is important for us to maintain a safe work environment for our patients and our team, managing the agitated patient requires more of us than administering Droperidol or Ketamine. Make sure to consult your friendly neighborhood pediatric neurologist and/or rheumatologist! The prevalence ranges from 12.5%-61%

Plasma 269

Plasma OR ED Critical Care 269

The Skeptics' Guide to EM

APRIL 13, 2024

When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago. A code stroke is activated, and the initial CT head shows no signs of hemorrhage or early ischemic changes. A CT angiogram shows a proximal middle cerebral artery occlusion. CT perfusion showed a 10 mL core and 189 mL penumbra.

ALS 281

ALS Emergency Department OR EMS 281

The Skeptics' Guide to EM

MARCH 2, 2024

It’s more common and more dangerous than Type B, as it can lead to serious complications like rupture into the pericardial space leading to cardiac tamponade, aortic valve insufficiency, or myocardial infarction. Symptoms can include sudden onset of pain in the back or abdomen, depending on the exact location and extent of the dissection.

Operating Room 296

Operating Room Emergency Department ALS ED 296

Core EM

JANUARY 25, 2024

Studies have shown that patients’ descriptions of their symptoms can frequently switch between these categories every few minutes. GRACE-3 Population of Interest Adult ED patients with dizziness present less than 2 weeks and without an apparent medical or neurological cause of dizziness.

EMS 246

EMS Emergency Department OR ED 246

ALiEM

JUNE 5, 2023

Human illness is most commonly acquired by handling animal fluids or pelts. There are several forms of anthrax, however cutaneous is the most common (95% of cases) and the least complicated to treat [2]. What are the symptoms of cutaneous anthrax? [3, 3, 4] Naturally occurring cases develop after spores of B. Is cutaneous anthrax reportable? [6,

ALS 256

ALS OR ED 256

Pediatric EM Morsels

JULY 19, 2024

Your support staff…depending on the amount of bleeding, you are about to have your hands full and may need IV access, medications, airway management, etc. Get a hold of ENT early as OR management and/or admission are common. Set up suction x2 in the room! Using a Mac Laryngoscope as a tongue blade can be helpful! Headlamps can also be helpful!

E-9-1-1 286

E-9-1-1 Epinephrine Emergency Department OR 286

ALiEM

AUGUST 7, 2023

The patient is reluctant to abduct the right arm secondary to pain. Neuro : No gross motor or sensory deficits were appreciated Laboratory Data Non-contributory Case Question: What is the diagnosis? Sternoclavicular (SC) joint dislocation SC joint dislocation can occur with anterior or posterior displacement of the medial clavicular head.

Emergency Department 246

Emergency Department OR EMS ED 246

Core EM

JANUARY 25, 2024

The differential diagnosis for this patient includes Ventricular Tachycardia (VT) and Supraventricular Tachycardia (SVT) with aberrancy. Differentiating between the two is difficult as multiple proposed diagnostic criteria have yet to demonstrate sufficient sensitivity or specificity for a definitive diagnosis. Sources [link] [link] [link] [link].

Coronary 246

Coronary Emergency Department ED OR 246

Core EM

JANUARY 25, 2024

Consider these medications if there are signs of end-organ dysfunction, there is a considerable delta in baseline BP, systolic is less than 90 and/or MAP is less than 65 Norepinephrine is a good pressor for a lot of the situations that we encounter in the emergency department, such as septic shock, undifferentiated shock and hypovolemic shock.

Epinephrine 246

Epinephrine Critical Care Emergency Department ED 246

ALiEM

NOVEMBER 17, 2023

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. Urethral prolapse is a rare condition occurring in prepubertal female pediatric patients.

Emergency Department 250

Emergency Department OR 250

EMS 12-Lead

MAY 15, 2024

Paramedics must recognize, however, that re-arrest is a dangerous and lethal condition that is more difficult to recognize with false electrical capture showing an arcing artifact that the crews interpret as a QRS complex. With the native beats quickly following the pacer spike, the paramedics rightly reported they palpated a pulse.

Epinephrine 331

Epinephrine Paramedic CPR ED 331

Emergency Medicine Cases

FEBRUARY 13, 2024

In this month's ECG Cases blog Dr. Jesse McLaren reviews interpretation of the pre-arrest ECG: identifying high risk ECGs requiring empiric treatment like calcium for hyperkalemia, magnesium for long QT, or reperfusion for Occlusion MI; the intra-arrest ECG: identifying pseudo-PEA; and post-arrest ECG: the importance of serial ECGs to reduce false (..)

STEMI 283

STEMI OR EMS 283

The Skeptics' Guide to EM

DECEMBER 16, 2023

Background: Patient experiences of care are associated with health outcomes and may impact perspectives of ED care and the patient recovery process.(1-5) 1-5) Perceptions of discrimination in healthcare are linked to delays in seeking medical treatment, nonadherence to clinician recommendations, and mistrust of clinicians and the healthcare system.(6-7)

Emergency Department 291

Emergency Department ED ALS OR 291

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. Technique: Probe selection: The linear probe is more ideal for pediatric patients and adults with a leaner body habitus. High-quality images obtained in <1 minute in 87.9%

ALS 246

ALS Critical Care OR 246

High Performance EMS

AUGUST 9, 2024

A brief delay on the low-priority call to obtain an appropriate match should not impact the immediate outcome or, potentially more importantly, the results of the next serious one. Life-threatening requests are similarly streamlined.

BLS 264

BLS CAD Advanced Life Support Life Support 264

Critical Care Scenarios

APRIL 24, 2024

He does not really count B-lines; if he sees B-lines in more than one dependent zone, he takes it as evidence the patient could be decongested. * IVC is a reasonable method of estimating RAP; it is not reliable to gauge fluid responsiveness or other questions. A non-plethoric IVC and absence of B-lines suggests a fluid tolerant patient.

OR 285

OR 285

Pediatric EM Morsels

SEPTEMBER 22, 2023

Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues. It may, however, be seen preceding or concurrently with neurogenic shock. Thought to be a “stunning” of the spinal cord.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

Pediatric EM Morsels

MARCH 15, 2024

Vitamin B6 Deficiency ). Being comfortable evaluating and managing pediatric seizures also requires a lot of humility. The vast spectrum of seizure presentations, especially subtle or focal seizures, makes it challenging to know all there is to know about seizures. Pathologic uncontrollable laughing without mirth (lacking joy).

Emergency Department 258

Emergency Department OR EMS 258