ALiEM

DECEMBER 3, 2024

The patient stated he was given Bactrim and amoxicillin about one month ago for another rash, though he was unsure of the diagnosis. He denied any known allergies or exposures to new foods or hygiene products. He had no chest pain, SOB, nausea, or diarrhea. He lives in a correctional facility and does not know of anyone with any rashes.

Emergency Department 152

Emergency Department OR 152

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Thus, the lumen observed may actually still be the same size as the original, normal lumen. Furthermore, in studies reporting progression of insignificant lesions to total thrombotic occlusions, the mean interval between angiography and acute myocardial infarction is 2.5 years, with the interval as long as 12 or 18 years in some studies.

Coronary 123

Coronary ACS OR EMR 123

ALiEM

JANUARY 13, 2025

Symptoms started approximately seven hours prior to arrival and progressive, severe pain eventually prompted her visit to the ED. This happened once 10 years ago, requiring reduction in the ED. The patient denied preceding trauma, rubbing her eyes/eye-lids, or any history of thyroid disease. She endorsed right eye blurred vision and severe pain.

Emergency Department 169

Emergency Department ED ALS OR 169

Core EM

JANUARY 1, 2025

Types of Necrotizing Fasciitis Type I (Polymicrobial) Involves aerobic and anaerobic organisms (e.g., Bacteroides, Clostridium, Peptostreptococcus). Common in immunocompromised patients or those with comorbidities (e.g., diabetes, peripheral vascular disease). Can occur in otherwise healthy individuals. Immunosuppression (e.g.,

Critical Care 130

Critical Care ICU OR 130

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 314

STEMI OR EMS 314

FOAMfrat

DECEMBER 26, 2024

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

Epinephrine 116

Epinephrine First Responder OR Emergency Management 116

EMDocs

DECEMBER 18, 2024

fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold

E-9-1-1 104

E-9-1-1 Emergency Department ICU ED 104

Don't Forget the Bubbles

DECEMBER 31, 2024

Communication is as Visual as it is Verbal Communication is not just about speaking words; its about connecting, understanding, and being understood. Whether interacting with children, young people, or even colleagues, the nuances of communication turn exchanges into meaningful dialogue. The tone of their voice, even when the words seem neutral.

Emergency Department 140

Emergency Department OR 140

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 343

Critical Care ALS ED Emergency Department 343

Emergency Medicine Cases

SEPTEMBER 12, 2023

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

Coronary 321

Coronary OR EMS 321

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 337

ALS Emergency Department OR EMS 337

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

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 124

OR STEMI ICU Coronary 124

Dr. Smith's ECG Blog

JANUARY 2, 2025

T-waves are quite tall and possibly peaked (HyperK?), but potassium returned normal. I do not see OMI here and all trops were only minimally elevated, consistent with either chronic injury from cardiomyopathy or with acute injury from sepsis. What is the QT interval? In LBBB, the QT interval is partly prolonged by the wide QRS. Bogossian et al. (1)

Coronary 117

Coronary OR Defibrillator ALS 117

Critical Care Scenarios

JANUARY 31, 2024

We discuss assessing patients prior to intubation or other airway management, including both elective and emergent circumstances, with Dr. Jed Wolpaw, anesthesiologist and intensivist from Johns Hopkins, anesthesiology residency program director, and host of the ACCRAC podcast. Find us on Patreon here! Buy your merch here! Find us on Patreon here!

OR 283

OR 283

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 107

E-9-1-1 ACS OR Emergency Department 107

The Skeptics' Guide to EM

NOVEMBER 16, 2024

A promising application of AI is the development of early warning systems to detect patient deterioration. These systems use real-time data from electronic health records (EHRs) and other sources to predict which patients are at risk of adverse outcomes, such as cardiac arrest or transfer to an intensive care unit (ICU) [1.2].

ICU 268

ICU Emergency Department ALS EMS 268

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 329

Emergency Department OR STEMI EMS 329

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 290

ALS ACS Emergency Department ED 290

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

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

American Ambulance Association

MARCH 3, 2025

This content is for AAA members only. Please either Log In or Join! The post Joint Position Statement on Criminal Liability for Alleged Deviations from Clinical Standards of Care in Emergency Medical Services appeared first on American Ambulance Association.

Emergency Medical Services 130

Emergency Medical Services Ambulance Emergency Medical Technician OR 130

Don't Forget the Bubbles

NOVEMBER 11, 2024

One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. Should we aim to prevent fever, or should we cool patients? A 12-year-old boy presents with a significant head injury following a road traffic accident. Fever is common among patients with TBI.

ALS 117

ALS Life Support Critical Care OR 117

ACEP Now

JANUARY 5, 2025

Her vital signs are normal, except for a heart rate of 115 bpm. Its going to take time to get her to a tertiary center. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. A patient’s mouth packed with gauze after tonsillectomy surgery. CREDIT: Dr. P.

Operating Room 98

Operating Room Epinephrine ALS ED 98

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 271

Plasma OR ED Critical Care 271

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 328

Operating Room Emergency Department ALS ED 328

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 318

Emergency Department ED ALS OR 318

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-9-1-1 290

E-9-1-1 Epinephrine Emergency Department OR 290

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

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

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

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

The Skeptics' Guide to EM

SEPTEMBER 28, 2024

Case: You are working a busy shift in a rural emergency department (ED) and your excellent Family Medicine trainee presents a case of a 63-year-old woman with chest pain and some intermittent radiation into the inter-scapular region. The patient has no specific risk factors for acute coronary syndrome (ACS) or dissection.

Emergency Department 231

Emergency Department ACS Coronary ALS 231

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 EMT 331

EMDocs

JANUARY 27, 2025

Variety of classes and types of ICIs: Anti-CTLA-4:Ipilimumab/Yervoy, Tremelimumab/Imjudo Anti-PD-1: Pembrolizumab/Keytruda, Nivolumab/Opdivo, Cemiplimab/Libtayo Anti-PD-L1: Avelumab/Bavencio, Atezolizumab/Tecentriq, Durvalumab/Imfinzi Anti-LAG-3/Anti-PD-1: Relatlimab and Nivolumab 20-90% of patients receiving ICIs will experience an adverse event; (..)

ACS 93

ACS OR 93

Emergency Medicine Cases

AUGUST 19, 2024

ECG artifact and lead reversal can mimic tachy-arrhythmia, infarct or Brugada. Learn how to identify these errors to prevent misdiagnosis on this month's ECG Cases with Dr. Jesse McLaren. The post ECG Cases 51 – Artifact and Lead Misplacement appeared first on Emergency Medicine Cases.

OR 266

OR EMS 266

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 ED OR 246