Emergency Medicine Cases

APRIL 2, 2024

In this part 2 of our 2-part podcast on asthma with Dr. Sameer Mal and Dr. Leeor Sommer, we dig into the recognition and management of life-threatening asthma. We answer such questions as: what are the key elements in recognition of threatening asthma? What are the most time-sensitive interventions required to break the vicious cycle of asthma? What are the best options for dosing and administering magnesium sulphate, epinephrine, fentanyl and ketamine in the management of the crashing asthmatic

Epinephrine 344

Epinephrine EMS 344

EMS 12-Lead

MAY 15, 2024

TCP in the ROSC Patient: False Electrical Capture at 75mA Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the second installment of a blog series showing how transcutaneous pacing (TCP) can be difficult and how you can improve your skills. We will be using redacted information from different cases where paramedics attempted TCP in the field.

Epinephrine 331

Epinephrine Paramedic CPR ED 331

ALiEM

JUNE 10, 2024

For years, adult literature has provided clear guidelines for cervical spine imaging through the NEXUS and Canadian C-spine Rule (CCR) tools. These have been invaluable in helping clinicians decide when to image the neck in trauma patients. Similarly, the Pediatric Emergency Care Applied Research Network (PECARN) has developed robust tools for assessing blunt head trauma in children.

Emergency Department 317

Emergency Department ED OR 317

The Skeptics' Guide to EM

FEBRUARY 11, 2024

Reference: McLatchie et al and DAShED investigators. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. EMJ Nov 2023. Date: February 11, 2024 Guest Skeptic: Nirdosh Ashok Kumar, Emergency Medicine Specialist – Aga Khan University Hospital, Karachi, Pakistan. […] The post SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Sy

ED 303

ED Emergency Department ALS OR 303

Pediatric EM Morsels

JULY 19, 2024

Previously, we covered Post-Tonsillectomy Hemorrhage and how we hope that “all bleeding eventually stops: ideally, by means that we have imposed rather than by exhaustion of the patient’s RBC resources.” Since the original morsel ( way back in 2012 ), the literature has shown that there are a few extra ingredients that we can add to our morsel recipe when we care for children with post-tonsillectomy hemorrhage.

E-9-1-1 286

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

American Ambulance Association

OCTOBER 10, 2024

FOR IMMEDIATE RELEASE Contact: Tristan North tnorth@ambulance.org October 10, 2024 Congressman Mike Bost Honored with Legislative Recognition Award from the American Ambulance Association Washington, D.C. — The American Ambulance […] The post Congressman Mike Bost Honored with Legislative Recognition Award appeared first on American Ambulance Association.

Ambulance 263

Ambulance 263

Critical Care Scenarios

APRIL 24, 2024

We discuss the role of point-of-care ultrasound in evaluating the patient with kidney injury and assessing volume status, with Abhilash Koratala (@nephroP), nephrologist, Director of Clinical Imaging for Nephrology at the Medical College of Wisconsin, and champion of nephrology-focused ultrasound. Find us on Patreon here! Buy your merch here! Takeaway lessons References Episode 4 with … Continue reading "Episode 73: POCUS for nephrology, with Abhilash Koratala" We discuss the role of point-of-ca

OR 285

OR 285

EMCrit Project

AUGUST 26, 2024

We often joke that the right ventricle is the “forgotten ventricle,” but there is a sad truth behind this joke. Recently, there has been increased recognition of the importance of right ventricle failure and systemic congestion within some circles (e.g., nephrologists and resuscitationists). However, overall the right ventricular failure continues to be commonly overlooked.

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138

St. Emlyn's

NOVEMBER 6, 2024

St.Emlyn's - Emergency Medicine #FOAMed Creating a learning culture in the emergency department (ED) fosters psychological safety, open communication, and continuous improvement. This approach supports team resilience, enhances patient care, and reduces burnout. Learn practical steps to build a strong learning culture in your ED, promoting growth and collaborative excellence in emergency medicine.

ED 123

ED Emergency Department 123

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think? If this EKG were handed to you to screen from triage without any clinical information, what would you think?

E-9-1-1 136

E-9-1-1 ACS Emergency Department Coronary 136

Emergency Medicine Cases

MAY 28, 2024

Once the diagnosis of nontraumatic subarachnoid hemorrhage (SAH) has been made, our job is not done. Mortality in SAH patients can be up to 30% even without neurological deficit. Paying attention to the time-sensitive details of ED management of SAH patients can have a significant impact on their outcome. In this second part of our 2-part podcast series on subarachnoid hemorrhage with Dr.

ED 307

ED EMS 307

EMS 12-Lead

MARCH 30, 2024

TCP In Transit: A case reviewing transcutaneous pacing, false electrical capture, and re-arrest. Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the first installment of a blog series showing how transcutaneous pacing (TCP) can be difficult, and how you can improve your skills. We will be using redacted information from different cases where paramedics attempted TCP in the field.

CPR 312

CPR Paramedic Ambulance Defibrillator 312

ALiEM

MARCH 18, 2024

A 30-year-old female with a past medical history of Crohn’s Disease presented to the ED for evaluation of an acutely bruised right 4th finger. She stated she was typing on a computer keyboard approximately 10 minutes prior to presentation and she noticed a sudden popping sensation at the base of her right ring finger. After the popping sensation, she noticed a cool sensation of the finger and numbness to the entire finger.

Emergency Department 306

Emergency Department ED OR 306

The Skeptics' Guide to EM

MARCH 2, 2024

Reference: Gibbons et al. The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol): A multicenter, prospective, observational study. AEM February 2024. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. He is the Vice Chair of the Emergency Department at Nassau University […] The post SGEM#432: SPEED, Give Me What I Need – To Diagnose Acute Aortic Dissections first appeared on Th

Operating Room 301

Operating Room Emergency Department ALS ED 301

Pediatric EM Morsels

MARCH 29, 2024

Often our job requires us to consider the presence of needles of significant illness in the haystack of nonspecific symptoms. With the help of our favorite geneticist , Dr. Liz Baker, we will dive into the haystack headfirst and find those needles. Hopefully, without getting poked. 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 , organom

ED 294

ED Plasma OR EMS 294

American Ambulance Association

JULY 23, 2024

To the Editor of The Guardian, On July 21, The Guardian published Jessica Glenza’s “Plan to end exorbitant ‘surprise’ ambulance bills heads to Congress.” The inflammatory title and lack of […] The post What The Guardian Missed About US Ambulance Balance Billing appeared first on American Ambulance Association.

Ambulance 278

Ambulance 278

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! Takeaway lessons References We discuss assessing patients prior to intubation or other airway management, including both elective and emergent circumstances, with Dr.

OR 286

OR 286

First 10 EM

APRIL 2, 2024

Give your patients a break. Nobody is a perfect diagnostician. Not even the best trained physician can determine, with 100% accuracy, which patients have serious pathology. Even with advanced testing, we aren’t close to perfect. However, if you listen to the subtext of breakroom complaints, it seems like we expect patients to be better diagnosticians […] The post Are you a perfect diagnostician?

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140

REBEL EM

FEBRUARY 15, 2024

Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits.

ICU 141

ICU ALS ED OR 141

St. Emlyn's

JULY 9, 2024

St.Emlyn's - Emergency Medicine #FOAMed A podcast with Steve Smith ECG educator extraordinaire where we discuss occlusive myocardial infarction and the future of AI and ECG interpretation. The post Podcast – Occlusive Myocardial Infarction, ECGs and Artificial Intelligence with Steve Smith appeared first on St.Emlyn's.

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EMOttawa

JANUARY 25, 2024

Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU. There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.

ICU 141

ICU ED OR Critical Care 141

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. The post ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain appeared first on Emergency Medicine Cases.

Emergency Department 307

Emergency Department OR STEMI EMS 307

EMS 12-Lead

APRIL 9, 2024

David Didlake @DidlakeDW EMS personnel responded to the residence of an 81 y/o Male with syncope. His spouse had called 911 after she heard a loud “thud” in the adjacent room. He was found altered, hypotensive, and with a large hematoma to the left periorbital region. 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 shor

Coronary 290

Coronary ACS CAD ED 290

ALiEM

JUNE 24, 2024

With some things in life, speed is everything. Adenosine is one of those things. With an ultrafast half-life estimated to be between 0.6 to 10 seconds [1], parenterally administered adenosine needs to reach the cells of the AV-node and cardiac pacemaker cells in an expedited fashion to facilitate the termination of supraventricular tachycardias (SVTs).

ALS 286

ALS 286

The Skeptics' Guide to EM

APRIL 13, 2024

Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. NEJM Feb 2024 Date: April 12, 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. He is an assistant professor in Emergency […] The post SGEM#436: For the Longest Time – To Give TNK for an Acute Ischemic Stroke first appeared on The Skeptics Guid

ALS 287

ALS Emergency Department OR EMS 287

Pediatric EM Morsels

APRIL 19, 2024

Trauma season is at hand and like all other pediatric emergency departments in the country, we find our ED breaking ( pun intended ) at the seams with orthopedic injuries. We see all different flavors of upper extremity injuries. Yes, we’re talking about your clavicular , proximal humeral, supracondylar, lateral condylar , scaphoid and metacarpal fractures.

ALS 286

ALS ACS Emergency Department ED 286

American Ambulance Association

OCTOBER 8, 2024

FOR IMMEDIATE RELEASE Contact: Tristan North tnorth@ambulance.org October 8, 2024 Senator Jerry Moran Honored with Legislative Recognition Award from the American Ambulance Association Washington, D.C. — The American Ambulance Association […] The post Senator Jerry Moran Honored with Legislative Recognition Award appeared first on American Ambulance Association.

Ambulance 263

Ambulance 263

Dr. Smith's ECG Blog

NOVEMBER 14, 2024

This was texted to me by a paramedic while I was out running one day: "54 yo male chest pain started at 1pm. History of diabetes type II and stent placement in 2018. I’m seeing hyperacute T waves III, aVF, down sloping depression I and aVL. Thoughts?" What do you think? I responded: "Definite inferior OMI. And Right Ventricular. Activated the Cath Lab.

ED 116

ED Coronary Paramedic OR 116

First 10 EM

NOVEMBER 11, 2024

In the most recent BroomeDocs podcast, we talk about an attempt to use the IM route to give cardiac arrest victims epinephrine faster. (The podcast and Research Roundups blog post might actually come out next week.) I was skeptical about the outcomes, partly because the evidence that epinephrine helps at all in cardiac arrest is […] The post IV versus IO for cardiac arrest (PARAMEDIC3 and IVIO) appeared first on First10EM.

Epinephrine 118

Epinephrine EMS 118

REBEL EM

MAY 27, 2024

Background: The REVERT Randomized Controlled Trial demonstrated the superiority of the modified valsalva maneuver (MVM) over the standard valsalva maneuver (VM) in re-establishing normal sinus rhythm (NSR) in patients with PSVT (Appelboam 2015). MVM exaggerates venous return to the heart and increases vagal outflow by elevating the patient’s legs.

OR 137

OR E-9-1-1 ED ALS 137

FOAMfrat

MARCH 19, 2024

The Hamilton T1 is quickly becoming one of the most prominent ventilators in the transport environment. While initially, all the bells and whistles can be intimidating, some high points make the learning curve slightly less steep. My goal for this blog is to highlight some "hacks" that are actually just strategies you should know and common misconceptions.

OR 135

OR 135

EMOttawa

MARCH 14, 2024

Posterior circulation ischemia accounts for approximately 20-25% of all ischemic strokes and is a significant cause of patient disability. The diagnosis can be extremely challenging as findings are often not typically focal. Posterior strokes are misdiagnosed more than 3x more often than anterior circulation strokes.1 Similar to anterior circulation strokes, posterior strokes are most commonly […] The post Posterior Circulation Strokes appeared first on EMOttawa Blog.

Critical Care 136

Critical Care ICU 136

Emergency Medicine Cases

AUGUST 19, 2024

We over-admit low risk acute heart failure patients and under-admit high risk heart failure patients. In this podcast we discuss the diagnostic accuracy of various clinical features, lab tests and imaging modalities for acute heart failure, the 3 validated risk stratification tools and a simple approach to PoCUS for the diagnosis and prognostication of acute heart failure in the ED to improve our diagnostic accuracy and disposition decisions for patients with acute heart failure.

ED 290

ED EMS 290

FirstNet Authority

OCTOBER 30, 2024

FirstNet Authority Welcomes New, Returning Board Members Press Releases michelle.fordi… Wed, 10/30/2024 - 13:08 The First Responder Network Authority (FirstNet Authority) is an independent authority within the U.S. Department of Commerce National Telecommunications and Information Administration. Established in 2012, the FirstNet Authority’s mission is to ensure the building, deployment, and operation of the nationwide broadband network that equips first responders to save lives and protect U.S.

First Responder 118

First Responder 118

ALiEM

MARCH 5, 2024

Which medication can be derived from the bark of the pictured tree? Aspirin Atropine Colchicine Quinine Reveal the Answer 1. Aspirin Background The photo shows a weeping willow, a member of the Salix genus of trees. Willow tree bark contains salicin from which aspirin (acetylsalicylic acid) can be derived. For over 3500 years, willow bark has been used as a traditional medicine to treat fevers and pain [1].

OR 286

OR 286

The Skeptics' Guide to EM

OCTOBER 5, 2024

Date: October 2, 2024 Reference: Paxton et al. Headpulse measurement can reliably identify large-vessel occlusion stroke in prehospital suspected stroke patients: Results from the EPISODE-PS-COVID study. AEM Sept 2024 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the UMass Chan Medical School – Baystate.

Emergency Medical Services 262

Emergency Medical Services ALS EMS Paramedic 262

NAEMSP

OCTOBER 9, 2024

Author: Joshua Stilley, MD FACEP FAEMS This article was written in collaboration with the National Adrenal Diseases Foundation Background: Adrenal crisis occurs when the adrenal glands are unable to produce enough endogenous steroids under stress. This is often due to primary adrenal insufficiency, also known as Addison’s disease, or secondary causes like chronic exogenous steroid use leading to adrenal suppression.

EMS 122

EMS Crisis Prevention Emergency Department BLS 122