Greater Sydney Area HEMS

FEBRUARY 20, 2024

This would therefore remove some of the limitations (perceived or real) around time delays associated with using ultrasound for central access as there would be no need for probe covers and positioning of the portable ultrasound (which often needs the help of a second operator, a significant limitation in a small prehospital medical team).

Ultrasounds 98

Ultrasounds Shock Research Operations 98

EMDocs

DECEMBER 2, 2023

BMC Neurol 11 , 8 (2011). He has no known medical history and has never been to the doctor. Kelliny, M., Binaghi, S. Cerebral aneurysm exclusion by CT angiography based on subarachnoid hemorrhage pattern: a retrospective study. link] Fang C, Leavitt JA, Hodge DO, Holmes JM, Mohney BG, Chen JJ. JAMA Ophthalmol. 2017 Jan 1;135(1):23-28.

EMS 95

EMS Operations Pediatrics Emergency Department 95

EMDocs

AUGUST 12, 2023

Management consists of intravenous antibiotics , and hand surgery should be consulted to consider operative debridement. Emergency Medicine News 33(12):p 8,9, December 2011. | Inoculation usually occurs by penetrating injury , which seeds the tendon sheath. Unrecognized or persistent infection can lead to necrosis of the tendon.

EMS 96

EMS Fractures Operations Ultrasounds 96

EMDocs

SEPTEMBER 7, 2024

In this patient with a penetrating posterior flank injury, trace-free fluid in the pelvis on eFAST, and ongoing signs of hemorrhagic shock despite fluid and blood product administration, transferring to the operating room for exploration is indicated, especially with high probability of zone III injury-related retroperitoneal bleeding.

EMS 98

EMS Fluid Resuscitation Resuscitation Radiology 98

ALiEM

SEPTEMBER 13, 2024

An emergent ophthalmology consult is needed to plan for operative repair. Epub 2011 Dec 2. Tonometry and ocular ultrasound (US) are generally not recommended as you could squeeze more liquid out of the eye or increase the intraocular pressure even more, pushing the iris further out. Endophthalmitis following open-globe injuries.

Emergency Department 64

Emergency Department Academics Fractures Hospitals 64

PulmCCM

SEPTEMBER 4, 2024

OP is operating point, the operating point defines the cardiac output on the y-axis and Pra on the x-axis; Rcardiac is cardiac resistance (i.e., OP1 is operating point 1 at baseline. With tamponade, operating point 2 (OP2) is formed. McNaughton DA, Abu-Yousef MM, (2011) Doppler US of the liver made simple.

Ultrasounds 84

Ultrasounds Operations Research Outcomes 84

PHEM Cast

DECEMBER 1, 2017

Journal of Special Operations Medicine : a Peer Reviewed Journal for SOF Medical Professionals , 13 (4), 53–58. Prehospital needle aspiration and tube thoracostomy in trauma victims: a six-year experience with aeromedical crews. The Journal of Emergency Medicine , 13 (2), 155–163. Beckett, A., Pannell, D., Acharya, S., Branco, B.

Academics 52

Academics Radiology Radiology Resuscitation 52

PHEM Cast

DECEMBER 12, 2016

Resuscitation; 2011: 1194-1197 pdf Equipment required for resuscitative thoracotomy: Surface anatomy: Appearance of pericardial clot A foley catheter being used to fill a cardiac wound – note how easily this could be pulled out. Guidelines for withholding or termination of resuscitation in prehospital cardiopulmonary arrest.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

ALiEM

NOVEMBER 27, 2023

One case report published in 1993 used RUQ abdominal ultrasound to identify septations (violin-string adhesions) and ascites to ultimately diagnose FHCS, later confirmed by serologic and operative evidence [2]. Gynecol Surg 8, 129–134 (2011). Yeungnam Univ J Med 35(1), 127-129 (2018). Theofanakis, C.P., Kyriakidis, A.V.

Ultrasounds 64

Ultrasounds Academics Operations OB/GYN 64

Don't Forget the Bubbles

JUNE 17, 2024

Exposure to incivility hinders clinical performance in a simulated operative crisis. 2011 Apr 1;78(2):202-9. Journal of nursing care quality. 2020 Jan 1;35(1):70-6. Katz D, Blasius K, Isaak R, Lipps J, Kushelev M, Goldberg A, Fastman J, Marsh B, DeMaria S. BMJ Quality & Safety. 2019 May 31:bmjqs-2019. Keller R, Allie T, Levine R.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

PHEM Cast

JULY 6, 2017

Cricothyrotomy performed with the Melker set or the QuickTrach kit: procedure times, learning curves and operators’ preference. British Journal of Anaesthesia (2011) 106 (5): 617-631. Il Giornale Di Chirurgia , 35 (7-8), 165–170. Woodall, N., & Frerk, C. link] Dover, K., Howdieshell, T.

Airway Management 52

Airway Management Academics Operations Resuscitation 52

Don't Forget the Bubbles

JANUARY 17, 2024

Forrester reported data from the Texas Poison Centers surrounding 110 cases of superabsorbent polymer bead ingestions between 2011 and 2016. They passed away a few days after a second operation. Children will swallow almost anything. Why should Orbeez be an exception? Unfortunately, the anastomosis broke down. It’s beads, too!

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

RebelEM

SEPTEMBER 11, 2023

Similarly, surgeons might hesitate to operate on older patients with multiple comorbidities due to higher associated risks. 2011 Mar;18(3):227-35. For instance, patients showing signs of jaundice and elevated bilirubin, indicative of choledocholithiasis, would more likely undergo MRCP and ERCP. Acad Emerg Med. PMID: 21401784.

Ultrasounds 69

Ultrasounds Radiology Radiology Emergency Department 69

Taming the SRU

JANUARY 29, 2024

Variations in sensitivity are thought to be related to operator technique, patient habitus, and difficulty evaluating the subclavian vein beneath the clavicle. [12] 2011 Dec;77(12):1606-12. 13] Ultimately, catheter-based venography is the gold-standard for diagnosis of thrombosis of the upper extremity deep veins.

Emergency Department 94

Emergency Department Fractures Hospitals Operations 94

RebelEM

NOVEMBER 30, 2022

Goldfrank’s Toxicologic Emergencies, 9e New York, NY: McGraw-Hill; 2011. 10, (-) LR = 0.13 Methemoglobin Inducers. In: Nelson LS, Lewin NA, Howland M, Hoffman RS, Goldfrank LR, Flomenbaum NE. Link Post Peer Reviewed By: Salim R.

Ultrasounds 52

Ultrasounds Pediatrics Operations EMS 52

RebelEM

MARCH 27, 2023

First ED-based study to evaluate how operational effects such as crowding can affect patient care in the form of LPV Included ARDS criteria relating to the usage of LPV in the ED allowing evaluation as to whether patients with ARDS were more likely to receive LPV settings. 2011 Feb 15; Epub 2010 Aug 27. PMID: 19325480 Gajic O, et al.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Taming the SRU

AUGUST 30, 2023

A 2011 meta-analysis in the journal of Academic Emergency Medicine found ESR, CRP, and PCT were not acutely useful in the diagnosis of septic arthritis due to wildly varying sensitivities and specificities between studies. 2011 Jan;3(1):118-27. 2011 Aug;18(8):781-96. 2011 Sep;18(9):1011. In: StatPearls [Internet].

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Taming the SRU

MAY 27, 2024

This often is seen in trauma, cancer, post-operatively, and end-stage metabolic conditions with excessive colloid or protein leak. If the volume of fluid is anticipated to re-accumulate quickly, a drain should be placed. a) left image: normal pleural cavity, image accessed from 2313 The Lung Pleurea - Pleural cavity - Wikipedia ; under CC 3.0

Emergency Department 87

Emergency Department Ultrasounds Radiology Radiology 87

Greater Sydney Area HEMS

APRIL 26, 2023

Although remember, as is observed intra-operatively from tourniquet application, muscle can tolerate hours of hypoxia. 2011, 22:77-86. This occurs via inadequate muscle perfusion. Thus, ST-induced rhabdo is secondary to stasis rather than direct physical trauma (as seen in crush injury). ST mechanisms can occur before then. Merchant D.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

ALiEM

AUGUST 9, 2023

The lung POCUS is also operator-dependent, and it has a steep learning curve. 2011 Oct;140(4):859-866. Limitations Lung pathology may be missed without a complete lung POCUS scanning protocol, as you will only see pathology located directly under the probe. J Ultrasound Med. 2017 Nov;36(11):2325-2328. West J Emerg Med.

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

Pediatric Emergency Playbook

JUNE 1, 2017

Fontan Operation and the Single Ventricle. 2011; 2(1):70-72. 2011 Jan-Jun; 4(1): 81–83. 2011; 32:492-497. 2011; 552-555. 2011; 128(6):1-6 Munk K et al. References Congenital AboulHosn JA et al. Congenit Heart Dis. 2007; 2:2-11. Aliku TO et al. Acute Myocardial Infarction related to Blunt Thoracic Trauma.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Pediatric Emergency Playbook

MARCH 1, 2016

Often children even with high-grade splenic and liver lacerations can be managed non-operatively. Unfortunately, a negative FAST cannot help with detecting or grading the laceration for non-operative management. CT Abdomen and Pelvis, IV contrast: helpful in grading splenic and liver lacerations with goal to manage non-operatively.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

PHEM Cast

SEPTEMBER 6, 2017

2013;118(1):192-201. doi:10.1097/ALN.0b013e318278c8b6 0b013e318278c8b6 A Prolonged phase II, increased α angle, and steeper phase III suggest bronchospasm or airway obstruction.

CPR 52

CPR Resuscitation Operations Shock 52

Northwestern EM Blog

DECEMBER 20, 2021

Management is orthopedic consultation for operative stabilization [12]. doi:10.1136/archdischild-2011-301245. Physical exam classically shows external rotation and abduction of the hip during hip flexion. References Smith E, Anderson M, Foster H. The child with a limp: a symptom and not a diagnosis. 2012;97(5):185-193.

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

RebelEM

NOVEMBER 3, 2022

Albert 2011, Jabre 2009) However, the existing literature comparing etomidate and ketamine is conflicting. The environment, operator-related factors, and equipment are different in a pre-hospital vs. ED setting. Background: Rapid sequence intubation (RSI) induction agent selection remains a heavily debated matter.

Emergency Department 52

Emergency Department Outcomes Sepsis Operations 52

Pediatric Emergency Playbook

FEBRUARY 1, 2016

REBOA If you have access to resuscitative endovascular balloon occlusion of the aorta or REBOA, this may be an option to temporize the child to get him to the relative control of the operating room. 2011 Dec;71(6):1869-72. J Pediatr Surg. 2013 Jun;48(6):1377-83. Stannard A, Eliason JL, Rasmussen TE.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Advanced Emergency Nursing from AENJ

MAY 27, 2014

St John History Volume 10 (2010-2011) **Australian review of Sparklet Resuscitators and CO2 therapy. The Therapeutic Use of Carbon Dioxid After Anesthesia and Operation. Select Bibliography: Fahey, D OStJ. The use of carbon dioxide in resuscitation. Link to photograph of Yandell Henderson, Ph. Biographical Memoirs, V. Haggard, H.

Resuscitation 40

Resuscitation Poisoning Research Administration 40

Advanced Emergency Nursing from AENJ

NOVEMBER 20, 2014

ET Hostile Fire Environments Murphy’s Law of Combat Operations [includes coarse military humor] Firearms in the Entertainment Industry International Movie Firearms Database Horman, GS. PMID: 24350154 [PubMed] PMCID: PMC3860682 Tactical Combat Casualty Care (ppt) Dan S. Mosely, Maj USA MC FS 20 Jun 05 Treatment Reviews Bruner, D.,

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

" [Coroners Society] King Richard I (the Lionheart) needed vast sums of money for the Third Crusade, operation of the kingdom, and for his ransom fro m Duke Leopold of Austria. Accessed 07/30/2016. Frontline® Post Mortem: Death Investigation in America. Accessed 07/30/2016.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

PEMBlog

JUNE 5, 2024

Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. 2011 Aug;58(2):145-55. That’s a spine or neurosurgery operation. MMWR Recomm Rep. 2012 Jan 13;61(RR-1):1-20. PMID: 22237112. Factors associated with cervical spine injury in children after blunt trauma.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

Pediatric Emergency Playbook

APRIL 1, 2017

Steady the operating hand by placing your hypothenar eminence on the child’s zygoma or temporal scalp, to avoid jutting the instrument into the ear canal with sudden movement. A commonly available suction catheter is the Frazier suction tip ( right ), a single-use device used in the operating room. Thieme; 2011. 2013.12.028.

Pediatrics 52

Pediatrics CPR Operations Resuscitation 52

Mind The Bleep

FEBRUARY 7, 2024

One of the few exceptions would be if the patient is paralysed, e.g. for an operation. 52-60, 2011. Initiation of breathing: Non synchronised, e.g. not physiological. this is very rarely used anymore as it is more likely to cause more barotrauma and result in asynchrony between the baby and the ventilator. 5-11, 2022.

Wellness 52

Wellness Seizures Documentation/Coding Operations 52

EB Medicine

AUGUST 1, 2018

From 2010 to 2011, the number of ED visits by children aged 12 to 17 years old due to synthetic cannabinoid use also has doubled. Make sure that the patient knows not to operate vehicles or heavy machinery under the influence of drugs. Discharge home should be in the care of a sober family member or friend.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Don't Forget the Bubbles

FEBRUARY 7, 2024

One systematic review of 1283 patients showed that if you got to the operating room within 6 hours, you had a 97% chance of saving the testicle. Urgent senior review, decision making and operation 31.3% This dropped to 79.3% by 18 hours, and if the diagnosis was delayed by more than 24 hours, the salvage rate was just 18.1%.

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

Don't Forget the Bubbles

MAY 24, 2023

Airway complications are also more likely to occur in the emergency department (ED) than in the operating theatre. It can also able to be applied in multiple scenarios, not just the operating theatre, and it more accurately depicts real-world practice. 2011 May;106(5):617–31 Cook TM. Why is it important? Part 1: Anaesthesia.

Airway Management 98

Airway Management Pediatrics Teamwork Emergency Department 98

EMDocs

JUNE 21, 2023

Common operator errors Failing to enter joint capsule before injecting STS. 2011 Nov;71(5):E110-3. When in the joint, you’ll obtain synovial fluid. Inject lidocaine first, then slowly start injecting STS looking at the wound for saline coming out. You can range the joint which may help you see fluid extruding. Clin Orthop Relat Res.

Soft Tissue Injuries 96

Soft Tissue Injuries Fractures Dislocations Radiology 96

Pediatric Emergency Playbook

JANUARY 1, 2017

Neonatal observational scales have been validated in the intensive care and post-operative settings; ED-specific quantitative scales are lacking. CRIES ( Table 1 ) was validated for post-operative patients; to adapt its use for the ED, the most conservative approach is to substitute “preoperative baseline” with normal range for age.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40