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EM@3AM: Stercoral Colitis

EMDocs

Well keep it short, while you keep that EM brain sharp. A 73-year-old female is brought in by EMS for abdominal pain, vomiting, and weakness for two days. Operative management is necessary for signs of peritonitis, evidence of perforation, extensive bowel involvement >40cm, or after failed medical management.

EMS 94
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Post-Tonsillectomy Hemorrhage: A Three-Pronged Approach

ACEP Now

Secondary hemorrhage occurs between days five and 14 post-operatively, peaking around days five to seven. 3 A three-pronged management approach provides a framework for addressing post-tonsillectomy bleeds: resuscitation, early ENT consultation with transport arrangements, and temporizing measures applied to control bleeding.

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EM@3AM: Retroperitoneal Hematoma

EMDocs

We’ll keep it short, while you keep that EM brain sharp. Laborator evaluation: CBC, CMP, lipase, type and screen, coagulation panel Treatment: 1-3 Resuscitation with blood products as necessary for hemodynamic stability. A 25-year-old man presents to the ED via EMS after he sustained a gunshot wound to the left flank.

EMS 93
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How Long Should EM Residency Be? New Studies Shed Light

ACEP Now

emergency medicine (EM) residency training length has been a decades-long dilemma: four vs. three years. First, is three years enough time to become an EM physician? But critical questions remain unanswered when it comes to specialization, career trajectory, and actual competence as an EM physician. 11 What should we take away?

EMS 114
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ToxCard: Iron

EMDocs

Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. 5 Orogastric lavage may also be considered for GI decontamination but likely to be limited by location, size of tablets, and operator familiarity. Case Follow-up: The patient received a fluid resuscitation with 20 mL/kg bolus of normal saline.

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Don’t Forget About the IO in the Critically Ill Patient

RebelEM

Critically ill patients requiring resuscitation often present with many challenges including the ability to secure safe, sterile, fast, and reliable intravenous (IV) access. This can often lead to significant delays in proper resuscitation. Studies reviewed landmark-based CVC compared to IO; using IJ, subclavian, and femoral CVC sites.

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Penetrating chest trauma

Don't Forget the Bubbles

In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. This was a randomised controlled multisite study comparing resuscitation of trauma patients requiring massive transfusion using either 1:1::1 or 1:1:2 ratios of platelets to plasma to red blood cells. to −0.5%]; P  = 0.03.).