Pediatric EM Morsels

NOVEMBER 3, 2023

Both have a range of detection limits, which can be greatly dependent on operator. With concern for malaria, it is very important to identify who is non-immune and semi-immune as this can affect both the timeframe for illness after departure from the endemic country as well as severity of illness. Third times the charm! vivax or P.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

Pediatric EM Morsels

APRIL 28, 2023

Has undergone many modifications as well to include up to 5 types. In general, non-operative treatment is reserved for Type I fractures and type II. The Athlete is at risk of both Osgood Schlatter’s disease as well as Tibial Tubercle Avulsion Fracture. Anterior knee pain is not always Osgood Schlatter’s.

Fractures 130

Fractures Pediatrics Operations Wellness 130

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Operations 86

Operations Radiology Radiology Fluid Resuscitation 86

EMDocs

OCTOBER 3, 2023

Here is an example of an order of operations for mid-shift overwhelm… Priority 1: Stabilize and manage critical (or potentially critical) patients. They say that dispo is king and you may want to put this elsewhere in your order of operations. This must always be the first priority. How do you re-enter your sequence?

Documentation/Coding 117

Documentation/Coding EMS Operations Emergency Department 117

EMDocs

DECEMBER 6, 2024

5 Orogastric lavage may also be considered for GI decontamination but likely to be limited by location, size of tablets, and operator familiarity. 9 Typical dose: Polyethylene glycol (Go-Lytely ) 25 mL/kg/hr in small children and 1.5-2 2 L/hr in adults. 9 There is no role for activated charcoal as it does not adsorb iron.11

Poisoning 94

Poisoning Fluid Resuscitation Seizures Resuscitation 94

ACEP Now

MAY 4, 2023

EMS recognized a chest wall deformity with movement of the chest wall, and a splint was devised and taped around his chest for what was suspected to be a flail chest. On hospital day 2, he was taken to the operating room for surgical rib fixation. Trauma imaging was performed including bedside X-rays of the chest and pelvis.

EMS 52

EMS Fractures Operations Ultrasounds 52

RebelEM

APRIL 17, 2023

However, It is unclear how well POCUS performs in ruling in or ruling out the diagnosis of PTA. Question: How well does the US perform in diagnosing PTA compared to CT, needle aspiration, or Incision and Drainage? While operator dependent, the dynamic ability of POCUS augments bedside diagnosis and can assist with drainage.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

ACEP Now

SEPTEMBER 5, 2024

Our state chapter members and leaders are uniquely positioned to follow EMRA’s lead in partnering with local EM residency programs to improve communication of ACEP’s value to EM-bound medical students and EM residents by hosting residency visits or local events relevant to our shared mission.

Leadership 98

Leadership PPE EMS Wellness 98

American Medical Compliance

FEBRUARY 15, 2023

No fines or fees are implemented as well. Hence, it is necessary to plan the core training well and the testing schedule accordingly. Such facilities may be fined for having problems but they remain to operate without paying penalties. The OSHA guidelines that are intended for assisted living facilities are voluntary.

EMS 52

EMS Administration Infectious Diseases Operations 52

Don't Forget the Bubbles

JUNE 19, 2024

Well-designed multicentre large studies in children were warranted; cue Leonard et al. Children in the validation cohort were admitted to the intensive care unit or operating room less frequently than those in the derivation cohort. In practice, questions remain about who applies the CDR and the inter-rater reliability.

CPR 124

CPR Research Documentation/Coding Outcomes 124

Taming the SRU

MAY 11, 2024

r1 clinical knowledge - r4 capstone - research grand rounds - the art of em - Community corner - PEM Lecture r1 Clinical knowledge: transplant complications WITH dr. gabor Time-sensitive peri-transplant emergencies: Bleeding fistula- stop the bleed. Flood syndrome- start fluids, give antibiotics, consult surgery.

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

Ziqitza HealthCare Ltd

MARCH 18, 2024

One critical area often overlooked is emergency medical services (EMS). As climate change intensifies, so do the challenges faced by EMS providers. As the demand for emergency assistance surges during such crises, EMS teams must be well-prepared to manage the influx of patients and navigate complex conditions to reach those in need.

Ambulance Services 52

Ambulance Services Telemedicine EMS Operations 52

RebelEM

JUNE 19, 2023

Demographics were well balanced in the two groups. We should expect TXA to help in immediate stabilization and allow trauma teams the time to intervene (whether that be continued resuscitation, interventional or operative procedures). Read More Core EM: CRASH-2: Tranexamic Acid in Major Trauma References: CRASH-2 Trial Collaborators.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. These procedures require an experienced operator. These procedures require an experienced operator. These procedures require an experienced operator. The trauma call goes out. So, what are your key priorities? Really, in a 14-year-old?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Dr. Smith's ECG Blog

DECEMBER 19, 2023

EMS obtained the following vital signs: pulse 50, respiratory rate 16, blood pressure 96/49. It appears EMS obtained two EKGs, but unfortunately these were not saved in the medical record. The EMS crew was only BLS certified, so EKG interpretation is not within their scope of practice. Fortunately, that is exactly what happened.

EKG/ECG 128

EKG/ECG EMS Wellness Operations 128

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

She took an oxycodone and called EMS. The cut points for what constitute OMI and not OMI as well as confidence levels are calibrated to maximize sensitivity and specificity according to the receiver operating characteristic. The diagonal branches are overlapping one another and not well visualized in this view.

EKG/ECG 67

EKG/ECG Operations Wellness Ultrasounds 67

Downeast Emergency Medicine

DECEMBER 17, 2021

Emergency medicine (EM) was first recognized as a specialty by the American Medical Association (AMA) in 1972. Since that time, EM residencies have grown and evolved to provide academic support and training for graduating medical students interested in pursuing a career in the field.

EMS 52

EMS Academics Operations Emergency Department 52

EM SIM Cases

SEPTEMBER 19, 2024

WHY IT MATTERS Patients in hemorrhagic shock require blood products expeditiously as well as identification and definitive management of the source of bleeding. EMS applied combat application tourniquet to leg on scene 45 minutes ago. No LOC but altered with some reported alcohol consumption.

Shock 52

Shock Emergency Nursing Operations Administration 52

RebelEM

AUGUST 22, 2024

1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Patients whose last known well (LKW) time was within 24 hours of presentation. Within 24 hours after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). Additionally, many if not most emergency physicians do not receive adequate training on topical awake intubations (TAI) (11).

Emergency Department 84

Emergency Department Soft Tissue Injuries Airway Management Operations 84

Taming the SRU

JUNE 11, 2023

Utilized in the pre-hospital setting, ICU and the Operating Room, it is a non-invasive measurement that reflects a patient’s current state of metabolism, circulation and ventilation. It’s reflection of underlying metabolism, circulation and ventilation may serve well to identify patients with early dysfunction of physiologic functions.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

RebelEM

AUGUST 7, 2023

This helps relieve agitation/pain while maintaining spontaneous breathing and airway reflexes allowing for adequate pre-oxygenation as well as facilitates other resuscitation interventions including IV access, vasopressors, fluids, etc. that would not be possible in an agitated/combative patient.

Head Injuries 96

Head Injuries Airway Management Outcomes Burns 96

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Her husband called EMS when the patient experienced new onset seizures accompanied by micturition. The ECG below was recorded by EMS. Regarding my Systematic assessment of ECG #1: There is significant baseline artifact , as well as baseline wander. Written by Magnus Nossen — with edits by Grauer. What is your assessment?

Seizures 114

Seizures EKG/ECG EMS Stroke 114

Ziqitza HealthCare Ltd

JULY 23, 2023

Ventilators are used in operating rooms, emergency departments, critical care transport units, and air medical transports. Ziqitza Health Care operates the ALS and BLS ambulances for various purposes under their 108 , 102 and 1298 helpline numbers. Conclusion Ventilator ambulance service is also known as EMS transport ventilator.

Ambulance Services 52

Ambulance Services Basic Life Support Blood Transfusions Patient Safety 52

Northwestern EM Blog

SEPTEMBER 12, 2022

This post will discuss a brief overview of hospital planning and operational setup with key elements of a disaster response from events that cause high numbers of blunt trauma, penetrating trauma, burns or crush injuries that may be seen following explosive events, mass shootings, or large scale motor vehicle collisions, to name a few.

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Hazardous Materials 52

EM Updates

MARCH 24, 2021

Video laryngoscopy uses a blade with a camera at the end; once the blade is positioned, the operator intubates looking at the screen. HAVL , which uses a blade that goes around the tongue, requires that the operator look at the screen. VL can employ either SG or HA blades.

Operations 52

Operations Airway Management EMS Wellness 52

Ziqitza HealthCare Ltd

JULY 14, 2023

Cardiac Ambulance Price Cardiac ambulances are well-equipped yet very cheap. In Conclusion Public-private partnerships between state governments and private EMS providers have, however, played a major role in reducing deaths due to cardiac diseases in India. You can get efficient service at an affordable rate.

Ambulance Services 52

Ambulance Services Basic Life Support Operations Stroke 52

EMDocs

DECEMBER 11, 2023

In addition to a posterior ECG, the ACC’s new recommendations emphasize consideration of an emergent TTE, though lack clarity in defining who should be the operator, stating “a clinician qualified in echocardiography” is necessary, without providing specific definitions. Notably, only 0.5mm of elevation is necessary in V7-9 to meet criteria.

EKG/ECG 119

EKG/ECG Emergency Department Academics Operations 119

Taming the SRU

NOVEMBER 3, 2023

The thought with introducing the serratus anterior plane block was that regional anesthesia is well within the purview of EM physicians and can offer a safe alternative to systemic pain medications. 50% were male, 50% were female and they had a median # of 4 rib fractures with a range 2-8. SD 3.28) and 6.5, respectively.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

Taming the SRU

AUGUST 4, 2024

We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift. The largest retrospective cohort study to date (Beyde et al.) shows that most will improve with empiric antibiotics.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

RebelEM

JANUARY 25, 2024

Point-of-care ultrasound (PoCUS) is inherently operator-dependent, which may have led to inconsistencies in the quality and findings of the ultrasound exams across different operators. CHF, in particular, lends itself well to diagnosis and treatment with PoCUS, as it readily reveals the presence of B lines. vs. 18.3%).

Ultrasounds 125

Ultrasounds Outcomes COPD Hospitals 125

RebelEM

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Ziqitza HealthCare Ltd

MARCH 29, 2024

Understanding Ambulance Response Times The urgency of medical emergencies necessitates a rapid response from emergency medical services (EMS). Various factors influence these response times, including population density, traffic conditions, infrastructure, and the availability of EMS resources.

Ambulance Services 52

Ambulance Services Outcomes EMS Operations 52

EMDocs

OCTOBER 30, 2023

Pillai, MBBS (@sspillai01, EM Resident Physician, University of Kentucky) and Christopher N. 2 In response to the constrained availability of contrast media, emergency medicine (EM) and radiology departments were compelled to enact modifications in their imaging techniques. Authors: Saran S. 11 Table 1.

Radiology 92

Radiology Radiology Emergency Department Hospitals 92

RebelEM

JUNE 8, 2023

Rezaie, MD (Twitter: @srrezaie ) The post The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults appeared first on REBEL EM - Emergency Medicine Blog. Am J Emerg Med. 2016; PMID: 27720568 Guest Post By: Courney Knieriem, MD PGY-1, Emergency Medicine Resident RWJBH Community Medical Center, Toms River, NJ Courtneyknieriem.md@rutgers.edu

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98