Emergency Medicine Journal

NOVEMBER 28, 2023

Clinical introduction A 74-year-old man presented to the ED with progressively worsening dyspnoea for 10 days. Physical examination revealed mild expiratory stridor, and laryngoscopy showed right vocal cord palsy without upper airway obstruction. Findings were consistent with central airway obstruction (CAO).

Documentation/Coding 40

Documentation/Coding 40

The Trauma Pro

APRIL 23, 2024

In the old days, the neck was conceptualized as three different zones that dictated the diagnostic and management algorithm. Let’s move on to the nuts and bolts of figuring out what needs to be done about the injury. We are now moving toward considering the neck as a single unit.

Operations 113

Operations Stroke Shock 113

Mind The Bleep

DECEMBER 19, 2023

Airway The most efficient way to check for airway patency would be seeing if the patient can speak in complete sentences. Signs of airway compromise include use of accessory muscles, diminished breath sounds and adventitious sounds, and cyanosis. Airway adjuncts that can be used are oropharyngeal and nasopharyngeal airways.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

Emergency Medicine Journal

NOVEMBER 28, 2023

EM trainees in South-East Scotland completed a one-day training course, rating aspects of the day, and self-assessed pre-and post-training procedural confidence, on 7-point Likert scales. 100% of trainees found the day "very useful" and 100% would want to repeat it annually. Sengstaken tube S-B tube, airway head mannikin 4.

EMS 40

EMS Resuscitation Ultrasounds 40

ACEP Now

OCTOBER 3, 2023

The GCS should be measured after airway, breathing, and circulation are assessed, after a clear airway is established, and after necessary ventilatory or circulatory resuscitation has been performed. There are at least 600 TBI-related hospitalizations and 175 TBI-related deaths per day.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation Pediatrics 98

Don't Forget the Bubbles

FEBRUARY 26, 2024

A 6-year-old known asthmatic presents to ED with a two-day history of cough and coryza, worsening wheeze and work of breathing over the last day. The inspiratory positive airway pressure (IPAP) is a higher level of pressure delivered when the patient inhales. Dai J, Wang L, Wang F, Wang L, Wen Q. 2002 Apr 1;3(2):181-4.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

Mind The Bleep

FEBRUARY 29, 2024

A – Airway This will vary depending on what kind of airway the patient has! A Assessment Endotracheal Tube For patients with artificial airways, check the size and whether there are spare ET tubes/tracheostomies of that size conveniently stored in case of an airway emergency.

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Best Practices 52

EMDocs

MAY 28, 2024

Consider risk factors for multi-drug resistant microbes: Recent IV antibiotics Hospitalization within 90 days. Airway support Target saturation 95% OR within 3% of patient’s baseline saturation. Use lung protective ventilation Tidal volume 6 ml/kg Peak airway and plateau pressures < 30 cmH 2 O.

Blood Transfusions 74

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 74

EM SIM Cases

NOVEMBER 15, 2022

Why it Matters Massive hemoptysis is a seldom-encountered, but potentially life-threatening airway crisis. Emergency medicine learners must be able to quickly recognize this presentation while learning manage the airway effectively. The patient is coming from home, where he was found sitting in his couch in mild respiratory distress.

COPD 52

COPD Military Emergency Department EMS 52

EMDocs

MAY 15, 2024

Consider risk factors for multi-drug resistant microbes: Recent IV antibiotics Hospitalization within 90 days. Signs and symptoms include chest pain, dyspnea, fever, cough, hemoptysis, extremity pain, and neurologic symptoms; these may occur suddenly, or they may progressively worsen over days. Prior cultures with resistance microbes.

Blood Transfusions 77

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 77

EMDocs

SEPTEMBER 25, 2023

She states that he tested positive for influenza three days prior and has been ill, but not unlike when he’s had the cold in the past. Additionally, she states that he has not been able to eat for the last 2 days and has therefore not taken any of his insulin. Minimal impact on airway reflexes. F, end tidal CO2 11 mm Hg.

Emergency Department 65

Emergency Department Operations Soft Tissue Injuries Airway Management 65

The Skeptics' Guide to EM

JUNE 3, 2023

Our usual go to guest skeptic for airway has been paramedic and PA Missy Carter ( SGEM#247 , SGEM#271 and SGEM#396 ). The primary outcome was an 8% absolute increase in all-cause mortality at seven days for patients allocated to the etomidate group. This outcome was no longer statistically different at 28 days.

Outcomes 110

Outcomes Wellness 110

RebelEM

JULY 17, 2023

PMID: Clinical Question: Does a single dose of ketamine or etomidate used for rapid sequence intubation (RSI) of critically adults in the ED impact the SOFA score within 3 days of hospitalization? Range 5 to 9) Etomidate: 7.0 Range 5 to 9) Diff -0.2; 95% CI -1.4 References: Knack SKS et al.

Outcomes 81

Outcomes Administration Emergency Department Resuscitation 81

ACEP Now

AUGUST 8, 2023

Sure, he made the national news for saving a life at an Eagles game while wearing an elaborate Mummer’s Day costume, but did you know he’s also his residency’s social chair and has all the best local recommendations for ACEP23 attendees? What is the Mummers Day Parade? It’s almost like Mardi Gras for Philadelphia. It’s outdoor.

CPR 94

CPR EMS 94

EMDocs

JUNE 7, 2023

F, HR 48, RR 28, BP 104/62, SPO2 88% on non-rebreather mask The patient’s friend who brought her to the ED tells you the patient made suicidal statements earlier in the day and was found in her yard shed. Aging can take anywhere from minutes to days and is dependent on the specific organophosphate. Vital signs : Temp: 99.1

Poisoning 82

Poisoning Airway Management Seizures PPE 82

RebelEM

FEBRUARY 29, 2024

Background: Ventilator-associated pneumonia (VAP), or what the CDC recently renamed infection-related ventilator-associated complication (IVAC), is defined as a nosocomial pneumonia occurring on day 3 of mechanical ventilation that was preceded by 2 days of stable or decreasing ventilator requirements.

CDC 99

CDC Outcomes Radiology Radiology 99

Taming the SRU

JANUARY 26, 2024

10 or greater days and high or moderate risk hormonal contraception amplifies risk to IRR of 44.8 Wosiski-Kuhn and Stothers BP cuff sizing: Using a cuff too large results in lower SBP, using too small results in higher BP VTE risk with hormonal contraception and NSAIDS Isolated use + and contraception leads to IRR of 7.2

Stroke 59

Stroke EKG/ECG Outcomes Seizures 59

Taming the SRU

SEPTEMBER 21, 2023

RSI is a technique for managing the emergency airway that induces immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent). Data was obtained from the National Emergency Airway Registry (NEAR). The NEAR database is a multi-center, prospective, observational, emergency medicine led registry.

Outcomes 81

Outcomes Emergency Department Shock 81

JournalFeed

MAY 7, 2022

Airway POCUS Spoon Feed: Upper airway ultrasound (UA-US) may eventually help us predict if a patient will have a difficult laryngoscopy ahead of time. The JournalFeed podcast for the week of May 2-6th,2022. These are summaries from just 2 of the 5 article we cover every week!

Advances Cardiac Life Support (ACLS) 40

Advances Cardiac Life Support (ACLS) Resuscitation Ultrasounds Outcomes 40

The Skeptics' Guide to EM

OCTOBER 8, 2022

Effect of high-flow nasal cannula therapy vs continuous positive airway pressure therapy on liberation from respiratory support in acutely ill children admitted to pediatric critical care units: a randomized clinical trial. Date: September 15, 2022 Reference: Ramnarayan P et al. Date: September 15, 2022 Reference: Ramnarayan P et al.

Pediatrics 52

Pediatrics Emergency Department Hospitals 52

Taming the SRU

FEBRUARY 12, 2024

After rescue, she had an apparent head injury and was confused but protecting her airway with grossly normal vital signs. Her primary survey reveals an intact airway, bilateral breath sounds and a strong carotid pulse. Hospital Course Based on the primary survey, no acute airway interventions were undertaken.

Administration 71

Administration Fractures Anaphylaxis Emergency Department 71

Pediatric EM Morsels

OCTOBER 6, 2023

Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective. Be suspicious!

Pediatrics 161

Pediatrics CDC Seizures Infectious Diseases 161

Sensible Medicine

JANUARY 3, 2024

In the ICU, patients fought COVID for days, even weeks, on the precipice of respiratory collapse. His chest x-ray was typical for COVID-19: diffuse airway opacities. Days wore on and he continued to require CPAP with 100% oxygen. One day, through gasps of air, he yelled a surprising request: vaccination against COVID-19.

CDC 142

CDC Allergic Reactions Hospitals COPD 142

Greater Sydney Area HEMS

APRIL 15, 2023

At one of our recent education days we heard Dr Mark Russell and Dr Mark Newcombe deliver excellent presentations of cases which they had been involved in, involving resuscitative hysterotomy and neonatal resuscitation respectively. Airway The neonatal airway is small, and easily compressible. More on airway skills later.

Hospitals 85

Hospitals Resuscitation Hyperthermia / Hypothermia Teamwork 85

EMDocs

JANUARY 4, 2024

Remember patients must be able to protect their airway/be intubated and have active bowel sounds. Patient must have bowel sounds and a secure airway (protecting their own airway or intubated). Bupropion is a beta-keto amphetamine (a substituted cathinone like amphetamine and bath salt derivatives).

Seizures 65

Seizures EKG/ECG Poisoning Shock 65

The Skeptics' Guide to EM

MARCH 2, 2019

Effect of a Strategy of a Supraglottic Airway Device
vs. The AIRWAYS-2 Randomized Clinical Trial. Effect of a Strategy of a Supraglottic Airway Device
vs. The AIRWAYS-2 Randomized Clinical Trial. They had a difficult time getting a definitive airway pre-hospital. The AIRWAYS-2 Randomized Clinical Trial.

Airway Management 52

Airway Management CPR Outcomes Hyperthermia / Hypothermia 52

Pediatric Education

APRIL 7, 2024

With nasal trauma the airway patency and nasal airflow are important to determine as the airway is more collapsible and also narrower in the pediatric patient. Sometimes subtle deviation or obstruction only becomes apparent in the next several days after the trauma as the edema may distort the structures.

Fractures 40

Fractures Head Injuries Pediatrics Wellness 40

Don't Forget the Bubbles

AUGUST 13, 2023

Assessment of the child ( NICE guidelines + NCBI – management of pediatric febrile seizures ) If the child is actively having seizures in the ED: Airway assessment and management – confirm and protect the airway. Start the child on high flow oxygen via the non-rebreather mask. How would you manage her?

Seizures 97

Seizures Pediatrics Dehydration Radiology 97

FEMinEM

DECEMBER 24, 2020

The chest tubes prepared, the airway tray ready A few seconds of quiet, holding my heartbeat steady When the EMS crew should appear With a young man, eyes wide open in fear With blood on his shirt and the hole from a gun I knew in a moment to call “Level One.” Quickly I asked the boy his name He responded and “airway” was not to blame.

EMS 52

EMS Hospitals 52

Critical Care Now

MARCH 3, 2022

The Pre-brief Working in a Pulmonary Function Lab plus providing in-patient care within the hospital, I see patients every day that have been diagnosed with chronic obstructive pulmonary disease (COPD). One form of COPD is chronic bronchitis, which is evident by airway inflammation and causes increased mucus secretion.

COPD 52

COPD Research Hospitals Wellness 52

Don't Forget the Bubbles

JUNE 12, 2023

It wasn’t until over 20 minutes later that they managed to secure an airway and transfer her to the ICU, where she died 13 days later. As they struggled to provide oxygenation, they lost sight of the bigger picture, and Elaine remained critically hypoxic.

Resuscitation 145

Resuscitation Anaphylaxis Best Practices Operations 145

Emergency Medicine Ireland

MARCH 27, 2023

Even if they do tolerate the mask it is frequently difficult to make a decent seal and maintain that lovely positive mean airway pressure that you’re looking for. Exacerbations of COPD in this scenario the lungs are scarred and the airways constricted and obstructed. NIV is not necessarily a free pass.

COPD 52

COPD Wellness Fractures Hospitals 52

Thinking Critical Care

MAY 20, 2023

Montreal – both at the Heart Institute (core days) and my shop, Santa Cabrini Hospital (pre/post courses). Go over and practice intubation and basic airway management, central and arterial line placement, thoracic and abdominal pigtail insertion and more! Of course, should be over 40 credits, watch this space in the next weeks.

Airway Management 97

Airway Management Resuscitation EKG/ECG CPR 97

Pediatric EM Morsels

JUNE 9, 2023

Prepare airway management tools (hoping to avoid needing them). Specific Therapies for Variceal Hemorrhage : [ Luoto, 2020 ; Castillo, 2019; Garcia-Tsao, 2007 ] Antibiotic prophylaxis (usually for 7 days) Ceftriaxone is reasonable 1st choice. Obtain large-bore access. Type & Cross and check Coagulation Studies and CBC.

Pediatrics 152

Pediatrics Head Injuries Airway Management Administration 152

EMDocs

AUGUST 15, 2023

Repeat labs approximately 6 hours after initial control and/or prior to discharge. Clinically often swelling and tenderness may be considered significant if they extend beyond one major joint from the bite site (e.g.,

Poisoning 80

Poisoning Administration CDC EMS 80

Don't Forget the Bubbles

MAY 22, 2023

The community physiotherapist (who has been visiting daily for the last 4 days) told Mum that Robin’s oxygen saturations were low. LTV is a form of respiratory support provided via mechanical ventilation every day for at least three months. He’s been taking them for the past few days. His oxygen requirement was slowly weaned.

Radiology 98

Radiology Radiology Hospitals Wellness 98

Emergency Medicine Ireland

JULY 18, 2022

This is nicely represented in the graph from deranged physiology in the show notes that shows a nice sigmoid curve of lung volume plotted against airway pressure. This is most of what you need to know for day to day practice. This is most of what you need to know for day to day practice.

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