Emergency Medicine Cases

AUGUST 10, 2021

The post EM Quick Hits 31 NG Tubes in SBO, Hyperacute T-Waves, Malignant Otitis Externa, CCTA in NSTEMI and Low-risk Chest Pain, Canadian Syncope Score appeared first on Emergency Medicine Cases.

EMS 52

EMS 52

The Trauma Pro

JUNE 9, 2023

Even so, it is more easily detected due to obvious displacement of the liver that can be seen on chest x-ray. Blunt injuries on the right side usually result in a large rent in the central tendon or detachment of the diaphragm from the chest wall. This image shows an acute herniation of the liver through the diaphragm.

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The Skeptics' Guide to EM

MARCH 23, 2024

Case: A 25-year-old female medical student presents with right chest pain and dyspnea. Chest x-ray (CXR) shows a “complete pneumothorax.” Background: The first time we got together to discuss chest tubes was on SGEM#129. Continue to obtain a CXR post chest tube knowing it will probably not change management.

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The Skeptics' Guide to EM

SEPTEMBER 6, 2020

Rick is also the founder of Western University’s Department of […] The post SGEM#300: The Lung is Up Where it Belongs – With or Without a Chest Tube first appeared on The Skeptics Guide to Emergency Medicine. NEJM 2020 Case: A 49-year-old healthy male electrician presents to the emergency room with right chest pain and dyspnea.

Research 40

Research Emergency Department Shock Hospitals 40

Taming the SRU

OCTOBER 1, 2023

Blunt or Penetrating Trauma : Often due to GSW, stab wounds, or blunt chest trauma such as those seen in motor vehicle crashes and falls. Occult Pneumothorax: Those discovered incidentally, usually on CT scan, not clinically suspected or seen on chest XR [17]. Chest XR: Sensitivity 44-47%, Specificity 100% [24-25].

Fractures 85

Fractures COPD Hospitals Emergency Department 85

The Trauma Pro

OCTOBER 13, 2023

The Submental Intubation Chest Tube Size: Where Did The French System For Catheter Size Come From? This issue’s theme is Weird Stuff. In this issue, you will learn about: Syndrome Of The Trephined Whaaat? Stuff You Sterilize Other Stuff With May Not Be Sterile?? To download the current issue, just click here!

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ALiEM

MAY 19, 2023

Esophageal Balloon Tamponade Devices – Linton-Nachlas, Sengstaken-Blakemore, Minnesota Tubes (image courtesy of Dr. Mark Ramzy at REBEL EM) What are esophageal balloon tamponade devices? There are 2 commonly used devices for tamponading the esophagus during a variceal bleed, the Sengstaken-Blakemore (SB) tube and the Minnesota tube.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

RebelEM

MAY 15, 2023

The patient’s emergent portable chest X-ray is shown below. Frantically look through the assisted care documents for do-not-resuscitate paperwork Place a chest tube on the left side Place a chest tube on the right side Start noninvasive or mechanical ventilation FOR THE RIGHT ANSWER CLICK ON THE ROSH REVIEW LOGO BELOW References: Dixon A.

EMS 82

EMS Documentation/Coding Resuscitation 82

Medagadget

OCTOBER 31, 2023

Arriving in two boxes reminiscent of Apple product packaging – one for the chest piece (the part that contacts the body), and another for the detachable earpiece (tubes + ear tips) – the CORE 500 is clearly an upgrade from the Eko DUO stethoscope. The CORE 500 chest piece itself is a bit heavier than the DUO at 6.6

EKG/ECG 91

EKG/ECG Burns Wellness Telemedicine 91

Pediatric Emergency Playbook

FEBRUARY 1, 2016

Large head, no neck, his chest and abdomen form an underdeveloped, amorphous shape. Be careful and minimize manipulation of the cervical spine, but do what you must to visualize the chords and place the tube. Preoxygenate and pass that tube quickly. Chest Tube Pearl #2: Try using a pigtail catheter. Pediatrics.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

EMDocs

JUNE 22, 2023

We have a knife stab wound to the chest or abdomen coming. Find the chest tube tray and thoracotomy kit. My eyes are redirected to a large wound on his chest at the costal margin just to the left of the midline. The patient needs an ET tube, but I’m worried he has a tension pneumothorax based on his injury.

Resuscitation 95

Resuscitation Ultrasounds Critical Access Documentation/Coding 95

Mount Sinai EM

MARCH 20, 2023

Gravid uterus can compress the IVC and displace the diaphragm Position in left lateral decubitus Displace uterus to the left during compressions Chest tube 1-2 IC spaces above Management: Fetal FAST: number of fetuses and position, placental location (exclude placenta previa before vaginal exam!),

Documentation/Coding 130

Documentation/Coding Resuscitation 130

EMDocs

JANUARY 16, 2024

The patient is actively receiving chest compressions with a LUCAS automated compression device. His LMA is exchanged for an endotracheal tube without induction or paralytic agents. Some authors recommend not starting chest compressions in hypothermia unless there is no organized cardiac activity (e.g.,

Hyperthermia / Hypothermia 83

Hyperthermia / Hypothermia Resuscitation CPR EMS 83

University of Maryland Department of Emergency Med

JANUARY 14, 2023

A systemic review and meta-analysis revealed that the literature and science surrounding timing and effectiveness of prophlactic antibiotic. Click to view the rest

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Taming the SRU

MAY 10, 2024

Factors associated with worse outcomes in the setting of a TCA: Firearm involvement Self-inflicted injury PEA with a rate <40bpm Wide-complex rhythm (excluding VT) Number of pre-hospital procedures Role of chest compressions in TCA: Chest compressions are unlikely to be helpful in the setting of a traumatic cardiac arrest.

Leadership 73

Leadership CPR Head Injuries Outcomes 73

ACEP Now

MARCH 14, 2024

A 24-year-old male with history of quadriplegia and traumatic brain injury presents to the emergency department with hemorrhage in his oral cavity and blood from his tracheostomy tube. Blood is spurting from the orifice of the tube. Vascular erosion from a tracheostomy tube requires at least 48 hours to develop.

Operations 52

Operations Pediatrics Airway Management Radiology 52

Dr. Smith's ECG Blog

MARCH 7, 2024

A young man presented with a gunshot wound to the right chest, with hemo-pneumothorax and hemorrhagic shock. He got a chest tube and intubation and massive transfusion and stabilized. CT of chest showed the bullet path through his right lung but nowhere near his heart. But he did get an EKG: What is this?

Shock 103

Shock EKG/ECG Documentation/Coding 103

Emergency Medicine Cases

JULY 27, 2021

In this main episode podcast we discuss the conservative management of large spontaneous pneumothorax, when a pigtail chest tube with Heimlich valve is indicated, detection of persistent air leak, removal of chest tube, surgical indications for spontaneous pneumothorax, management pitfalls and more.

Ultrasounds 52

Ultrasounds EMS 52

PulmCCM

JUNE 5, 2023

Read in NEJM Aspiration vs tube thoracostomy for primary spontaneous pneumothorax. Among 402 patients with primary spontaneous pneumothorax at 31 French hospitals, 71% of those randomized to aspiration had lung expansion 24 hours later, vs 82% of those receiving chest tube drainage. In the U.S.,

Advances Cardiac Life Support (ACLS) 96

Advances Cardiac Life Support (ACLS) Documentation/Coding CPR Shock 96

Emergency Medicine Cases

SEPTEMBER 27, 2022

He answers such questions as: Do all patients with a traumatic pneumothorax require tube thoracostomy? How do CXR and CT differ in determining which patients require a chest tube? Do all patients receiving positive pressure ventilation require a chest tube for their traumatic pneumothorax?

EMS 52

EMS 52

Taming the SRU

FEBRUARY 23, 2024

Total RBC count (<500 RBCs in last tube), as well as clearance by the last tube (decrease in RBC count by at least 70% by the last tube), can be used to differentiate between traumatic taps and a SAH. Consider alternative pathways that can facilitate a quicker disposition such as utilizing CCTAs for chest pain patients.

Pediatrics 68

Pediatrics Ultrasounds Wellness Fractures 68

ALiEM

FEBRUARY 16, 2024

His daughter had reported to staff he had been feeling unwell for five days, intermittently having nausea and generalized abdominal pain, subjective fevers, chest pain, and shortness of breath. high), AlkP 328 (high), AST/ALT normal Lipase : Normal Troponin x2 : Negative Chest x-ray : No acute abnormality Case Question: What is the diagnosis?

Radiology 64

Radiology Radiology Ultrasounds COPD 64

Taming the SRU

JULY 2, 2023

Intubation End-tidal monitoring is the most accurate method for immediate confirmation of endotracheal tube placement. Breath sounds, fogging or condensation in the ET tube, and chest rise may all be present in esophageal intubations. Transport is associated with a higher risk of tube displacement. 2017): 829-842.

Emergency Department 77

Emergency Department Pediatrics CPR Administration 77

The Trauma Pro

JANUARY 5, 2024

One of the potential complications of chest trauma causing hemothorax is the retained hemothorax. Patients undergoing chest tube placement for hemothorax received irrigation of the chest cavity immediately after placement. They irrigated 82 of 198 patients undergoing chest tube placement.

Hospitals 173

Hospitals Wellness Outcomes 173

The Skeptics' Guide to EM

JULY 31, 2021

DISCLAIMER: THE VIEWS AND OPINIONS OF THIS PODCAST DO NOT REPRESENT THE […] The post SGEM#339: I Don’t Need this Pressure On – Chest Wall Thickness at Needle Decompression Site first appeared on The Skeptics Guide to Emergency Medicine. Continue to obtain a CXR post chest tube knowing it will probably not change management.

Military 52

Military Ultrasounds EMS Wellness 52

EMDocs

NOVEMBER 1, 2023

A 39-year-old male with history of achalasia with recent endoscopic dilation 24 hours prior presents to the ED for progressively worsening chest pain with radiation to his left shoulder. Performed in intubated patients via placement of nasogastric or orogastric tube proximal to area of suspected injury.

Operations 65

Operations Radiology Radiology Fluid Resuscitation 65

Taming the SRU

JUNE 14, 2023

She was intubated for airway protection and the decision was made to perform balloon tamponade with placement of a Minnesota Tube. She required MAC line placement, MTP activation and transfusion. Recommend using rocuronium to give you time with the patient paralyzed.

Shock 76

Shock CPR Wellness 76

Emergency Medicine Cases

JANUARY 28, 2020

Mike Misch guides us through this part 2 of a blunt chest trauma case with a presumed bronchopulmonary fistula requiring 3 chest tubes and describes options to optimize one-lung ventilation for safe transport. The post Crit Cases 14 Bronchopleural Fistula Management appeared first on Emergency Medicine Cases.

Resuscitation 52

Resuscitation EMS 52

Mind The Bleep

FEBRUARY 29, 2024

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. If more established, the senior is more likely to be able to reinsert a tracheostomy tube if it needs to be replaced.

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Best Practices 52

Mind The Bleep

NOVEMBER 23, 2023

Suspected oesophageal perforation Symptoms include severe neck/chest/back pain, surgical emphysema, tachycardia, fever. Management steps Step 1 A-E assessment – call anaesthetics and ENT team early Encourage coughing Consider Heimlich manoeuvre/back blows/chest thrusts/abdominal thrusts Step 2 Examine oropharynx.

Patient Safety 52

Patient Safety Resuscitation Outcomes 52

ACEP Now

MAY 4, 2023

Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. The patient complained of right chest wall pain and shortness of breath that improved once splinted.

EMS 52

EMS Fractures Operations Ultrasounds 52

Taming the SRU

JULY 8, 2023

Scope of practice fights includes many common procedures we do today (intubations, chest tubes, central lines), use of POCUS, and even expansion into AirCare. Primary Board certification was not official until 1989!

EMS 77

EMS Emergency Department Hospitals 77

JournalFeed

JUNE 12, 2021

We cover overuse of antibiotics for ED sepsis alerts, HEART or EDACS with hs-cTn 0-1 hour rule outs, ED-AWARENESS - paralysis awareness after RSI, thoracentesis or chest tubes in coagulopathic patients, and a review on managing the difficult airway. It’s the JournalFeed Podcast for the week of Jun 7-11, 2021.

Sepsis 52

Sepsis 52

The Skeptics' Guide to EM

MARCH 15, 2019

Ultrasonography for the Confirmation of Endotracheal Tube Intubation: A Systematic Review and Meta-Analysis. Chip […] The post SGEM#249: Ace in the Hole – Confirming Endotracheal Tube Placement with POCUS first appeared on The Skeptics Guide to Emergency Medicine. Date: March 12th, 2019 Reference: Gottlieb, Holladay and Peksa.

Ultrasounds 52

Ultrasounds Fractures EMS Hospitals 52

EM SIM Cases

JANUARY 10, 2023

CASE SUMMARY Adult male with penetrating extremity and chest trauma (gun shot wounds) with peripheral vascular compromise. For senior learners, there will be an additional element of instability from the penetrating chest injury requiring chest tube. CLINICAL VIGNETTE Multiple gunshot wounds. Patient intoxicated.

Academics 40

Academics Emergency Department Hospitals Resuscitation 40

EMDocs

AUGUST 22, 2023

J Emerg Med. 2013;45(4):626-632. PMID: 23871325 Nassar BS, Schmidt GA. Capnography During Critical Illness. 2016;149(2):576-585. PMID: 26447854 Godwin SA, Burton JH, Gerardo CJ, et al.

Emergency Department 66

Emergency Department Blood Transfusions Resuscitation Sepsis 66

ALiEM

OCTOBER 14, 2023

Highlighted Quality Posts: Respiratory Site Article Author Date Label EMCrit IBCC: Asthma Josh Farkas, MD April 12, 2023 AIR EMCrit IBCC: Severe Community Acquired Pneumonia Josh Farkas, MD October 11, 2022 AIR EM Docs Empyema: ED Presentation, Evaluation, and Management Heath Garner, MD April 11, 2022 AIR Rebel EM Pigtail Catheter vs Large Bore Chest (..)

EMS 67

EMS Academics Emergency Department Hospitals 67