EM:RAP

How and what are you doing first for this patient?
Young man found down. Brought in by EMS with unknown mechanism and unclear injury.
He is agitated and uncooperative whenever you try and start the work up.
You want to get him to CT stat. This is a pretty common situation for most of us. The question of what to do next can only be answered by understanding the options in front of you as well as the resources you have at your disposal.
Jan and Swami go through the myriad of choices and discuss in-depth their thinking dependent on a variety of settings.

These are the kind of discussions that make EM:RAP so valuable to the work you do everyday. There can be many paths to disposition and finding the ones that work for you and your team are critical to ensure you keep moving forward and avoid getting stuck on a patient that there is no one size fits all answer for.

Check out the VIDEO of the entire conversation to see and hear Jan and Swami work through the options together. https://youtu.be/3KOw7OGCHNA

Where do you land on the spectrum of observation vs antibiotics in kiddos with suspected or diagnosed otitis media? 👂🏽 Comment below.

The pediatric dream team is back and this discussion of AOM is a must listen if your patient population includes children, and of course it does. Ilene, Al and Jeff provide their expert opinions and there own practice insights so you have a full range of options to use on your next shift. These are never cookie cutter presentations and having this depth of knowledge at your fingertips can make your decision making easier and your patients, and importantly, their parents' lives a bit better.

A demonstration of the Kona push-pull method for anterior shoulder reduction: using simultaneous axial traction on the humerus and counter-pressure on the acromion to stabilize the scapula and guide the humeral head back into place.

Would you consider yourself a resuscitation expert? Comment below how you’d grade your skills from 1-10.
Regardless of where you land, Swami and Scott will make sure this segment has something for you to take away to your practice, and you are going to want to tune in to hear it.

They will be discussing
👍 The Good: Higher first-shock energy settings (≥200 J) are preferable to lower energy.

👎 The Bad: Guidelines still say to continue giving Epi every 3 to 5 minutes. There is no definitive evidence of improved neurologic outcomes, and outcomes may be worse in shockable rhythm states.

❌ The Ugly: International Liaison Committee on Resuscitation (ILCOR) states that dual sequential external defibrillation (DSED) may be performed for shockable rhythms.

One important thing to note: The ACLS guidelines were made for all-comers in medicine and, therefore, should be approached with understanding that your expertise as a resuscitationist may go beyond ACLS.

A brief, resolved, unexplained event can be terrifying, but management hinges on careful history, exam, and risk stratification. Knowing who is truly low risk helps guide safe disposition and reassurance.

Listen now: https://www.emrap.org/episode/systemsofcare/pediatricpearls18

Aren’t we all looking for a novel treatment to reduce the negative impacts of ischemic stroke on our patients?

Because post-stroke neuroinflammation is considered a potential mediator of functional outcome, minocycline is increasingly being considered. This drug has been studied in a few small RCTs yielding heterogeneous results.

This study, the Efficacy and Safety of Minocycline in Patients with Acute Ischaemic Stroke (EMPHASIS) trial, was a fully powered, double-blinded RCT of minocycline vs placebo administered twice daily for 5 days poststroke. Adult participants were included if they had a confirmed stroke on imaging and were

5 days post-tonsillectomy, a patient presents with active bleeding on the tonsillar bed. How are you feeling about that presentation?
If you are like us, you might be feeling a bit uneasy right now, but we are going to ease that anxious thinking with a tin of great information. Jess brings in Laura Bontempo, an ED doctor and friend of the show.
This segment walks you through a real case, and the patient is the 22-year-old daughter of an ED doctor. So you know it’s gonna be a good one.

Jess and Laura will boost your confidence with tips, tricks, and expert advice that will have you saying “bring it on” to the next Post-Tonsillectomy Bleed that comes through the door.

Here are a few Pearls to get you in the proper mindset
- Postoperative days 5-7 represent the highest risk period for post-tonsillectomy hemorrhage.
- Beware of sentinel bleeding, which should be treated as a precursor to massive hemorrhage.
- Do not disturb a stable clot on the tonsillar bed; avoid suctioning and call ENT!

Ultrasound confidence starts with the basics. 🩺⚡

Whether you’re learning e-FAST exams for the first time or just need a quick refresher before your next shift, our new Ultrasound Basics series breaks down the essential views every clinician should know.

In this sneak peek, we cover the LEFT upper quadrant view during the eFAST exam:
🔹 Probe positioning at the posterior axillary line
🔹 How to work around rib shadowing
🔹 Identifying the spleen and kidney
🔹 Where to look for free fluid in the LUQ

Practical tips. Real scanning techniques. Better bedside care. 💥