The Skeptics' Guide to EM

MARCH 6, 2021

Reference: Reuben A et al. Reference: Reuben A et al. Background: Epistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% ( Gifford 2008 , Pallin 2005 ). The episode included the Dundee protocol for adult epistaxis management from 2012.

ALS 130

ALS Emergency Department EMS ED 130

The Skeptics' Guide to EM

DECEMBER 17, 2022

Date: December 16th, 2022 Reference: Hohle et al. Date: December 16th, 2022 Reference: Hohle et al. Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home. years ( 2 ).

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

EMDocs

JULY 25, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Chuck Pilcher, MD, FACEP Editor, Medical Malpractice Insights Editor, Med Mal Insights The challenge of suicide evaluation in the ED “I’ve changed my mind. Ronquillo L et al. Oct 04, 2012.

ED 82

ED ALS Emergency Department OR 82

REBEL EM

SEPTEMBER 13, 2023

Both conditions can range in severity from benign to life threatening (Wilkerson 2012). Read More EMCrit: Podcast 145 – Awake Intubation Lecture from SMACC ERCast: Angioedema References: Baş M et al. PMID 25629740 Hassen GW et al. PMID 23062323 Kostis JB et al. PMID 16043683 McCormick M et al. N Engl J Med.

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

The Skeptics' Guide to EM

APRIL 8, 2023

John Brown PhD is a Professor of Health Services Research in Ireland who has been studying rural healthcare issues since 2012. In Ontario alone there have been approximately 160 emergency departments (ED) temporarily closed since the beginning of 2022. This is an SGEM Xtra episode.

Emergency Department 139

Emergency Department ED Ambulance ALS 139

The Skeptics' Guide to EM

JUNE 5, 2021

References: * Suzuki et al. JAMA 2021 * Zi et al. Background: Management of acute ischemic stroke has been discussed on the SGEM ever since this knowledge translation project was launched in 2012. At work Garreth imagines himself as a student of evidence-based medicine trying to provide the best care based on the best evidence.

ALS 130

ALS Emergency Department ED 130

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. Richards JE et al. NEJM 1994. [2]

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

Don't Forget the Bubbles

JANUARY 17, 2024

After Meshram et al, 2020 When Orbeez are exposed to water, the water molecules diffuse into the polymer network through osmosis. Image adapted from Mullens et al., ” ( Ed. After Darracq et al., A recent literature review by Caré et al. Zamora et al., From Mullens et al.,

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

Don't Forget the Bubbles

AUGUST 23, 2023

Very rarely are the ED team allowed to stand, in silence, with a purpose. Kapoor et al. 2012) “Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue”. 2012) “Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting”.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

EMDocs

AUGUST 22, 2024

6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. 6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. One cohort study in a public ED found that 84.5%

Emergency Department 82

Emergency Department ALS E-9-1-1 ED 82

Core EM

JULY 23, 2024

New York, NY: McGraw-Hill; 2012:51–57. New York, NY: McGraw-Hill; 2012:51–57. 2021, [link] Shen, J, et al. 2020, [link] Shen, J, et al. 2020, [link] Shen, J, et al. Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Elsevier; 2018:(Ch) 138. EmDOCs.net – Emergency Medicine Education, 7 Apr.

ALS 130

ALS OR Emergency Department ED 130

Core EM

MARCH 12, 2024

New York, NY: McGraw-Hill; 2012:51–57. New York, NY: McGraw-Hill; 2012:51–57. 2021, [link] Shen, J, et al. 2020, [link] Shen, J, et al. 2020, [link] Shen, J, et al. Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Elsevier; 2018:(Ch) 138. EmDOCs.net – Emergency Medicine Education, 7 Apr.

ALS 130

ALS OR Emergency Department ED 130

Don't Forget the Bubbles

OCTOBER 10, 2024

This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. 2012 Aug 15;(8):CD004872.

ED 75

ED Emergency Department OR ALS 75

EMS 12-Lead

JUNE 20, 2022

Here is the final ECG just prior to ED transfer. Attached below is the initial ED tracing upon hospital arrival, approximately 25 minutes after the prehospital ECG. Upon hospital arrival, the patient verbalized slight attenuation of pain. There is some “deflation” of the ST/T configuration upon juxtaposition with ECG 2. 2] Driver, B.

ACS 130

ACS Coronary STEMI CAD 130

REBEL EM

AUGUST 30, 2023

Graphics Image 1: [link] Image 2: [link] References Berbari EF, Kanj SS, et al. PMID: 26316526 Boody B, et al. New Delhi: JP Brothers Medical Ltd; 2012 Della-Guistina, D. PMID: 25892724 Gouliouris T, et al. 2010 Nov;65 Suppl 3:iii 11-24 PMID: 20876624 Mylona E, et al. In: Sherman SC eds.

E-9-1-1 104

E-9-1-1 ALS ED OR 104

EMDocs

NOVEMBER 7, 2023

For more on the ED evaluation of diverticulitis, please see Part 1. 2012 Apr;99(4):532-9. The DIABLO trial: Daniels L, Ünlü Ç, de Korte N, et al; Dutch Diverticular Disease (3D) Collaborative Study Group. Randomized van Dijk ST, Daniels L, Ünlü Ç, et al; Dutch Diverticular Disease (3D) Collaborative Study Group.

ACPE 88

ACPE ALS OR ED 88

Don't Forget the Bubbles

SEPTEMBER 30, 2024

In the UK, as in most developed countries, more patients are presenting to Emergency Departments (EDs) with minor illnesses or injuries. Simpson et al. Patients who Did Not Wait are a feature of most EDs worldwide. A 2011-2012 Australian study by Blake et al. of those children later returned to the ED.

Emergency Department 89

Emergency Department ALS ED OR 89

Dr. Smith's ECG Blog

JUNE 2, 2023

Despite otherwise normal vital signs, she was appropriately triaged to the critical care area of the ED. They are rare and hard to find in normal practice in the ED. She denied chest pain and denied feeling any palpitations, even during her triage ECG: What do you think? J Electrocardiol, 42 (2009), pp.

ED 83

ED OR ALS CAD 83

EMDocs

NOVEMBER 13, 2024

Major takeaway: Consider SBP in any patient who comes into the ED with ascites. Biggins SW, Angeli P, Garcia-Tsao G, et al. Mattos AA, Wiltgen D, Jotz RF, et al. Aithal GP, Palaniyappan N, China L, et al. Angeli P, Bernardi M, Villanueva C, et al. Arvaniti V, D’Amico G, Fede G, et al. Hepatology. Hepatology.

E-9-1-1 79

E-9-1-1 ALS OR ED 79

EMDocs

MAY 11, 2024

A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al.

EMS 89

EMS E-9-1-1 ALS OR 89

REBEL EM

NOVEMBER 30, 2022

Perform manual detorsion after diagnosis Read More: Video: The New Testicular Torsion Traction Technique Ben-Israel T et al. Clinical predictors for testicular torsion as seen in the pediatric ED. PMID: 20837255 Sidler D et al. Pediatric Emer Care 2012; 28: 80-6. Pediatric Emer Care 2012; 28: 80-6. OR = 58.8 (Ben-Israel

ALS 52

ALS ED OR EMS 52

REBEL EM

NOVEMBER 2, 2022

grams/kg on day 3 of treatment Patients with a single episode of SBP should be considered for antibiotic prophylaxis (with norfloxacin, ciprofloxacin or TMP/SMX) ( Runyon 2012 ) Take Home Points SBP is a difficult diagnosis to make because presentations are variable. References Runyon BA et al. PMID: 3338704 Borzio M et al.

ALS 52

ALS ED EMS OR 52

REBEL EM

FEBRUARY 8, 2023

Surv Ophthalmol 2012; 57(5):448-462. PMID: 3652623 Wilhelmus KR et al. PMID: 4739528 Weiner et al. Link McDonald et al. Link Welder et al. Link Wilhelmus KR et al. PMID: 7997324 Chan RV et al. Link White et al. Herpes simplex epithelial and stromal keratitis: an epidemiologic update.

ALS 52

ALS OR EMS ED 52

REBEL EM

JULY 20, 2022

References: Frappe P, et al the STEPH Study Group. PMID: 12814979 Blumenberg RM, et al.: PMID: 9510288 Coon WW et al. PMID: 25903684 Guyatt GH et al. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.

ALS 52

ALS OR ED EMS 52

EMDocs

SEPTEMBER 9, 2023

He presents to the ED with profound difficulty extending his middle and ring finger. e1 Rosh AJ, Kwon NS, Wilburn JM, et al. Examination reveals the following: What is the diagnosis? Rosh Review Website Link References Park CW, Juliano ML, Woodhall D. Tendon Lacerations. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. Ann Plast Surg.

EMS 78

EMS ED ALS Emergency Department 78

ACEP Now

JULY 7, 2023

Last month’s article focused on ACEP’s efforts and resources to support EDs and patients with psychiatric emergencies. Emergency departments (EDs) focus on rapid initiation of medical treatment. However, rapid initiation of treatment is actually patient-centered care that can both lead to better outcomes and limit ED boarding.

Emergency Department 52

Emergency Department ED Naloxone ALS 52

Don't Forget the Bubbles

JULY 26, 2023

Prioritise listening to the first 30 minutes which given a good overview of aetiology and treatment (53 mins) Basics of cardiac rhythm problems in the ED Palpitations are a common reason for children to present to the emergency department, the majority of these will be benign from a cardiac perspective and instead related to stress or anxiety.

ALS 98

ALS ED OR CPR 98

Dr. Smith's ECG Blog

MAY 21, 2023

Here is the first ED ECG: COMPUTER INTERPRETATION: Electronic Atrial Pacemaker. An elderly patient had a fall from probable syncope, and could not get up. He complained of weakness and shortness of breath, but no CP. Vital signs were normal. Marked ST Elevation, ACUTE MI What do you think? First, the QRS is incredibly wide!

ALS 78

ALS OR ED 78

EMDocs

SEPTEMBER 23, 2023

A 36-year-old female presents to the ED after experiencing an episode of sudden syncope. Rosh Review Website Link References Antzelevitch C, Brugada P, Borggrefe M, et al. Priori SG, Napolitano C, Gasparini M, et al. Chen Q, Kirsch GE, Zhang D, et al. Wilde AA, Antzelevitch C, Borggrefe M, et al. Circulation.

E-9-1-1 84

E-9-1-1 EMS ALS Defibrillator 84

This Podcast Will Kill You

SEPTEMBER 26, 2023

History Biology Al-Doory, Yousef, and Arthur F. DiSalvo, eds. Springer Science & Business Media, 2012. 2012): e1002808-e1002808. Andes et al. But, as we discuss in the episode’s conclusion, that protection may be weakened as our warming planet selects for fungi that can tolerate increasing temperatures.

ALS 52

ALS ED 52

Dr. Smith's ECG Blog

MARCH 13, 2013

A 36 yo male smoker presented to the ED with chest pain. In a 1999 study by Engelen et al. Approximately 10% of patients with anterior STEMI have STE of at least 1 mm in aVR (as measured at 60 ms after the J-point), ( Wong, 2012 ) and 25% have at least 0.5 Wong, 2012) STE in aVR of at least 0.5 Wong, 2012)" 1.

STEMI 52

STEMI Coronary ALS ACS 52

REBEL EM

JANUARY 25, 2023

3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 PMID: 23758299 Maung AA et al. Louis, Mosby, Inc., 2010, (Ch) 92: p 1216-1227.

ED 52

ED ALS OR ICU 52

ACEP Now

FEBRUARY 13, 2024

A 77-year-old man presented to the emergency department (ED) with hip pain following a fall. On ED presentation, he was experiencing 10 out of 10 pain level. In the January issue of Annals of Emergency Medicine , Merz-Herrara, et al., Trends in opioid prescriptions among part D medicare recipients from 2007 to 2012.

E-9-1-1 52

E-9-1-1 Emergency Department ED ALS 52

REBEL EM

MARCH 8, 2023

et al, Emergency Medicine Clinical Essentials ed 2. Eye Emergencies, in Tintinalli J et al (eds): Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, Seventh Edition New York City: McGraw-Hill 2016 (Ch) 241 Guluma K, Lee JE. . >10 floaters, (+) LR 8.1-36 Philadelphia: Elsevier, 2013 (Ch) 26: p.

Emergency Department 52

Emergency Department ALS ED OR 52

ACEP Now

MARCH 13, 2024

Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. ED crowding impairs this mission. The Emergency Medical Treatment and Labor Act (EMTALA) mandates examination, treatment, and stabilization of anyone who comes to the ED.

Emergency Department 52

Emergency Department ED ALS OR 52

ACEP Now

MARCH 15, 2024

A 20-year-old man presents to the emergency department (ED) directly from the scene of a fall from a bicycle, where he lost balance and landed on his outstretched hand. 6 A missed DRUJ injury may lead to chronic wrist supination deficit and pain, which can be prevented with surgery in some cases, so early diagnosis in the ED is important.

ALS 52

ALS ED OR EMS 52

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

He was brought to the ED. See the February 6, 2015 post in Dr. Smith's ECG Blog - and - the Case Study of polymorphic VT induced by exercise, by Hoffmayer, Scheinman et al — Heart Rhythm 19:1214-1216, 2022 ). Appropriately, the medics electrically cardioverted immediately. They did not feel they had time to sedate.

E-9-1-1 67

E-9-1-1 ALS OR ED 67