EMDocs

OCTOBER 9, 2023

Yoo, MD (Assistant Professor/Core Faculty, San Antonio, TX) // Reviewed by Brit Long, MD (@long_brit) Case An 18-year-old man with a history of asthma and medication noncompliance presents to the emergency department (ED) with acute onset shortness of breath. He states that he recently moved to Texas from Colorado. Which one do you select?

ED 81

ED Life Support Advanced Life Support CPR 81

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 81

ED ALS Emergency Department OR 81

REBEL EM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. Article: Arvig MD, Lassen AT, Gæde PH, et al. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.

ED 130

ED E-9-1-1 Emergency Department ALS 130

The Skeptics' Guide to EM

DECEMBER 2, 2023

Reference: Shaikh N, et al. Reference: Shaikh N, et al. Case: A 4-year-old girl presents to your emergency department (ED) with fever and nasal drainage. Identifying children likely to benefit from antibiotics for acute sinusitis: a randomized clinical trial. Her vaccinations are all up to date.

Emergency Department 297

Emergency Department ALS OR ED 297

The Skeptics' Guide to EM

JULY 8, 2023

Date: July 6, 2023 Reference: Hanula R et al. Date: July 6, 2023 Reference: Hanula R et al. Case: A 57-year-old woman with hypertension, hyperlipidemia and type-2 diabetes mellitus presents to the emergency department (ED) with fever, cough, myalgias, headache and congestion. JAMA Int Med 2023. JAMA Int Med 2023.

ALS 237

ALS Emergency Department EMS ED 237

The Skeptics' Guide to EM

MAY 14, 2022

Date: May 13th, 2022 Reference: Abril et al. Date: May 13th, 2022 Reference: Abril et al. Case: A 45-year-old man without a significant past medical history presents to your emergency department (ED) with two days of severe lower back pain after shoveling some dirt. EDs annually (1). His twitter handle is @PainFreeED.

ALS 130

ALS Emergency Department ED OR 130

EMDocs

SEPTEMBER 25, 2023

However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). While RSI should remain the gold standard in the vast majority of patients in the ED, FI presents an additional technique to mitigate anatomic or physiologic risk. To date, ketamine has been the agent of choice (12).

ED 65

ED Emergency Department ALS Paramedic 65

REBEL EM

SEPTEMBER 13, 2023

Read More EMCrit: Podcast 145 – Awake Intubation Lecture from SMACC ERCast: Angioedema References: Baş M et al. PMID 25629740 Hassen GW et al. J Emerg Med 2013; 44 (4): 764-772. PMID 23062323 Kostis JB et al. PMID 16043683 McCormick M et al. PMID 20954277 Sinnert R et al. Zuraw et al.

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

ALiEM

MARCH 7, 2024

Transvere ultrasound views of the bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.) Sagittal view of bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.)

E-9-1-1 177

E-9-1-1 Emergency Department ALS ED 177

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 81

Emergency Department ALS E-9-1-1 ED 81

EMDocs

NOVEMBER 13, 2024

Major takeaway: Consider SBP in any patient who comes into the ED with ascites. A 2013 meta-analysis found IV albumin was associated with 22.3% 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.

E-9-1-1 72

E-9-1-1 ALS OR ED 72

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

This Podcast Will Kill You

NOVEMBER 27, 2023

2013): 131-140. Brown, Amanda MV, et al. Ferri, Emanuele, et al. Gerth, Michael, et al. Kaur, Rupinder, et al. 2013): 385-393. ” Infection, Genetics and Evolution 14 (2013): 137-146. Quek, Shannon, et al. History Biology Hoerauf, Achim, and Ramakrishna U. and Nutman, T.B., Addiss, D.

E-9-1-1 52

E-9-1-1 ALS ED 52

The Skeptics' Guide to EM

APRIL 24, 2021

Reference: Martel et al. Way back in 2013 we looked at haloperidol for agitation due to psychosis ( SGEM#45 ) and concluded that it was an effective treatment but had common side effects. Reference: Martel et al. Kirsty is also the creator of the wonderful infographics called #PaperinaPic.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

Don't Forget the Bubbles

OCTOBER 25, 2023

It is often difficult to do this in an ED setting. Image adapted by Holland JA et al. Image adapted by Holland JA et al. 2013 Sep 24;81(13):1159-65. Epub 2013 Aug 21. Strabismus alone is a rare sign of a brain tumour in this age group; however, the associated papilloedema is concerning. Manometer three-way tap.

ALS 124

ALS OR ED 124

EMDocs

NOVEMBER 21, 2023

In ED, repeat potassium level was 2.6 Permanent weakness usually affects the proximal lower extremities, happens in older patients, and develops late. Diagnosis: Can be made in the ED based on history, exam, lab testing. Consult neurology in the ED. ED workup should exclude alternate causes of symptoms. Muscle Nerve.

E-9-1-1 68

E-9-1-1 ALS ED OR 68

Don't Forget the Bubbles

JUNE 14, 2023

Lava SAG, et al. Hsiao W, et al. Mullaly R, et al. Arch Dis Child Fetal Neonatal Ed. Arch Dis Child Fetal Neonatal Ed. Puoti MG, et al. Stenson EK, et al. Bruinsma RA, et al. Rivetti G, et al. van Gameren-Oosterom HBM, et al. Lester TR, et al. Mansell H, et al.

ALS 119

ALS ACS ED OR 119

Don't Forget the Bubbles

JULY 22, 2024

Pre-school wheezers remain a poorly understood cohort of children despite seeing them every day in paediatric EDs. However, there was no difference in LOS (83 minutes for placebo vs 79 minutes for prednisolone) in participants who were discharged straight from the ED ( 32% ). Compare this with the Panickar et al.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

The Skeptics' Guide to EM

JUNE 12, 2021

Reference: McLaren SH, et al. Reference: McLaren SH, et al. In 2013, the American Academy of Pediatrics (AAP) updated recommendations for the diagnosis and management of acute otitis media (AOM) for children older than 6 months. Reference: McLaren SH, et al.

Emergency Department 100

Emergency Department ALS ED OR 100

ACEP Now

JULY 7, 2024

1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). 2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus).

Emergency Department 52

Emergency Department Critical Care ALS ICU 52

Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. link] Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. 2012.05.028 Silvagni D, Baggio L, Mazzi C, et al. and Seaver, M.

E-9-1-1 269

E-9-1-1 Emergency Medical Services Life Support ALS 269

ACEP Now

DECEMBER 11, 2023

The Emergency Department Benchmarking Alliance (EDBA) is a membership organization composed of high-performance emergency departments (EDs) that share a commitment to quality. Thus, the survey included data for about one-third of all patients seen in US ED’s in 2022. 1 Boarding time increases led to unprecedented ed walkaway rates.

Emergency Department 52

Emergency Department ED EMS ALS 52

FOAMfrat

NOVEMBER 21, 2024

upon ED arrival incur mortality rates of up to 3-5x that of patients without coagulopathy. One study out of Taiwan observed mortality rates of 100% when patients met all three trauma triad criteria and had a systolic blood pressure <60mmHg upon arrival to the ED. Jessica Dawkins Mills BSN, et al. 2013 Apr 17;10(6):747-50.

ICU 111

ICU Emergency Department OR Ambulance 111

EMDocs

FEBRUARY 22, 2024

A 43-year-old male, with no significant medical history, presents to the ED for right eye pain. 2013; 7362. In: Tintinalli JE, Ma OJ, Yealy DM, et al., In: Knoop KJ, Stack LB, Storrow AB, Thurman RJ, eds. In: Tintinalli JE, Ma OJ, Yealy DM, et al., Wakai A, Lawrenson JG, Lawrenson AL, et al.

ALS 76

ALS ED EMS OR 76

REBEL EM

MAY 11, 2023

5 Paper: Lebin J et al. Authors assessed how many of the 470 had return ED visits (for any reason) within 3 days of discharge, within 3-7 days, and after 7 days of discharge. 1, 2 Phenobarbital has been studied as an alternative or adjunct to benzodiazepines with encouraging results, but primarily among inpatient services.

Emergency Department 98

Emergency Department ED EMR OR 98

The Skeptics' Guide to EM

MARCH 13, 2021

Reference: Post et al. Reference: Post et al. Lancet 2021 Case: You’re working a busy evening shift in your community emergency department (ED) when a 58 year old female presents with a rapid onset terrible intensity headache. Robert Edmonds is an emergency physician in the US Air Force in Ohio.

ALS 100

ALS Emergency Department ED OR 100

Silk City Blog

DECEMBER 6, 2022

TXA has become the standard practice in the ED based on small RCTs, though larger trials have not demonstrated the same benefit (REBEL EM review). Paper: Zahed R, Moharamzadeh P, Alizadeharasi S et al. 2013 Sep;31(9):1389-92. Epub 2013 Jul 30. Am J Emerg Med. PMID: 23911102.

Epinephrine 40

Epinephrine EMS ED ALS 40

FOAMfrat

JULY 3, 2024

If they are not already there, get ALS-level care to the patient as soon as possible. I personally know of 2 ALS providers who were exposed to chlorine gas in a pool incident on the job and both ended up retiring from their service and still have lifelong breathing problems as a result. Thomas, Eds.) 2013, 9 9).

Life Support 106

Life Support ALS Emergency Response OR 106

REBEL EM

JULY 20, 2022

Bauersachs 2013 ) Clinical Significance SVT previously thought to be a benign disease entity ( Cosmi 2015 ) However, subsequent studies have demonstrated that in patients with lower extremity SVT concomitant DVT and PE was seen in approximately 25% and 5% respectively. References: Frappe P, et al the STEPH Study Group. 13(7):1175-83.

ALS 52

ALS OR ED EMS 52

The Skeptics' Guide to EM

JANUARY 19, 2019

Date: January 17th , 2019 Reference: Clemency et al. Date: January 17th , 2019 Reference: Clemency et al. Wave 3: Significant increase in overdose deaths involving synthetic opioids (like illicitly-manufactured or prescribed fentanyl) beginning in 2013 [4]. Reference: Clemency et al.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

The Skeptics' Guide to EM

OCTOBER 28, 2017

[display_podcast] Date: October 24th, 2017 Reference: Harrison et al. display_podcast] Date: October 24th, 2017 Reference: Harrison et al. That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015. Reference: Harrison et al.

ALS 130

ALS Emergency Department OR ED 130

This Podcast Will Kill You

NOVEMBER 12, 2024

Routledge, 2013. Acres of skin: Human experiments at Holmesburg prison. Draelos, ZK, editor. Cosmetic Dermatology: Products and Procedures. John Wiley & Sons, Inc, 2022. Kligman, Albert M., “Oral vitamin A in acne vulgaris Preliminary report.” ” International Journal of Dermatology 20.4 1981): 278-285. Burgess, C.M.

E-9-1-1 52

E-9-1-1 ALS ED OR 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 Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

ED 52

ED ALS OR ICU 52

Don't Forget the Bubbles

AUGUST 4, 2024

Brewster RCL, et al. Strunk T, et al. Pinon A, et al. Vassilopoulou E, et al. Calvert A, et al. Roumeliotis N, et al. Gallo Ruelas M, et al. Morris R, et al. Arch Dis Child Fetal Neonatal Ed. Lorenzo M, et al. van Dam MJCM, et al. van Dam MJCM, et al. Lommi S, et al.

E-9-1-1 52

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

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 83

E-9-1-1 EMS ALS Defibrillator 83

This Podcast Will Kill You

NOVEMBER 5, 2024

Routledge, 2013. Acres of skin: Human experiments at Holmesburg prison. Draelos, ZK, editor. Cosmetic Dermatology: Products and Procedures. John Wiley & Sons, Inc, 2022. Kligman, Albert M., “Oral vitamin A in acne vulgaris Preliminary report.” ” International Journal of Dermatology 20.4 1981): 278-285. Burgess, C.M.

E-9-1-1 52

E-9-1-1 ALS ED OR 52

Don't Forget the Bubbles

AUGUST 7, 2023

The controversy around what is ‘normal’ in infants’ and children’s vitals was demonstrated in a 2011 systematic review by Fleming et al. and two cohort studies, one performed in Australia by O’Leary et al. and one in the US by Bonafide et al. Brennan et al. Our study supports previous work by Nijman et al.

Life Support 98

Life Support Advanced Life Support ALS Emergency Department 98