REBEL EM

NOVEMBER 13, 2024

cefazolin or cefuroxime) If risk factors for MRSA present, use agent with activity against MRSA (i.e. vancomycin) If significant soft tissue injury, add gram negative coverage like late generation cephalosporin, extended-spectrum penicillin, or aminoglycoside (i.e.

ED 105

ED OR EMS 105

The Skeptics' Guide to EM

JANUARY 6, 2024

Case: After your shift in the emergency department (ED) one day, the medical director pulls you aside. Two previous studies conducted assessing the state of nationwide pediatric readiness were conducted in 2003 and 2013. July 2023 * Population: ED leadership across the United States. JAMA Netw Open.

Emergency Department 256

Emergency Department Emergency Medical Services ALS ED 256

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth. Case: It is a steady Saturday afternoon in your rural emergency department (ED). He has been a guest skeptic on the SGEM multiple times.

Critical Care 303

Critical Care ALS ED Emergency Department 303

ALiEM

FEBRUARY 20, 2024

2013 Dec;15(4):90-2. Epub 2013 Nov 7. Successful treatment of flecainide-induced cardiac arrest with extracorporeal membrane oxygenation in the ED. Sivalingam SK, Gadiraju VT, Hariharan MV, Atreya AR, Flack JE, Aziz H. Flecainide toxicity–treatment with intravenous fat emulsion and extra corporeal life support.

Life Support 183

Life Support Overdose ED 183

EMOttawa

FEBRUARY 22, 2024

In 2013, in the United States there were 7 million visits to the emergency department (ED) for lacerations making up a total of 5.2% of ED visits(1). Lacerations are a common presenting complaint to emergency department.

Emergency Department 89

Emergency Department ED OR 89

Pediatric EM Morsels

SEPTEMBER 8, 2023

Epub 2013 Nov 5. Summer penile syndrome: an acute hypersensitivity reaction. J Emerg Med. 2014 Jan;46(1):e21-2. doi: 10.1016/j.jemermed.2013.08.081. 2013.08.081. PMID: 24199728. Shah A, Sobolewski B, Mittiga MR. Summer Penile Syndrome. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e. McGraw Hill; 2021.

EMS 275

EMS ED OR 275

Pediatric EM Morsels

AUGUST 9, 2024

Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306. Congenital Syphilis may still occur in patients presenting to your ED! 2013 Aug;20(4):337-9. Epub 2013 Feb 27. Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Rates of congenital syphilis are increasing.

E-9-1-1 152

E-9-1-1 Plasma Emergency Department OR 152

ALiEM

AUGUST 30, 2024

A 5-year-old female presented to the emergency department (ED) with a one-year history of gradually increasing anterior neck swelling. She was discharged from the ED on levothyroxine 25 mcg daily with endocrinology outpatient follow-up. 2013 Mar;34(3):115-24; quiz 125. The patient had no significant past medical history.

ACS 161

ACS Emergency Department ED OR 161

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 66

ED Emergency Department ALS Paramedic 66

Broome Docs

MAY 31, 2024

Do we need to intubate French drunkards in ED? 2013 Sep;24(9):1848-53. Epub 2013 Jul 17. Justin and I discuss 7 papers covering a range of topics from securing IVCs in kids to intubating in space and the use of religious sham artifacts in middle-age, French “psychiatry” Yep, it was a strange month on the pod!

E-9-1-1 97

E-9-1-1 ED Critical Care ICU 97

The Skeptics' Guide to EM

DECEMBER 2, 2023

Case: A 4-year-old girl presents to your emergency department (ED) with fever and nasal drainage. The latest clinical practice guidelines from the American Academy of Pediatrics (AAP) on the diagnosis and management of acute bacterial sinusitis in children was published in 2013 [1]. Her vaccinations are all up to date.

Emergency Department 290

Emergency Department ALS OR ED 290

Core EM

JANUARY 25, 2024

More than 1/3 of geriatric trauma patients presenting to the ED after a fall return to the ED or die within one year of initial evaluation. 4 Elderly patients, who comprise only 8-12% of total ED major trauma cases, represent a disproportionate 15-30% of trauma mortalities and costs. Int J Emerg Med 2013; 6:12.

ALS 246

ALS ED ICU OR 246

ALiEM

NOVEMBER 15, 2023

2013 ;2013:610648. PMID: 17079589 Chaouali N, Gana I, Dorra A, Khelifi F, Nouioui A, Masri W, Belwaer I, Ghorbel H, Hedhili A. Potential Toxic Levels of Cyanide in Almonds (Prunus amygdalus), Apricot Kernels (Prunus armeniaca), and Almond Syrup. ISRN Toxicol. PMID: 24171123 Suchard JR, Wallace KL, Gerkin RD. Ann Emerg Med.

OR 169

OR ED 169

Pediatric EM Morsels

JULY 26, 2024

It is commonly missed during the first few ED visits. Keep a high index of suspicion for anti-NMDAr encephalitis in children and adolescents who have had multiple ED visits for new and worsening psych/behavioral concerns, seizures, and/or movement disorders over several months. Epub 2013 Dec 18. Serum AND CSF antibody titers!

Plasma 269

Plasma OR ED Critical Care 269

The Skeptics' Guide to EM

JULY 8, 2023

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. Managing editor of EM:RAP and Associate Editor at REBEL EM. It’s flu season and you’ve already seen 15 people with the same symptoms.

ALS 232

ALS Emergency Department EMS ED 232

Core EM

JANUARY 25, 2024

One week prior to ED arrival, the patient was becoming progressively despondent, less interactive with peers, exhibiting slow speech and movements, and was not eating. In Diagnostic and statistical manual of mental disorders (5th ed.). Catatonia: a case report by Brown Emergency Medicine. Burrow JP, Spurling BC, Marwaha R.

MICU 246

MICU Emergency Department OR ED 246

Core EM

OCTOBER 16, 2024

In: Marx J, ed. In: Wolfson A, ed. 2013 Feb;160(4):434-44. Br J Haematol. 2009 Nov;147(4):431-43. link] Emery, M. Blood and blood components. Rosen’s emergency medicine. Philadelphia, PA: Elsevier; 2014:75-80. Transfusion Reactions and Complications. Harwood-Nuss’ Clinical Practice of Emergency Medicine. Hirayama F.

Allergic Reaction 145

Allergic Reaction Plasma ED Epinephrine 145

The Skeptics' Guide to EM

MAY 14, 2022

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). He is also one of the world’s leading researchers on pain management in the emergency department and specifically the use of ketamine.

ALS 130

ALS Emergency Department ED OR 130

REBEL EM

SEPTEMBER 13, 2023

J Emerg Med 2013; 44 (4): 764-772. In: UptoDate, Feldweg AM (ed.) N Engl J Med. 2015; 372(5):418-25. PMID 25629740 Hassen GW et al. Fresh frozen plasma for progressive and refractory angiotensin-converting enzyme inhibitor-induced angioedema. PMID: 23114109 Hessert MJ and Bennett BL. Wilderness and Environmental Medicine. 2012; 14(11).

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

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

REBEL EM

MAY 11, 2023

PMID: 34697777 Clinical Question: In patients with moderate to severe alcohol withdrawal being discharged from the emergency department (ED), does treatment with phenobarbital alone and phenobarbital plus benzodiazepines compared to benzodiazepines alone decrease the odds of returning to the ED within 3 days after initial discharge?

Emergency Department 98

Emergency Department ED EMR OR 98

The Skeptics' Guide to EM

APRIL 24, 2021

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. Droperidol has been used widely, particularly in Australasia, for acute severe agitation. Droperidol has been used widely, particularly in Australasia, for acute severe agitation.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

EMDocs

AUGUST 13, 2024

HTN was the primary diagnosis in over 1 million ED visits in 2023, and rates of HTN emergencies have increased over the past 20 years. From 2006-2013, HTN emergencies occurred in approximately 2 of every 1000 adult ED visits. In the ED setting, they recommend avoiding intensifying HTN medications.

ED 85

ED OR 85

EMDocs

DECEMBER 1, 2024

A 52-year-old male with a history of essential hypertension presents to your South Texas ED for his second visit this week complaining of indolent fever, shortness of breath, pleuritic chest pain, and a rash on his trunk and extremities. Flea-Borne Typhus: Epidemiology Summary 2013-2019. Flea-Borne Typhus. Accessed August 19, 2024.

EMS 75

EMS E-9-1-1 OR ED 75

Don't Forget the Bubbles

NOVEMBER 29, 2023

Even though sedation after endotracheal intubation (ETI) reduces the risk of self-extubation, uncontrolled pain, and awakening awareness, several small single-centre studies demonstrate low rates of sedative drug administration after ETI in the emergency department (ED). 2013 Jan;31(1):222-6. What are the only exceptions? Br J Anaesth.

E-9-1-1 135

E-9-1-1 Emergency Department ED CPR 135

Core EM

OCTOBER 2, 2024

In: Marx J, ed. In: Wolfson A, ed. 2013 Feb;160(4):434-44. Br J Haematol. 2009 Nov;147(4):431-43. link] Emery, M. Blood and blood components. Rosen’s emergency medicine. Philadelphia, PA: Elsevier; 2014:75-80. Transfusion Reactions and Complications. Harwood-Nuss’ Clinical Practice of Emergency Medicine. Hirayama F.

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk. Am J Emerg Med.

E-9-1-1 161

E-9-1-1 ED OR Emergency Department 161

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). 2013 Sep;31(9):1389-92. Epub 2013 Jul 30. However, the benefit vs. harm of using TXA topically for epistaxis is unclear. Am J Emerg Med. PMID: 23911102.

Epinephrine 40

Epinephrine EMS ED ALS 40

This Podcast Will Kill You

NOVEMBER 27, 2023

2013): 131-140. 2013): 385-393. ” Infection, Genetics and Evolution 14 (2013): 137-146. History Biology Hoerauf, Achim, and Ramakrishna U. Wolbachia: a bug’s life in another bug. Karger Medical and Scientific Publishers, 2007. and Nutman, T.B., Immunology of lymphatic filariasis. Parasite immunology , 36 (8), pp.338-346.

E-9-1-1 52

E-9-1-1 ALS ED 52

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

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

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 69

E-9-1-1 ALS ED OR 69

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

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

FOAMfrat

JULY 3, 2024

This is the mechanism that will eventually kill the patient as well with the high concentration (430 ppm+ exposure) Vajner JE 3rd (2013) references several studies on the inhalation of chlorine. Advanced Hazmat Life Support Provider Manual (4th ed.). (F. Thomas, Eds.) 2013, 9 9). Bronstein, A. Fernandez, M. Walter, J.

Life Support 106

Life Support ALS Emergency Response OR 106

EMergucate

MAY 30, 2013

A mid fifties male presents to your ED with 2 hours of chest pain and this ECG

ED 100

ED EMS 100

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. 2013 Apr 17;10(6):747-50. normal value is between 0.8

ICU 105

ICU Emergency Department OR Ambulance 105