The Skeptics' Guide to EM

FEBRUARY 18, 2023

Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. AEM Feb 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and Assistant Professor at the University of Calgary. The SGEM has done two previous podcasts on APPs in the ED.

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Emergency Department ALS ED EMS 130

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.

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ALS Emergency Department EMS ED 233

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. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

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ED E-9-1-1 Emergency Department ALS 129

EMOttawa

FEBRUARY 22, 2024

Lacerations are a common presenting complaint to emergency department. 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).

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Pediatric EM Morsels

AUGUST 9, 2024

Neonates presenting to the Emergency Department often cause a lot of uncertainty. Let’s review how Congenital Syphilis may present to our Emergency Departments: Congenital Syphilis : Basics Occurs when the spirochete Treponema pallidum is transmitted from mother to fetus. Emerg Radiol. 2013 Aug;20(4):337-9.

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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. Pediatric neck masses. Pediatr Rev.

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ACS Emergency Department ED OR 161

ALiEM

MARCH 7, 2024

Facts and Literature Review Bladder volume estimation Measuring bladder volume via POCUS in pediatric patients has been studied, demonstrating a benefit on Emergency Department workflow and length of stay (Table 1). The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Chen et al.,

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

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.

Emergency Department 52

Emergency Department ED EMS ALS 52

The Skeptics' Guide to EM

MAY 14, 2022

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

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ALS Emergency Department ED OR 130

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.

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ED Life Support Advanced Life Support CPR 82

Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. Pediatric Endotracheal Intubations for Airway Management in the Emergency Department.

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

Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Emergency Medical Services for Children] “Red to Head.” One end of the tape is red with an arrow. PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. Int J Emerg Med. J Emerg Med.

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

The Skeptics' Guide to EM

APRIL 24, 2021

Randomized Double-blind Trial Intramuscular Droperidol, Ziprasidone and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department. 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.

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Emergency Department ALS Ambulance ED 100

The Skeptics' Guide to EM

JANUARY 19, 2019

He is alert and oriented times three with normal vital signs by the time he arrives in the emergency department. Wave 3: Significant increase in overdose deaths involving synthetic opioids (like illicitly-manufactured or prescribed fentanyl) beginning in 2013 [4]. . This recommendation was based on the St.

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Naloxone Overdose Emergency Medical Services Emergency Department 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. Blogpost, June 2013.

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ED ALS Emergency Department OR 82

The Skeptics' Guide to EM

OCTOBER 28, 2017

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. There are certain patient populations who are at risk for in adequate pain management. One medication that should not be use in children under 12 years of age is codeine.

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ALS Emergency Department OR ED 130

The Skeptics' Guide to EM

JUNE 12, 2021

Pediatrics 2021 Case: You are working with a medical student at the emergency department when a 2-month-old boy is […] The post SGEM#334: In My Life there’s been Earache and Pain I don’t know if it’s IBI again – in an Afebrile Infant with Acute Otitis Media first appeared on The Skeptics Guide to Emergency Medicine.

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Emergency Department ALS ED OR 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.

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

REBEL EM

SEPTEMBER 13, 2023

patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 J Emerg Med 2013; 44 (4): 764-772. Optimizing Emergent Surgical Cricothyrotomy for Austere Environments. Emergency Medicine Practice.

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Frozen Plasma Allergic Reaction FFP Plasma 105

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. examined 977,907 first-time ED presentations by children aged 0-15 across thirteen acute hospital trusts (between April 2014 and March 2017), trying to figure out how many were non-urgent.

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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. We don’t want to go backwards!

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ED Emergency Department ALS Paramedic 66

REBEL EM

DECEMBER 4, 2024

PMID: 25701296 The SGEM: Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol) ALiEM: Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers. ALiEM: Beta Blockers Vs. Calcium Channel Blockers for Atrial Fibrillation Rate Control: Thinking Beyond the ED. Emerg Med J 2005;22:411–4.

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Emergency Department ALS ED EMS 103

EMDocs

DECEMBER 18, 2024

A 36-year-old male presents to the emergency department after being found down at home by his spouse. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. Per the mans wife, the patient is a heavy drinker often consuming two to three pints of vodka daily.

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E-9-1-1 Emergency Department ICU ED 61

The Skeptics' Guide to EM

MARCH 13, 2021

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. Jeff was actually on the SGEM as the guest skeptic discussing this clinical decision instrument way back in 2013 ( SGEM#48 ).

ALS 100

ALS Emergency Department ED OR 100

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%

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

EMDocs

JUNE 7, 2023

F, HR 48, RR 28, BP 104/62, SPO2 88% on non-rebreather mask The patient’s friend who brought her to the ED tells you the patient made suicidal statements earlier in the day and was found in her yard shed. These are send-out labs with turn-around times that make them unlikely to affect the ED course or guide treatment. 2013; 6:524.

E-9-1-1 84

E-9-1-1 ICU Emergency Department ED 84

Don't Forget the Bubbles

AUGUST 7, 2023

Clinicians may under or over-estimate paediatric patients presenting to the ED as being at high-risk for sepsis if there do not have evidence-based heart and respiratory rate ranges, Brennan et al set out to add to our understanding of what is ‘normal ’ in paediatric vital signs. 2013 Apr 1;131(4):e1150–7. Acad Emerg Med.

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Life Support Advanced Life Support ALS Emergency Department 98

EMDocs

FEBRUARY 22, 2024

A 43-year-old male, with no significant medical history, presents to the ED for right eye pain. 2013; 7362. Eye Emergencies. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. In: Knoop KJ, Stack LB, Storrow AB, Thurman RJ, eds.

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ALS ED EMS OR 77

REBEL EM

AUGUST 18, 2022

Fletcher, MD, FACEP and Nicholas Slattery, MD Background: Diverticulitis is a common finding amongst Emergency Department patients, accounting for more than 360,000 visits in 2013 alone 1. Once appropriate symptom control was achieved, patients were discharged home with medical treatment and diet recommendations.

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Emergency Department ALS ED OR 52

AAEM RSA

MAY 7, 2021

Schreyer, MD CMQ FAAE Originally published: Common Sense January/February 2021 The advent and broad availability of ridesharing services, such as Lyft and Uber, are changing the way patients access medical services, and emergency departments (EDs) are taking notice. 5 The cost of transport is also an issue.

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EMR Emergency Medical Services Ambulance Emergency Department 52

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).

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Emergency Department Critical Care ALS ICU 52

REBEL EM

MARCH 8, 2023

Emergency Department Management: Emergency ophthalmology consultation. Emergency surgical management indicated if concomitant retinal tear, vitreous hemorrhage, or retinal detachment. et al, Emergency Medicine Clinical Essentials ed 2. Philadelphia: Elsevier, 2013 (Ch) 26: p.

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Emergency Department ALS ED OR 52

EMDocs

JUNE 14, 2023

These are send-out labs with turn-around times that make them unlikely to affect the ED course. This prevents ongoing exposure to the patient and ED staff. In: Mattu A and Swadron S, ed. Parenteral organophosphorus poisoning in a rural emergency department: a case report. Published 2013 Dec 9. CorePendium.

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E-9-1-1 Emergency Department Plasma ACS 70

EMDocs

OCTOBER 30, 2023

Belcher, MD (EM Attending Physician, University of Kentucky, Department of Emergency Medicine) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) “What do you call an IV contrast shortage? Alternative contrast agents.

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E-9-1-1 Emergency Department ALS ED 73

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% ). Reattendance to GP/ED was more important.

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E-9-1-1 ALS ACS ED 105

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). 2013 Jan 24;368(4):394]. Ann Emerg Med.

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Defibrillator CPR Epinephrine Life Support 85

EMDocs

SEPTEMBER 23, 2023

A 36-year-old female presents to the ED after experiencing an episode of sudden syncope. A 23-year-old man with no significant medical history presents to the emergency department for evaluation of a syncopal episode. ECGpedia , 22 May 2013, [link]. We’ll keep it short, while you keep that EM brain sharp. Heart Rhythm.

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E-9-1-1 EMS ALS Defibrillator 84