The Skeptics' Guide to EM

AUGUST 28, 2021

Case: A forty-year-old woman presents to the emergency department […] The post SGEM#342: Should We Get Physical, Therapy for Minor Musculoskeletal Disorders in the ED? Case: A forty-year-old woman presents to the emergency department (ED) with a sore lower back after moving some boxes at home over the weekend.

ED 130

ED Emergency Department ALS 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. Which one do you select?

ED 107

ED Life Support Advanced Life Support CPR 107

The Skeptics' Guide to EM

FEBRUARY 18, 2023

Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. The SGEM has done two previous podcasts on APPs in the ED. Date: February 17, 2023 Reference: Gettel et al.

Emergency Department 130

Emergency Department ALS ED EMS 130

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. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.

ED 128

ED E-9-1-1 Emergency Department ALS 128

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

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

EMDocs

JANUARY 11, 2025

Up to 1/3 of adults over 60 suffer from chronic constipation. Evaluation: A good history and a high index of clinical suspicion is paramount, especially in high-risk patient populations 4 CT of the abdomen and pelvis with contrast is the best choice for diagnosis. Enemas (some studies show this may be associated with perforation risk).

E-9-1-1 97

E-9-1-1 EMS Emergency Department OR 97

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 93

Emergency Department ED OR 93

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). The pain is 10/10 in intensity, gets worse with bending, turning, and prolonged walking. million visits to U.S.

ALS 130

ALS Emergency Department ED OR 130

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. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Heyming 2012] How Do You Use The Broselow-Luten System/Tape? x exp[0.02

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

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. Reference: Martel et al.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

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 is a RANThony on pediatric pain control and one of the interesting treatments was sucrose. Sweet Solutions to Reduce Procedural Pain in Neonates: A Meta-analysis.

ALS 130

ALS Emergency Department OR ED 130

ALiEM

MARCH 7, 2024

The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Her mother denies any fevers, upper respiratory symptoms, sore throat, or diarrhea. She adds that her daughter has complained of 2-3 episodes of dysuria and gross hematuria over the last few days. Lay the patient supine when possible.

E-9-1-1 177

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

REBEL EM

SEPTEMBER 13, 2023

of people who take NSAIDs ( Nzeako 2010 ). 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 of people who take NSAIDs ( Nzeako 2010 ). Typically involves the mouth, larynx, pharynx, and subglottic tissue ( Kostis 2005 ).

Frozen Plasma 104

Frozen Plasma Allergic Reaction FFP Plasma 104

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 95

Emergency Department ED EMR OR 95

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 98

ED OR 98

Don't Forget the Bubbles

OCTOBER 25, 2023

It is often difficult to do this in an ED setting. 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. The fact that fundoscopy has been carried out on this child is a feat. How is IIH diagnosed? doi: 10.1212/WNL.0b013e3182a55f17.

ALS 124

ALS OR ED 124

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 ). Reference: Post et al.

ALS 100

ALS Emergency Department ED OR 100

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. Exam: 2/5 strength when attempting to flex his bilateral thighs.

E-9-1-1 94

E-9-1-1 ALS ED OR 94

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 82

E-9-1-1 ED Critical Care ICU 82

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 104

Emergency Department ALS E-9-1-1 ED 104

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. Also, start a hazmat company and engine company as quickly as possible. Be prepared to take an advanced airway early.

Life Support 105

Life Support ALS Emergency Response OR 105

EMDocs

FEBRUARY 22, 2024

A 43-year-old male, with no significant medical history, presents to the ED for right eye pain. 2013; 7362. The patient notes his pain as constant and sharp (8/10); associated with light-sensitivity, tearing, and blurred vision. The man does not use glasses or contact lenses. He denies known ocular trauma or ocular surgical history.

ALS 97

ALS ED EMS OR 97

Core EM

OCTOBER 2, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

Don't Forget the Bubbles

OCTOBER 2, 2023

mmol/L) with acute illness between 2013 and 2018. Younger age, higher bicarbonate levels and lower ketones in children with acute illness and hypoglycaemia on presentation to ED are potential predictors of establishing a hypoglycaemia diagnosis. A threshold of 3.9mmol was used, higher than that used in UK practice.

ALS 138

ALS OR ED Emergency Department 138

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.

Emergency Department 89

Emergency Department ALS ED OR 89

EMS 12-Lead

APRIL 2, 2022

Upon arrival he was found alert and oriented, and without gross distress. He denied difficulty breathing, epigastric pain, or chest discomfort. BP 110/67 HR 68 RR 14 (non-labored) SpO2 95 RA Physical exam revealed slight pallor and diaphoresis. Auscultation of breath sounds did not yield any evidence of wheezing, crackles, or diminished fields.

ALS 130

ALS STEMI Coronary OR 130

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. We’ll keep it short, while you keep that EM brain sharp. Vital signs include BP 168/89, HR 96, T 98.3,

EMS 111

EMS E-9-1-1 ALS OR 111

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, of the patients received vasopressors through a peripheral IV.

Overdose 92

Overdose ACS Critical Care OR 92

EMDocs

AUGUST 12, 2023

Answer : Flexor tendon injury Epidemiology: Secondary to deep penetration with sharp objects or blunt trauma at tendinous attachments to bone 2 Common in young men in manual labor (20-45 years) Literature has conflicting data regarding dominance of hand injured 2,3 Usually injured when using a sharp object or catching a falling object Overall epidemiology (..)

EMS 94

EMS ALS Emergency Department ED 94

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. What did previous studies show? What is the problem?

Life Support 98

Life Support Advanced Life Support ALS Emergency Department 98

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 There is no history or physical exam feature that rules out the disease Lactate elevation is a late finding in SBO. Absent bowel sounds Peritoneal signs (i.e.

ED 52

ED ALS OR ICU 52

EMDocs

JANUARY 29, 2024

Introduction: Neurologic emergencies are common in the Emergency Department (ED), and blood pressure management is critical to immediate management. His blood pressure (BP) is 220/120 mmHg. What are the next best steps in BP management for this patient? hypertensive emergency, need for thrombolytic administration) [1].

ALS 98

ALS Critical Care OR EMS 98

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

Don't Forget the Bubbles

SEPTEMBER 27, 2023

Jamie is admitted to the Paediatric Ward, and the paediatric trainee calls the ED to ask if a viral respiratory panel was obtained. SpO2 is 88%. Jamie does not improve after receiving nebulized salbutamol and low-flow O2 via mask. What do the guidelines say? What is the evidence for avoiding respiratory viral panels (RVP)? cystic fibrosis).

Emergency Department 84

Emergency Department ALS ED OR 84

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. mg/day or rivaroxaban 10 mg/day as second line. >

ALS 52

ALS OR ED EMS 52

REBEL EM

OCTOBER 19, 2022

2013, July 2). Treat moderate to severe symptoms and any EKG changes with IV calcium salts Always search for and treat the underlying cause of hypocalcemia REBEL Core Cast 88.0 – Hypocalcemia Click here for Direct Download of the Podcast Definition: A serum calcium level < 8.5 Louis, Mosby, Inc., 2014, (Ch) 125: p 1636-53.

ED 52

ED ALS EMS OR 52