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

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 130

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

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

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 297

Emergency Department ALS OR ED 297

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

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

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 261

Emergency Department Emergency Medical Services ALS ED 261

Pediatric EM Morsels

AUGUST 9, 2024

Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306. Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal? Is this bloody stool concerning? Are this odd movements part of normal development? Is that umbilical area ok or concerning? May be on soles of feet !

E-9-1-1 152

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

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

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. The prevalence ranges from 12.5%-61%

Plasma 269

Plasma OR ED Critical Care 269

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. Patient Case: History: A 60-year-old male with history of schizophrenia and depression on multiple unknown antipsychotic medications presents with unresponsiveness x 1 day.

MICU 246

MICU Emergency Department OR ED 246

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 145

Allergic Reaction Plasma ED Epinephrine 145

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.

ED 65

ED Emergency Department ALS Paramedic 65

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

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

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. compared to patients with mild acidosis or normal pH.

ICU 111

ICU Emergency Department OR Ambulance 111

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

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 105

Frozen Plasma Allergic Reaction FFP Plasma 105

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

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.

E-9-1-1 161

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

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 84

ED OR 84

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. Reference: Martel et al.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

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). What are the only exceptions? How can we prevent this?

E-9-1-1 135

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

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

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

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

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 68

E-9-1-1 ALS ED OR 68

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

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 106

Life Support ALS Emergency Response OR 106

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

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

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

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 76

ALS ED EMS OR 76

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.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

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. Initial interventions include local pressure, ice, and forward head positioning for persistent bleeds. Am J Emerg Med. PMID: 23911102.

Epinephrine 40

Epinephrine EMS ED ALS 40

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