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).

Emergency Department 89

Emergency Department ED OR 89

ALiEM

NOVEMBER 10, 2023

A 33-year-old male presented to the emergency department with a diffuse pruritic rash that appeared several days after starting Trimethoprim/Sulfamethoxazole (TMP-SMX) for a dental infection. 2013 Apr;168(4):726-32. Epub 2013 Feb 16. Progression stopped after discontinuing TMP-SMX. Br J Dermatol. doi: 10.1111/bjd.12133.

Emergency Department 161

Emergency Department OR 161

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. Case: It is a steady Saturday afternoon in your rural emergency department (ED). Reference: Snelling et al.

Critical Care 310

Critical Care ALS ED Emergency Department 310

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. 2013 Mar;34(3):115-24; quiz 125. The patient had no significant past medical history. She also endorsed three weeks of cough and congestion, and one day of muffled voice. Abdominal : Soft.

ACS 161

ACS Emergency Department ED OR 161

The Skeptics' Guide to EM

DECEMBER 15, 2018

He specialises in Paediatric Emergency Medicine and is a passionate […] The post SGEM#239: Febrile Seizure Recurrence – With or Without You Acetaminophen? first appeared on The Skeptics Guide to Emergency Medicine. Fever fear is a real concern for parents and they often come to the emergency department for evaluation and reassurance.

OR 130

OR Emergency Department ALS 130

Core EM

JANUARY 25, 2024

An estimated 7% to 15% of acutely hospitalized psychiatric patients and psychiatric emergency department patients exhibit catatonia [4]. Malignant Catatonia (AKA “lethal catatonia”): An acute onset life-threatening subtype of catatonia that is characterized by fever, autonomic instability, delirium, and rigidity [4].

MICU 246

MICU Emergency Department OR ED 246

Pediatric EM Morsels

MAY 24, 2024

Low Risk Intra-Abdominal (IAI) Trauma – Derivation of the Rule The PECARN Group first released their derivation of a pediatric prediction rule for intra-abdominal injury in 2013. 2013 Aug 1;167(8):700-707. Only 6 patients classified as very low risk were found to have IAI requiring intervention. Lancet Child Adolesc Health.

ALS 161

ALS EMS Emergency Department OR 161

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. Emergency department overcrowding is a complex issue with multiple contributing factors. Learning about international trends sparked our curiosity about our own department.

Emergency Department 89

Emergency Department ALS ED OR 89

ALiEM

DECEMBER 18, 2023

A 19-year-old female with a past medical history of epilepsy presented to the emergency department for evaluation of rash and fever. 2013 Jun;6(6):31-7. Two days prior to presentation she began to experience fevers with a Tmax of 103°F. The patient endorsed associated pruritus and cervical lymphadenopathy with the rash.

Emergency Department 177

Emergency Department OR 177

FOAMfrat

NOVEMBER 21, 2024

Hypothermia Hypothermia, defined as core temperature less than 35oC (95oF) has been identified in up to 2/3 of trauma patients upon arrival to the emergency department. Coagulopathy is identified through lab work in the emergency department and is correlated in current literature with significantly worse patient outcomes.

ICU 111

ICU Emergency Department OR Ambulance 111

The Skeptics' Guide to EM

AUGUST 28, 2021

Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial. 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?

ED 130

ED Emergency Department ALS OR 130

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.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

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. A 12-year-old male is being transported by ambulance after a road traffic accident. His name is Ben.

E-9-1-1 135

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

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 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

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

The Skeptics' Guide to EM

MAY 14, 2022

Sergey Motov is an Emergency Physician in the Department of Emergency Medicine, Maimonides Medical Center in New York City. He is also one of the world’s leading researchers on pain management in the emergency department and specifically the use of ketamine. His twitter handle is @PainFreeED.

ALS 130

ALS Emergency Department ED OR 130

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? You may be more familiar with the term “limited English proficiency” (LEP), defined as: someone who does not speak English as their primary language and has a limited ability to read, speak, write, or understand English.

Emergency Department 81

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

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

The Skeptics' Guide to EM

AUGUST 5, 2023

Computerized tomography (CT) is commonly used in the emergency department in the diagnosis of TBI. Population: Children less than 18 years of age presenting with head injury to a level 2 pediatric trauma center in the United States between 2012-2013.

ALS 100

ALS Emergency Department OR 100

Don't Forget the Bubbles

OCTOBER 21, 2024

Olivia, 7, has been brought to the emergency department. Her mother has brought her to the emergency department because she is worried that Olivia is doing the movements more frequently and would like a brain scan. Over the last couple of weeks, Olivia has been having episodes of rapid blinking and grimacing.

ALS 59

ALS Emergency Department OR 59

The Skeptics' Guide to EM

OCTOBER 20, 2018

Lauren is currently funded by an NHLBI K12 grant (1K12HL138049-01) studying the implementation of evidence-based diagnosis of pulmonary embolism in the emergency department. She presents to the emergency department with chest pain and some shortness of breath. Case: A 64-year-old woman with type-2 diabetes.

Coronary 174

Coronary Emergency Department ALS OR 174

Pediatric EM Morsels

OCTOBER 27, 2023

Most emergency drugs except for amiodarone and succinylcholine are based on ideal body weight [Emergency Medical Services for Children, Luten 2007] Epinephrine, dopamine, fentanyl, ketamine based on what child should weigh. PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. Int J Emerg Med. J Emerg Med.

E-9-1-1 269

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

The Skeptics' Guide to EM

OCTOBER 3, 2020

Date: October 2nd, 2020 Guest Skeptic: Dr.Barbra Backus is an emergency physician at the Emergency Department of the Erasmus University Medical Center in Rotterdam, the Netherlands. She is the creator of the HEART Score and an enthusiastic researcher. Reference: Claiborne Johnston S et al. Reference: Claiborne Johnston S et al.

Emergency Department 100

Emergency Department ALS OR 100

The Skeptics' Guide to EM

AUGUST 19, 2023

I responded by posting the 2013 SGEM episode on INTERACT-2 ( SGEM#73 ) which showed no statistical difference between intensive (<140 mmHg) and guideline directed (<180 mmHg). Case: A 67-year-old male presents to the emergency department obtunded with left hemiplegia. Symptoms began just prior to presentation.

EMS 126

EMS ALS Emergency Department OR 126

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.

Emergency Department 100

Emergency Department ALS ED OR 100

Pediatric EM Morsels

FEBRUARY 2, 2024

While there is no “right” work up for these patients, hopefully this morsel will help illuminate your evaluation of Travel-Related Illness in Children: Travel-related Illness: Basics International travel has been significantly increasing since commercial airlines made travel much easier.

E-9-1-1 161

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

ACEP Now

JULY 7, 2024

Should emergency physicians rely on standard textbooks for diagnostic and treatment regimens? 1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). 1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED).

Emergency Department 52

Emergency Department Critical Care ALS ICU 52

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

This was the third time coming to McGill University Department of Emergency Medicine to give Grand Rounds. The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest. The bottom line was this was interesting, but VSE protocol was not ready for routine use.

Epinephrine 130

Epinephrine Emergency Department EMS ALS 130

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]. . Reference: Clemency et al.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

The Skeptics' Guide to EM

MARCH 13, 2021

Date: March 11th, 2021 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Ohio. Lancet 2021 Case: You’re […] The post SGEM#322: TXA for SAH – Won’t Stop Me Now first appeared on The Skeptics Guide to Emergency Medicine. Reference: Post et al. Reference: Post et al.

ALS 100

ALS Emergency Department ED OR 100

REBEL EM

MARCH 8, 2023

Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. Emergency Department Management: Emergency ophthalmology consultation. Emergency surgical management indicated if concomitant retinal tear, vitreous hemorrhage, or retinal detachment. >10 floaters, (+) LR 8.1-36

Emergency Department 52

Emergency Department ALS ED OR 52

EMDocs

JUNE 7, 2023

She is speaking one word at a time and constantly coughing. She complains of dizziness, nausea, and abdominal cramps. On exam, you notice there is a garlic-like odor filling the room. Questions: What is the most likely causative xenobiotic that led to these findings? Influenza vaccine Methanol Organophosphate Paraquat Are her symptoms reversible?

E-9-1-1 83

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

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. The pediatric age group represents one of the populations at risk for oligoanalgesia.

ALS 130

ALS Emergency Department OR ED 130

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.

Emergency Department 52

Emergency Department ALS ED OR 52

EMDocs

SEPTEMBER 23, 2023

A 23-year-old man with no significant medical history presents to the emergency department for evaluation of a syncopal episode. On arrival, vital signs are stable with a HR of 71, BP of 121/71 mmHg, RR of 17 bpm, and SpO2 of 97% on room air. Physical exam reveals a well-appearing female in no acute distress.

E-9-1-1 83

E-9-1-1 EMS ALS Defibrillator 83

EMDocs

JUNE 14, 2023

He has been having difficulty walking and is having trouble manipulating tools he uses for work with his hands. He has a glove and stocking pattern of numbness to his extremities. Motor and sensory findings are symmetrical. Patellar reflexes are 1+. Paraquat Influenza vaccine Methanol Organophosphate Are his symptoms reversible?

E-9-1-1 70

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

EMDocs

SEPTEMBER 25, 2023

However, emergency physicians have recently faced a multitude of patients requiring ETI with anatomically and physiologically difficult airways; these patients increase the risk of a can’t intubate/can’t oxygenate scenario or significant hypoxemia, hypercarbia, or acidemia. Paradoxical reactions (i.e., agitation or aggression).

ED 65

ED Emergency Department ALS OR 65

FOAMfrat

DECEMBER 28, 2023

I have been a nurse since 2013. An Emergency Nurse since 2016 with prehospital experience starting in 2019 with a ground service where I was a paramedic-exempt nurse at the beginning of 2019. Data was pulled from June 2013 to June 2018. Quick background I am a nurse. During this time, 5,451 charts were reviewed. Take a movement.

Paramedic 52

Paramedic Emergency Medical Services Operating Room OR 52