The Skeptics' Guide to EM

DECEMBER 2, 2023

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]. Untreated sinusitis is associated with complications such as pre septal cellulitis, orbital cellulitis. However, in the interest of antibiotic stewardship.

Emergency Department 297

Emergency Department ALS OR ED 297

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. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019.

Emergency Department 130

Emergency Department ALS ED EMS 130

The Skeptics' Guide to EM

DECEMBER 15, 2018

Eur J Paediatr Neurol 2013) that concluded antipyretics were ineffective in reducing the recurrence of febrile seizures in children. Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Associate Professor for the University of Leicester’s SAPPHIRE group. Date: December 13th , 2018 Reference: Murata et al.

OR 130

OR Emergency Department ALS 130

Pediatric EM Morsels

SEPTEMBER 8, 2023

Epub 2013 Nov 5. Treatment is supportive. References: Schulert GS, Gigante J. 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.

EMS 275

EMS ED OR 275

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

This includes SGEM#19 way back in 2013 reporting a bandage wrap is a safe alternative to traditional casting for children with greenstick fractures. Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. He is also a fully-fledged ultrasonographer. Reference: Snelling et al.

Critical Care 310

Critical Care ALS ED Emergency Department 310

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

ALiEM

AUGUST 30, 2024

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. She denied difficulty swallowing, fatigue, cold intolerance, or hair and nail changes. Physical Exam Vitals : BP 87/62; Pulse 80; Temp 36°C (96.8°F); Abdominal : Soft.

ACS 161

ACS Emergency Department ED OR 161

ALiEM

MARCH 5, 2024

2013 May;5(5):330. Willow tree bark extract has been used as an herbal supplement for chronic lower back pain, joint pain, osteoarthritis, sports performance, and weight loss [3]. Willow tree bark supplements are available as tablets, tinctures, powders, or tea. Ingestion of willow bark supplements can cause salicylism. Phytotherapy Research.

OR 286

OR 286

Pediatric EM Morsels

MAY 10, 2024

2013 Oct;132(4):e1010-7. Ask about suicidal ideation : Let’s not miss a caustic ingestion… Ask about birth control : Teens may be on OCPs and at increased risk for PE and their parents don’t know it Ask about drugs : Does your patient smoke, vape, or use cocaine? Have you ever had chest pain or shortness of breath in exercise? Equal pulses?

E-9-1-1 268

E-9-1-1 OR EMS 268

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% Lacerations are a common presenting complaint to emergency department. of ED visits(1).

Emergency Department 89

Emergency Department ED OR 89

Pediatric EM Morsels

JULY 26, 2024

Epub 2013 Dec 18. While it is important for us to maintain a safe work environment for our patients and our team, managing the agitated patient requires more of us than administering Droperidol or Ketamine. Make sure to consult your friendly neighborhood pediatric neurologist and/or rheumatologist! The prevalence ranges from 12.5%-61%

Plasma 269

Plasma OR ED Critical Care 269

Dr. Smith's ECG Blog

DECEMBER 12, 2022

This " imbalance of precordial T waves" is not seen very often — and in the “right” clinical setting, has been associated with recent OMI from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM ). This is termed " pseudo-normalization."

OR 52

OR ACS STEMI Coronary 52

Pediatric EM Morsels

MAY 5, 2023

2013 Aug;110(4):755-73. Epub 2013 Jan 14. Supplementation is key! Key nutrients and vitamins are not always found in specialized diets (or picky children) and adherence to multivitamins is a must! Look out for nutritional deficiencies ! References: Alexy U, Fischer M, Weder S, Längler A, Michalsen A, Sputtek A, Keller M.

E-9-1-1 130

E-9-1-1 OR EMS 130

ALiEM

DECEMBER 18, 2023

2013 Jun;6(6):31-7. The patient specifically denied mucous membrane involvement (mouth, eyes, genitalia), vomiting, diarrhea, dysuria, hematuria, neck stiffness, cough, dyspnea, chest pain, or exposure to ticks or exotic animals. Additional Images Physical Exam Vitals : T 39.6°C; Additional Images Physical Exam Vitals : T 39.6°C;

Emergency Department 177

Emergency Department OR 177

The Skeptics' Guide to EM

JANUARY 6, 2024

Two previous studies conducted assessing the state of nationwide pediatric readiness were conducted in 2003 and 2013. Are general emergency departments ready to care for children? 1,2] Today we’re covering the third study. Pediatric readiness is important because it is associated with decreased mortality in ill and injured children. [3,

Emergency Department 261

Emergency Department Emergency Medical Services ALS ED 261

Core EM

JANUARY 25, 2024

Definition: Catatonia: A behavioral motor dysregulation syndrome marked by an inability to move normally despite full physical capacity, which can occur in the context of many underlying psychiatric and general medical disorders [4]. Epidemiology : Who typically suffers from catatonia? Who typically suffers from malignant catatonia?

MICU 246

MICU Emergency Department OR ED 246

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

Core EM

JANUARY 25, 2024

Background: The lumbar puncture (LP or spinal tap) is a procedure that has been in the medical arsenal since first described in 1891 by German physician Heinrich Quincke. Technique: Probe selection: The linear probe is more ideal for pediatric patients and adults with a leaner body habitus. High-quality images obtained in <1 minute in 87.9%

ALS 246

ALS Critical Care OR 246

Pediatric EM Morsels

APRIL 5, 2024

Treatment : Supportive care Omsk hemorrhagic fever/Kyasanur Forest disease (CDC 2013) Causative Agent: Flavivirus Incubation period : 3-8 days Symptoms start with chills, fevers, headache and GI symptoms followed by symptoms of bleeding 3-4 days later including petechial rash, low hemoglobin and low WBC. Global Change Research Program.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

Broome Docs

MAY 31, 2024

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! Do we need to intubate French drunkards in ED? Psychol Sci.

E-9-1-1 97

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

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

FOAMfrat

NOVEMBER 21, 2024

Acidosis Existing literature demonstrates mortality rates up to three times higher in trauma patients presenting with extreme acidosis (pH <7.0) compared to patients with mild acidosis or normal pH. Acidosis can worsen coagulopathy and hypothermia, and vice versa. In trauma patients, acidosis (pH < 7.35) is usually caused by lactic acid.

ICU 111

ICU Emergency Department OR Ambulance 111

EMDocs

APRIL 6, 2024

Source Adverse Tracheal Intubation Events in Critically Ill Underweight and Obese Children: Retrospective Study of the National Emergency Airway for Children Registry (2013-2020). We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Pediatr Crit Care Med. 2024 Feb 1;25(2):147-158.

OR 75

OR 75

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

Pediatric EM Morsels

NOVEMBER 3, 2023

2013 Sep 4; 89(3): 527–530. Additionally in a head-to-head study, there was improved mortality with IV artesunate (Forgie 2022) IV artesunate is extremely expensive to stock and may not be available at every hospital in non-endemic regions. It appears after an asymptomatic period. Treating malaria is an ART! vivax or P. Am J Trop Med Hyg.

ALS 278

ALS Critical Care EMS OR 278

First Responders Foundation

AUGUST 26, 2024

Her research and advocacy led to the implementation of OPD’s Peer Support Team (PST) in 2013, under the leadership of Omaha Police Chief Todd Schmaderer. After years of serving in Uniform Patrol, including a specialized assignment in the Weed and Seed Unit focusing on gang and narcotics activity, Mary was promoted to Sergeant in 1998.

First Responder 98

First Responder Public Safety Paramedic OR 98

Pediatric EM Morsels

JULY 28, 2023

Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 or serum bicarbonate between 11-17 mmol/L Moderate : venous pH < 7.2 or serum bicarbonate between 5-10 mmol/ L Severe : venous pH < 7.1 Neuroimaging is NOT required. GCS score is not sensitive enough.

E-9-1-1 246

E-9-1-1 ALS OR Critical Care 246

Core EM

JANUARY 25, 2024

Int J Emerg Med 2013; 6:12. 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. Heffernan &al. 2010;69:813.

ALS 246

ALS ED ICU OR 246

The Skeptics' Guide to EM

AUGUST 5, 2023

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. But we’re always trying to balance the potential harms and potential benefits in medicine. Thankfully, clinically important intracranial injuries are rare in children [2].

ALS 100

ALS Emergency Department OR 100

EMDocs

FEBRUARY 29, 2024

2013 Dec;45(6):835-41. 2013 Nov;126(11):962-3. Ashman’s phenomenon can be conducted consecutively which can mimic wide complex tachycardia, specifically non-sustained ventricular tachycardia. However, Ashman phenomenon does not respond to ventricular tachycardia treatment (e.g., amiodarone or sodium channel blockade). J Emerg Med.

EMS 80

EMS OR 80

Don't Forget the Bubbles

OCTOBER 25, 2023

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. It is often difficult to do this in an ED setting. How is IIH diagnosed? Manometer three-way tap.

ALS 124

ALS OR ED 124

Don't Forget the Bubbles

OCTOBER 21, 2024

Available at: The DSM‐5: Classification and criteria changes – Regier – 2013 – World Psychiatry – Wiley Online Library Szejko N, Robinson S, Hartmann A, Ganos C, Debes NM, Skov L et al. Tics are the most common type of paediatric movement disorder. The first three always start before 18 years of age. World Psychiatry.

ALS 59

ALS Emergency Department OR 59

REBEL EM

MAY 29, 2024

Laryngoscope 2013; 123: 2928-9. Take Home Points: Posterior epistaxis is a rare, life-threatning presentation. The key is in identifying and rapidly gaining control with a posterior pack or foley catheter. These patients often require surgical intervention so get ENT to the bedside and admit to a place with a higher level of monitoring.

ICU 105

ICU ALS ACS EMS 105

Emergency Medicine Cases

NOVEMBER 7, 2017

Yet according to a 2013 Medscape survey, 40% of physicians reported burnout in U.S. Burnout – it’s the elephant in the room that we all know about but prefer not to discuss. They explain why wellness matters, how you can strive to achieve it and how to recognize when you or a colleague are unwell so that you can get the help you need.

OR 130

OR EMS 130

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

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

The Skeptics' Guide to EM

MAY 14, 2022

They include: CBT and mindfulness ( Cherkin et al JAMA 2016), chiropractic ( Paige et al JAMA 2017), physical therapy ( Paolucci et al J Pain Research 2018) and acupuncture (Colquhoun and Novella Anesthesia and Analgesia 2013 ). The pain is 10/10 in intensity, gets worse with bending, turning, and prolonged walking.

ALS 130

ALS Emergency Department ED OR 130