EMDocs

NOVEMBER 13, 2024

Major takeaway: Consider SBP in any patient who comes into the ED with ascites. Biggins SW, Angeli P, Garcia-Tsao G, et al. Mattos AA, Wiltgen D, Jotz RF, et al. Aithal GP, Palaniyappan N, China L, et al. Angeli P, Bernardi M, Villanueva C, et al. Arvaniti V, D’Amico G, Fede G, et al. Hepatology. Hepatology.

E-9-1-1 105

E-9-1-1 ALS OR ED 105

ALiEM

APRIL 12, 2023

Accessed April 5, 2023 Afzal S, Zahid M, Rehan ZA, et al. 20 – Local Anesthetics, Ed(s): Hugh C. Hynynen, 10.08 – Ultrasound Therapy, Editor(s): Anders Brahme, Comprehensive Biomedical Physics, Elsevier, 2014, Pages 153-168, ISBN 9780444536334. 2022 Jan 6;8(1):42. doi: 10.3390/gels8010042. Hemmings, Talmage D.

Emergency Department 258

Emergency Department ALS ED 258

The Skeptics' Guide to EM

JUNE 17, 2023

Date: June 15, 2023 Reference: Rees CA et al. Date: June 15, 2023 Reference: Rees CA et al. Case: A 14-year-old male with sickle cell disease (SCD) presents to your emergency department (ED) with a vaso-occlusive pain episode (VOE) of his bilateral legs and back. Reference: Rees CA et al. Opioids are the primary therapy.

Emergency Department 186

Emergency Department ALS ED OR 186

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. Article: Arvig MD, Lassen AT, Gæde PH, et al. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.

ED 129

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

The Skeptics' Guide to EM

MAY 14, 2022

Date: May 13th, 2022 Reference: Abril et al. Date: May 13th, 2022 Reference: Abril et al. 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). His twitter handle is @PainFreeED.

ALS 130

ALS Emergency Department ED OR 130

EMDocs

JANUARY 11, 2025

A 75-year-old woman who is bedridden after a stroke presents to the ED from a nursing facility with abdominal pain and constipation. Therefore, discharging the patient on lactulose (C) would not be recommended without additional treatment in the ED. Ahmad H, Jannat H, Khan U, et al. Al-Maharmeh, Q., Stercoral Colitis.

E-9-1-1 98

E-9-1-1 EMS Emergency Department OR 98

ALiEM

MARCH 7, 2024

Transvere ultrasound views of the bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.) Sagittal view of bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.)

E-9-1-1 177

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

The Skeptics' Guide to EM

OCTOBER 10, 2020

Reference: Friedman et al. Date: October 9th, 2020 Guest Skeptic: Dr. Reference: Friedman et al. Background: Pain is one of the most frequent reasons to attend an ED. of all ED visits resulting in 2.6 million visits each year in the USA ( Friedman et al Spine 2010 ). His twitter handle is @PainFreeED.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

FEBRUARY 26, 2022

Date: February 21st 2022 Reference: Kim et al. Date: February 21st 2022 Reference: Kim et al. Case: You are in discussion with your emergency department (ED) manager about the number of patients boarding for hours to days and you are both aware that many of these patients are attending with mental health crises.

ED 130

ED ALS Emergency Department OR 130

The Skeptics' Guide to EM

NOVEMBER 20, 2021

Date: November 16th, 2021 Reference: Hammouda et al. Date: November 16th, 2021 Reference: Hammouda et al. AEM November 2021 Guest Skeptic: Dr. You wonder if any emergency department (ED)-based interventions would help her and people like her be safe. Reference: Hammouda et al. There are three other GEAR 1.0

ALS 130

ALS ED Emergency Department OR 130

ALiEM

SEPTEMBER 27, 2023

Hoffman et al. Koppaka V, Thompson DC, Chen Y, et al. Mushrooms, Coprine. Encyclopedia of Toxicology (Third Edition), Academic Press. doi: 10.1016/B978-0-12-386454-3.00754-5. Goldfrank L. In: Goldfrank’ s Toxicologic Emergencies. New York, NY. McGraw-Hill.

ALS 169

ALS OR ED 169

ALiEM

NOVEMBER 29, 2023

PMID: 34529640 Ayub S, Parnia S, Poddar K, et al. Published 2014 Mar 26. PMID: 24769343 Ehrman-Dupre R, Kaigh C, Salzman M et al. PMID: 36148197 Love JS, Levine M, Aldy K, et al. PMID: 37014353 Ball NS, Knable BM, Relich TA et al. How do you treat xylazine toxicity? MMWR Morb Mortal Wkly Rep. 2023;15(3):e36864.

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

The Skeptics' Guide to EM

JANUARY 14, 2018

[display_podcast] Date: January 9th, 2018 Reference: Soleimanpour H et al. display_podcast] Date: January 9th, 2018 Reference: Soleimanpour H et al. A study from Bindman et al. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department.

Emergency Department 130

Emergency Department ALS ED OR 130

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. To date, ketamine has been the agent of choice (12).

ED 92

ED Emergency Department ALS Paramedic 92

The Skeptics' Guide to EM

JULY 17, 2021

Date: July 14th, 2021 Reference: Pernica et al. Date: July 14th, 2021 Reference: Pernica et al. Case: Six-year-old Morten comes into your emergency department (ED) with what looks like pneumonia. This is because most pneumonias in this age-group are caused by viral pathogens ( Bradley et al 2011 ). Bradley et al 2011 ).

ALS 130

ALS Emergency Department ED 130

The Skeptics' Guide to EM

DECEMBER 17, 2022

Date: December 16th, 2022 Reference: Hohle et al. Date: December 16th, 2022 Reference: Hohle et al. Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home. years ( 2 ).

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

ALiEM

NOVEMBER 1, 2023

In: Nelson LS, Goldfrank LR et al (eds): Goldfrank’s Toxicologic Emergencies. Intensive Care Med 2014; 40(1):104. PMID The post was peer reviewed on behalf of ACMT by Drs. Blake Froberg, Bryan Judge, and Louise Kao. Read More in the Series References Perrone J. McGraw-Hill Education; 2019 Madiwale T, Liebelt E.

E-9-1-1 161

E-9-1-1 ALS OR ED 161

The Skeptics' Guide to EM

OCTOBER 22, 2017

[display_podcast] Date: October 19th, 2017 Reference: Hofmann et al. display_podcast] Date: October 19th, 2017 Reference: Hofmann et al. Studies have shown that oxygen can cause vasoconstriction, increase blood pressure and decrease coronary artery blood flow ( Kones et al AM J Med 2011). NEJM Sept 2017. NEJM Sept 2017.

Emergency Medical Services 130

Emergency Medical Services Coronary ALS STEMI 130

REBEL EM

JANUARY 9, 2024

Bottom Line Up Top: In patients with infectious processes that are stable for discharge home, there is no role for giving a first dose of antibiotics IV in the ED. PMID: 9114201 Siegel RE et al. BMJ (Clinical research ed.). PMID: 17090560 Castro-Guardiola A et al. PMID: 1664833 Addo-Yobo E, et al. Pneumonia 2017.

ALS 99

ALS ICU ED OR 99

ACEP Now

AUGUST 14, 2024

Rate Versus Rhythm in the ED The 2023 AHA/ACC guideline doesn’t give explicit recommendations or preference regarding initial rate or rhythm control strategy for new-onset AF patients who are hemodynamically stable. based care of ED patients with AFRVR. References Joglar JA, Chung MK, Armbruster AL, et al. Circulation.

ALS 105

ALS Emergency Department ED OR 105

The Skeptics' Guide to EM

DECEMBER 28, 2019

Date: December 16th, 2019 Reference: Moore et al. Date: December 16th, 2019 Reference: Moore et al. There was a trial published in 2014 comparing radiology department ultrasound, POCUS and CT for suspected nephrolithiasis (Smith-Bindman et al. NEJM 2014 ). Annals of EM, JU, and JACR 2019.

Emergency Department 100

Emergency Department ALS EMS ED 100

ACEP Now

AUGUST 25, 2023

Intranasal Fentanyl for Sickle Cell Vaso-Occlusive Pain Case A 15-year-old female with sickle cell disease (SCD) presents to your emergency department (ED) with a vaso-occlusive pain episode (VOE) of her legs and back. Children with SCD often present to the ED in pain due to VOE. Reference Rees CA et al. Am J Hematol.

Emergency Department 97

Emergency Department ED ALS OR 97

EMDocs

JUNE 22, 2024

A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. Epub 2014 Jun 30. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in. The newborn is doing well, but the mother is complaining of shortness of breath and chest pain.

EMS 111

EMS FFP Ambulance ICU 111

REBEL EM

DECEMBER 5, 2023

The risk of a biphasic reaction is what keeps patients in the ED while being observed for a set period of time. up to 23% ( Lieberman 2005 , Rohacek 2014 , Tole 2007 , Grunau 2014 ). Since half of biphasic reactions occur within the first 6-12 hrs ( Lee 2014 ) physicians often choose an observation time of 4-6 hrs.

Epinephrine 81

Epinephrine Allergic Reaction Emergency Department Emergency Management 81

ALiEM

MAY 13, 2024

Study N Methods POCUS Sensitivity (95% CI) POCUS Specificity (95% CI) Conclusions Gottleib et al., Lam et al., of cases* Subramaniam et al., Lam et al., of cases* Subramaniam et al., Adams et al., Adams et al., Sivitz et al., Yen ZS, Wang HP, Ma HM, et al. 2014 Feb;15(1):111-3.

E-9-1-1 161

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

Don't Forget the Bubbles

OCTOBER 25, 2023

It is often difficult to do this in an ED setting. Image adapted by Holland JA et al. Image adapted by Holland JA et al. 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. doi: 10.1212/WNL.0b013e3182a55f17.

ALS 124

ALS OR ED 124

REBEL EM

AUGUST 30, 2023

Graphics Image 1: [link] Image 2: [link] References Berbari EF, Kanj SS, et al. PMID: 26316526 Boody B, et al. PMID: 25892724 Gouliouris T, et al. 2010 Nov;65 Suppl 3:iii 11-24 PMID: 20876624 Mylona E, et al. 2010 Nov;65 Suppl 3:iii 11-24 PMID: 20876624 Mylona E, et al. In: Sherman SC eds.

E-9-1-1 100

E-9-1-1 ALS ED OR 100

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. Simpson et al. Patients who Did Not Wait are a feature of most EDs worldwide. A 2011-2012 Australian study by Blake et al. of those children later returned to the ED.

Emergency Department 89

Emergency Department ALS ED OR 89

EMDocs

DECEMBER 19, 2023

In: Marx JA, Hockenberger RS, Biros MH, et al., Philadelphia: Elsevier Saunders; 2014:805-807. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill; 2020. Accessed August 25, 2022. link] Edward OJ. Venomous Marine Animals.

First Aid 105

First Aid ED OR ALS 105

Don't Forget the Bubbles

AUGUST 23, 2023

Very rarely are the ED team allowed to stand, in silence, with a purpose. Kapoor et al. 2014) “Death of a child in the emergency department” American Academy of Pediatrics. 2014) “Death of a child in the emergency department” American Academy of Pediatrics. The Pause allows us to take the foot off the pedal briefly.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

EMDocs

JANUARY 29, 2024

Introduction: Neurologic emergencies are common in the Emergency Department (ED), and blood pressure management is critical to immediate management. References: Powers WJ, Rabinstein AA, Ackerson T, et al. Leonardi-Bee J, et al; IST Collaborative Group. Okumura K, et al. Oliveira-Filho J, et al. Vlcek M, et al.

ALS 99

ALS Critical Care OR EMS 99

EMDocs

SEPTEMBER 7, 2023

Metabolism of DEG adapted from Bessenhofer, et al. References: Abubukar et al. “Diethylene Glycol” in Goldfrank’s Toxicologic Emergencies , 11e Eds. Nelson, et al. Conklin, Laura, et al. 6, 1 June 2014, pp. “Fomepizole” in Goldfrank’s Toxicologic Emergencies , 11e Eds.

E-9-1-1 92

E-9-1-1 ALS Plasma Emergency Department 92

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. There was a significant reduction of RVP ordering both in the ED and paediatric wards without impacting ED returns. Take home points References Byington CL, Ampofo K, Stockmann C, et al.

Emergency Department 84

Emergency Department ALS ED OR 84

EMDocs

JANUARY 3, 2024

He has been taking increased doses of torsemide without improvement in his symptoms and was directed to the ED for inpatient therapy. Now, a remote outpatient pulmonary arterial pressure monitor and other heart failure detection devices (Table 1) are available that you may begin to see in your ED. Published May 2014.

Defibrillator 113

Defibrillator Allergic Reaction ED ALS 113

REBEL EM

MAY 11, 2023

5 Paper: Lebin J et al. Authors assessed how many of the 470 had return ED visits (for any reason) within 3 days of discharge, within 3-7 days, and after 7 days of discharge. 1, 2 Phenobarbital has been studied as an alternative or adjunct to benzodiazepines with encouraging results, but primarily among inpatient services.

Emergency Department 97

Emergency Department ED EMR OR 97

FOAMcast

SEPTEMBER 6, 2023

Apple Podcasts , Spotify , Listen Here Alcohol-related emergency department (ED) visits are common – estimated to be comprise nearly 4% of all ED visits and up to 6% of hospitalizations. Historically, EDs have had little engagement in harm reduction around alcohol use disorder (AUD) and provision of medication for AUD.

Emergency Department 52

Emergency Department ALS ED OR 52

EMDocs

AUGUST 22, 2023

Capnography has several novel uses in other disease states commonly seen in the ED such as trauma, DKA, sepsis and obstructive lung disease. PMID: 26447854 Godwin SA, Burton JH, Gerardo CJ, et al. PMID: 28395927 Panchal AR, Berg KM, Hirsch KG, et al. PMID: 26821648 Hemnes AR, Newman AL, Rosenbaum B, et al.

Emergency Department 94

Emergency Department ALS Life Support OR 94