The Skeptics' Guide to EM

APRIL 20, 2024

A clinical decision tool called the STUMBL score was derived and validated by Battle et al in 2014 [3]. An attempt was made to externally validate this tool in New Zealand by Murkerji et al 2021 [4]. These risks are particularly higher in the elderly [2]. It risks stratified older patients with blunt trauma.

Emergency Department 218

Emergency Department Overdose ALS ED 218

Pediatric EM Morsels

JULY 21, 2023

We use the GCS score in both trauma and medical patients, but where did this score come from? When is it useful and what does it tell us? Is it actually validated in children, like the Ottawa Ankle Rules or are we using a tool for something other than that for which it was designed and validated, like using Kocher criteria for knee and ankle joints?

Critical Care 246

Critical Care ALS Life Support OR 246

This Podcast Will Kill You

FEBRUARY 11, 2025

Now imagine that your tongue suddenly shriveled up and fell off and that in its place is a tongue-sized isopod aka rollie pollie aka pillbug. Just there, hanging out, forever. How are you feeling? Hey, we get it. But at least youll never be alone again. Believe it or not, this is not some bad creative writing exercise. This is a very real parasite.

E-9-1-1 97

E-9-1-1 ALS OR 97

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 98

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

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. The National Heart, Lung, and Blood Institute (NHLBI) released an expert panel report in 2014 with evidence-based guidelines for management of sickle cell disease recommending timely administration of parenteral opioids for VOE. [7]

Emergency Department 186

Emergency Department ALS ED OR 186

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The note also says "slight lateral ST elevations noted, likely early repolarization since unchanged compared to 2014." The original term " benign early repolarization" has fallen out of favor since the seminal paper by Haïssaguerre et al. (This patient was not one of the lucky 6.4% per 100,000 to 11 per 100,000 [Rosso].

E-9-1-1 131

E-9-1-1 OR Coronary ACS 131

The Skeptics' Guide to EM

MAY 14, 2022

Date: May 13th, 2022 Reference: Abril et al. Date: May 13th, 2022 Reference: Abril et al. These include: acetaminophen ( Williams et al Lancet 2014), steroids ( Balakrishnamoorthy et al Emerg Med J 2014) and benzodiazepines ( Friedman et al Ann Emerg Med 2017).

ALS 130

ALS Emergency Department ED OR 130

ALiEM

SEPTEMBER 27, 2023

Hoffman et al. Koppaka V, Thompson DC, Chen Y, et al. Disulfiram-like reaction with ethanol consumption Coprinus atramentarius or Ink Cap mushroom is well known to cause a disulfiram-like reaction when it is consumed prior to ethanol. This results in significant nausea and vomiting and can lead to tachycardia and hypotension.

ALS 169

ALS OR ED 169

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.) The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Lay the patient supine when possible.

E-9-1-1 177

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

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. MMWR Morb Mortal Wkly Rep. 2021;70(37):1300-1302. Published 2021 Sep 17.

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

The Skeptics' Guide to EM

SEPTEMBER 10, 2017

[display_podcast] Date: September 7th, 2017 Reference: Cohen et al. display_podcast] Date: September 7th, 2017 Reference: Cohen et al. Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non-inferiority trial. million visits annually.

Emergency Department 130

Emergency Department ALS OR 130

The Skeptics' Guide to EM

OCTOBER 10, 2020

Reference: Friedman et al. Reference: Friedman et al. million visits each year in the USA ( Friedman et al Spine 2010 ). These include: acetaminophen ( Williams et al Lancet 2014), muscle relaxants ( Friedman et al JAMA 2015), NSAIDs ( Machado et al

Emergency Department 130

Emergency Department ALS ED OR 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 As ferrioxamine is excreted, the patient’s urine becomes an orange or brown rusty hue, classically referred to as vin rosé urine [1,2]. For iron toxicity, what are the indications for deferoxamine?

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

The Skeptics' Guide to EM

MAY 4, 2019

Date: April 29th, 2019 Reference: Kuppermann et al. Date: April 29th, 2019 Reference: Kuppermann et al. A study by Easter et al ( Ann Emerg Med 2014 ) concluded that PECARN seemed to be the best of the three tools. Reference: Kuppermann et al. She is a blog editor for RCEM Learning.

ALS 130

ALS Emergency Department OR 130

Pediatric EM Morsels

JUNE 16, 2023

Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Overdose 154

Overdose OR Critical Care ALS 154

The Skeptics' Guide to EM

FEBRUARY 26, 2022

Date: February 21st 2022 Reference: Kim et al. Date: February 21st 2022 Reference: Kim et al. ED visits in the US for mental health conditions has increased by 44% from 2006 to 2014. Reference: Kim et al. AEM February 2022. AEM February 2022. AEM February 2022.

ED 130

ED ALS Emergency Department OR 130

The Skeptics' Guide to EM

AUGUST 5, 2023

Reference: Easter JS et al. Annals of Emergency Medicine 2014. Reference: Easter JS et al. Annals of Emergency Medicine 2014. Reference: Easter JS et al. Annals of Emergency Medicine 2014. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study.

ALS 100

ALS Emergency Department OR 100

The Skeptics' Guide to EM

MAY 1, 2021

Reference: Donaldson et al. Reference: Donaldson et al. The Donaldson et al SRMA included 10,431 patients in 26 randomized trials comparing intravenous thrombolysis with placebo or standard care in acute ischemic stroke [1]. He is also one of the SGEM Hot Off the Press Faculty. A systematic review and meta-analysis.

ALS 130

ALS OR 130

This Podcast Will Kill You

JULY 23, 2024

2014): 6-7. Caio, Giacomo, et al. Cenit, María Carmen, et al. Al-Dulaimi, D., Gasbarrini, Giovanni, et al. Gasbarrini, Giovanni Battista, et al. ” Internal and emergency medicine 9 (2014): 249-256. Suddenly, grocery stores were filled with gluten-free crackers, cookies, buns, you name it.

E-9-1-1 98

E-9-1-1 ALS OR 98

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

The Skeptics' Guide to EM

NOVEMBER 20, 2021

Date: November 16th, 2021 Reference: Hammouda et al. Date: November 16th, 2021 Reference: Hammouda et al. In 2014 the SGEM looked at a systematic review by Dr. Chris Carpenter , which concluded that there wasn’t a good tool to help us predict which ED patients are at risk of recurrent falls ( SGEM #89 ).

ALS 130

ALS ED Emergency Department OR 130

Pediatric EM Morsels

AUGUST 18, 2023

Rose 2014) They are the most frequently prescribed class of medications in adults; however, in children they are the least frequently prescribed class , <2% of antibiotics. Hersh 2014) Another study looked at all MAEs in juvenile beagles given either low dose or high dose fluoroquinolone. Which is a risk of 1 event for 62.5

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

REBEL EM

JANUARY 9, 2024

This finding persists when looking at a number of other infections including skin and soft tissue infections (SSTI) ( First10EM ), pyelonephritis ( Strohmeier 2014 ) and even bone and joint infections ( Li 2019 ). This feels intuitive as the IV route seems like it would be stronger, faster, and fix the patient better than the oral route.

ALS 99

ALS ICU ED OR 99

The Skeptics' Guide to EM

SEPTEMBER 12, 2020

Shanafelt et al. Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014. Mayo Clin Proc 2015 * Shanafelt et al. A distinction between burnout and moral injury was made during the presentation.

Emergency Department 130

Emergency Department ALS OR 130

ACEP Now

AUGUST 14, 2024

This recommendation is a departure from the 2014 guideline iteration that only recommended against CCBs in patients with decompensated heart failure. The American Heart Association and American College of Cardiology released a comprehensive guideline on the management of atrial fibrillation (AF). based care of ED patients with AFRVR.

ALS 105

ALS Emergency Department ED OR 105

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

Date: September 10th, 2019 Reference: Fournier et al. Date: September 10th, 2019 Reference: Fournier et al. million emergency department visits in the US in 2014 [1], with the most significant proportion of visits occurring in the elderly ≥75 (1,682/100,000) [1]. Emergency Medicine Journal 2019. Emergency Medicine Journal 2019.

Emergency Department 130

Emergency Department ALS EMS OR 130

ALiEM

MAY 13, 2024

Scan the entirety of the affected area in 2 planes. Be aware of the patient’s comfort throughout the examination. A water bath may be helpful to visualize lesions in extremities such as the hands or feet. The probe sits just below the water’s surface and does not need to contact the skin. It may also aid in identifying nearby vasculature.

E-9-1-1 161

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

The Skeptics' Guide to EM

DECEMBER 17, 2022

Date: December 16th, 2022 Reference: Hohle et al. Date: December 16th, 2022 Reference: Hohle et al. Massive Blood Transfusion Following Older Adult Trauma: the Effect of Blood Ratios on Mortality. AEM December 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. years ( 2 ).

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

The Skeptics' Guide to EM

DECEMBER 16, 2017

[display_podcast] Date: November 27th, 2017 Reference: Legriel et al. display_podcast] Date: November 27th, 2017 Reference: Legriel et al. The American Epilepsy Society has guidelines on the acute management of convulsive status epilepticus ( Glauser et al Epilepsy Currents 2016 ). Reference: Legriel et al.

ALS 100

ALS ICU Emergency Department Paramedic 100

EMDocs

JUNE 22, 2024

A) Amniotic fluid embolism B) Eclampsia C) Placental abruption D) Pulmonary embolism Answer: A Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy. AFE should be considered in a patient who experiences cardiorespiratory collapse during labor or shortly thereafter.

EMS 111

EMS FFP Ambulance ICU 111

The Skeptics' Guide to EM

SEPTEMBER 7, 2018

[display_podcast] Date: September 5th, 2018 Reference: Franklin et al. display_podcast] Date: September 5th, 2018 Reference: Franklin et al. Since bronchiolitis is a clinical diagnosis, there is no test, including viral testing and radiography, which rules it in or out ( Schuh et al 2007). NEJM March 2018. NEJM March 2018.

ALS 100

ALS Emergency Department OR 100

The Skeptics' Guide to EM

JANUARY 12, 2019

Date: January 10th , 2019 Reference: Busse JW et al. Date: January 10th , 2019 Reference: Busse JW et al. Acetaminophen: Williams et al (Lancet 2014) showed acetaminophen did not affect recovery time compared with placebo in low-back pain. Steroids: Balakrishnamoorthy et al (Emerg Med J 201.

Emergency Department 100

Emergency Department ALS OR 100

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety profile [3][4]. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

ALS 136

ALS ACS OR CPR 136

Don't Forget the Bubbles

OCTOBER 25, 2023

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. It is often difficult to do this in an ED setting. How is IIH diagnosed?

ALS 124

ALS OR ED 124

ACEP Now

AUGUST 25, 2023

The National Heart, Lung, and Blood Institute released an expert panel report in 2014 with evidence-based guidelines for management of SCD recommending timely administration of parenteral opioids for VOE.2 Reference Rees CA et al. Children with SCD often present to the ED in pain due to VOE. Am J Hematol. Am J Hematol. Am J Hematol.

Emergency Department 97

Emergency Department ED ALS OR 97

Dr. Smith's ECG Blog

APRIL 18, 2024

Amsterdam et al. 2014 AHA/ACC guideline for the management of patients with non-ST elevation acute coronary syndromes. Circulation 2014 2. Alencar et al. Lupu et al. Herman, Meyers, Smith et al. 1] European guidelines add "regardless of biomarkers". But only 6.4% link] References 1. Int J Cardiol 2024 3.

STEMI 121

STEMI Coronary ALS CAD 121