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. 2014 Feb;13(2):167-77. 2014 Feb;13(2):135.

Plasma 269

Plasma OR ED Critical Care 269

The Skeptics' Guide to EM

JULY 8, 2023

Case: A 57-year-old woman with hypertension, hyperlipidemia and type-2 diabetes mellitus presents to the emergency department (ED) with fever, cough, myalgias, headache and congestion. Managing editor of EM:RAP and Associate Editor at REBEL EM. It’s flu season and you’ve already seen 15 people with the same symptoms.

ALS 237

ALS Emergency Department EMS ED 237

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). 2014 May;32(5):452-6. Epub 2014 Jan 15. Epub 2014 Sep 9.

E-9-1-1 135

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

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. 2014 Dec;24(12):1670-751. The patient had no significant past medical history.

ACS 161

ACS Emergency Department ED OR 161

The Skeptics' Guide to EM

NOVEMBER 11, 2023

Case: A 24-year-old manual labourer presents to the emergency department (ED) after drinking a few too many beers, having a disagreement with another beer drinker and gets knocked down. Background: Fractures of the scaphoid are the most common carpal fractures presenting to the ED. We went into some detail on SGEM#385.

ALS 244

ALS Emergency Department ED OR 244

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 65

ED Emergency Department ALS Paramedic 65

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). He is also one of the world’s leading researchers on pain management in the emergency department and specifically the use of ketamine.

ALS 130

ALS Emergency Department ED OR 130

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

The Skeptics' Guide to EM

JUNE 17, 2023

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. 1-6] Children with SCD presenting to the ED with VOE require timely and effective pain control. Opioids are the primary therapy.

Emergency Department 182

Emergency Department ALS ED OR 182

ALiEM

APRIL 12, 2023

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. PMID: 35049577 ; PMCID: PMC8774352 Suzuko S, Peter G, Philipp L. Hemmings, Talmage D. DOI: 10.1016/B978-0-323-48110-6.00020-X R.

Emergency Department 258

Emergency Department ALS ED 258

ALiEM

SEPTEMBER 11, 2023

A 29-year-old female with a past medical history of migraine headaches presented to the emergency department (ED) for several hours of bilateral eye pain, redness, and decreased visual acuity. Contact Lens Wearer Demographics and Risk Behaviors for Contact Lens-Related Eye Infections–United States, 2014.

Emergency Department 152

Emergency Department ED OR 152

The Skeptics' Guide to EM

FEBRUARY 26, 2022

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 visits in the US for mental health conditions has increased by 44% from 2006 to 2014. Reference: Kim et al.

ED 130

ED ALS Emergency Department OR 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. BMJ (Clinical research ed.). 2014; PMID: 25066627 Li HK et al. 2014; 32(10):1195-9. Her vitals are: HR 115, BP 120/80, Temp 102.8, O2 Sat 99% on RA, RR 18.

ALS 100

ALS ICU ED OR 100

The Skeptics' Guide to EM

OCTOBER 14, 2023

Case: A 5-year-old boy presents to the emergency department (ED) with his parents for fever and fatigue. Background: We have looked at pediatric vital signs on the SGEM back in 2014 with PedEM superhero Dr. Anthony Crocco ( SGEM#98 ). He has had three days of high fevers at home. It seems awfully high. Does he have sepsis?”

Life Support 221

Life Support Advanced Life Support Emergency Department ALS 221

ALiEM

MARCH 7, 2024

Ann Emer Med , 2005 [7] Prospective, blinded, observational study performed in the pediatric ED, 3 month period N=44, < 2 years of age Created a bladder urinary index by multiplying the AP and transverse bladder diameters. Author, Title, Journal, Publication Year Study Type, Location, Time Frame N, Ages Summary Milling et al., Chen et al.,

E-9-1-1 177

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

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. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation.

ALS 105

ALS Emergency Department ED OR 105

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

NOVEMBER 20, 2021

You wonder if any emergency department (ED)-based interventions would help her and people like her be safe. Back then we found that at one academic site older adults attending ED with falls didn’t receive guideline-based assessment, risk stratification or management. There are three other GEAR 1.0 Reference: Hammouda et al.

ALS 130

ALS ED Emergency Department OR 130

Core EM

OCTOBER 16, 2024

In: Marx J, ed. Philadelphia, PA: Elsevier; 2014:75-80. In: Wolfson A, ed. Br J Haematol. 2009 Nov;147(4):431-43. link] Emery, M. Blood and blood components. Rosen’s emergency medicine. Transfusion Reactions and Complications. Harwood-Nuss’ Clinical Practice of Emergency Medicine. Hirayama F.

Allergic Reaction 145

Allergic Reaction Plasma ED Epinephrine 145

The Skeptics' Guide to EM

DECEMBER 17, 2022

Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home. Falling is the most common cause of traumatic injury resulting in older adults presenting to the ED [4]. years ( 2 ).

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

ALiEM

SEPTEMBER 27, 2023

Read More in the Series References Peredy. 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. Hoffman et al. New York, NY. McGraw-Hill. Koppaka V, Thompson DC, Chen Y, et al.

ALS 169

ALS OR ED 169

This Podcast Will Kill You

OCTOBER 24, 2023

eds (2015) Broughton, E., Eds Converey, I., 2014 Sharma, S. 2014 The Bhopal Disaster and its aftermath: conflict over safe water, environment and justice. In Conflicts around domestic water and sanitation in India: cases, issues and prosects eds: Joy, KJ., Drug and chemical toxicology , 42 (3), pp.321-327.

E-9-1-1 52

E-9-1-1 ED ALS 52

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

The Skeptics' Guide to EM

OCTOBER 10, 2020

Case: A 41-year-old man without a significant past medical history presents to the emergency department (ED) with a chief complaint of lower back pain that started 48 hours prior to the ED visits after attempting to move a couch in his house. Background: Pain is one of the most frequent reasons to attend an ED.

Emergency Department 130

Emergency Department ALS ED OR 130

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 96

EMS Ambulance FFP ICU 96

Core EM

OCTOBER 2, 2024

In: Marx J, ed. Philadelphia, PA: Elsevier; 2014:75-80. In: Wolfson A, ed. Br J Haematol. 2009 Nov;147(4):431-43. link] Emery, M. Blood and blood components. Rosen’s emergency medicine. Transfusion Reactions and Complications. Harwood-Nuss’ Clinical Practice of Emergency Medicine. Hirayama F.

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

EMDocs

DECEMBER 20, 2023

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. In 2014 I was asked by 4 different plaintiff attorneys to review 4 separate cases of a missed SEA, all in Washington State. To opt in to the free subscriber list, click here.

ED 77

ED OR 77

This Podcast Will Kill You

NOVEMBER 27, 2023

2014): 5117. ” Infection, Genetics and Evolution 28 (2014): 33-43. History Biology Hoerauf, Achim, and Ramakrishna U. Wolbachia: a bug’s life in another bug. Karger Medical and Scientific Publishers, 2007. and Nutman, T.B., Immunology of lymphatic filariasis. Parasite immunology , 36 (8), pp.338-346. Addiss, D.

E-9-1-1 52

E-9-1-1 ALS ED 52

ACEP Now

JUNE 14, 2024

And the Board approved a new clinical policy, “Critical Issues in the Management of Adult Patients Presenting to the ED with Seizures,” rescinding the 2014 clinical policy with same title. Open applications will be coming soon, but you can find out more and get on the interest list today at acep.org/EDap.

ED 52

ED EMS OR 52

ALiEM

NOVEMBER 29, 2023

Published 2014 Mar 26. How do you treat xylazine toxicity? Treatment consists of supportive care, ranging from IV fluids to mechanical ventilation in patients with severe respiratory depression [10]. Xylazine Intoxication in Humans and Its Importance as an Emerging Adulterant in Abused Drugs: A Comprehensive Review of the Literature.

Naloxone 169

Naloxone Overdose ALS Epinephrine 169

EMDocs

DECEMBER 19, 2023

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. In: Marx JA, Hockenberger RS, Biros MH, et al.,

First Aid 91

First Aid ED OR ALS 91

The Skeptics' Guide to EM

DECEMBER 28, 2019

There was a trial published in 2014 comparing radiology department ultrasound, POCUS and CT for suspected nephrolithiasis (Smith-Bindman et al. NEJM 2014 ). We covered this on SGEM#97 with Dr. Tony Seupaul and Dr. Spencer Wright.

Emergency Department 100

Emergency Department ALS EMS ED 100

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

JULY 17, 2021

Case: Six-year-old Morten comes into your emergency department (ED) with what looks like pneumonia. He is the co-founder of website lead of Don’t Forget the Bubbles ( DFTB ). When not drinking coffee and reading Batman comics he is playing with his children. This was a relatively small study (n=115) from Israel.

ALS 130

ALS Emergency Department ED 130

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

REBEL EM

FEBRUARY 8, 2023

Herpes simplex keratitis: A treatment guideline – 2014. PMID: 7997324 Chan RV et al. Herpes simplex keratitis – Latin America. American Academy of Ophthalmology. Link White et al. Link Post Created By: Christina Chien, MD Post Peer Reviewed By: Salim R.

ALS 52

ALS OR EMS ED 52

REBEL EM

NOVEMBER 30, 2022

Clinical predictors for testicular torsion as seen in the pediatric ED. PMID: 22217895 Ban KM, Easter JS: Selected Urologic Problems; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. 2014, (Ch) 99: p 1326-1356. Am J Emerg Med 2010; 28:786-789. S Afr Med J.

ALS 52

ALS ED OR EMS 52