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

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

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.

Life Support 221

Life Support Advanced Life Support Emergency Department ALS 221

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk. Am J Emerg Med.

E-9-1-1 161

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

ALiEM

MARCH 7, 2024

Facts and Literature Review Bladder volume estimation Measuring bladder volume via POCUS in pediatric patients has been studied, demonstrating a benefit on Emergency Department workflow and length of stay (Table 1). The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Chen et al.,

E-9-1-1 177

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

The Skeptics' Guide to EM

MAY 14, 2022

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

ALS 130

ALS Emergency Department ED OR 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

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. emDOCs.net – Emergency Medicine Education. PMID: 35049577 ; PMCID: PMC8774352 Suzuko S, Peter G, Philipp L.

Emergency Department 258

Emergency Department ALS ED 258

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. We don’t want to go backwards!

ED 65

ED Emergency Department ALS Paramedic 65

The Skeptics' Guide to EM

OCTOBER 10, 2020

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, specifically the use of ketamine. of all ED visits resulting in 2.6

Emergency Department 130

Emergency Department ALS ED OR 130

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

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 Manager 81

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. Ann Emerg Med. Ann Emerg Med. 2014 May 14;311(18):1889-900. Ann Emerg Med. 2021 Dec;78(6):752-758.

Emergency Department 52

Emergency Department ALS ED OR 52

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. J Emerg Med. The study compared four grams and 9.5 2015;49(2):175-182.

ALS 105

ALS Emergency Department ED OR 105

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.

ED 130

ED ALS Emergency Department OR 130

EM Didactic

OCTOBER 7, 2018

It is commonly used in Emergency Departments, especially in febrile and possibly infectious patients. Take Home In the ED, CRP should not be used to make a diagnosis but to assist evaluation and support your clinical suspicion. In clinically unwell patients, a normal CRP level should never delay antibiotic coverage in ED.

Emergency Department 40

Emergency Department ACS Critical Care Coronary 40

The Skeptics' Guide to EM

DECEMBER 17, 2022

Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. 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

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

ALS 130

ALS ED Emergency Department OR 130

The Skeptics' Guide to EM

JANUARY 14, 2018

Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. Urology 2012 Guest Skeptics: Dr. Tony Seupaul is the Chairman of the Department of Emergency Medicine at the University of Arkansas. Of course we were skeptical and wanted to review the evidence.

Emergency Department 130

Emergency Department ALS ED OR 130

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 ). The bottom line from that episode was bedside emergency department ultrasound is safe and has several advantages over CT for the diagnosis of kidney stones.

Emergency Department 100

Emergency Department ALS EMS ED 100

Don't Forget the Bubbles

AUGUST 23, 2023

In most Emergency Departments, staff are allotted little of that scarce resource, time, to begin processing what has just occurred. The Pause Jonathon Bartels worked as an Emergency Nurse in America in 2009. After the death of a young person in the Emergency Department, he initiated ‘ The Pause.’ & Liska, H.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

ALiEM

NOVEMBER 29, 2023

Xylazine Intoxication in Humans and Its Importance as an Emerging Adulterant in Abused Drugs: A Comprehensive Review of the Literature. Published 2014 Mar 26. Opioid overdoses involving xylazine in emergency department patients: a multicenter study. How do you treat xylazine toxicity? Forensic Sci Int. 2014;240:1-8.

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

EMDocs

JULY 9, 2024

What can we do about this in the pediatric ED? Social Emergency Medicine: Capitalizing on the Pediatric Emergency Department Visit to Screen and Connect Patients and Families to Community Resources. Community Resource Needs Assessment Among Families Presenting to a Pediatric Emergency Department. Pediatrics.

Emergency Department 71

Emergency Department Emergency Medical Services ED EMS 71

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

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. Capnography in the Emergency Department: A Review of Uses, Waveforms, and Limitations. J Emerg Med. Ann Emerg Med. West J Emerg Med. BMC Emerg Med.

Emergency Department 67

Emergency Department ALS Life Support OR 67

ALiEM

MAY 13, 2024

Case Introduction: Child with abdominal pain Wendy is a 7-year-old girl who comes into the emergency department with redness, swelling, and pain on her left calf. Point-of-Care Ultrasound on Management of Cellulitis Versus Local Angioedema in the Pediatric Emergency Department. Pediatr Emerg Care. West J Emerg Med.

E-9-1-1 161

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

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. Despite its frequency, the majority of cases of acute diverticulitis are uncomplicated, and can be effectively managed on an outpatient basis 2.

Emergency Department 52

Emergency Department ALS ED OR 52

ACEP Now

SEPTEMBER 13, 2023

But what if we could measure a patient’s spleen via ultrasound in the emergency department (ED) to guide specific patient care? This would suggest that measuring the spleen via ultrasound is not a reliable method to predict splenic function in the ED setting. Acad Emerg Med. Is there a correlation?

Emergency Department 52

Emergency Department ALS ED OR 52

REBEL EM

AUGUST 30, 2023

Evaluation and Treatment of Acute Back Pain in the Emergency Department. Orthopedic Emergencies 2015 May; 33(2) 311-26. In: Sherman SC eds. Simon’s Emergency Orthopedics. New York, NY: McGraw-Hill; 2014 Winters ME, Kluetz P et al. Back Pain Emergencies. J Spinal Disord Tech. Semin Arthritis Rheum.

E-9-1-1 104

E-9-1-1 ALS ED OR 104

Don't Forget the Bubbles

MAY 24, 2023

A 5-year-old boy with a past medical history of Crouzon syndrome presents in the Pediatric ED. Airway complications are also more likely to occur in the emergency department (ED) than in the operating theatre. Intubation of the Critically Unwell Child in the Emergency Department. Anaesthesia. 14123 Currie V.

Emergency Department 98

Emergency Department ED ALS OR 98

EMDocs

FEBRUARY 12, 2024

Louis); Marina Boushra, MD (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case Emergency Medical Services brings in a 62-year-old male with COPD in acute on chronic hypoxemic respiratory failure (usually on 3 L nasal cannula, now on non-rebreather at 15 L/min).

Emergency Department 93

Emergency Department E-9-1-1 ED ICU 93

Don't Forget the Bubbles

MARCH 19, 2024

This case underscores the struggles many children with complex disabilities encounter, often arriving at the paediatric ED in crisis when their families can no longer provide safe care at home. Becasue paediatric emergency departments are accessible out-of-hours they become the de facto place of safety with access to immediate support.

Mental Health Services 52

Mental Health Services ED OR Emergency Department 52

REBEL EM

FEBRUARY 22, 2023

difficult to see due to corneal edema) Emergency Department Management All patients should get emergency ophthalmologic consultation Start with eye drops (see table below) and add systemic medications if severe or refractory symptoms/IOP. et al, Emergency Medicine Clinical Essentials ed 2. Cup to disc ratio >0.6

Emergency Department 52

Emergency Department ALS ED Coronary 52

EMDocs

SEPTEMBER 27, 2023

It includes a number of expensive medications that patients in the ED are commonly prescribed such as Xarelto, Eliquis, and insulin. As emergency medicine physicians, we are acutely aware of how being unable to afford chronic medications leads to severe life-threatening complications and preventable visits to our Emergency Departments.

Emergency Department 62

Emergency Department ALS OR ED 62

EMDocs

MARCH 25, 2024

2, 3 Biliary POCUS can help decrease patient length of stay in the Emergency Department. 2, 3 Biliary POCUS can help decrease patient length of stay in the Emergency Department. Decreasing length of stay with emergency ultrasound examination of the gallbladder. Acad Emerg Med. Am J Emerg Med.

ALS 87

ALS Coronary Emergency Department ED 87

EMDocs

SEPTEMBER 7, 2023

2 Laboratory assays for DEG are not widely available and have long turn-around-times, thus have limited utility in diagnosis in the emergency department. “Diethylene Glycol” in Goldfrank’s Toxicologic Emergencies , 11e Eds. 6, 1 June 2014, pp. CDC’s Morbidity and Mortality Weekly Report.

E-9-1-1 65

E-9-1-1 ALS Emergency Department Plasma 65

EMDocs

JUNE 7, 2023

F, HR 48, RR 28, BP 104/62, SPO2 88% on non-rebreather mask The patient’s friend who brought her to the ED tells you the patient made suicidal statements earlier in the day and was found in her yard shed. These are send-out labs with turn-around times that make them unlikely to affect the ED course or guide treatment. BMC Res Notes.

E-9-1-1 83

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