The Skeptics' Guide to EM

APRIL 20, 2024

Case: You are doing great things and helping many patients during your shift in the emergency department (ED) when you hear a trauma alert being called overheard. A clinical decision tool called the STUMBL score was derived and validated by Battle et al in 2014 [3]. These risks are particularly higher in the elderly [2].

Emergency Department 218

Emergency Department Overdose ALS ED 218

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 264

Life Support Advanced Life Support Emergency Department ALS 264

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. 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

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

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." The note also says "slight lateral ST elevations noted, likely early repolarization since unchanged compared to 2014." This patient was not one of the lucky 6.4%

E-9-1-1 130

E-9-1-1 OR Coronary ACS 130

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. He denies any fever or difficulty breathing.

Emergency Department 186

Emergency Department ALS ED OR 186

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). What are the only exceptions? How can we prevent this?

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

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 188

Allergic Reaction Plasma ED Epinephrine 188

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). The pain is 10/10 in intensity, gets worse with bending, turning, and prolonged walking. million visits to U.S.

ALS 130

ALS Emergency Department ED OR 130

EMDocs

NOVEMBER 13, 2024

Major takeaway: Consider SBP in any patient who comes into the ED with ascites. Literature concerning risk with PPIs is controversial. Presentation: Classic presentation is abdominal pain or tenderness, fever, and altered mental status. Literature suggests 10-33% of patients are asymptomatic or only have mild symptoms. increase in mortality.

E-9-1-1 105

E-9-1-1 ALS OR ED 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

ALiEM

MARCH 7, 2024

The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Her mother denies any fevers, upper respiratory symptoms, sore throat, or diarrhea. She adds that her daughter has complained of 2-3 episodes of dysuria and gross hematuria over the last few days. Lay the patient supine when possible.

E-9-1-1 177

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

ALiEM

SEPTEMBER 27, 2023

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. Read More in the Series References Peredy. Mushrooms, Coprine. Goldfrank L.

ALS 169

ALS OR ED 169

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

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

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.

ED 92

ED Emergency Department ALS Paramedic 92

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

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

The Skeptics' Guide to EM

JANUARY 14, 2018

SGEM#71 : Like a Rolling Kidney Stone (A Systematic Review of Renal Colic) * Bottom Line: Tamsulosin is useless in most ED patients with ureteral colic unless their stone size exceeds at least 4mm. *

Emergency Department 130