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 ). years ( 2 ).

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

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. The AHA/ACC cites a meta-analysis including five RCTs of 745 participants.

ALS 105

ALS Emergency Department ED OR 105

ALiEM

NOVEMBER 29, 2023

Published 2014 Mar 26. Like opioid intoxication, xylazine exposure may result in [4]: Respiratory depression Bradycardia Miosis Hypotension CNS depression Skin findings from chronic use range from superficial ulcerations and cellulitis to severe soft tissue destruction either at or distant from the IV injection sites. Forensic Sci Int.

Naloxone 169

Naloxone Overdose ALS Epinephrine 169

The Skeptics' Guide to EM

OCTOBER 22, 2017

Oxygen supplementation in non-hypoxemic patients with acute myocardial infarction has been a hot topic since the publication of the AVOID-trial ( Stub et al Circulation 2014). However, this difference between the two groups was not statistically significant (relative risk 0.9; What would you rather have, more death or less VT?

Emergency Medical Services 130

Emergency Medical Services Coronary ALS STEMI 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 80

Epinephrine Allergic Reaction Emergency Department Emergency Management 80

EMDocs

DECEMBER 18, 2024

fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold

E-9-1-1 78

E-9-1-1 Emergency Department ICU ED 78

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 65

ED Emergency Department ALS Paramedic 65

EMDocs

JUNE 22, 2024

A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. 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

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 95

Emergency Department ED EMR OR 95

Core EM

OCTOBER 2, 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 100

Allergic Reaction Plasma ED Epinephrine 100

EMDocs

DECEMBER 19, 2023

Philadelphia: Elsevier Saunders; 2014:805-807. Possible early antibiotic treatment Minor Marine Trauma Mechanism: Bites, Stings, Nematocysts Envenomation Presentation: All can cause localized pain, erythema, and warmth Dermatologic: Urticaria, burning, pruritus, localized paresthesia. Marine Trauma and Envenomation. Accessed August 25, 2022.

First Aid 91

First Aid ED OR ALS 91

Dr. Smith's ECG Blog

DECEMBER 11, 2023

The neighbor recorded a systolic blood pressure again above 200 mm Hg and advised her to come to the ED to address her symptoms. Both the outdated 2014 AHA/ACC guidelines and the updated 2023 ESC guidelines recommend immediate invasive management of patients with uncontrolled chest pain. She contacted her neighbor, a nurse, for help.

E-9-1-1 124

E-9-1-1 ACS Coronary STEMI 124

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

Don't Forget the Bubbles

OCTOBER 25, 2023

It is often difficult to do this in an ED setting. doi: 10.1136/archdischild-2022-324881 Babiker MOE, Prasad M, MacLeod S , et al Fifteen-minute consultation: the child with idiopathic intracranial hypertension Archives of Disease in Childhood – Education and Practice 2014; 99: 166-172. How is IIH diagnosed?

ALS 124

ALS OR ED 124

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. It’s a simple 3 step process: 1.

ED 76

ED OR 76

REBEL EM

AUGUST 30, 2023

REBEL Core Cast 107.0 – Vertebral Osteomyelitis Click here for Direct Download of the Podcast Definition Inflammation of the vertebrae due to a pyogenic, fungal or mycobacterial organism. Classified as either acute (days), subacute (weeks) or chronic (months) Spondylodiscitis: a term encompassing osteomyelitis, spondylitis and discitis.

E-9-1-1 95

E-9-1-1 ALS ED OR 95

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

Don't Forget the Bubbles

JUNE 30, 2023

All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The ODP is caught up leaving theatres and has not yet made it down to ED. The trauma call goes out. You will be running the show today, and you want to use your preparation time well. The priority is the drain and blood replacement.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

ACEP Now

DECEMBER 7, 2024

A 28-year-old female is brought to the emergency department (ED) by police after a sexual assault. 1 A significant number of patients present to the ED with concerns related to traumatic experiences. 1 A significant number of patients present to the ED with concerns related to traumatic experiences.

Mental Health Services 52

Mental Health Services Emergency Department ED OR 52