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-9-1-1 116

E-9-1-1 OR Coronary ACS 116

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

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 207

Emergency Department Overdose ALS ED 207

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

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

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 145

Allergic Reaction Plasma ED Epinephrine 145

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

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 182

Emergency Department ALS ED OR 182

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

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

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

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

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

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

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. Clinical Scenario: A 45-year-old woman with hypertension presents with a productive cough and fever. 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

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

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

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

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

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

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 95

EMS Ambulance FFP ICU 95

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

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

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

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

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

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

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

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. Decisions are pending and discussions continue.

ED 52

ED EMS OR 52

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-9-1-1 104

E-9-1-1 ALS ED OR 104

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. In 2014, 71% (397) of emergency removals of children by police occurred out-of-hours or at weekends.

Mental Health Services 52

Mental Health Services ED OR Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Written by Jesse McLaren Two patients in their 70s presented to the ED with chest pain and RBBB. The prehospital and ED computer interpretation was inferior STEMI: There’s normal sinus rhythm, first degree AV block and RBBB, normal axis and normal voltages. Do either, both, or neither have occlusion MI? Vitals were normal. Take away 1.

STEMI 73

STEMI Paramedic Coronary ED 73

EMDocs

AUGUST 3, 2023

Patient is asymptomatic. A 4-hour acetaminophen level is obtained and results with a level of 180 mcg/mL. These local protocols vary from the labeled dosing; contacting and using your local poison center’s protocol is recommended.

Overdose 81

Overdose E-9-1-1 OR ED 81

REBEL EM

NOVEMBER 30, 2022

Clinical predictors for testicular torsion as seen in the pediatric ED. Epidemiology: Most common cause of acute scrotal pain in prepubertal boys Torsion present in 3.2% Epidemiology: Most common cause of acute scrotal pain in prepubertal boys Torsion present in 3.2% OR = 58.8 (Ben-Israel 10, (-) LR = 0.13 Am J Emerg Med 2010; 28:786-789.

ALS 52

ALS ED OR EMS 52

REBEL EM

FEBRUARY 8, 2023

Herpes simplex keratitis: A treatment guideline – 2014. However, the American Academy of Ophthalmology recommends treatment of epithelial keratitis to prevent recurrence and progression to stromal or endothelial keratitis. PMID: 7997324 Chan RV et al. Herpes simplex keratitis – Latin America. American Academy of Ophthalmology.

ALS 52

ALS OR EMS ED 52

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-9-1-1 121

E-9-1-1 ACS Coronary STEMI 121