The Skeptics' Guide to EM

APRIL 20, 2024

A clinical decision tool called the STUMBL score was derived and validated by Battle et al in 2014 [3]. With the 2014 CDC declaration that prescription drug overdose is one of the five top health threats, there has been a movement away from opioids as the mainstay of pain management for rib fractures [6].

Emergency Department 204

Emergency Department Overdose ALS ED 204

Pediatric EM Morsels

AUGUST 18, 2023

Rose 2014) They are the most frequently prescribed class of medications in adults; however, in children they are the least frequently prescribed class , <2% of antibiotics. Hersh 2014) Another study looked at all MAEs in juvenile beagles given either low dose or high dose fluoroquinolone. Which is a risk of 1 event for 62.5

E-9-1-1 130

E-9-1-1 OR ACS ALS 130

ALiEM

SEPTEMBER 16, 2024

2014 Jul; 3(4):351-67. Neuro : Awake, alert, oriented x 3. 0/5 strength in bilateral lower extremities. 5/5 strength in bilateral upper extremities. They are cool to the touch with poor capillary refill. Palpable left dorsalis pedis pulse, absent right dorsalis pedis pulse. Laboratory Data Hemoglobin/Hematocrit : 13.2 g/dL, 41.5% 2014.07.05.

ACS 130

ACS Coronary OR 130

Core EM

JANUARY 25, 2024

Background: The lumbar puncture (LP or spinal tap) is a procedure that has been in the medical arsenal since first described in 1891 by German physician Heinrich Quincke. Technique: Probe selection: The linear probe is more ideal for pediatric patients and adults with a leaner body habitus. High-quality images obtained in <1 minute in 87.9%

ALS 246

ALS Critical Care OR 246

This Podcast Will Kill You

JULY 23, 2024

2014): 6-7. ” Internal and emergency medicine 9 (2014): 249-256. 2014): 19-36. CW: discussion of disordered eating, eating disorders Did the word gluten manifest in everyone’s consciousness one day in 2010? Suddenly, grocery stores were filled with gluten-free crackers, cookies, buns, you name it. Tune in today!

E-9-1-1 98

E-9-1-1 ALS OR 98

REBEL EM

FEBRUARY 7, 2024

Take Home Points Infections are a leading cause of maternal mortality worldwide. Prompt recognition is critical in management. Most infectious processes will require admission and close observation for improvement or decompensation. References: Abbrescia, K. Sheridan (2003). “Complications of second and third trimester pregnancies.”

ED 96

ED ALS OR EMS 96

Pediatric EM Morsels

JUNE 16, 2023

Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Overdose 152

Overdose OR Critical Care ALS 152

This Podcast Will Kill You

SEPTEMBER 3, 2024

” Applied and environmental microbiology 80.12 (2014): 3552-3561. 2014): 176-180. “Is it gonna be poop or is it gonna be barf?” It’s the question we all fear during a bout of food poisoning when time is of the essence and a decision has to be made before it’s made for us. Clinical microbiology reviews , 28 (1), pp.134-164.

ALS 52

ALS OR 52

REBEL EM

DECEMBER 5, 2023

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. Biphasic anaphylactic reactions: occurrence and mortality Allergy 2014 Jun;69(6):791-7 Tole JW, Lieberman P.

Epinephrine 78

Epinephrine Allergic Reaction Emergency Department Emergency Manager 78

ALiEM

NOVEMBER 10, 2023

2014 Nov;107(11):724-7. Management of FDE anchors on identification and discontinuation of the causative agent. Topical or systemic steroids are common adjuncts and there is limited evidence suggesting the utility of systemic cyclosporine for severe cases [1]. Medicina (Kaunas). 2021 Sep 1;57(9):925. doi: 10.3390/medicina57090925.

Emergency Department 161

Emergency Department OR 161

ALiEM

NOVEMBER 1, 2023

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? 1, 3, 5] Vin rosé urine is simply indicates the excretion of ferrioxamine and is not harmful.

E-9-1-1 161

E-9-1-1 ALS OR ED 161

The Good, The Bad & The Ugly Paramedic

NOVEMBER 15, 2020

By the time we add reduced empathy levels, increased judgmental responses and less overall joy in life to the mix, it becomes clear to see that a negative spiral can occur, either gradually or suddenly, with every aspect further impacting on each other. So why would we want to do this to ourselves?

OR 52

OR EMS Paramedic Emergency Medical Services 52

The Skeptics' Guide to EM

MAY 14, 2022

These include: acetaminophen ( Williams et al Lancet 2014), steroids ( Balakrishnamoorthy et al Emerg Med J 2014) and benzodiazepines ( Friedman et al Ann Emerg Med 2017). The pain is 10/10 in intensity, gets worse with bending, turning, and prolonged walking. A heating pad and acetaminophen has not helped with the pain.

ALS 130

ALS Emergency Department ED OR 130

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. The post was peer reviewed on behalf of ACMT by Drs. Mushrooms, Coprine.

ALS 169

ALS OR ED 169

The Skeptics' Guide to EM

OCTOBER 14, 2023

Background: We have looked at pediatric vital signs on the SGEM back in 2014 with PedEM superhero Dr. Anthony Crocco ( SGEM#98 ). It seems awfully high. We have been reading online about something called sepsis that can be deadly. Does he have sepsis?”

Life Support 228

Life Support Advanced Life Support Emergency Department ALS 228

EMergucate

FEBRUARY 21, 2014

This week’s ECG is from a 62 yr old male who presented complaining of palpitations for the preceding 4 hours. No significant medical history or medications. See the ECG at: ECG of the Week &#…

OR 100

OR EMS 100

The Skeptics' Guide to EM

JUNE 17, 2023

The National Heart, Lung, and Blood Institute (NHLBI) released an expert panel report in 2014 with evidence-based guidelines for management of sickle cell disease recommending timely administration of parenteral opioids for VOE. [7] He denies any fever or difficulty breathing. The rest of his exam is unremarkable.

Emergency Department 181

Emergency Department ALS ED OR 181

EMDocs

JUNE 22, 2024

A) Amniotic fluid embolism B) Eclampsia C) Placental abruption D) Pulmonary embolism Answer: A Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy. AFE should be considered in a patient who experiences cardiorespiratory collapse during labor or shortly thereafter.

EMS 96

EMS Ambulance FFP ICU 96

Don't Forget the Bubbles

SEPTEMBER 2, 2024

Paediatric Trauma Protocols from Royal College of Radiologists 2014 – due for update any second now! 2024 Apr 1;14(4):e081426. Paediatric Emergency Medicine Bubble Wrap from Chris Connolly Jain A, Greig AV, Jones A, Cooper C, Davies L, Greshon A, Fletcher H, Sierakowski A, Dritsaki M, Nguyen TT, Png ME. British Journal of Surgery.

ALS 105

ALS EMS OR 105

ALiEM

SEPTEMBER 11, 2023

Contact Lens Wearer Demographics and Risk Behaviors for Contact Lens-Related Eye Infections–United States, 2014. She removed the contacts five hours later at 23:00, at which time she noted her eyes to feel drier than normal but did not note significant pain with removal, significant trauma, or a partial contact removal.

Emergency Department 152

Emergency Department ED OR 152

ALiEM

OCTOBER 2, 2023

2014 Jun;30(6):437-9. An outpatient ultrasound was performed showing “multiple scalp echogenic nodular lesions measuring from 0.5 cm in the long axis diameter.” The following differential diagnosis was entertained: lymphadenitis, benign avascular mass, epidermal inclusion cyst, or pilomatricoma, and the patient was started on clindamycin.

E-9-1-1 189

E-9-1-1 Emergency Department OR 189

Pediatric EM Morsels

MAY 12, 2023

doi: 10.1136/archdischild-2014-307119. 2014 Jan 25;383(9914):308. PECARN is highly sensitive for identifying those with clinically important TBI. of these had a CT performed 1 (0.2%) had a clinically important TBI (ciTBI) 10 (5.1%) had any TBI on CT 9 (4.6%) had skull fractures Remember to always watch out for NAT ! Arch Dis Child.

OR 130

OR EMS 130

Emergency Medicine Cases

FEBRUARY 11, 2020

Although the mortality rate in patients with Coronavirus in this outbreak is less than 1% (which pales in comparison to Ebola or SARS), historically these types of outbreaks have occured every 5-6 years (SARS 2003, HINI 2009, Ebola 2014, Coronavirus 2020), so they are somewhat predictable and we should know how to prepare for them in our EDs.

ED 130

ED EMS OR 130

Don't Forget the Bubbles

MAY 29, 2023

Explored in seminal research, incivility is described as “ behaviours or mistreatment which violate the workplace norms of mutual respect “ Incivility isn’t just about obvious aggression but can take the form of passive aggression, public beratement, intimidation or habitual interruption. link] Isn’t it just ‘part of the job?’

Critical Care 97

Critical Care E-9-1-1 Paramedicine Paramedicine 97

ACEP Now

AUGUST 25, 2023

The National Heart, Lung, and Blood Institute released an expert panel report in 2014 with evidence-based guidelines for management of SCD recommending timely administration of parenteral opioids for VOE.2 Evidence-based management of sickle cell disease: Expert panel report, 2014. link] Published 2014. Am J Hematol.

Emergency Department 97

Emergency Department ED ALS OR 97

EMDocs

DECEMBER 20, 2023

In 2014 I was asked by 4 different plaintiff attorneys to review 4 separate cases of a missed SEA, all in Washington State. Chuck Pilcher, the editor and publisher of a free monthly educational newsletter, Medical Malpractice Insights – Learning from Lawsuits. Missed SEA’s were the genesis of Med Mal Insights.

ED 77

ED OR 77

This Podcast Will Kill You

JANUARY 30, 2024

BMJ clinical evidence , 2014. Raise your hand if you or someone you know has had their tonsils removed. If your hand is sky-high, there’s a pretty good chance that you (or that person you know) are from the US and were born before 1980. “Vestigial organ.” ” Encyclopedia of Animal Cognition and Behavior. Georgalas, C.C.,

OR 98

OR 98

EMDocs

FEBRUARY 12, 2024

How would an ABG even change the initial stabilization of any of these patients? What alternative testing can be done in these circumstances? Recent studies suggest that clinicians can obtain similarly actionable results from VBGs as ABGs and using the “gold standard” ABG might not be as clinically relevant as it once was.

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

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

AAEM RSA

NOVEMBER 23, 2020

Wahington, DC: 2014. In the past this discrepancy could be explained by a higher percentage of male medical and professional school graduates. Yet today, when the percentage of females in medical school, law school, and business school equals or exceeds the percentage of males, a significant leadership gap persists. Shollen et al.

OR 52

OR E-9-1-1 ALS 52

REBEL EM

MARCH 9, 2023

Prerost 2014) In a patient with chronic alcohol use, hallucinations should prompt consideration of acute intoxication, alcoholic hallucinosis, or delirium tremens (DT). However, evaluating and managing patients with acute alcohol intoxication in the emergency department can be challenging.

Emergency Department 52

Emergency Department OR EMS 52

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Both the outdated 2014 AHA/ACC guidelines and the updated 2023 ESC guidelines recommend immediate invasive management of patients with uncontrolled chest pain. So I would be worried about inferior OMI. A patient with OMI can have a totally normal ECG!" This is especially true for circumflex occlusion. At midnight.

E-9-1-1 125

E-9-1-1 ACS Coronary STEMI 125

FOAMcast

SEPTEMBER 6, 2023

2014 May 14;311(18):1889-900. Historically, EDs have had little engagement in harm reduction around alcohol use disorder (AUD) and provision of medication for AUD. Often efforts to help patients with dangerous or harmful alcohol consumption have encouraged abstinence-only, or referral to detoxification centers. Ann Emerg Med. Jonas DE et al.

Emergency Department 52

Emergency Department ALS ED OR 52

Emergency Medicine Cases

APRIL 12, 2017

In 2014, the CDC reported that UTI antibiotic treatment was avoidable at least 39% of the time. Over-diagnosis and treatment results from the fact that asymptomatic bacteriuria is very common in all age groups, urine cultures are frequently ordered without an appropriate indication, and urinalysis results are often misinterpreted. Their exam?

OR 130

OR EMS 130

Don't Forget the Bubbles

JULY 24, 2023

2014 Jun;164. 2014 Mar;58. Neonates – septic/irritable 6 months – 6 years – non-specific limp, refusal to walk, back pain (often difficult to localise), low grade or no fever >6 years – back pain (more localised), fever, generally unwell The underlying pathology is usually infectious. One study found 88% were sterile.

ALS 98

ALS OR 98

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

APRIL 18, 2024

2014 AHA/ACC guideline for the management of patients with non-ST elevation acute coronary syndromes. Circulation 2014 2. Similarly, if a patient with known CAD presents with refractory ischemic chest pain, the ECG barely matters: the pre-test likelihood of acute coronary occlusion is so high that they need an emergent angiogram.

STEMI 121

STEMI Coronary ALS CAD 121