The Skeptics' Guide to EM

MAY 20, 2023

Date: May 10, 2023 Reference: Harhay MO, et al. Date: May 10, 2023 Reference: Harhay MO, et al. Case: You are working at the community emergency department (ED) when you receive a call from the local Emergency Medicine Service (EMS) team that they are bringing a 2-year-old boy who had a cardiac arrest at home. NEJM Evidence.

CPR 130

CPR ALS Emergency Department EMS 130

REBEL EM

JUNE 5, 2023

One study from a county in Massachusetts found that of all nonfatal opioid doses seen in the emergency department from 2011-2015, 1 in 20 patients subsequently died within one year of initial visit with 66% of these deaths being directly related to an opioid overdose (4). PMID 33392580.

Naloxone 98

Naloxone ED Overdose Emergency Department 98

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. To date, ketamine has been the agent of choice (12).

ED 65

ED Emergency Department ALS Paramedic 65

REBEL EM

AUGUST 30, 2023

Most common organism is Staph Aureus (36-67% of cases) ( Boody 2015 ). Graphics Image 1: [link] Image 2: [link] References Berbari EF, Kanj SS, et al. Executive Summary: 2015 Infectious Disease Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults.

E-9-1-1 104

E-9-1-1 ALS ED OR 104

ALiEM

APRIL 12, 2023

Accessed April 5, 2023 Afzal S, Zahid M, Rehan ZA, et al. 20 – Local Anesthetics, Ed(s): Hugh C. References Cleaning and Disinfecting FUJIFILM SonoSite Products User Guide [PDF]. Accessed April 5, 2023. Disinfectants and Cleaning Solutions for Ultrasound Systems and Transducers [PDF]. 2022 Jan 6;8(1):42. doi: 10.3390/gels8010042.

Emergency Department 258

Emergency Department ALS ED 258

REBEL EM

SEPTEMBER 23, 2024

What The Evidence Says: Etomidate has long been the favored induction agent for ED RSI in the US. Opponents of ketamine often point to the risks of spiking intracranial pressure but this concern has been widely debunked ( Cohen 2015 ). PMID: 21373823 Cohen L et al. Ann Emerg Med 2015; 65(1): 43-51. Intensive Care Med.

ALS 75

ALS EMS ED OR 75

EMDocs

AUGUST 22, 2024

have limited English proficiency according to the 2015 U.S. 6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. 6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits.

Emergency Department 81

Emergency Department ALS E-9-1-1 ED 81

The Skeptics' Guide to EM

SEPTEMBER 10, 2022

Date: August 25th, 2022 Reference: Martin et al. Date: August 25th, 2022 Reference: Martin et al. Case: A 7-year-old female with asthma presents to the emergency department (ED) with difficulty breathing in the setting of 1-2 days of cough and runny nose. Reference: Martin et al. Pediatr Emerg Care. Pediatr Emerg Care.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

NOVEMBER 20, 2021

Date: November 16th, 2021 Reference: Hammouda et al. Date: November 16th, 2021 Reference: Hammouda et al. You wonder if any emergency department (ED)-based interventions would help her and people like her be safe. Background: We looked at geriatric falls on an SGEM Xtra in 2015. Reference: Hammouda et al.

ALS 130

ALS ED Emergency Department OR 130

ALiEM

SEPTEMBER 27, 2023

Hoffman et al. Koppaka V, Thompson DC, Chen Y, et al. Encyclopedia of Toxicology (Third Edition), Academic Press. doi: 10.1016/B978-0-12-386454-3.00754-5. Goldfrank L. In: Goldfrank’ s Toxicologic Emergencies. New York, NY. McGraw-Hill.

ALS 169

ALS OR ED 169

EMDocs

JUNE 16, 2023

Podcast: Play in new window | Download (Duration: 13:57 — 19.2MB) Subscribe: Apple Podcasts | Google Podcasts | RSS Management of the child with mental health problems who is boarding in the ED In episode 1 of this series, we discussed differentiating organic vs psychiatric causes of agitation in children.

ED 52

ED Mental Health Services Emergency Department Emergency Medical Services 52

The Skeptics' Guide to EM

DECEMBER 17, 2022

Date: December 16th, 2022 Reference: Hohle et al. Date: December 16th, 2022 Reference: Hohle et al. 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

OCTOBER 10, 2020

Reference: Friedman et al. Date: October 9th, 2020 Guest Skeptic: Dr. Reference: Friedman et al. Background: Pain is one of the most frequent reasons to attend an ED. of all ED visits resulting in 2.6 million visits each year in the USA ( Friedman et al Spine 2010 ). His twitter handle is @PainFreeED.

Emergency Department 130

Emergency Department ALS ED OR 130

EMDocs

JUNE 3, 2023

The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. This is less critical in ED management of the unstable pelvic fracture, as the optimal site for identification of rectal or vaginal tears is the operating room.

ED 54

ED Operating Room ALS Frozen Plasma 54

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Date: September 8th, 2021 Reference: Desch et al. He is interested and experienced in healthcare informatics, previously worked with ED-directed EMR design, and is involved in the New York City Health and Hospitals Healthcare Administration Scholars Program (HASP).

EMR 130

EMR Coronary Defibrillator Life Support 130

Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Britnell 2015] Broselow tape performed better than APLS method in Chinese children. Khouli 2015] In South Sudan, the Broselow system overestimated weight by 26.6% 2012.05.028 Silvagni D, Baggio L, Mazzi C, et al.

E-9-1-1 269

E-9-1-1 Emergency Medical Services Life Support ALS 269

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. PMID: 9114201 Siegel RE et al. BMJ (Clinical research ed.). PMID: 17090560 Castro-Guardiola A et al. PMID: 1664833 Addo-Yobo E, et al. Pneumonia 2017.

ALS 100

ALS ICU ED OR 100

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. Richards JE et al. NEJM 1994. [2]

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

ACEP Now

NOVEMBER 7, 2024

The emergency department (ED) was frequently overwhelmed by suicidal adolescents who needed inpatient psychiatric treatment but couldn’t be admitted, because the hospital had no free beds. Many sought help from EDs, which were not and are not set up to provide involved care for such problems.

ED 59

ED Emergency Department ALS OR 59

Don't Forget the Bubbles

JULY 19, 2023

Olivia, a previously well 13-year-old girl, is referred to the paediatric ED from the Ophthalmology ED. When they examined her and found that she had enlarged optic discs, they sent Olivia to the ophthalmology ED. Two smaller retrospective reviews ( Elhusseiny et al., 2023 and Kovarik et al., 2020 and Hyde et al.

ALS 98

ALS Emergency Department ED OR 98

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. Simpson et al. Patients who Did Not Wait are a feature of most EDs worldwide. A 2011-2012 Australian study by Blake et al. of those children later returned to the ED.

Emergency Department 89

Emergency Department ALS ED OR 89

REBEL EM

SEPTEMBER 13, 2023

Read More EMCrit: Podcast 145 – Awake Intubation Lecture from SMACC ERCast: Angioedema References: Baş M et al. 2015; 372(5):418-25. PMID 25629740 Hassen GW et al. PMID 23062323 Kostis JB et al. PMID 16043683 McCormick M et al. PMID 20954277 Sinnert R et al. Zuraw et al. N Engl J Med.

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

The Skeptics' Guide to EM

MARCH 12, 2022

Date: March 3rd, 2022 Reference: Macnow et al. Date: March 3rd, 2022 Reference: Macnow et al. Dr. Varner’s research interests are in concussion and pregnancy care in the ED. Case: An 18-year-old female presents to the emergency department (ED) after falling off a moving snowmobile and hitting her head on the ground.

Emergency Department 100

Emergency Department ED ALS OR 100

ALiEM

NOVEMBER 22, 2023

Pagel, Mark (ed.). “Evolution of Dietary Specialization and Chemical Defense in Poison Frogs (Dendrobatidae): A Comparative Analysis” The American Naturalist. Published 2015 Oct 19. Tarvin RD, Borghese CM, Sachs W, et al. The poison Dart frog’s batrachotoxin modulates Nav1.8. 2004;577(1-2):245-248.

ALS 284

ALS ED OR 284

EMDocs

MAY 11, 2024

A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al.

EMS 88

EMS E-9-1-1 ALS OR 88

REBEL EM

JULY 20, 2022

White 2003 ) The most common locations of SVT of the lower extremity are: ( Cosmi 2015 ) Long saphenous vein – 50-60% Short saphenous vein – 11-15% Tributaries of the long/short saphenous – 30-40% Pathophysiology, causes and risk factors: Vascular clots are caused by a combination of venous stasis, endothelial injury and hypercoagulability.

ALS 52

ALS OR ED EMS 52

ALiEM

MAY 13, 2024

Study N Methods POCUS Sensitivity (95% CI) POCUS Specificity (95% CI) Conclusions Gottleib et al., Lam et al., of cases* Subramaniam et al., Lam et al., of cases* Subramaniam et al., Adams et al., Adams et al., Sivitz et al., Yen ZS, Wang HP, Ma HM, et al. Epub 2015 Nov 10.

E-9-1-1 161

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

ALiEM

AUGUST 9, 2023

Study N Sensitivity Specificity Comments Pereda et al., Pediatrics 2015 8 studies; 765 patients 96% 93% Evidence supports lung POCUS as an alternative for diagnosis of pneumonia in children. Balk et al., Tsou et al., ED Course The patient received antibiotics for pneumonia. 2015 Apr;135(4):714-22.

E-9-1-1 246

E-9-1-1 Emergency Department ALS OR 246

The Skeptics' Guide to EM

JUNE 5, 2021

References: * Suzuki et al. JAMA 2021 * Zi et al. The tipping point came with the publication of MR. CLEAN in 2015. At work Garreth imagines himself as a student of evidence-based medicine trying to provide the best care based on the best evidence. A non-contrast CT shows no evidence of intracranial hemorrhage.

ALS 130

ALS Emergency Department ED 130

Don't Forget the Bubbles

JANUARY 17, 2024

After Meshram et al, 2020 When Orbeez are exposed to water, the water molecules diffuse into the polymer network through osmosis. Image adapted from Mullens et al., ” ( Ed. After Darracq et al., 2015 But we all know that what happens in the lab does not always mirror what happens in real life. Zamora et al.,

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. Here is the ED ECG (a photo of the paper printout) What do you think? The American Journal of Emergency Medicine 2015; 33(6):786-790. No Chest Pain, but somnolent. Smith : There is 1mm of STE in V1 and almost 1.5mm in V2.

EMS 106

EMS CPR ED Coronary 106

ALiEM

JULY 17, 2023

The Study In an Annals of Emergency Medicine paper , Preiksaitis et al. Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., In fact, the average number of applicants between 2015-2020 and 2022-2023 were relatively similar, with the latter demonstrating 122 more applicants (2,801 vs 2,923).

EMS 130

EMS ALS Emergency Department ED 130

EMDocs

FEBRUARY 22, 2024

A 43-year-old male, with no significant medical history, presents to the ED for right eye pain. In: Tintinalli JE, Ma OJ, Yealy DM, et al., In: Knoop KJ, Stack LB, Storrow AB, Thurman RJ, eds. Published June 11, 2015. In: Tintinalli JE, Ma OJ, Yealy DM, et al., Wakai A, Lawrenson JG, Lawrenson AL, et al.

ALS 76

ALS ED EMS OR 76

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

He was intubated on arrival at the ED for mental status and airway protection due to vomiting. Rituparna et al — as well as Chauhan and Brahma ( Int. There is also large T wave inversion and long QT. Clinical context: A man in his 50s was found down outside in the cold, unresponsive but with intact vital signs. Smith’s ECG Blog ).

ICU 132

ICU OR ALS ED 132

EMDocs

JUNE 12, 2024

Giancarelli et al found that 97% of patients who underwent massive transfusion protocols during trauma resuscitation were hypocalcemic (iCa < 1.1 Kyle et al demonstrated that transfusing a single unit of pRBCs can lead to significant decreases in Ca. How does this impact what you do in the ED? J Trauma Acute Care Surg.

ALS 89

ALS FFP Plasma Emergency Department 89

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

He was brought to the ED. See the February 6, 2015 post in Dr. Smith's ECG Blog - and - the Case Study of polymorphic VT induced by exercise, by Hoffmayer, Scheinman et al — Heart Rhythm 19:1214-1216, 2022 ). Appropriately, the medics electrically cardioverted immediately. They did not feel they had time to sedate.

E-9-1-1 64

E-9-1-1 ALS OR ED 64

The Skeptics' Guide to EM

OCTOBER 28, 2017

[display_podcast] Date: October 24th, 2017 Reference: Harrison et al. display_podcast] Date: October 24th, 2017 Reference: Harrison et al. That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015. Reference: Harrison et al.

ALS 130

ALS Emergency Department OR ED 130