The Skeptics' Guide to EM

OCTOBER 28, 2023

Case: A 37-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 three days prior to the ED visit after unloading a truck with furniture. His twitter handle is @PainFreeED.

ALS 228

ALS Emergency Department ED OR 228

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

The Skeptics' Guide to EM

MAY 20, 2023

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. Upon arrival at the ED, your team promptly begins high quality CPR and manages to obtain return of spontaneous circulation.

CPR 130

CPR ALS Emergency Department EMS 130

EMDocs

JUNE 15, 2024

1: PREOXI RCT – Preoxygenation with Noninvasive Ventilation vs. Non-rebreather Mask Spoon Feed Noninvasive ventilation (NIV) was superior to a standard non-rebreather (NRB) oxygen mask for preoxygenation of critically ill ED or ICU patients requiring intubation, with a NNT of 11 to prevent 1 episode of hypoxemia <85%. Ann Emerg Med.

ICU 75

ICU Emergency Department ED OR 75

Core EM

JANUARY 25, 2024

We revisit the topic of Hyperkelamia to update our prior episode from 2015 (pre-Lokelma) Hosts: Brian Gilberti, MD Jonathan Kobles, MD [link] Download Leave a Comment Tags: Renal Colic Show Notes Introduction Background Physiology : Normal range and the significance of deviations (>5.5 mEq/L alone With insulin, ~1.2

Epinephrine 246

Epinephrine OR ED 246

REBEL EM

AUGUST 30, 2023

Most common organism is Staph Aureus (36-67% of cases) ( Boody 2015 ). 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. Often used interchangeably with osteomyelitis. Other pathogens include: E.

E-9-1-1 103

E-9-1-1 ALS ED OR 103

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. 2015 Aug 21;64(32):865-70. The patient is a contact lens wearer. MMWR Morb Mortal Wkly Rep. doi: 10.15585/mmwr.mm6432a2.

Emergency Department 152

Emergency Department ED OR 152

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 82

Emergency Department ALS E-9-1-1 ED 82

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. Encyclopedia of Toxicology (Third Edition), Academic Press. Goldfrank L.

ALS 169

ALS OR ED 169

Pediatric EM Morsels

JUNE 30, 2023

I’m sure you can recall at least several parents who bring their children into the ED for concern of recurrent pneumonias. Often the parents focus on a possible underlying immunodeficiency. Fortunately, most commonly these pneumonias are due to viral infections, and we can often offer reassurances to the parent.

E-9-1-1 258

E-9-1-1 ED EMS OR 258

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 108

EMS CPR ED Coronary 108

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% Reduces dosing errors during resus, up to 33.88%.

E-9-1-1 268

E-9-1-1 Emergency Medical Services Life Support ALS 268

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

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. The amount of toxin collected from one frog is potent enough to kill 10 humans and can be used to cover 30-50 darts for hunting [4].

ALS 284

ALS ED OR 284

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

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). She arrives in the emergency department (ED) with decreased level of consciousness and shock.

EMR 130

EMR Coronary Defibrillator Life Support 130

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. Sci 5[4] 268-270, 2015 ) both highlight a likely association between acute development of ischemic J waves — and high risk of developing malignant ventricular arrhythmias ( My Comment in the September 23, 2020 post ). Smith’s ECG Blog ).

ICU 135

ICU OR ALS ED 135

The Skeptics' Guide to EM

MARCH 12, 2022

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. It was a witnessed fall; she was wearing a helmet at the time and there was no loss of consciousness.

Emergency Department 100

Emergency Department ED ALS OR 100

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

REBEL EM

JANUARY 24, 2024

Take Home Points Achilles tendon rupture is a clinical diagnosis. The Thompson Test should be applied in all suspected cases. Remember to brace or splint a rupture, even if suspected, in the resting equinus position for optimal healing and prevention of further injury. Weakness with plantar flexion.

ALS 103

ALS ED OR EMS 103

ALiEM

APRIL 17, 2023

A 29 year-old-male with a past medical history of left eye enucleation secondary to a gunshot wound several years prior presents to the Emergency Department (ED) for blurry vision, redness, and concern for a deformity to his right eye. Published 2015 Dec 11. He also reports photophobia and mild eye pain. Visual Diagnosis Ophthalmology.

Emergency Department 130

Emergency Department OR ED 130

ALiEM

AUGUST 9, 2023

Ultrasound Technique Background The lungs were traditionally considered poorly accessible to ultrasound, as ultrasound waves cannot penetrate air-filled structures; however, lung POCUS relies on the interpretation of patterns of artifacts to evaluate the normal, air-filled lungs. Warm gel helps with the child’s comfort.

E-9-1-1 246

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

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

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. We’ll keep it short, while you keep that EM brain sharp. Vital signs include BP 168/89, HR 96, T 98.3,

EMS 89

EMS E-9-1-1 ALS OR 89

EMDocs

FEBRUARY 22, 2024

A 43-year-old male, with no significant medical history, presents to the ED for right eye pain. The patient notes his pain as constant and sharp (8/10); associated with light-sensitivity, tearing, and blurred vision. The man does not use glasses or contact lenses. He denies known ocular trauma or ocular surgical history.

ALS 77

ALS ED EMS OR 77

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

ALiEM

JULY 17, 2023

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). However, between 2015 and 2023, the number of available EM positions grew, with an annual addition of 149 PGY1 positions. Many of these characteristics are immutable.

EMS 130

EMS ALS Emergency Department ED 130

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. Whilst paediatric social admissions (PSA) are not a novel concept, they have gained increased attention and significance in recent years.

Mental Health Services 52

Mental Health Services ED OR Emergency Department 52

REBEL EM

FEBRUARY 22, 2023

Bagheri 2015 ). Giant Cell Arteritis (arteritic anterior ischemic neuropathy) ( Bagheri 2015 , Hayreh 2009 ) Pathophysiology Giant cell arteritis(GCA) affects that medium-sized and large arteries. Persistent vision loss defined as loss of vision >24 hours. Causes: There are multitude of causes of vision loss. Signs IOP >21.

Emergency Department 52

Emergency Department ALS ED Coronary 52

EMDocs

JUNE 28, 2023

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. EMS is called, and he is brought to the ED for a reported “slip and fall” with associated facial abrasions. None of this is otherwise communicated to the ED provider – only noted in reports.

EMS 68

EMS ED OR 68

ACEP Now

MARCH 13, 2024

Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. ED crowding impairs this mission. The Emergency Medical Treatment and Labor Act (EMTALA) mandates examination, treatment, and stabilization of anyone who comes to the ED.

Emergency Department 52

Emergency Department ED ALS OR 52

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. Thus, if the patient has complete resolution of symptoms after appropriate treatment of anaphylaxis, there is no set time period for monitoring in the ED. 2015 May-Jun;3(3):408-16 Ellis A, Day J. Read More: 1.

Epinephrine 80

Epinephrine Allergic Reaction Emergency Department Emergency Manager 80

EMDocs

NOVEMBER 1, 2023

A 39-year-old male with history of achalasia with recent endoscopic dilation 24 hours prior presents to the ED for progressively worsening chest pain with radiation to his left shoulder. This series provides evidence-based updates to previous posts so you can stay current with what you need to know.

Critical Care 67

Critical Care ED EMS OR 67

EMDocs

JUNE 8, 2024

A 27-year-old male presents to the ED for left eye pain after being hit in the face with a spare car part while working under the hood of his car. What is the diagnosis, and how do we manage it from the ED? We’ll keep it short, while you keep that EM brain sharp. 95% occupational injuries occur in males [1]. UpToDate , 30 Oct.

EMS 81

EMS Allergic Reaction Emergency Department ED 81

EMDocs

JUNE 27, 2024

An 8-year old male with a history of sickle cell anemia presents to the ED for evaluation of fever for 2 days and “feeling like I can’t get a full breath”. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. Other lung fields unremarkable. C or 100.4 mg/kg, max 0.4 C or 100.4

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

EMDocs

MARCH 2, 2024

A 58-year-old female with a history of diabetes, hypertension, and chronic back pain presents to the ED with severe headache and nausea. On arrival, she is awake and alert and in obvious distress. Her vitals signs include temperature of 98.8F, HR of 64, BP 133/78, and O2 saturation of 98% on room air with a respiratory rate of 18.

EMS 114

EMS E-9-1-1 OR ED 114

ACEP Now

NOVEMBER 7, 2023

The 2015 Edition Cures Act sought to promote “transparency, modern standards, and enhanced health IT capabilities by fostering innovation in the health care technology ecosystem to deliver better information to patients, clinicians, and other users.” The most frequently invoked exception in the ED is preventing harm.

ED 52

ED ALS OR Emergency Department 52

REBEL EM

MARCH 22, 2023

Valsalva maneuvers Have patient bear down as if they are having a bowel movement Have patient blow as hard as they can into a straw Syringe technique Postural Modification Success rate: 43% vs. 17% (standard Valsalva) (Appleboam 2015) Details of technique found at the St. Serum troponins should not routinely be obtained.

ALS 52

ALS EMS ED OR 52