The Skeptics' Guide to EM

APRIL 13, 2024

When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago. A code stroke is activated, and the initial CT head shows no signs of hemorrhage or early ischemic changes. A CT angiogram shows a proximal middle cerebral artery occlusion. CT perfusion showed a 10 mL core and 189 mL penumbra.

ALS 287

ALS Emergency Department OR EMS 287

Pediatric EM Morsels

NOVEMBER 15, 2024

Have you ever had that feeling of falling that rapidly wakes you from sleep? While it’s unlikely that you were having Benign Epilepsy with CentroTemporal Spikes (BECTS) seizures or a benign Rolandic seizure, that tenuous state between sleeping and waking is a time when some odd neurologic things can happen, including BECTS.

ALS 152

ALS OR EMS 152

ALiEM

NOVEMBER 1, 2024

2015 Apr;20(2):131-8. There remains more research to be done on the matter but it appears that clot in transit signifies a need for advanced forms of PE management (thrombolysis or thrombectomy ) to improve mortality in comparison to normal systemic anticoagulation. References Athappan G, Sengodan P, Chacko P, Gandhi S. Eur Respir J.

ED 161

ED OR 161

Pediatric EM Morsels

AUGUST 18, 2023

Binz 2015) Remember, dogs grow 18 times as fast an infant in the first year of life. Binz 2015) More recent lamb studies have been performed, where the growth more closely approximates a human child. Musculoskeletal Adverse Events include: Articular cartilage damage causing arthralgias or arthritis , Tendonitis , and Tendon rupture.

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

ALiEM

DECEMBER 4, 2023

2015 Jul;66(1):133-46. Epub 2015 May 7. He then noticed the pain start and grow in intensity without radiating anywhere else except the glans. He denies any discharge or pain with urination with 2-3 small volume voids daily but denies urine trapping. There is no crepitus or swelling. The rest of the physical exam is benign.

Emergency Department 152

Emergency Department OR 152

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

ALiEM

MAY 24, 2023

In: Fleisher and Ludwig’s Textbook of Pediatric Emergency Medicine, 7th ed, Shaw K, Bachur RG (Eds), Lippincott Williams & Wilkins, Philadelphia 2015. All revolve around understanding zipper anatomy and obtaining adequate exposure to assess how the skin is entrapped. Apply lidocaine gel on the area of entrapment for 2-3 minutes.

ED 233

ED OR 233

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-9-1-1 104

E-9-1-1 ALS ED OR 104

Handtevy

MARCH 28, 2019

The AHA published data in 2015 that states that outcomes from out of hospital pediatric arrest haven’t changed since the 1980’s. The amazing part of this story is that it took more than 20 years for the scientific community to prove this theory to be correct and for other doctors to accept it as standard practice.

OR 52

OR Paramedic 52

The Skeptics' Guide to EM

OCTOBER 28, 2023

Acetaminophen ( Williams et al Lancet 2014) * Muscle relaxants ( Friedman et al JAMA 2015) * NSAIDs ( Machado et al Ann Rheum Dis 2017) * Steroids ( Balakrishnamoorthy et al Emerg Med J 2014) * Benzodiazepines ( Friedman et al Ann Emerg Med 2017) Many non-pharmacologic therapies have also been tried with limited efficacy.

ALS 221

ALS Emergency Department ED OR 221

The Skeptics' Guide to EM

MAY 20, 2023

However, we have not covered the Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest (OHCA) in Children or THAPCA-OH published in the New England Journal of Medicine in 2015. Other therapeutic hypothermia trials included Target Temperature Management or TTM trial ( SGEM #82 ), HYPERION ( SGEM #275 ), TTM2 ( SGEM #336 ). N Engl J Med.

CPR 130

CPR ALS Emergency Department EMS 130

Pediatric EM Morsels

JULY 21, 2023

We use the GCS score in both trauma and medical patients, but where did this score come from? When is it useful and what does it tell us? Is it actually validated in children, like the Ottawa Ankle Rules or are we using a tool for something other than that for which it was designed and validated, like using Kocher criteria for knee and ankle joints?

Critical Care 246

Critical Care ALS OR Life Support 246

Core EM

OCTOBER 23, 2024

2015 May 12;2(3):147-157. The Case A 24-year-old man with no past medical or surgical history presented to the emergency department with 5 days of progressively worsening bilateral leg cramping, paresthesias, and multiple falls. and tends to occur in men of Asian descent. and tends to occur in men of Asian descent. Circulation.

Emergency Department 130

Emergency Department Critical Care ICU Ambulance 130

The Skeptics' Guide to EM

OCTOBER 21, 2023

In SGEM#181, we were unconvinced of the value of routine use of whole body CT in trauma patients, and right back in 2015 on SGEM#106 discussing the Canadian CT head rule and the New Orleans Criteria. However, we’ve not previously looked at the intersection of non-traumatic back pain and rational investigation. AEM October 2023.

Emergency Department 264

Emergency Department ALS ED OR 264

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

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

SEPTEMBER 23, 2024

Opponents of ketamine often point to the risks of spiking intracranial pressure but this concern has been widely debunked ( Cohen 2015 ). Ann Emerg Med 2015; 65(1): 43-51. What The Evidence Says: Etomidate has long been the favored induction agent for ED RSI in the US. Intensive Care Med. 2011;37(6):901-910.

ALS 75

ALS EMS ED OR 75

ALiEM

DECEMBER 22, 2023

2015 Nov 18;10:55. The patient stated that upon getting out of bed, she took 4-5 steps, lost her balance, and fell backward onto the bedroom floor. She denied loss of consciousness. She denied syncope or vertigo before the fall. Additional Images Physical Exam Vitals : 37.8°C; of cases were diagnosed by MRI and 14.6% World J Emerg Surg.

OR 161

OR 161

Pediatric EM Morsels

OCTOBER 27, 2023

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%. Recommended by ATLS and PALS. Krug 2007] What If the Child is Obese or Emaciated? Validation study done in Italy.

E-9-1-1 269

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

EMDocs

JUNE 15, 2024

Source Shifts in Diagnostic Testing for Headache in the Emergency Department, 2015 to 2021. Originally published at JournalFeed , a site that provides daily or weekly literature updates. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: JAMA Netw Open. 2024 Apr 1;7(4):e247373. doi: 10.1001/jamanetworkopen.2024.7373.

ICU 75

ICU Emergency Department ED OR 75

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

ALiEM

SEPTEMBER 11, 2023

2015 Aug 21;64(32):865-70. 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. For the eye dryness and mild irritation, she rinsed her eyes with her contact solution.

Emergency Department 152

Emergency Department ED OR 152

Pediatric EM Morsels

MAY 12, 2023

2015 Nov;100(11):1032-7. Epub 2015 Aug 21. 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

Don't Forget the Bubbles

AUGUST 19, 2024

2015 Apr;34(4):e92-e101. 2015 Sep;35(6):634-9. He points to his sternum when you ask him where the pain is. and tells you that it is made worse by deep breathing and movement. His sternum is warm to touch and exquisitely tender, inferior to the manubrium. There is no overlying bruising, erythema, or skin changes. Pediatr Infect Dis J.

Emergency Department 104

Emergency Department OR 104

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

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 ). They’ve also been called the “camel-hump” sign. Rituparna et al — as well as Chauhan and Brahma ( Int. Smith’s ECG Blog ).

ICU 132

ICU OR ALS ED 132

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

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

This Podcast Will Kill You

FEBRUARY 13, 2024

“That time of the month”, “Aunt Flo”, “the red wave”, “period”, the list goes on. But what about euphemisms for menopause? We’ve got “the change” or “change of life”, “climacteric”, and… that’s it? There may be more out there, but the comparison is revealing. The slow moon climbs: The science, history, and meaning of menopause. Davis, S.R.,

ALS 98

ALS OR 98

REBEL EM

APRIL 29, 2024

In these situations, the American Heart Association (AHA) and the European Resuscitation Council (ERC) of 2015 recommend the intraosseous (IO) route after the peripheral route and before the central venous route ( 1). One meta-analysis in trauma patients demonstrated that the first-attempt success rate was higher in IO compared to PIVs ( 2).

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

FOAMcast

JANUARY 25, 2023

Epub 2015 Dec 30. doi: 10.1136/emermed-2015-205096. Apple Podcasts , Spotify , or Listen Here References: Wray JP, Bridwell RE, Schauer SG, Shackelford SA, Bebarta VS, Wright FL, Bynum J, Long B. The diamond of death: Hypocalcemia in trauma and resuscitation. Am J Emerg Med. 2021 Mar;41:104-109. doi: 10.1016/j.ajem.2020.12.065.

Emergency Department 52

Emergency Department OR 52

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

REBEL EM

MARCH 30, 2023

Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. Ranges from ambulatory state to severe dementia or paralysis.

Coronary 83

Coronary CPR OR ICU 83

This Podcast Will Kill You

OCTOBER 1, 2024

” Journal of Molecular Evolution 80 (2015): 1-9. 2015): 589-596. 2015): 3-16. .” Experimental & molecular medicine 49.3 2017): e301-e301. Commins, S.P., Satinover, S.M., Lewis, B.D., Woodfolk, J.A. and Platts-Mills, T.A., Journal of Allergy and Clinical Immunology , 123 (2), pp.426-433. 426-433. . Steinke, J.W.,

E-9-1-1 52

E-9-1-1 ALS OR 52

Pediatric EM Morsels

JUNE 30, 2023

Let’s take a moment to digest a morsel on this condition that may lead to recurrent pulmonary problems: Congenital Pulmonary Airway Malformation: Basics Developmental lesion of the lungs characterized by pseudocysts, lesions, and dilated airways (Dessole, 2019) Incidence is 1 in 11,000 to 1 in 35,000 (Dessole, 2019) Most often unilateral 85% (..)

E-9-1-1 281

E-9-1-1 ED EMS OR 281

REBEL EM

MAY 25, 2023

JAMA 2015 [7] The PROPPR Trial 680 severely injured adult trauma patients Patients randomized to Plasma, Platelets, and PRBCs in a 1:1:1 ratio vs 1:1:2 ratio No difference in overall mortality at 24 hrs BUT 1:1:1 achieved hemostasis faster and fewer experienced death due to exsanguination at 24hrs Crombie N et al.

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

REBEL EM

SEPTEMBER 13, 2023

of people who take NSAIDs ( Nzeako 2010 ). patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 of people who take NSAIDs ( Nzeako 2010 ). Typically involves the mouth, larynx, pharynx, and subglottic tissue ( Kostis 2005 ).

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

The Skeptics' Guide to EM

APRIL 6, 2019

This changed in 2015 when the Food and Drug Administration (FDA) approved idarucizumab for the reversal of dabigatran. We covered the interim analysis of 90 patients included in a prospective cohort study by Pollack et al NEJM 2015 on SGEM#139. Dabigatran is a direct thrombin inhibitor.

Frozen Plasma 130

Frozen Plasma Plasma ALS EMS 130