The Skeptics' Guide to EM

OCTOBER 1, 2022

Date: September 28th, 2022 Reference: Hartford et al. Date: September 28th, 2022 Reference: Hartford et al. Patients with migraines often present to the ED looking for pain relief. Brown et al , Selbst and Clark ). Reference: Hartford et al. AEM September 2022. AEM September 2022. AEM September 2022.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

MAY 14, 2022

Date: May 13th, 2022 Reference: Abril et al. Date: May 13th, 2022 Reference: Abril et al. 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). His twitter handle is @PainFreeED.

ALS 130

ALS Emergency Department ED OR 130

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

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. 2016 Nov;23(11):1298-1306.

E-9-1-1 161

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

Don't Forget the Bubbles

JULY 22, 2024

Pre-school wheezers remain a poorly understood cohort of children despite seeing them every day in paediatric EDs. However, there was no difference in LOS (83 minutes for placebo vs 79 minutes for prednisolone) in participants who were discharged straight from the ED ( 32% ). Compare this with the Panickar et al.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

The Skeptics' Guide to EM

JULY 30, 2022

Date: July 28th, 2022 Reference: Brower et al. Date: July 28th, 2022 Reference: Brower et al. Case: A 63-year-old woman presents to your emergency department (ED) with two-day history of nausea, vomiting and constipation. Reference: Brower et al. She is also the creator of all those wonderful Paper in a Pictures.

ALS 130

ALS ED Emergency Department EMS 130

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

ALiEM

MARCH 7, 2024

Transvere ultrasound views of the bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.) Sagittal view of bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.)

E-9-1-1 177

E-9-1-1 Emergency Department ALS ED 177

The Skeptics' Guide to EM

APRIL 17, 2021

Reference: Schuh et al. Reference: Schuh et al. JAMA Nov 2020 Case: A four-year-old girl with a known history of asthma presents to your emergency department (ED) after a one-day history of runny nose and cough. Background: Asthma is a common presenting complaint for children in the ED.

Emergency Department 130

Emergency Department ALS ED 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. Bowen 2016] Moral of the Morsel: Weight Matters! link] Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. 2012.05.028 Silvagni D, Baggio L, Mazzi C, et al. in non-malnourished children.

E-9-1-1 269

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

EMDocs

AUGUST 22, 2024

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. One cohort study in a public ED found that 84.5%

Emergency Department 81

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

The Skeptics' Guide to EM

AUGUST 14, 2021

Date: August 12th, 2021 Reference: Daya et al. Date: August 12th, 2021 Reference: Daya et al. This was the ALPS randomized control trial published in NEJM 2016. This was a critical appraisal of an observational study published in Annals of EM ( Kawano et al 2018 ). Reference: Daya et al.

CPR 130

CPR BLS ALS Paramedic 130

REBEL EM

JANUARY 23, 2023

Article: Abella BS et al. Key Secondary Endpoints: 5 (3.9%) patients in the IV cetirizine group returned to any ED or clinic within 24 hours compared to 15 (11.1%) in the IV diphenhydramine group; P=0.04 Anecdotally, the persistence of urticaria often has little influence on the decision to discharge a patient from the ED.

Allergic Reaction 52

Allergic Reaction ED E-9-1-1 Emergency Department 52

The Skeptics' Guide to EM

MAY 29, 2021

Date: May 20th, 2021 Guest Skeptic: Dr. Robert Edmonds is an emergency medicine physician in the Air Force in Dayton, Ohio, and a University of Missouri-Kansas City residency alumni from 2016. Reference: Jhunjhunwala et al. Reference: Jhunjhunwala et al. Journal of Trauma and Acute Care Surgery.

Emergency Medical Services 130

Emergency Medical Services ACS ALS Emergency Department 130

ACEP Now

OCTOBER 11, 2024

ED treatment should focus on airway, breathing, and circulation with consideration for cervical spine protection depending on the circumstances surrounding the event. References Webb AC, Wheeler A, Ricci A, et al. Pellegrino F, Raffaldi I, Rossi R, et al. Chotai PN, Manning L, Eithun B, et al. South Med J. Ital J Pediatr.

ALS 52

ALS Emergency Department Emergency Medical Services ED 52

The Skeptics' Guide to EM

NOVEMBER 1, 2022

Date: October 27th, 2022 Reference: Hayashi et al. Date: October 27th, 2022 Reference: Hayashi et al. Although minor adverse events, such as brief apnea or hypoxia, are common, significant adverse events are very rare, and the benefits are clear (Bellolio 2016).

ALS 154

ALS Emergency Department OR ED 154

EMDocs

NOVEMBER 13, 2024

Major takeaway: Consider SBP in any patient who comes into the ED with ascites. Biggins SW, Angeli P, Garcia-Tsao G, et al. Mattos AA, Wiltgen D, Jotz RF, et al. Aithal GP, Palaniyappan N, China L, et al. Angeli P, Bernardi M, Villanueva C, et al. Arvaniti V, D’Amico G, Fede G, et al. Hepatology. Hepatology.

E-9-1-1 71

E-9-1-1 ALS OR ED 71

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. This data was collected over a five-year period (2016-2020) had true papilloedema. 2023 and Kovarik et al.,

ALS 98

ALS Emergency Department ED OR 98

EMS 12-Lead

JUNE 1, 2022

He advises, however, recurrent syncopal episodes for the past six months, some of which have resulted in ED admission, yet no identifying mechanism could be determined. Chou’s Electrocardiography in Clinical Practice (6th ed). Josephson’s Clinical Cardiac Electrophysiology: Techniques and Interpretations (6th ed). 2] Meyers, H.

Coronary 130

Coronary ALS Firefighter ACS 130

REBEL EM

NOVEMBER 2, 2022

mg/dL, BUN > 30 mg/dL or Total bilirubin > 4 mg/dL) Read More Oyama LC: Disorders of the liver and biliary tract, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. References Runyon BA et al. PMID: 3338704 Borzio M et al. Link Sort P et al.

ALS 52

ALS ED EMS OR 52

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., Forrester reported data from the Texas Poison Centers surrounding 110 cases of superabsorbent polymer bead ingestions between 2011 and 2016. ” ( Ed.

E-9-1-1 111

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

Don't Forget the Bubbles

JULY 17, 2023

Sethi SK, et al. Agostino H, et al. Rassekh SR, et al. Goulet K, et al. McClellan JM, et al. Arneitz C, et al. Van Rossem EJD, et al. Smyrnaios A, et al. Satir AN, et al. Cortés J, et al. Al Dhaheri FA, et al. Rivacoba MC, et al. Feldman PM, et al.

E-9-1-1 98

E-9-1-1 ALS Emergency Department Emergency Medical Services 98

The Skeptics' Guide to EM

JANUARY 19, 2019

Date: January 17th , 2019 Reference: Clemency et al. Date: January 17th , 2019 Reference: Clemency et al. 1] Two-thirds of the all the drug overdoses in the US in 2016 (63,632) involved an opioid (42,249). [2] This teaching has been challenged by a systematic review by Willman et al 2017. Reference: Clemency et al.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

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

Don't Forget the Bubbles

AUGUST 23, 2023

Very rarely are the ED team allowed to stand, in silence, with a purpose. 2016) “Implementation of a Post-Code Pause: Extending Post-Event Debriefing to Include Silence”. Kapoor et al. It gives us permission to stop, breathe, recognise the enormity of what has happened, and provide a platform for acknowledgement. & Liska, H.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

ALiEM

AUGUST 9, 2023

Study N Sensitivity Specificity Comments Pereda et al., Balk et al., Tsou et al., ED Course The patient received antibiotics for pneumonia. PMID: 14722643 Pereda MA, Chavez MA, Hooper-Miele CC, et al. PMID: 25780071 Balk DS, Lee C, Schafer J, et al. PMID: 29696826 Tsou PY, Chen KP, Wang YH, et al.

E-9-1-1 246

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

This Podcast Will Kill You

NOVEMBER 27, 2023

Brown, Amanda MV, et al. 2016): 34955. . 2016): 34955. Ferri, Emanuele, et al. Gerth, Michael, et al. Kaur, Rupinder, et al. Quek, Shannon, et al. History Biology Hoerauf, Achim, and Ramakrishna U. Wolbachia: a bug’s life in another bug. Karger Medical and Scientific Publishers, 2007.

E-9-1-1 52

E-9-1-1 ALS ED 52

Don't Forget the Bubbles

AUGUST 7, 2023

The controversy around what is ‘normal’ in infants’ and children’s vitals was demonstrated in a 2011 systematic review by Fleming et al. and two cohort studies, one performed in Australia by O’Leary et al. and one in the US by Bonafide et al. Brennan et al. Our study supports previous work by Nijman et al.

Life Support 98

Life Support Advanced Life Support ALS Emergency Department 98

The Skeptics' Guide to EM

OCTOBER 22, 2017

[display_podcast] Date: October 19th, 2017 Reference: Hofmann et al. display_podcast] Date: October 19th, 2017 Reference: Hofmann et al. Studies have shown that oxygen can cause vasoconstriction, increase blood pressure and decrease coronary artery blood flow ( Kones et al AM J Med 2011). NEJM Sept 2017. NEJM Sept 2017.

Emergency Medical Services 130

Emergency Medical Services Coronary ALS STEMI 130

Dr. Smith's ECG Blog

JUNE 2, 2023

Despite otherwise normal vital signs, she was appropriately triaged to the critical care area of the ED. They are rare and hard to find in normal practice in the ED. She denied chest pain and denied feeling any palpitations, even during her triage ECG: What do you think? Cardiac MRI will tell you if ARVC is or is not present.

ED 79

ED OR ALS CAD 79

EMDocs

DECEMBER 19, 2023

In: Marx JA, Hockenberger RS, Biros MH, et al., link] Published April 7, 2016. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e. McGraw Hill; 2020. Accessed August 25, 2022. link] Edward OJ. Venomous Marine Animals.

First Aid 91

First Aid ED OR ALS 91

EMS 12-Lead

APRIL 8, 2022

1] Here is the admitting ED ECG after cancellation of Code STEMI. The patient continued to verbalize cessation of symptoms while in the ED. However, in this context (i.e. cessation of symptoms), and in this unique territory (V2-V4), the T-wave characteristics are consistent with posterior reperfusion! [1] 1] Driver, B. 3] Niu, T.,

STEMI 130

STEMI ALS Coronary CAD 130

ACEP Now

FEBRUARY 11, 2024

A 95-year-old female with a history of stage III chronic kidney disease (CKD), heart failure with reduced ejection fraction (HFrEF), and dementia with baseline orientation only to person and place, presented to the emergency department (ED) for upper extremity myoclonic jerking for one day. Lam N, Weir M, Yao Z, et al. Am J Kidney Dis.

Emergency Department 52

Emergency Department ALS ED OR 52

The Skeptics' Guide to EM

MAY 11, 2019

Date: May 6th, 2019 Reference: Sceats et al. Date: May 6th, 2019 Reference: Sceats et al. Case: An 18-year-old woman presents with a Grade 1 appendicitis (Tominaga et al J Trauma Acute Care Surg 2016). Omar et al (2008) showed just how safe laparoscopic appendectomies have become. Reference: Sceats et al.

Critical Care 130

Critical Care ALS OR ED 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. Electronic address, p. link] j.ajog.2016.03.012

EMS 95

EMS Ambulance FFP ICU 95

EMDocs

NOVEMBER 19, 2024

10 Table 1: Second-Generation Antipsychotics and Associated Adverse Effects Adapted from: UpToDate 8 with additional sources Micromedex 9 and Riboldi, et al 11 *SL=sublingual, IM=intramuscular, PO=oral, ODT=orally disintegrating tablets, ER=extended release, IR=immediate release. +to Gummin DD, Mowry JB, Beuhler M, et al. Juurlink D.

Overdose 74

Overdose EMS Emergency Medical Services OR 74

EMDocs

OCTOBER 21, 2023

Median time from ED arrival to diagnosis was 8 hours 24 min in one study, with only 19% being diagnosed within the 4.5-hour References: Gaillard F, Glick Y, Tatco V, et al. doi: 10.1136/neurintsurg-2016-012515. Epub 2016 Jul 15. Post TW, ed. 61.4.496 Navi BB, Kamel H, Shah MP, et al. J Neurointerv Surg.

EMS 73

EMS ALS OR ACS 73