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A quick primer on hypocalcemia in the ED. Pfenning CL, Slovis CM: Electrolyte Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. 2016, January 27). J Intensive Care Med 2013; 28:166. Louis, Mosby, Inc., 2014, (Ch) 125: p 1636-53.
Date: October 20, 2023 Reference: Cai et al. Case: You are in your group meeting and have heard about a case at a nearby emergency department (ED) where the […] The post SGEM#418: I Ain’t Missing You – Spinal Epidural Abscess first appeared on The Skeptics Guide to Emergency Medicine. Date: October 20, 2023 Reference: Cai et al.
Date: August 27th, 2021 Reference: Gagnon et al. Case: A forty-year-old woman presents to the emergency department […] The post SGEM#342: Should We Get Physical, Therapy for Minor Musculoskeletal Disorders in the ED? Date: August 27th, 2021 Reference: Gagnon et al. first appeared on The Skeptics Guide to Emergency Medicine.
Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics.
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.
Date: April 24th, 2020 Reference: Watanabe et al. This is Bob’s eleventh visit […] The post SGEM#291: Who’s Gonna Drive you to…the ED – with Lights & Sirens? This is Bob’s eleventh visit […] The post SGEM#291: Who’s Gonna Drive you to…the ED – with Lights & Sirens? Date: April 24th, 2020 Reference: Watanabe et al.
Using this decision rule would have cut down on ED CT C-spine ordering by >50% in this derivation cohort. I am hopeful it will also improve the flow in the ED.” While plain films for C-spine injury had previously fallen out of routine ED practice, we now have more evidence to support their use in intermediate risk patients.
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.
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.
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.)
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.
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.
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.
[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.
[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.
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.
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.
fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold
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.
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.
To assess the clinical impact and relevance of these concerns, Alwang et al. Applicability to Emergency Medicine: For emergency medicine providers, the greatest challenge with this study is that it did not include or account for ED care. PMID: 28423290 Kidwell K, Albo C, Pope M, et al. Sickle Cell Disease in the ED.
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.
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).
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.
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.
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.
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.,
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).
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.
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.,
Mumenthaler M , Mattle H , Taub E , ed. 2016 Apr-Jun;19(2):183-7. Available from: [link] Hemmer B, Glocker FX, Schumacher M , et al Subacute combined degeneration: clinical, electrophysiological, and magnetic resonance imaging findings Journal of Neurology, Neurosurgery & Psychiatry 1998;65:822-827. References Neurology.
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.
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.
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.
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%
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.
Paper: Singer S, et al. This study chose a relevant topic to analyze that could influence acute management in the ED and has a fairly larger sample size of patients to do so. References: Singer S, et al. PMID: 36108346 Cole JB, et al. PMID: 31270748 Maheshwari K, et al. PMID: 29872882 Jones AE, et al.
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.
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.
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
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.
An ECG was perfomed on arrival to our ED: NSR with ST elevation II,III, aVF with reciprocal depression in aVL Would you refer this pediatric patient for emergent PCI? Pediatric cardiology performed a bedside echo in ED with EF estimation of 60%, no pericardial effusion, and no regional wall motion abnormalities. Circulation.
5 Paper: Lebin J et al. What They Did: Retrospective cohort study at a single academic medical center between July 1, 2016 to June 30, 2019. Authors assessed how many of the 470 had return ED visits (for any reason) within 3 days of discharge, within 3-7 days, and after 7 days of discharge. J Med Toxicol 2022.
Chou’s Electrocardiography in Clinical Practice, 6th ed. 4] Baranchuk, A, et al. Goldberger’s Clinical Electrocardiography: A Simplified Approach, 9th ed. Below is a refresher on appropriate precordial lead placement. [6] Annals of Noninvasive Electrocardiology, 18 (1), 21-28. [2] 2] Surawicz, B. 3] Smith, S. 6] Goldberger, A.
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