Core EM

JANUARY 25, 2024

Renal injury: isolated proteinuria or hematuria, moderate acute kidney injury with serum creatinine levels <2 mg/dL Skin: petechiae and purpura Despite severe thrombocytopenia, clinically significant bleeding is rare Figure 1.

Plasma 246

Plasma Frozen Plasma Emergency Department FFP 246

Pediatric EM Morsels

JUNE 16, 2023

Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Overdose 152

Overdose OR Critical Care ALS 152

The Skeptics' Guide to EM

JUNE 11, 2017

[display_podcast] Date: June 5th, 2017 Reference: Baharoglu et al. Lancet 2016. display_podcast] Date: June 5th, 2017 Reference: Baharoglu et al. Lancet 2016. Background: In the US, daily or every other day aspirin use has been reported to be as high as 61% in adults aged 65 or older ( Ajani et al Am J Prev Med 2006 ).

ALS 130

ALS OR EMS 130

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

Date: August 30, 2023 Reference: Griffey et al. Date: August 30, 2023 Reference: Griffey et al. However, over the past 20 years, there is burgeoning evidence that fast-acting subcutaneous insulin analogs could be a potential treatment option for mild to moderate severity DKA including a 2016 Cochrane SRMA [4].

ICU 196

ICU ED Critical Care ALS 196

Pediatric EM Morsels

JULY 5, 2024

It seems like just yesterday ( or maybe ~ a month ago ) when we served up a tasty morsel on the PECARN decision rule for intra-abdominal traumatic injuries in children. Our friends at the PECARN injury group have remained busy this spring with generating more externally validated clinical decision rules. High Risk (12.8% High Risk (12.8%

ALS 161

ALS OR ED Emergency Department 161

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

Pediatric EM Morsels

APRIL 5, 2024

Climate change and changes in land usage have contributed to an expanded range of ticks (Beard 2016). Traveling Ticks are more than just ticking off a checklist before you get ready to travel! There are species of ticks found on every continent and carrying a variety of vectors capable of infecting humans.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

The Skeptics' Guide to EM

NOVEMBER 11, 2017

[display_podcast] Date: November 9th, 2017 Reference: Cronin JJ et al. display_podcast] Date: November 9th, 2017 Reference: Cronin JJ et al. Reference: Cronin JJ et al. There have been a number of recent studies that have compared prednisolone to dexamethasone for outpatient treatment of asthma. mg/kg (max. mg/kg (max.

Emergency Department 130

Emergency Department ALS OR 130

The Skeptics' Guide to EM

DECEMBER 7, 2019

Date: October 2nd, 2019 Reference: Ramgopal et al. Date: October 2nd, 2019 Reference: Ramgopal et al. The change in name took place in 2016. The subcommittee on ALTEs in the AAP published a practice guideline renaming ALTEs to brief resolved unexplained events ( BRUEs ) in 2016.

CPR 130

CPR ALS OR 130

The Skeptics' Guide to EM

NOVEMBER 24, 2018

The highest prevalence of burnout (70%) was reported by emergency physicians (Shanafelt et al 2015). One of the most common reasons cited for burnout is the electronic medical record (EMR) (Shanafelt et al 2016). West et al 2016 published a SRMA in the Lancet on interventions to prevent and reduce physician burnout.

EMR 130

EMR ALS Emergency Department OR 130

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

[display_podcast] Date: September 26th, 2017 Reference: Kaufman, et al. display_podcast] Date: September 26th, 2017 Reference: Kaufman, et al. In 2016, the American Academy of Pediatrics (AAP) reaffirmed their clinical practice guidelines for the diagnosis and management of UTIs. BMJ April 17. BMJ April 17.

Emergency Department 130

Emergency Department ALS 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. These include: acetaminophen ( Williams et al Lancet 2014), steroids ( Balakrishnamoorthy et al Emerg Med J 2014) and benzodiazepines ( Friedman et al Ann Emerg Med 2017). An Analysis of Data From Randomized Studies.

ALS 130

ALS Emergency Department ED OR 130

The Skeptics' Guide to EM

DECEMBER 16, 2017

[display_podcast] Date: November 27th, 2017 Reference: Legriel et al. NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. display_podcast] Date: November 27th, 2017 Reference: Legriel et al. Reference: Legriel et al.

ALS 100

ALS ICU Emergency Department Paramedic 100

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

Pediatric EM Morsels

APRIL 7, 2023

References: Al Kasab S, Lynn MJ, Turan TN, Derdeyn CP, Fiorella D, Lane BF, Janis LS, Chimowitz MI; SAMMPRIS Investigators. Epub 2016 Oct 17. Observation, interaction with patient, as well as parent information is key to bring the whole picture together! Increase the Adult Percent! J Stroke Cerebrovasc Dis. 2017 Jan;26(1):108-115.

ALS 130

ALS OR EMS Critical Care 130

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

Pediatric EM Morsels

AUGUST 18, 2023

Jackson 2016) Ciprofloxacin was the first fluoroquinolone approved by the FDA in the 1980’s as a broad-spectrum antibiotic. Jackson 2016) It can also be used in UTIs , but is typically reserved for special cases where the infectious bacteria is found to be multidrug resistant or in complicated UTIs. Arthropathy was seen in 13.7%

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

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.) The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Lay the patient supine when possible.

E-9-1-1 177

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

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

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

The Skeptics' Guide to EM

OCTOBER 7, 2017

[display_podcast] Date: October 5th, 2017 Reference: Brison et al. BMJ Nov 2016. display_podcast] Date: October 5th, 2017 Reference: Brison et al. BMJ Nov 2016. Hupperets et al. BMJ 2009 * Janssen et al. Reference: Brison et al. BMJ Nov 2016. Guest Skeptic: Dr. Steve Joseph.

Emergency Department 100

Emergency Department ALS OR 100

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 118

E-9-1-1 ACS OR Emergency Department 118

The Skeptics' Guide to EM

FEBRUARY 23, 2019

Date: February 22nd, 2019 Reference: Lane et al. Date: February 22nd, 2019 Reference: Lane et al. The study by Alam et al took adult patients with a diagnosis of suspected infection and randomized them to ceftriaxone 2g IV started pre-hospital or usual care with a primary outcome of all-cause mortality at 28 days.

Paramedic 130

Paramedic ALS Ambulance EMS 130

The Skeptics' Guide to EM

AUGUST 28, 2021

Date: August 27th, 2021 Reference: Gagnon et al. Date: August 27th, 2021 Reference: Gagnon et al. Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial. first appeared on The Skeptics Guide to Emergency Medicine.

ED 130

ED Emergency Department ALS OR 130

The Skeptics' Guide to EM

MAY 1, 2021

Reference: Donaldson et al. Reference: Donaldson et al. Emerg Med Australas 2016. The Donaldson et al SRMA included 10,431 patients in 26 randomized trials comparing intravenous thrombolysis with placebo or standard care in acute ischemic stroke [1]. He is also one of the SGEM Hot Off the Press Faculty.

ALS 130

ALS OR 130

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.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

The Skeptics' Guide to EM

OCTOBER 1, 2022

Date: September 28th, 2022 Reference: Hartford et al. Date: September 28th, 2022 Reference: Hartford et al. Brown et al , Selbst and Clark ). Reference: Hartford et al. Disparities in the emergency department management of pediatric migraine by race, ethnicity, and language preference. AEM September 2022.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

MAY 25, 2019

Date: May 23rd, 2019 Reference: Joseph et al. Date: May 23rd, 2019 Reference: Joseph et al. Reference: Joseph et al. Population: All adult (over 18 years of age) patients in the ACS-TQIP database from 2015-2016. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma.

ACS 130

ACS Emergency Department ALS OR 130

Pediatric EM Morsels

JUNE 21, 2024

Available from: [link] Liu H, Li D, Yuan H, et al. The management of pediatric thermal burns always seems to be a hot topic , whether we are caring for a little future chef who splashed a scalding microwaved noodle cup on himself, or a toddling youngster who pulled a pot of boiling water on herself. Updated 2023 May 29]. doi: 10.1097/PEC.0000000000003098.

ALS 169

ALS OR EMS 169

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety profile [3][4]. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

ALS 136

ALS ACS OR CPR 136

The Skeptics' Guide to EM

OCTOBER 3, 2020

Reference: Claiborne Johnston S et al. Reference: Claiborne Johnston S et al. SGEM#24 reviewed a randomized controlled trial (RCT) of aspirin vs. aspirin + clopidogrel in patients with recent symptomatic lacunar infarcts identified by MRI ( Benavente et al NEJM 2012 ).

Emergency Department 100

Emergency Department ALS OR 100

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 118

ALS Emergency Department OR ED 118

REBEL EM

NOVEMBER 30, 2023

Studies without IRB approval Studies older than 2016 Intervention: Administration of <30 mL/kg IV crystalloid fluids within three hours of sepsis identification. Limitations: The investigators excluded studies published before 2016, non-English studies, and non-published studies, potentially missing valuable data. 2.89, p = 0.01.

E-9-1-1 121

E-9-1-1 ALS ACS ICU 121

The Skeptics' Guide to EM

MAY 2, 2020

Date: April 24th, 2020 Reference: Watanabe et al. Date: April 24th, 2020 Reference: Watanabe et al. Reference: Watanabe et al. Yes Results: The 2016 NEMSIS database contained 20.4 Is Use of Warning Lights and Sirens Associated With Increased Risk of Ambulance Crashes? Annals of Emergency Medicine.

ED 100

ED Ambulance Medical Transportation EMS 100

REBEL EM

APRIL 29, 2024

A study by Lee et al ( 7) compared femoral CVC placement to IO and demonstrated a first-pass success pass rate with IO of 90.3% Over the years emergency and critical care physicians have tried many ways to establish IV access in emergencies including the “crash” or “dirty” central line. compared to only 37.5% in the CVC group.

ALS 105

ALS Epinephrine Critical Care Emergency Department 105

Don't Forget the Bubbles

JULY 22, 2024

Compare this with the Panickar et al. The most recent meta-analysis , published in 2016 (comparing eleven studies from 1986 to 2009), struggled to reach a consensus because the trials were too heterogeneous to make robust conclusions. Fortunately, Lee et al. Lee B, Turner S, Borland M, Csonka P, Grigg J, Guilbert TW, et al.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105