The Skeptics' Guide to EM

MAY 2, 2020

This is Bob’s eleventh visit […] The post SGEM#291: Who’s Gonna Drive you to…the ED – with Lights & Sirens? July 2019 * Population: All dispatches of a transport-capable ground EMS vehicle to a 911 emergency scene from the 2016 National EMS Information System, both the response to the scene and the transport from the scene.

ED 100

ED Ambulance Medical Transportation EMS 100

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. However, the ICU is full and the patient will likely be boarding in your ED for a bit before coming upstairs.

ICU 209

ICU ED Critical Care ALS 209

ALiEM

JANUARY 8, 2024

She then presented again to the ED with two weeks of worsening shortness of breath, intermittent fevers (Tmax 101°F), nausea/vomiting, fatigue, and arthralgias. 2016 May;68(5):689-94. She underwent a brief admission of six days for shortness of breath but did not have an oxygen requirement at that time. kg/m2; Wt 79.4 doi: 10.1002/acr.22728.

ED 152

ED OR 152

ALiEM

FEBRUARY 20, 2024

2016 Mar;12(1):121-9. Successful treatment of flecainide-induced cardiac arrest with extracorporeal membrane oxygenation in the ED. A Literature Review of the Use of Sodium Bicarbonate for the Treatment of QRS Widening. J Med Toxicol. doi: 10.1007/s13181-015-0483-y. PMID: 26159649 ; PMCID: PMC4781799. Reynolds JC, Judge BS.

Life Support 183

Life Support Overdose ED 183

The Skeptics' Guide to EM

JULY 30, 2022

Case: A 63-year-old woman presents to your emergency department (ED) with two-day history of nausea, vomiting and constipation. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. She is also the creator of all those wonderful Paper in a Pictures.

ALS 130

ALS ED Emergency Department EMS 130

The Skeptics' Guide to EM

MAY 14, 2022

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). He is also one of the world’s leading researchers on pain management in the emergency department and specifically the use of ketamine.

ALS 130

ALS Emergency Department ED OR 130

ALiEM

MAY 13, 2024

Acad Emerg Med 2016 [7] 800 Systematic review of adult and pediatric (patients from birth – 21yrs) studies 97% (94-98%) 83% (75-88%) POCUS may assist physicians in distinguishing cellulitis versus abscess. 2016 Nov;23(11):1298-1306. Epub 2016 Nov 1. 2016 Feb;169:122-7.e1. Lam et al., 94.7%) 80% (70.0-87.4%)

E-9-1-1 161

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

EMDocs

JULY 9, 2024

What can we do about this in the pediatric ED? 2016 Nov 7;170(11):e162521. Epub 2016 Nov 7. 2016 Mar;16(2):168-74. If we don’t, it’s possible no one will. Gottlieb LM, Hessler D, Long D, Laves E, Burns AR, Amaya A, Sweeney P, Schudel C, Adler NE. JAMA Pediatr. doi: 10.1001/jamapediatrics.2016.2521. PMID: 27599265.

Emergency Department 71

Emergency Department Emergency Medical Services ED EMS 71

The Skeptics' Guide to EM

MARCH 20, 2021

Literature from the USA reports that 90% of patients diagnosed with PE are admitted ( Singer et al 2016 ). Another study showed less than 10% of PE patients are discharged home from the ED for out-patient therapy ( Vinson et al 2017 ).

ALS 130

ALS ED 130

ALiEM

NOVEMBER 15, 2023

6.2017JADWEB-2016-0075. PMID: 9832674 Tatli M, Eyüpoğlu G, Hocagil H. Acute cyanide poisoning due to apricot kernel ingestion. Journal of Acute Disease. 2017;6(2): 87-88. DOI: 10.12980/jad.6.2017JADWEB-2016-0075. Cigolini D, Ricci G, Zannoni M, Codogni R, De Luca M, Perfetti P, Rocca G. BMJ Case Rep. 2011;2011:bcr0320113932.

OR 169

OR ED 169

ACEP Now

OCTOBER 26, 2023

The Case A two-year-old female, seen three days ago at different local emergency department (ED)—Children’s General—presents with fever, headache, and neck pain. They return to the ED because her symptoms have not resolved, and her headache seems worse. Published January 2016. HHS website. Accessed October 9, 2023.

ED 52

ED Emergency Department OR 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

The Skeptics' Guide to EM

APRIL 17, 2021

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. Her usual triggers are upper respiratory infections and cats.

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! Good correlation to bed scale weight in trauma patients (Pearson coefficient 0.86), but there was some error in the highest weight category. in non-malnourished children.

E-9-1-1 268

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

EMDocs

DECEMBER 19, 2023

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. In: Marx JA, Hockenberger RS, Biros MH, et al., McGraw Hill; 2019.

First Aid 92

First Aid ED OR ALS 92

The Skeptics' Guide to EM

NOVEMBER 1, 2022

AEM October 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: A 19-year-old man presents to the emergency department (ED) with his first time anterior should dislocation after trying to recreate one of his favourite scenes in the movie Lethal Weapon.

ALS 152

ALS Emergency Department OR ED 152

The Skeptics' Guide to EM

FEBRUARY 8, 2020

Population: Neurologically intact adult presenting to the ED with a chief complaint of a nontraumatic, acute headache, or syncope associated with a headache. We were surprised that in their background/introduction material they did not include the excellent SRMA on this topic by Carpenter et al.

Emergency Department 130

Emergency Department Critical Care ALS EMS 130

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 OR 130

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. August 3, 2016; Available from: [link] -acute-corneal-hydrops.htm Stack L, Sheedy C, Bales B.

Emergency Department 130

Emergency Department OR ED 130

The Skeptics' Guide to EM

AUGUST 14, 2021

Missy is also now the director for Difficult Airway EMS course in Washington State Case: An EMS crew arrives to your emergency department (ED) with a 58-year-old female who suffered a witnessed ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA). This was the ALPS randomized control trial published in NEJM 2016.

CPR 130

CPR BLS ALS Paramedic 130

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 82

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

ACEP Now

NOVEMBER 7, 2023

1 In 2016, the 21st Century Cures Act (Cures Act) took additional steps to authorize the Secretary of Health and Human Services to identify and define information blocking and associated exceptions. The most frequently invoked exception in the ED is preventing harm. Published December 16, 2016. HealthIT.gov website.

ED 52

ED ALS OR Emergency Department 52

Core EM

MARCH 1, 2024

Mumenthaler M , Mattle H , Taub E , ed. 2016 Apr-Jun;19(2):183-7. The goal is to enhance early detection and treatment of N2O-induced SCD and to educate patients on the potential long-term health consequences of recreational nitrous oxide use. References Neurology. 4th Edition. Stuttgart: Thieme; 2003. Neuroanatomy, Motor Neuron.

Emergency Department 162

Emergency Department ED OR ALS 162

This Podcast Will Kill You

SEPTEMBER 12, 2023

” Human color vision (2016): 317-354. The history of color blindness. Wayenborgh Publishing, 2018. Gegenfurtner, K.R. and Kiper, D.C., Color vision. Annual review of neuroscience , 26 (1), pp.181-206. An immense world: How animal senses reveal the hidden realms around us. Knopf Canada, 2022. Simunovic, M.P., Colour vision deficiency.

ALS 52

ALS ED 52

ACEP Now

FEBRUARY 13, 2024

A 77-year-old man presented to the emergency department (ED) with hip pain following a fall. On ED presentation, he was experiencing 10 out of 10 pain level. 2016 May;31(5):478-85. Physical examination was notable for left lower extremity with foreshortening and external rotation. A radiograph is shown (see figure 1).

E-9-1-1 52

E-9-1-1 Emergency Department ED ALS 52

Pediatric EM Morsels

OCTOBER 6, 2023

Recently, a pediatric patient presented to the ED who just returned from abroad with a gastroenteritis presentation. Mogsale 2016, Shah 2021)Stool cultures are only positive in 30% of cases if collected in 2 nd -3 rd week of illness which makes them a poor choice for definitive diagnosis. 2016; 15: 32.

OR 161

OR EMS ED 161

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. “Amniotic fluid embolism.”

EMS 96

EMS Ambulance FFP ICU 96

EMDocs

FEBRUARY 12, 2024

As the only respiratory therapist in the ED has been paged and is starting BiPAP for this patient, an overhead call for two incoming trauma alerts from a multivehicle collision sounds. Because the RT responsible for drawing arterial blood gases is busy caring for these patients, ABGs will be delayed.

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

Don't Forget the Bubbles

JULY 3, 2024

Respiratory Syncytial Virus-Associated Hospitalizations in Children <5 Years: 2016-2022. Arch Dis Child Fetal Neonatal Ed. Arch Dis Child Fetal Neonatal Ed. Arch Dis Child Fetal Neonatal Ed. Current practice in the care of children with functional constipation: What is the hold up? van der Zande JMJ, et al.

ALS 105

ALS ED OR EMS 105

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? American Academy of Ophthalmology , AAO, 5 May 2016, www.aao.org/eyenet/article/savvy-steroid-use. and John O.

EMS 81

EMS Allergic Reaction Emergency Department ED 81

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. Published April 12, 2021. Accessed January 8, 2024.

Emergency Department 52

Emergency Department ALS ED OR 52

The Skeptics' Guide to EM

OCTOBER 28, 2017

Stevens and colleagues updated their review in 2016 and concluded “sucrose is effective for reducing procedural pain” and “no serious side effects or harms have been documented with this intervention”. 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.

ALS 130

ALS Emergency Department OR ED 130

FOAMfrat

JULY 3, 2024

The CDC (Guldner GT, 2023)reports over 6300 exposures to chlorine in the US in 2016, making it a common emergency, however these were not limited to just household chemical mixtures. Advanced Hazmat Life Support Provider Manual (4th ed.). (F. Thomas, Eds.) Bronstein, A. Fernandez, M. Walter, J. Schauben, R. Klein, & R.

Life Support 105

Life Support ALS Emergency Response OR 105

The Skeptics' Guide to EM

JANUARY 19, 2019

1] Two-thirds of the all the drug overdoses in the US in 2016 (63,632) involved an opioid (42,249). [2] They concluded: “For patients treated in the ED for opioid overdose, an observation period of one hour is sufficient if they ambulate as usual, have normal vital signs and a Glasgow Coma Scale of 15”.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

REBEL EM

MARCH 8, 2023

et al, Emergency Medicine Clinical Essentials ed 2. Eye Emergencies, in Tintinalli J et al (eds): Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, Seventh Edition New York City: McGraw-Hill 2016 (Ch) 241 Guluma K, Lee JE. Philadelphia: Elsevier, 2013 (Ch) 26: p. 209-225 Walker R, Adhikari S.:

Emergency Department 52

Emergency Department ALS ED OR 52

Dr. Smith's ECG Blog

DECEMBER 5, 2023

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.

Coronary 115

Coronary CAD ACS ALS 115

Dr. Smith's ECG Blog

APRIL 30, 2024

He went in and out of arrest until arrival at the ED. Here is the only prehospital 12-lead: Sinus tachycardia, somewhat wide QRS, Ischemia Here is the first ED ECG: What is the rhythm here? Medics found patient in PEA arrest. He was resuscitated into a perfusing rhythm.

CPR 89

CPR EMS ED OR 89