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 195

ICU ED Critical Care ALS 195

Pediatric EM Morsels

AUGUST 4, 2023

Let’s take a take a minute to review Superior Mesenteric Artery Syndrome presenting in the ED so we will be prepared when you see it! Reece, 2016) There is multiple cases of sudden death from undiagnosed SMA syndrome in the literature attributed to a variety of causes at autopsy. 2016: 7809281. Pictures are worth a 1000 words!

E-9-1-1 246

E-9-1-1 ED OR EMS 246

ALiEM

SEPTEMBER 9, 2024

A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today. 2016 Dec 28;7(Suppl 44):S1150-S1153.

Emergency Department 152

Emergency Department ED OR 152

REBEL EM

SEPTEMBER 9, 2024

Post TW, ed. In: Shaw KN, Bachur RG, eds. Philadelphia, PA: Wolters Kluwer; 2016:27–54. Neonatal resuscitation in the delivery room. UpToDate Inc. Accessed August 15, 2020. link] Myers SR, Schinasi DA, Nadel FM. Cardiopulmonary resuscitation. Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine.

Emergency Department 59

Emergency Department ED EMS 59

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

REBEL EM

NOVEMBER 13, 2024

cefazolin or cefuroxime) If risk factors for MRSA present, use agent with activity against MRSA (i.e. vancomycin) If significant soft tissue injury, add gram negative coverage like late generation cephalosporin, extended-spectrum penicillin, or aminoglycoside (i.e.

ED 105

ED OR EMS 105

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 66

ED Emergency Department ALS Paramedic 66

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

The Skeptics' Guide to EM

OCTOBER 1, 2022

That includes an episode on steroids to prevent bounce back visits to the ED ( SGEM#28 ), ketorolac for acute treatment ( SGEM#66 ), acupuncture for prophylaxis ( SGEM#211 ) and a calcitonin gene-related peptide antagonist ( SGEM#279 ). Patients with migraines often present to the ED looking for pain relief. Reference: Hartford et al.

Emergency Department 130

Emergency Department ALS ED OR 130

Pediatric EM Morsels

JULY 5, 2024

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.

ALS 161

ALS OR ED Emergency Department 161

REBEL EM

JANUARY 23, 2023

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 7 (5.5%) patients in the IV cetirizine group returned to any ED or clinic within 48 hours compared to 19 (14.1%) in the IV diphenhydramine group; P=0.02

Allergic Reaction 52

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

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

Core EM

OCTOBER 16, 2024

In: Marx J, ed. In: Wolfson A, ed. Br J Haematol. 2009 Nov;147(4):431-43. link] Emery, M. Blood and blood components. Rosen’s emergency medicine. Philadelphia, PA: Elsevier; 2014:75-80. Transfusion Reactions and Complications. Harwood-Nuss’ Clinical Practice of Emergency Medicine. Hirayama F. link] Metcalf, R. Bakhtary, S.,

Allergic Reaction 145

Allergic Reaction Plasma ED Epinephrine 145

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

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

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 72

Emergency Department Emergency Medical Services ED EMS 72

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. study from 200 9.

E-9-1-1 104

E-9-1-1 ALS ACS ED 104

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

Core EM

OCTOBER 2, 2024

In: Marx J, ed. In: Wolfson A, ed. Br J Haematol. 2009 Nov;147(4):431-43. link] Emery, M. Blood and blood components. Rosen’s emergency medicine. Philadelphia, PA: Elsevier; 2014:75-80. Transfusion Reactions and Complications. Harwood-Nuss’ Clinical Practice of Emergency Medicine. Hirayama F. link] Metcalf, R. Bakhtary, S.,

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

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

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? In contrast — a broader passband ( typically from 0.05

ED 82

ED OR ALS CAD 82

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-9-1-1 269

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

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 154

ALS Emergency Department OR ED 154

REBEL EM

MAY 11, 2023

PMID: 34697777 Clinical Question: In patients with moderate to severe alcohol withdrawal being discharged from the emergency department (ED), does treatment with phenobarbital alone and phenobarbital plus benzodiazepines compared to benzodiazepines alone decrease the odds of returning to the ED within 3 days after initial discharge?

Emergency Department 98

Emergency Department ED EMR OR 98

ALiEM

MARCH 7, 2024

Ann Emer Med , 2005 [7] Prospective, blinded, observational study performed in the pediatric ED, 3 month period N=44, < 2 years of age Created a bladder urinary index by multiplying the AP and transverse bladder diameters. Author, Title, Journal, Publication Year Study Type, Location, Time Frame N, Ages Summary Milling et al., Chen et al.,

E-9-1-1 177

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

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

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 Paramedic ALS 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

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

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. Journal of Gastroenterology and Hepatology 2016. grams/kg within 6 hours 1.0 Read more

ALS 52

ALS ED EMS OR 52

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.

ALS 98

ALS Emergency Department ED OR 98

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