The Skeptics' Guide to EM

JUNE 4, 2017

Lancet August 2016. Lancet August 2016. Lancet August 2016. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. first appeared on The Skeptics Guide to Emergency Medicine. A FAST examination is performed and is negative.

OR 130

OR ALS CPR ICU 130

Pediatric EM Morsels

NOVEMBER 3, 2023

Worldwide, children <5 years old account for 76% of deaths related to malaria, but these are predominantly in Sub-Saharan Africa (WHO 2022) P. falciparum accounts for >70% of cases of imported malaria , primarily seen in those returning from travel in Sub-Saharan Africa (Mischlinger 2020) Other species include P. vivax , P. knowlesi and P.

ALS 278

ALS Critical Care EMS OR 278

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

ALiEM

SEPTEMBER 9, 2024

2016 Dec 28;7(Suppl 44):S1150-S1153. No peritoneal signs. Neuro : Awake, alert and oriented x3, no focal neurologic deficits. Rectum : Narrow lumen tube-like structure protruding from anus. Soft stool present at anus with no blood or melena. Non-tender rectal exam. Bales J, Morton RP, Airhart N, Flum D, Avellino AM. Surg Neurol Int.

Emergency Department 152

Emergency Department ED OR 152

REBEL EM

NOVEMBER 13, 2024

Saline load test Has mainly been supplanted by CT scan due to ease in obtaining, reported performance characteristics, consultant recommendation and difficulty in interpreting test. cefazolin or cefuroxime) If risk factors for MRSA present, use agent with activity against MRSA (i.e.

ED 102

ED OR EMS 102

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

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

Pediatric EM Morsels

AUGUST 4, 2023

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. (England, 2021) In SMA syndrome the angle is decreased to < 22 o and the normal distance <8 mm. Oka, 2023) Female to male predominance with a ratio of 3:2.

E-9-1-1 246

E-9-1-1 ED OR EMS 246

Pediatric EM Morsels

APRIL 7, 2023

Epub 2016 Oct 17. 2016 Dec 2;2016(1):625-631. Observation, interaction with patient, as well as parent information is key to bring the whole picture together! J Stroke Cerebrovasc Dis. 2017 Jan;26(1):108-115. doi: 10.1016/j.jstrokecerebrovasdis.2016.08.038. 2016.08.038. PMID: 27765556. J Chronic Dis. 1985;38(6):495-505. PMID: 4008590.

ALS 130

ALS OR Critical Care EMS 130

Pediatric EM Morsels

MAY 12, 2023

However clinical judgement was more specific in this same group (54% vs 92%) [ Atabaki, 2016 ]. 2016 May;23(5):566-75. Epub 2016 Apr 20. PECARN is highly sensitive for identifying those with clinically important TBI. Acad Emerg Med. doi: 10.1111/acem.12923. PMID: 26825755.

OR 130

OR EMS 130

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 59

E-9-1-1 ACS OR Emergency Department 59

The Skeptics' Guide to EM

OCTOBER 21, 2023

Population: Adults attending at continuously-staffed EDs in a health network covering 15 states, 2016-19. Implementation of a Clinical Management Tool for Spinal Epidural Abscess Early Diagnosis. AEM October 2023.

Emergency Department 264

Emergency Department ALS ED OR 264

This Podcast Will Kill You

SEPTEMBER 3, 2024

2016): 421-433. 2016): e0143759. “Is it gonna be poop or is it gonna be barf?” It’s the question we all fear during a bout of food poisoning when time is of the essence and a decision has to be made before it’s made for us. Often, the germ forcing this question upon us is none other than the dreaded norovirus. De Graaf, M., and Paul W.

ALS 52

ALS OR 52

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

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]. They reported that the type of intravenous fluids (0.45% NaCl or 0.9%

ICU 201

ICU ED Critical Care ALS 201

Pediatric EM Morsels

OCTOBER 27, 2023

Bowen 2016] Moral of the Morsel: Weight Matters! Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. Krug 2007] What If the Child is Obese or Emaciated? Validation study done in Italy.

E-9-1-1 269

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

Pediatric EM Morsels

JULY 21, 2023

We use the GCS score in both trauma and medical patients, but where did this score come from? When is it useful and what does it tell us? Is it actually validated in children, like the Ottawa Ankle Rules or are we using a tool for something other than that for which it was designed and validated, like using Kocher criteria for knee and ankle joints?

Critical Care 246

Critical Care ALS OR Life Support 246

NVFC

NOVEMBER 5, 2024

CRSW, initiated by the Federal Highway Administration (FHWA) in 2016, is our opportunity to positively shift driver behavior, encourage adherence to Move Over laws, and to promote life-saving National Traffic Incident Management (TIM) Responder Training for all traffic incident responders. Be sure to use hashtag #CRSW.

EMS 59

EMS OR 59

Pulsara

MAY 23, 2024

During major emergencies like earthquakes, floods, or mass shootings, health resources can quickly become overwhelmed, causing breakdowns in communication and coordination. Hospitals may reach capacity, leaving some patients stranded without adequate care and making it difficult for family or friends to locate them.

Emergency Medical Services 82

Emergency Medical Services Public Information EMS OR 82

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 145

Allergic Reaction Plasma ED Epinephrine 145

FOAMcast

JANUARY 25, 2023

2016 May 1;202(1):182-7. 2016 Aug;33(8):569-72. Epub 2016 Feb 4. Apple Podcasts , Spotify , or Listen Here References: Wray JP, Bridwell RE, Schauer SG, Shackelford SA, Bebarta VS, Wright FL, Bynum J, Long B. The diamond of death: Hypocalcemia in trauma and resuscitation. Am J Emerg Med. 2021 Mar;41:104-109. doi: 10.1016/j.ajem.2020.12.065.

Emergency Department 52

Emergency Department OR 52

NAEMSP

OCTOBER 9, 2024

Author: Joshua Stilley, MD FACEP FAEMS This article was written in collaboration with the National Adrenal Diseases Foundation Background: Adrenal crisis occurs when the adrenal glands are unable to produce enough endogenous steroids under stress. As a result, patients cannot produce cortisol, the body’s primary stress hormone.

EMS 122

EMS Crisis Prevention Emergency Department BLS 122

The Skeptics' Guide to EM

DECEMBER 7, 2019

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. It is a diagnosis of exclusion that applies to infants under the age of 12 months. . * The name was not reassuring and the definition was vague.

CPR 130

CPR ALS OR 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

ALiEM

AUGUST 18, 2023

2016 May-Aug;9(2):80-6. The presentation of complete isolated CN III palsy generally involves ipsilateral ptosis (due to levator palpebrae paralysis) and “down and out” ocular deviation (due to preservation of superior oblique and lateral rectus function). Case Question: What are the most common etiologies of the diagnosis?

Emergency Department 130

Emergency Department OR 130

The Skeptics' Guide to EM

JUNE 11, 2017

Lancet 2016. Lancet 2016. Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. first appeared on The Skeptics Guide to Emergency Medicine. You wonder if they would benefit from a platelet transfusion.

ALS 130

ALS OR EMS 130

First Responders Foundation

AUGUST 26, 2024

In 2003, she became the first Employee Resources Sergeant, a role she held until her retirement in 2016. After years of serving in Uniform Patrol, including a specialized assignment in the Weed and Seed Unit focusing on gang and narcotics activity, Mary was promoted to Sergeant in 1998.

First Responder 98

First Responder Public Safety Paramedic OR 98

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

Emergency Medicine Education

MAY 9, 2023

NEJM study in 2016 showed no survival benefits or favorable neurological outcome regarding use of Amiodarone vs Lidocaine vs placebo in OHCA. NEJM study in 2016 Acad Emerg Med

OR 40

OR 40

The Skeptics' Guide to EM

DECEMBER 16, 2017

NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. 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.

ALS 100

ALS ICU Emergency Department Paramedic 100

The Skeptics' Guide to EM

AUGUST 14, 2021

This was the ALPS randomized control trial published in NEJM 2016. Date: August 12th, 2021 Reference: Daya et al. Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. first appeared on The Skeptics Guide to Emergency Medicine. Reference: Daya et al.

CPR 130

CPR BLS ALS Paramedic 130

ALiEM

APRIL 17, 2023

August 3, 2016; Available from: [link] -acute-corneal-hydrops.htm Stack L, Sheedy C, Bales B. Over the past 3-4 days, he noticed an acute decline in his vision with what the patient describes as a “cloudy bump” appearing during that time. He also reports photophobia and mild eye pain. Head: No visible traumatic injuries. EyeRounds.org.

Emergency Department 130

Emergency Department OR ED 130

The Skeptics' Guide to EM

NOVEMBER 11, 2017

Ann Emerg Med 2016 Guest Skeptic: Dr. Michael Falk is a Pediatric Emergency Medicine provider who works at Harlem Hospital Center in New York and Children’s […] The post SGEM#194: Highway to the Dexamethasone – For Pediatric Asthma Exacerbations first appeared on The Skeptics Guide to Emergency Medicine. Intervention Dexamethasone (DEX) 0.3

Emergency Department 130

Emergency Department ALS OR 130

This Podcast Will Kill You

JANUARY 30, 2024

” Molecular Immunology 69 (2016): 131-138. Raise your hand if you or someone you know has had their tonsils removed. If your hand is sky-high, there’s a pretty good chance that you (or that person you know) are from the US and were born before 1980. Immunological investigations , 39 (4-5), pp.303-355. Sepahi, Ali, and Irene Salinas.

OR 98

OR 98

Dr. Smith's ECG Blog

OCTOBER 12, 2024

2016 Nov;34(11):2182-2185. Epub 2016 Aug 27. CTA head and neck were obtained and showed no evidence of intracranial hemorrhage, large vessel occlusion stroke (what a helpful and apt name for an acute arterial occlusion paradigm, by the way.), or basilar ischemia. EKG on arrival to the ED is shown below: What do you think? 2016.08.053.

STEMI 97

STEMI Coronary Emergency Department OR 97

EMDocs

SEPTEMBER 6, 2023

2016 study published in American Journal of Emergency Medicine , “ Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection ” by Reyner et al. 2016 Apr;34(4):694-6. IV fluids administrated, IV vancomycin and piperacillin-tazobactam. Arterial line started. Am J Emerg Med.

ACS 71

ACS ICU EMS ALS 71

Don't Forget the Bubbles

JANUARY 24, 2024

Going beyond the algorithm, what can we do when a child is still fitting despite appropriate treatment? Four-year-old Fern is a previously healthy girl who presents with a febrile illness and seizures. Whilst in PICU, amplitude-integrated EEG monitoring is commenced and reveals ongoing seizure activity. What is the problem with SRSE?

Critical Care 111

Critical Care ALS OR 111

ALiEM

JANUARY 8, 2024

2016 May;68(5):689-94. References Huang K, Levy RD, Avina-Zubieta JA. Anti-Melanoma Differentiation-Associated Gene 5 Is Associated With Rapidly Progressive Lung Disease and Poor Survival in US Patients With Amyopathic and Myopathic Dermatomyositis. Arthritis Care Res (Hoboken). doi: 10.1002/acr.22728. PMID: 26414240; PMCID: PMC4864500.

ED 152

ED OR 152