The Skeptics' Guide to EM

OCTOBER 14, 2023

Reference: Brennan L et al. Reference: Brennan L et al. Case: A 5-year-old boy presents to the emergency department (ED) with his parents for fever and fatigue. That episode reviewed the 2011 Fleming et al systematic review for the normal ranges of HR and RR in children from birth to 18 years of age. A prospective study.

Life Support 221

Life Support Advanced Life Support Emergency Department ALS 221

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 65

ED Emergency Department ALS Paramedic 65

EMDocs

JUNE 3, 2023

For a broader overview of pelvic trauma, please review Dr. Lupez’s 2017 article here: [link]. The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. 12 An AP x-ray of the pelvis should be obtained in the ED for unstable patients.

ED 54

ED Operating Room ALS Frozen Plasma 54

Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Shah 2017] In Turkey, it has a “reliable correlation.” Gültekingil-Keser 2017] Broselow out-performed age-based formulas (Theron, APLS, and Shann) in New Zealand, estimating within 10% of actual weight 73% of the time.

E-9-1-1 269

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

ALiEM

JUNE 15, 2023

Goldfrank’s Toxicologic Emergencies, 11e New York, NY: McGraw-Hill; 2019 Morimoto M, Tatsumi K, Yuui K, et al. Elsevier; 2017. PMID 29855084 De Silva HA, Fonseka MM, Pathmeswaran A et al. Retrieved Jun 5, 2023. Nelson LS, Goldfrank LR. In: Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. Vet Med Sci.

ALS 246

ALS ED OR 246

EMDocs

NOVEMBER 22, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. He attributes the pain to neck extension during the ride, but 2 days later he notes numbness and tingling in both arms and goes to the ED. Kachalia A et al. Blogpost, January, 2017. 11, Nov 2018.

ED 70

ED Emergency Department OR ALS 70

ALiEM

APRIL 12, 2023

Accessed April 5, 2023 Afzal S, Zahid M, Rehan ZA, et al. 20 – Local Anesthetics, Ed(s): Hugh C. Preparation and Evaluation of Polymer-Based Ultrasound Gel and Its Application in Ultrasonography. 2022 Jan 6;8(1):42. doi: 10.3390/gels8010042. PMID: 35049577 ; PMCID: PMC8774352 Suzuko S, Peter G, Philipp L. Hemmings, Talmage D.

Emergency Department 258

Emergency Department ALS ED 258

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.) Sagittal view of bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.)

E-9-1-1 177

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

The Skeptics' Guide to EM

DECEMBER 17, 2022

Date: December 16th, 2022 Reference: Hohle et al. Date: December 16th, 2022 Reference: Hohle et al. Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home. years ( 2 ).

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

Core EM

JANUARY 8, 2024

JAMA Network, 2023 Background Computed tomography of the abdomen and pelvis (CT AP) is the most common diagnostic imaging test to evaluate abdominal pain in the ED. Clinical Question What is the diagnostic accuracy of using CT abdomen pelvis (CT AP) without contrast compared to contrast-enhanced CT AP in ED patients with acute abdominal pain?

Emergency Department 100

Emergency Department EMS ED ALS 100

The Skeptics' Guide to EM

OCTOBER 28, 2017

[display_podcast] Date: October 24th, 2017 Reference: Harrison et al. Pediatrics 2017 Guest Skeptic: Dr. Anthony Crocco is a Pediatric Emergency Physician and is the Medical Director & Division Head of the Division of Pediatric Emergency at McMaster’s Children’s Hospital. Reference: Harrison et al.

ALS 130

ALS Emergency Department OR ED 130

The Skeptics' Guide to EM

DECEMBER 8, 2017

[display_podcast] Date: November 28th, 2017 Reference: Motov S et al. display_podcast] Date: November 28th, 2017 Reference: Motov S et al. A systematic review was just published in the Emergency Medicine Journal looking at 43 management of acute low back pain in the ED. The conclusions…we need more evidence.

Emergency Department 130

Emergency Department ALS OR EMS 130

REBEL EM

JANUARY 9, 2024

Bottom Line Up Top: In patients with infectious processes that are stable for discharge home, there is no role for giving a first dose of antibiotics IV in the ED. PMID: 9114201 Siegel RE et al. BMJ (Clinical research ed.). PMID: 17090560 Castro-Guardiola A et al. PMID: 1664833 Addo-Yobo E, et al. Pneumonia 2017.

ALS 100

ALS ICU ED OR 100

REBEL EM

FEBRUARY 21, 2024

Clinical Scenario: A 34-year-old woman presents to the ED with back pain. Schwartz and colleagues performed an ingenious trial ( Schwartz 2000 ) Enrolled 64 ED patients with acute pain. The ceiling pain relief dose for ketorolac is 15 mg IV ( Motov 2017 ). PMID: 34133820 Arora S et al. PMID: 17391598 Wright JM et al.

E-9-1-1 64

E-9-1-1 Emergency Department ALS ED 64

ACEP Now

JULY 11, 2024

The United States Preventive Services Task Force (USPSTF) recommends screening for problem drinking in the primary setting, but we know that patients who present to the ED are twice as likely to engage in dangerous drinking, so arguably the ED is an important venue for screening as well. Pilar MR, Eyler AA, Moreland-Russell S, et al.

Emergency Department 98

Emergency Department ALS ED OR 98

Don't Forget the Bubbles

SEPTEMBER 30, 2024

In the UK, as in most developed countries, more patients are presenting to Emergency Departments (EDs) with minor illnesses or injuries. Simpson et al. Patients who Did Not Wait are a feature of most EDs worldwide. A 2011-2012 Australian study by Blake et al. of those children later returned to the ED.

Emergency Department 89

Emergency Department ALS ED OR 89

Core EM

JANUARY 24, 2024

2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. 2017.09.1085 Gómez-Outes A, Alcubilla P, Calvo-Rojas G, et al. doi:10.1186/s13054-019-2492-8 Baugh CW, Levine M, Cornutt D, et al.

FFP 130

FFP Frozen Plasma Plasma ALS 130

The Skeptics' Guide to EM

JANUARY 20, 2018

[display_podcast] Date: January 15th, 2018 Reference: Sadeghirad B, et al. BMJ 2017 Guest Skeptic: Meghan Groth is an Emergency Medicine Pharmacist at the UMass Memorial Medical Center in Worcester, Massachusetts. display_podcast] Date: January 15th, 2018 Reference: Sadeghirad B, et al. Reference: Sadeghirad B, et al.

Emergency Department 130

Emergency Department ALS EMS ED 130

The Skeptics' Guide to EM

OCTOBER 22, 2017

[display_podcast] Date: October 19th, 2017 Reference: Hofmann et al. NEJM Sept 2017. display_podcast] Date: October 19th, 2017 Reference: Hofmann et al. NEJM Sept 2017. A systematic review by Wijesinge et al from 2009 found only two randomized control trials looking at supplemental oxygen.

Emergency Medical Services 130

Emergency Medical Services Coronary ALS STEMI 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 81

Emergency Department ALS E-9-1-1 ED 81

REBEL EM

JANUARY 23, 2023

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.

Allergic Reaction 52

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

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. References Tsao CW, et al. Benjamin EJ, et al. Kimblad H, et al. Sakai T, et al. Kudenchuk PJ, et al. Lee YH, et al. Benjamin EJ, et al. Hajjar K, et al. Circulation.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

Core EM

JULY 23, 2024

2017, [link] Lopez AM, Stephani JA. 2021, [link] Shen, J, et al. 2020, [link] Shen, J, et al. Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Elsevier; 2018:(Ch) 138. Ionizing Radiation Injuries and Illnesses: Ensuring Patient Safety and Self-Preservation.” Radiation injuries. 2020, [link] Tsujiguchi, T.,

ALS 130

ALS OR Emergency Department ED 130

The Skeptics' Guide to EM

SEPTEMBER 1, 2018

[display_podcast] Date: August 22nd, 2018 Reference: Riskin A, Erez A, Foulk TA, et al. February 2017 Guest Skeptic: Dr. Simon McCormick is an Emergency Medicine Consultant from Northern Ireland who works in Rotherham Hospital in Yorkshire, England. display_podcast] Date: August 22nd, 2018 Reference: Riskin A, Erez A, Foulk TA, et al.

ALS 130

ALS Emergency Department OR EMS 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. Background: There have been close to 400,000 deaths from an overdose involving any opioid (prescription and illicit opioids) between 1999 and 2017. [1] Reference: Clemency et al.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

ACEP Now

OCTOBER 11, 2024

ED treatment should focus on airway, breathing, and circulation with consideration for cervical spine protection depending on the circumstances surrounding the event. References Webb AC, Wheeler A, Ricci A, et al. Pellegrino F, Raffaldi I, Rossi R, et al. Chotai PN, Manning L, Eithun B, et al. South Med J. Ital J Pediatr.

ALS 52

ALS Emergency Department Emergency Medical Services ED 52

Don't Forget the Bubbles

JULY 17, 2023

Sethi SK, et al. Agostino H, et al. Rassekh SR, et al. Goulet K, et al. McClellan JM, et al. Arneitz C, et al. Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. Van Rossem EJD, et al. Smyrnaios A, et al. Satir AN, et al. Cortés J, et al.

E-9-1-1 98

E-9-1-1 ALS Emergency Department Emergency Medical Services 98

The Skeptics' Guide to EM

NOVEMBER 1, 2022

Date: October 27th, 2022 Reference: Hayashi et al. Date: October 27th, 2022 Reference: Hayashi et al. There have been a few randomized control trials (RCTs) of peripheral nerve blocks for shoulder dislocation, but without definitive results (Raeyat Doost 2017; Blaivas 2011).

ALS 154

ALS Emergency Department OR ED 154

REBEL EM

AUGUST 28, 2023

Clinical Scenario: A 34-year-old woman presents to the ED with back pain. Schwartz and colleagues performed an ingenious trial ( Schwartz 2000 ) Enrolled 64 ED patients with acute pain. The ceiling pain relief dose for ketorolac is 15 mg IV ( Motov 2017 ). PMID: 34133820 Arora S et al. PMID: 17391598 Wright JM et al.

E-9-1-1 52

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

The Skeptics' Guide to EM

JUNE 12, 2021

Reference: McLaren SH, et al. Reference: McLaren SH, et al. Reference: McLaren SH, et al. Date: June 11th, 2021 Guest Skeptic: Dr. Dennis Ren is a paediatric emergency medicine fellow at Children’s National Hospital in Washington, DC. Invasive bacterial infections in afebrile infants diagnosed with acute otitis media.

Emergency Department 100

Emergency Department ALS ED OR 100

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. Richards JE et al. NEJM 1994. [2]

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

EMDocs

NOVEMBER 7, 2023

For more on the ED evaluation of diverticulitis, please see Part 1. The DIABLO trial: Daniels L, Ünlü Ç, de Korte N, et al; Dutch Diverticular Disease (3D) Collaborative Study Group. Randomized 2017 Jan;104(1):52-61. van Dijk ST, Daniels L, Ünlü Ç, et al; Dutch Diverticular Disease (3D) Collaborative Study Group.

ACPE 88

ACPE ALS OR ED 88

REBEL EM

SEPTEMBER 13, 2023

Read More EMCrit: Podcast 145 – Awake Intubation Lecture from SMACC ERCast: Angioedema References: Baş M et al. PMID 25629740 Hassen GW et al. PMID 23062323 Kostis JB et al. PMID 16043683 McCormick M et al. PMID 20954277 Sinnert R et al. J Allergy Clin Immune Tract 2017; 5(5): 1402-9. Zuraw et al.

Frozen Plasma 105

Frozen Plasma Allergic Reaction FFP Plasma 105

Core EM

MARCH 12, 2024

2017, [link] Lopez AM, Stephani JA. 2021, [link] Shen, J, et al. 2020, [link] Shen, J, et al. Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Elsevier; 2018:(Ch) 138. Ionizing Radiation Injuries and Illnesses: Ensuring Patient Safety and Self-Preservation.” Radiation injuries. 2020, [link] Tsujiguchi, T.,

ALS 130

ALS OR Emergency Department ED 130

The Skeptics' Guide to EM

FEBRUARY 2, 2018

[display_podcast] Date: January 31st, 2018 Reference: Frohlich LC, et al. AEM Dec 2017. display_podcast] Date: January 31st, 2018 Reference: Frohlich LC, et al. AEM Dec 2017. Reference: Frohlich LC, et al. AEM Dec 2017. Prospective validation of clinical score for males presenting with an acute scrotum.

Operating Room 100

Operating Room Emergency Department ALS ED 100

This Podcast Will Kill You

SEPTEMBER 26, 2023

History Biology Al-Doory, Yousef, and Arthur F. DiSalvo, eds. Mediators of inflammation , 2017. Andes et al. 2017): 10-1128. ” Nature Reviews Immunology 17.10 (2017): 635-646. Dinos, dogs, deep time, and deadly outbreaks – this episode has it all. Blastomycosis. Gauthier, G.M., McBride, J.A.,

ALS 52

ALS ED 52

ACEP Now

APRIL 5, 2024

A 68-year-old man presents to the emergency department (ED) with altered mental status and fever. The study found a mean increase in time to intubation of 13 seconds in the ED setting. References von Hellmann R, Fuhr N, et al. Koh LK, Kong CE, et al. Driver BE, Prekker ME, et al. Waldron O, Sena R, et al.

OR 73

OR ALS Emergency Department Critical Care 73