The Skeptics' Guide to EM

APRIL 13, 2024

Reference: Albers GW et al. Reference: Albers GW et al. When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. TIMELESS Investigators. Tenecteplase for Stroke at 4.5

Emergency Department 287

Emergency Department ALS OR EMS 287

REBEL EM

JANUARY 25, 2024

A 2018 systematic review and meta-analysis of 25 studies focusing on the accuracy of emergency lung ultrasound showed sensitivity of 85-95% and specificity of 75-90% for pneumonia, sensitivity of 78% and specificity of 94% for COPD/asthma, and sensitivity of 75-90% and specificity of 80-90% for acute heart failure [4]. Emerg Med J.

ED 130

ED E-9-1-1 Emergency Department ALS 130

Core EM

JANUARY 25, 2024

Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients.

Emergency Department 246

Emergency Department ICU Critical Care ALS 246

EMDocs

JULY 17, 2023

and is poorly tolerated by patients with obstruction, it should not be a routine part of the ED evaluation for LBO unless it is critical for another diagnosis on the differential. doi:10.3390/cancers13092025 Pisano M, Zorcolo L, Merli C, et al. Published 2018 Aug 13. 2021.03.001 Bauman BD, Witt JE, Vakayil V, et al.

E-9-1-1 77

E-9-1-1 ED Operating Room ALS 77

Pediatric EM Morsels

SEPTEMBER 22, 2023

Tenenbein M, Macias CG, Sharieff GQ, et al, eds. 2018 Oct;14(2):47-54. Epub 2018 Oct 31. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Treat patients suspected of having neurogenic shock with warming and vasopressors. They may even need atropine and/or pacing for persistent bradycardia. 5 th Edition.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

The Skeptics' Guide to EM

JULY 30, 2022

Date: July 28th, 2022 Reference: Brower et al. Date: July 28th, 2022 Reference: Brower et al. Case: A 63-year-old woman presents to your emergency department (ED) with two-day history of nausea, vomiting and constipation. Reference: Brower et al. 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

Date: May 13th, 2022 Reference: Abril et al. Date: May 13th, 2022 Reference: Abril et al. 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). His twitter handle is @PainFreeED.

ALS 130

ALS Emergency Department ED OR 130

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. 11, Nov 2018. Health Affairs, Vol.

ED 78

ED Emergency Department OR ALS 78

ALiEM

JUNE 15, 2023

Goldfrank’s Toxicologic Emergencies, 11e New York, NY: McGraw-Hill; 2019 Morimoto M, Tatsumi K, Yuui K, et al. 2018 Oct;32(8):e22583. 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.

ALS 246

ALS ED OR 246

The Skeptics' Guide to EM

SEPTEMBER 10, 2022

Date: August 25th, 2022 Reference: Martin et al. Date: August 25th, 2022 Reference: Martin et al. Case: A 7-year-old female with asthma presents to the emergency department (ED) with difficulty breathing in the setting of 1-2 days of cough and runny nose. Reference: Martin et al. Pediatr Emerg Care. Pediatr Emerg Care.

Emergency Department 130

Emergency Department ALS ED OR 130

EMDocs

JUNE 3, 2023

The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. This is less critical in ED management of the unstable pelvic fracture, as the optimal site for identification of rectal or vaginal tears is the operating room.

ED 54

ED Operating Room ALS Frozen Plasma 54

The Skeptics' Guide to EM

JUNE 24, 2018

[display_podcast] Date: June 15th, 2018 Reference: Silva et al. 2018 Guest Skeptics: Dr. Sergey Motov is an Emergency Physician in the Department of Emergency Medicine, Maimonides Medical Center in New York City. display_podcast] Date: June 15th, 2018 Reference: Silva et al. Reference: Silva et al.

Emergency Department 130

Emergency Department ED ALS OR 130

The Skeptics' Guide to EM

JUNE 18, 2022

Date: June 18th, 2022 Reference: Crombie et al. Date: June 18th, 2022 Reference: Crombie et al. He is also now a fully fledged “sonologist” Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth.

Plasma 100

Plasma Critical Care Paramedic ALS 100

EMDocs

SEPTEMBER 26, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Patient not informed of enlarged heart, dies 3 weeks post ED visit Miscommunicated radiology findings are a hot topic. Someone should have – either the first ED doc, the second ED doc, or my PCP.

Emergency Department 74

Emergency Department ED ALS Coronary 74

ALiEM

MAY 13, 2024

Study N Methods POCUS Sensitivity (95% CI) POCUS Specificity (95% CI) Conclusions Gottleib et al., Lam et al., J Emerg Med 2018 [6] 327 Prospective cohort study of children 6mo-18yrs comparing clinical assessment to POCUS 90.3% (83.4-94.7%) of cases* Subramaniam et al., Lam et al., of cases* Subramaniam et al.,

E-9-1-1 161

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

ALiEM

JUNE 5, 2023

ED providers are only exposed in these cases if they have direct contact with drainage from open wounds while not using PPE or there is concern for aerosolization of spores For inhalational anthrax exposure, AVA should be given in combination with antimicrobials (ciprofloxacin or doxycycline) for 60 days. Pathophysiology of anthrax.

ALS 256

ALS OR ED 256

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. Heart disease and stroke statistics—2018 update: A report from the American Heart Association. Kimblad H, et al. Sakai T, et al. Lee YH, et al.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

The Skeptics' Guide to EM

OCTOBER 13, 2018

[display_podcast] Date: October 10th , 2018 Reference: Karlow et al. AEM Oct 2018. display_podcast] Date: October 10th , 2018 Reference: Karlow et al. AEM Oct 2018. One alternative or adjunct to limit the use of opioids in the ED is low dose ketamine (LDK). Reference: Karlow et al.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

OCTOBER 6, 2018

[display_podcast] Date: October 5th , 2018 Reference: Stiell et al. Annals of EM Oct 2018 Guest Skeptic: Alison Armstrong is an Emergency Department Nurse, TNCC Course Director, Trauma Program Coordinator and Canadian C-Spine Rule Nurse Champion. display_podcast] Date: October 5th , 2018 Reference: Stiell et al.

Emergency Department 130

Emergency Department EMS ALS ED 130

REBEL EM

JANUARY 23, 2023

Second-generation H1 antihistamines (cetirizine, loratadine, and fexofenadine) do not cross the blood-brain barrier as easily (Bernstein J 2018). Article: Abella BS et al. 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

The Skeptics' Guide to EM

OCTOBER 8, 2022

Date: September 15, 2022 Reference: Ramnarayan P et al. Date: September 15, 2022 Reference: Ramnarayan P et al. Case: A 10-month-old male infant presents to the emergency department (ED) with a low-grade fever, rhinorrhea and reduced feeding during the last two days. In 2018, Ramnarayan et al.

Critical Care 130

Critical Care ALS Emergency Department ED 130

The Skeptics' Guide to EM

SEPTEMBER 22, 2018

[display_podcast] Date: September 17th, 2018 Reference: Meltzer, A. JAMA Internal Med, 2018. display_podcast] Date: September 17th, 2018 Reference: Meltzer, A. JAMA Internal Med, 2018. Case: A 51-year-old man presents to the emergency department (ED) with five-hour history of acute onset left flank pain.

Emergency Department 130

Emergency Department ALS ED OR 130

ALiEM

NOVEMBER 1, 2023

In: Nelson LS, Goldfrank LR et al (eds): Goldfrank’s Toxicologic Emergencies. 22 Aug 2018. The post was peer reviewed on behalf of ACMT by Drs. Blake Froberg, Bryan Judge, and Louise Kao. Read More in the Series References Perrone J. McGraw-Hill Education; 2019 Madiwale T, Liebelt E. Iron: not a benign therapeutic drug.

E-9-1-1 161

E-9-1-1 ALS OR ED 161

EMDocs

NOVEMBER 13, 2024

Major takeaway: Consider SBP in any patient who comes into the ED with ascites. Biggins SW, Angeli P, Garcia-Tsao G, et al. Mattos AA, Wiltgen D, Jotz RF, et al. Aithal GP, Palaniyappan N, China L, et al. Angeli P, Bernardi M, Villanueva C, et al. 2018 Apr;36(4):689-698. Arvaniti V, D’Amico G, Fede G, et al.

E-9-1-1 72

E-9-1-1 ALS OR ED 72

The Skeptics' Guide to EM

JUNE 29, 2018

[display_podcast] Date: June 20th, 2018 Reference: Fox LM et al. Am J EM 2018 Guest Skeptics: Dr. Robert Edmonds is an emergency physician in the US Air Force in Virginia. display_podcast] Date: June 20th, 2018 Reference: Fox LM et al. The first time was with Dr. Al Sacchetti. Reference: Fox LM et al.

Emergency Department 100

Emergency Department ALS ED EMS 100

The Skeptics' Guide to EM

MARCH 6, 2021

Reference: Reuben A et al. Reference: Reuben A et al. Background: Epistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% ( Gifford 2008 , Pallin 2005 ). Anand Swaminathan is an Assistant Professor of Emergency Medicine at St. SGEM#210 ).

ALS 130

ALS Emergency Department EMS ED 130

ALiEM

JUNE 1, 2023

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? Is phenobarbital safe for the treatment of EtOH withdrawal in the ED? References Rosenson J, Clements C, Simon B, et al. If not, you probably should be. Well not exactly.

Emergency Department 246

Emergency Department ICU ED OR 246

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 a critical appraisal of an observational study published in Annals of EM ( Kawano et al 2018 ). Reference: Daya et al. first appeared on The Skeptics Guide to Emergency Medicine.

CPR 130

CPR BLS ALS Paramedic 130

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. The 2018 PREVIEW trial reported a significant reduction in length of stay (LOS) in children given prednisolone in Australia (24-71 months, mean 41 months) compared to placebo. Compare this with the Panickar et al.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

The Skeptics' Guide to EM

OCTOBER 19, 2019

Date: October 17th, 2019 Reference: Driver et al. JAMA May 2018 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a physician assistant practicing in emergency medicine in the […] The post SGEM#271: Bougie Wonderland for First Pass Success first appeared on The Skeptics Guide to Emergency Medicine.

Firefighter 130

Firefighter Emergency Department Paramedic ALS 130

Core EM

JULY 23, 2024

Philadelphia, PA: Elsevier; 2018:(Ch) 138. 2021, [link] Shen, J, et al. 2020, [link] Shen, J, et al. Emergency Medicine: Concepts and Clinical Practice. Ionizing Radiation Injuries and Illnesses: Ensuring Patient Safety and Self-Preservation.” EmDOCs.net – Emergency Medicine Education, 7 Apr. Radiation injuries.

ALS 130

ALS OR Emergency Department ED 130

The Skeptics' Guide to EM

APRIL 16, 2022

Date: April 16th, 2022 Reference: Blom et al. Date: April 16th, 2022 Reference: Blom et al. Case: A 55-year-old man comes into the emergency department (ED) for increasing knee pain and decrease in function. Tricoci et al. An update was published by Fanaroff et al in JAMA 2019. Reference: Blom et al.

Emergency Department 100

Emergency Department ALS OR ED 100

The Skeptics' Guide to EM

JANUARY 19, 2019

Date: January 17th , 2019 Reference: Clemency et al. Date: January 17th , 2019 Reference: Clemency et al. This teaching has been challenged by a systematic review by Willman et al 2017. We reviewed the Willman et al publication on SGEM#179 and generally agreed with the authors’ conclusions. Reference: Clemency et al.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

The Skeptics' Guide to EM

JANUARY 27, 2018

[display_podcast] Date: January 25th, 2018 Reference: Hawkins et al. AEM Jan 2018 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. display_podcast] Date: January 25th, 2018 Reference: Hawkins et al. Some studies report that up to half of these are never used ( Limm et al).

Emergency Department 100

Emergency Department ALS OR EMS 100

Don't Forget the Bubbles

AUGUST 23, 2023

Very rarely are the ED team allowed to stand, in silence, with a purpose. 2018) “Benefits of using the pause after death in emergency departments: a Delphi study”. Kapoor et al. 2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. The Pause allows us to take the foot off the pedal briefly.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

ALiEM

AUGUST 9, 2023

Study N Sensitivity Specificity Comments Pereda et al., Balk et al., Pediatr Pulmonol 2018 12 studies; 1510 patients 96% 95% Lung POCUS had significantly better sensitivity than chest X-ray, which had a sensitivity of 87%. Tsou et al., ED Course The patient received antibiotics for pneumonia. Pediatrics.

E-9-1-1 246

E-9-1-1 Emergency Department ALS OR 246

The Skeptics' Guide to EM

MAY 11, 2019

Date: May 6th, 2019 Reference: Sceats et al. JAMA Surgery 2018 Guest Skeptic: Dr. Robert Leeper is an assistant professor of surgery at Western University and the London Health Sciences Centre. Date: May 6th, 2019 Reference: Sceats et al. Omar et al (2008) showed just how safe laparoscopic appendectomies have become.

Critical Care 130

Critical Care ALS OR ED 130