The Skeptics' Guide to EM

APRIL 13, 2024

Reference: Albers GW et al. Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. A CT angiogram shows a proximal middle cerebral artery occlusion.

Emergency Department 287

Emergency Department ALS OR EMS 287

Core EM

JANUARY 25, 2024

Pfenning CL, Slovis CM: Electrolyte Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. In: rimer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 9th ed, Bilezikian JP (Ed), Wiley-Blackwell, Hoboken, NJ 2018. link] Kelly A, Levine MA.

Critical Care 246

Critical Care ED ALS OR 246

The Skeptics' Guide to EM

DECEMBER 15, 2018

Date: December 13th , 2018 Reference: Murata et al. 2018 Guest Skeptic: Dr. Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Associate Professor for the University of Leicester’s SAPPHIRE group. Date: December 13th , 2018 Reference: Murata et al. Pediatrics. Pediatrics.

OR 130

OR Emergency Department ALS 130

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.) The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Lay the patient supine when possible.

E-9-1-1 177

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

Core EM

JANUARY 25, 2024

References: Yuan TH, Kerns WP, Tomaszewski CA, et al. von Lewinski D, Bruns S, Walther S, et al. Cole JB, Corcoran JN, Engebretsen KM, et al. Holger JS, Engebretsen KM, Fritzlar SJ, et al. Kerns W, Schroeder D, Williams C, et al. Kline JA, Tomaszewski CA, Schroeder JD, et al. Disposition to ICU. Circulation.

Overdose 246

Overdose ALS Epinephrine Critical Care 246

The Skeptics' Guide to EM

DECEMBER 21, 2019

It was published last year in the 2018 BMJ holiday edition ( Yeh et al BMJ Dec 2018 ). Laupacis A et al NEJM 1988 ). Mathew Reeves is a Professor and Interim Chair of the Department of Epidemiology and Biostatistics at the College of Human Medicine at MSU. Date: December 17th, 2019 Reference: Reeves and Reynolds.

OR 100

OR ALS ED 100

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The original term " benign early repolarization" has fallen out of favor since the seminal paper by Haïssaguerre et al. linking the finding with long term risk of idiopathic ventricular fibrillation. The link is quite modest, increasing the chance of VF from 3.4 per 100,000 to 11 per 100,000 [Rosso].

E-9-1-1 122

E-9-1-1 OR Coronary ACS 122

The Skeptics' Guide to EM

MAY 23, 2020

Date: May 19th, 2020 Reference: Yang P et al. Date: May 19th, 2020 Reference: Yang P et al. Guest Skeptic: Dr. This led to a pro/con publication in the Canadian Journal of Emergency Medicine (CJEM) tPA should be the initial treatment in eligible patients presenting with an acute ischemic stroke ( Milne et al CJEM April 2020 ).

OR 100

OR ALS EMS 100

Pediatric EM Morsels

JUNE 14, 2024

Tavasoli 2018, Wolf 2012) More common in adults; children comprise 20% of total cases (Pidcock 2007, Wang 2019) Bimodal age distribution (Absoud 2016) Children < 5 years Children > 10 years Symptoms evolve over 2-4 days and peak at 5-6 days (Absoud 2016) ATM may occur alone OR as part of another disorders (e.g. first sign of MS).

Plasma 141

Plasma ALS OR EMS 141

Pediatric EM Morsels

JUNE 16, 2023

Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Overdose 152

Overdose OR Critical Care ALS 152

REBEL EM

NOVEMBER 20, 2023

Paper: Jansen JO, Hudson J, Cochran C, et al. Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. 2023;e2320850. 97% of patients sustained blunt trauma.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

The Skeptics' Guide to EM

FEBRUARY 11, 2024

Reference: McLatchie et al and DAShED investigators. Reference: McLatchie et al and DAShED investigators. This study found that between 2003 and 2018, there were 1,299 cases of AAS in Ontario, the largest province in the country. EMJ Nov 2023. first appeared on The Skeptics Guide to Emergency Medicine. per 100,000. [4-8]

ED 303

ED Emergency Department ALS OR 303

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

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. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Moral of the Morsel Anatomy Matters!

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

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

JUNE 21, 2024

Palmieri 2002, Choi 2018, Raymond 2018] A systematic review with moderate quality evidence found no difference in the rate of wound healing or epithelialization with silver sulfadiazine compared to silver impregnated foam dressing. Irie 2018] Moral of the Morsel Burns are Bad! Available from: [link] Liu H, Li D, Yuan H, et al.

ALS 169

ALS OR EMS 169

The Skeptics' Guide to EM

OCTOBER 20, 2018

[display_podcast] Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Ann Emerg Med 2018 (CRD42017056195) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. NEJM 2018 (ClinicalTrials.gov NCT01467466.) [display_podcast] Date: October 17th , 2018 Reference #1: Aycock, Westafer et al.

Coronary 174

Coronary Emergency Department ALS OR 174

Core EM

JANUARY 25, 2024

Critical Care Medicine 2018 Sedation: After absence of pain is ensured, pharmacologic sedation may be indicated to help relieve discomfort, improve synchrony with mechanical ventilation and decrease oxygen requirements and overall work of breathing. μg/kg IV Maintenance dose: 0.5 – 15 μg/kg/hr Rapid onset. Short acting.

ICU 246

ICU Emergency Department Critical Care ALS 246

ALiEM

JUNE 5, 2023

Human illness is most commonly acquired by handling animal fluids or pelts. There are several forms of anthrax, however cutaneous is the most common (95% of cases) and the least complicated to treat [2]. What are the symptoms of cutaneous anthrax? [3, 3, 4] Naturally occurring cases develop after spores of B. Is cutaneous anthrax reportable? [6,

ALS 256

ALS OR ED 256

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

EMDocs

NOVEMBER 13, 2024

Literature concerning risk with PPIs is controversial. Presentation: Classic presentation is abdominal pain or tenderness, fever, and altered mental status. Literature suggests 10-33% of patients are asymptomatic or only have mild symptoms. Clinician sensitivity for SBP based on bedside assessment is between 40-75%. increase in mortality.

E-9-1-1 80

E-9-1-1 ALS OR ED 80

Dr. Smith's ECG Blog

JUNE 5, 2024

Uncontrolled coronary spasm may be associated with serious arrhythmias , including cardiac arrest ( Looi et al — Postgrad Med, 2012 ; Tan et al — Eur Heart J Case Rep, 2018 ; Chevalier et al — JACC, 1998 ; Rodriguez-Manero — EP Europace, 2018 ). It is unclear if the patient was pain free at this time.

Coronary 111

Coronary ACS ALS OR 111

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. Lily of the valley ( Convallaria majalis ) is a woodland perennial with a sweet scented, white bell-shaped flower. Vet Med Sci.

ALS 246

ALS ED OR 246

ALiEM

AUGUST 9, 2023

Ultrasound Technique Background The lungs were traditionally considered poorly accessible to ultrasound, as ultrasound waves cannot penetrate air-filled structures; however, lung POCUS relies on the interpretation of patterns of artifacts to evaluate the normal, air-filled lungs. Warm gel helps with the child’s comfort.

E-9-1-1 246

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

The Skeptics' Guide to EM

MARCH 11, 2023

Date: March 8, 2023 Reference: Smida et al. Date: March 8, 2023 Reference: Smida et al. Two large trials, PART by Wang et al and AIRWAYS-2 by Benger et al recently evaluated the King-LT and the iGel respectively as alternatives to endotracheal intubation (ETI) in cardiac arrest. Reference: Smida et al.

CPR 130

CPR Defibrillator BLS Paramedic 130

ALiEM

OCTOBER 30, 2023

After spending her first year acclimating to the new department and achieving board certification, Dr. Garcia finds herself at a bit of a crossroad. She likes teaching, but are not sure residency or medical student education leadership is for her. And as study after study tells us, everyone is susceptible to burnout. In short, no.

E-9-1-1 161

E-9-1-1 ALS OR 161

The Skeptics' Guide to EM

MAY 14, 2022

Date: May 13th, 2022 Reference: Abril et al. Date: May 13th, 2022 Reference: Abril et al. These include: acetaminophen ( Williams et al Lancet 2014), steroids ( Balakrishnamoorthy et al Emerg Med J 2014) and benzodiazepines ( Friedman et al Ann Emerg Med 2017). An Analysis of Data From Randomized Studies.

ALS 130

ALS Emergency Department ED OR 130

The Skeptics' Guide to EM

JUNE 9, 2018

[display_podcast] Date: June 8th, 2018 Reference: April MD, et al. Ann Emerg Med 2018 Guest Skeptic: Meghan Groth is a pharmacist who has been practicing in emergency medicine for the past six years. display_podcast] Date: June 8th, 2018 Reference: April MD, et al. Reference: April MD, et al.

Emergency Department 130

Emergency Department ALS OR 130

The Skeptics' Guide to EM

FEBRUARY 23, 2019

Date: February 22nd, 2019 Reference: Lane et al. JAMA 2018 Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. Date: February 22nd, 2019 Reference: Lane et al. JAMA 2018 Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service.

Paramedic 130

Paramedic ALS Ambulance EMS 130

ALiEM

NOVEMBER 1, 2023

In: Nelson LS, Goldfrank LR et al (eds): Goldfrank’s Toxicologic Emergencies. 22 Aug 2018. As ferrioxamine is excreted, the patient’s urine becomes an orange or brown rusty hue, classically referred to as vin rosé urine [1,2]. For iron toxicity, what are the indications for deferoxamine? Blake Froberg, Bryan Judge, and Louise Kao.

E-9-1-1 161

E-9-1-1 ALS OR ED 161

The Skeptics' Guide to EM

DECEMBER 7, 2018

Date: December 6th , 2018 Reference: Perkins et al. Date: December 6th , 2018 Reference: Perkins et al. There have been a number of papers published since OPALS that support the findings of not using ACLS drugs like epinephrine for OHCA ( Olavseengen et al. JAMA 2009, Hagihara et al.

Epinephrine 130

Epinephrine Life Support Advanced Life Support Defibrillator 130

This Podcast Will Kill You

NOVEMBER 26, 2024

Clinical management and impact of scarlet fever in the modern era: findings from a cross-sectional study of cases in London, 2018–2019. WHO 2022 Increased incidence of scarlet fever and invasive Group A Streptococcus infection – multi-country [link] Warinner, Christina, et al. But it didn’t go away entirely or lose its bite completely.

E-9-1-1 52

E-9-1-1 ALS OR 52

The Skeptics' Guide to EM

OCTOBER 31, 2018

[display_podcast] Date: October 30th , 2018 Reference: Raskob GE et al. NEJM 2018 Guest Skeptic: Dr. Anand Swaminathan is an assistant professor of Emergency Medicine at the St. display_podcast] Date: October 30th , 2018 Reference: Raskob GE et al. Reference: Raskob GE et al.

ALS 130

ALS EMS OR 130

The Skeptics' Guide to EM

FEBRUARY 15, 2020

Date: February 11th, 2020 Reference: Yeh et al. Date: February 11th, 2020 Reference: Yeh et al. Reference: Yeh et al. Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial. Guest Skeptic: Marcus Prescott is a nurse in Norway. He is also now a third-year medical student.

ALS 130

ALS Emergency Department OR 130

The Skeptics' Guide to EM

APRIL 1, 2018

[display_podcast] Date: March 30th, 2018 Reference: Bronzetti et al. February 2018. display_podcast] Date: March 30th, 2018 Reference: Bronzetti et al. February 2018. Reference: Bronzetti et al. February 2018. International Journal of Cardiology. This is his 6th visit to the SGEM.

Emergency Department 130

Emergency Department ALS OR 130

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

Core EM

JULY 23, 2024

Author: Mallika Singh, MD Editor: Jonathan Kobles, MD Background Unintentional or intentional exposure to radiological material represents a potential threat to human health on the individual to mass-casualty scale. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. 10-Hour Flight: 0.03

ALS 130

ALS OR Emergency Department ED 130