Emergency Medicine Cases

JANUARY 29, 2019

In this EM Cases main episode podcast, a follow up to our episode on TIA released in November 2018 with Walter Himmel and David Dushenski, we’ll try to simplify the confusing time-based and brain tissue-based options for stroke management. Which patients should be considered for lytic therapy? and many more.

ED 130

ED EMS 130

Pediatric EM Morsels

APRIL 19, 2024

Trauma season is at hand and like all other pediatric emergency departments in the country, we find our ED breaking ( pun intended ) at the seams with orthopedic injuries. 2018;Volume 00(00):DOI:10.1097/BPO.0000000000001169. We see all different flavors of upper extremity injuries. Clin Orthop Relat Res. 1984 Sep;(108):103-111.

ALS 286

ALS ACS Emergency Department ED 286

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. Published 2018 Aug 13. Bowel Perforation: ED Presentations, evaluation and management. He reports distension and the sensation of fullness.

E-9-1-1 78

E-9-1-1 ED Operating Room ALS 78

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

ACEP Now

OCTOBER 31, 2023

Emergency physicians have a unique opportunity to recognize these cases and to intervene, as medically neglected children may be brought to the ED once illness becomes severe. Following appropriate medical treatment in the ED, the patient is hospitalized. Published May 1, 2018. Accessed October 11, 2023. Prince v Massachusetts.

ED 52

ED OR EMS 52

The Skeptics' Guide to EM

APRIL 13, 2024

When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago. They noticed this earlier in the day and let her rest, but when she had trouble moving her right arm, they called 911. Initial evaluation by medics revealed right hemiplegia, a right facial droop, left gaze deviation, and aphasia.

Emergency Department 280

Emergency Department ALS OR EMS 280

ALiEM

MARCH 18, 2024

A 30-year-old female with a past medical history of Crohn’s Disease presented to the ED for evaluation of an acutely bruised right 4th finger. 2018 Jun 27;40:1-2. After the popping sensation, she noticed a cool sensation of the finger and numbness to the entire finger. EJVES Short Rep. doi: 10.1016/j.ejvssr.2018.05.008.

Emergency Department 306

Emergency Department ED OR 306

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! Ganss, 2018) There are additional associations with scoliosis, burn injuries, and spinal cord injuries. (Oka, 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

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. Ventriculoperitoneal shunt complications: A review.

Emergency Department 152

Emergency Department ED OR 152

Pediatric EM Morsels

OCTOBER 6, 2023

Recently, a pediatric patient presented to the ED who just returned from abroad with a gastroenteritis presentation. The first case of extensively-drug resistant (XDR) typhoid fever was seen in Pakistan in 2018. Britto 2017, Chiodini 2018) Abdominal pain is the second most common symptom in pediatric patients, followed by diarrhea.

OR 161

OR EMS ED 161

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. Neurogenic Shock.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

ALiEM

FEBRUARY 28, 2024

This blog post provides an update to our 2018 blog articles to reflect these changes. References Iverson C, ed. We also must recognize the important contributions of media such as clinical photographs, radiology images, and ECGs. The American Medical Association (AMA) Manual of Style released its 11th edition in 2020. Video Title.

OR 130

OR ED 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

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). 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 2, 2001, pp.

Allergic Reaction 52

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

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. CT is generally the first choice of imaging, the “abdominal series” of plain X-rays have been demonstrated to have poor predictive value, but a 2018 meta-analysis found 92.4% sensitivity and 96.6%

ALS 130

ALS ED Emergency Department EMS 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. 11, Nov 2018. To opt in to the free subscriber list, click here.

ED 81

ED Emergency Department OR ALS 81

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. Intervention: IV lidocaine given in the ED.

Emergency Department 130

Emergency Department ED ALS 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

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. Opiates became a very common treatment for acute pain in the ED setting after JACHO and the introduction of new and powerful opioids like oxycodone.

Emergency Department 130

Emergency Department ALS ED OR 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.

ICU 246

ICU Emergency Department Critical Care ALS 246

The Skeptics' Guide to EM

JUNE 18, 2022

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. They have two large bore intravenous (IV) access and are planning to bring them to your ED as soon as possible.

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 75

Emergency Department ED Coronary ALS 75

The Skeptics' Guide to EM

SEPTEMBER 10, 2022

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. Background: Asthma affects around 9% of children in the United States and asthma exacerbations are a common cause for ED visits. Pediatr Emerg Care.

Emergency Department 130

Emergency Department ALS ED OR 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? Therapeutic Drug Monitoring of Antiepileptic Drugs in Epilepsy: A 2018 Update. Well not exactly.

Emergency Department 246

Emergency Department ICU ED OR 246

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

ALiEM

JUNE 15, 2023

2018 Oct;32(8):e22583. Read More in the Series References Lily of the valley: Convallaria majalis (Liliales: Liliaceae). Invasive Plant Atlas of the United States. Retrieved Jun 5, 2023. Nelson LS, Goldfrank LR. In: Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. New York, NY: Springer; 2007. Dasgupta A, Bourgeois L.

ALS 246

ALS ED OR 246

EM Literature of Note

SEPTEMBER 13, 2024

These authors compare the burden of lower respiratory tract infections and bronchiolitis admissions at 15 pediatric emergency departments across 2018 to 2024, with 2023-24 being the first season where nirsevimab was in wide usage. The catch: nirsevimab costs ~USD$500 per dose.

Emergency Department 85

Emergency Department ED 85

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

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. Battlefield acupuncture to treat low back pain in the emergency department.

Emergency Department 100

Emergency Department ALS ED EMS 100

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. Published 2020 May 12.

ALS 256

ALS OR ED 256

Silk City Blog

JANUARY 27, 2023

Written by Jessica DiPeri, MD This post first appeared on REBEL EM Background: Pneumothorax management is a common clinical condition in the emergency department (ED) occurring in patients of varying ages and caused by multiple etiologies, including spontaneous, traumatic, and iatrogenic pneumothorax. 153,5 (2018): 1201-1212.

Emergency Department 52

Emergency Department ALS EMS ED 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? J Electrocardiol, 42 (2009), pp.

ED 82

ED OR ALS CAD 82

The Skeptics' Guide to EM

OCTOBER 8, 2022

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. On exam, you notice increased work of breathing, nasal flaring, grunting with subcostal and intercostal retractions.

Critical Care 130

Critical Care ALS Emergency Department ED 130

ACEP Now

NOVEMBER 13, 2023

Physicians, nurses, and staff in emergency departments (EDs) across the country have encountered workplace violence for years. While staff exposure to this violence varies, literature shows nurses are most frequently exposed, with up to 90 percent having experienced workplace violence in their ED careers.

Emergency Department 52

Emergency Department Emergency Response ED ALS 52

ALiEM

MAY 13, 2024

J Emerg Med 2018 [6] 327 Prospective cohort study of children 6mo-18yrs comparing clinical assessment to POCUS 90.3% (83.4-94.7%) 2018 Jan;54(1):96-101. 2018 Nov;55(5):693-701. Epub 2018 Aug 28. Study N Methods POCUS Sensitivity (95% CI) POCUS Specificity (95% CI) Conclusions Gottleib et al., 97.4%) 85.4% (78.9-90.2%)

E-9-1-1 161

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

EMDocs

AUGUST 28, 2023

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. The ED physician orders an x-ray of the leg. The ED is notified that further imaging is recommended, but the family is not informed so it is never done. To opt in to the free subscriber list, click here.

ED 65

ED EMS OR 65