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. Initial evaluation by medics revealed right hemiplegia, a right facial droop, left gaze deviation, and aphasia. A code stroke is activated, and the initial CT head shows no signs of hemorrhage or early ischemic changes.

Emergency Department 295

Emergency Department ALS OR EMS 295

The Skeptics' Guide to EM

DECEMBER 21, 2019

Outside of his academic duties, he works clinically in the adult ED at Spectrum Health in Grand Rapids, Michigan, the tertiary care center for Western Michigan. It was published last year in the 2018 BMJ holiday edition ( Yeh et al BMJ Dec 2018 ). Date: December 17th, 2019 Reference: Reeves and Reynolds.

OR 100

OR ALS ED 100

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. What additional workup is necessary in the ED?

ED 85

ED E-9-1-1 ALS OR 85

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. He describes the pain as a gradually worsening pressure-like discomfort distributed across his entire abdomen. He reports distension and the sensation of fullness.

E-9-1-1 77

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

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. She denied trauma to the hand or finger. EJVES Short Rep.

Emergency Department 306

Emergency Department ED OR 306

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

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. medical neglect accounts for approximately 2 percent of child-abuse cases. Caregivers may neglect the medical care of children for varied reasons.

ED 52

ED OR EMS 52

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" On arrival to the ED, while waiting for cath lab team, he obtained another ECG: You can now see the full voltage of the high-voltage QRS, likely with some degree of LVH. Both were awake and alert with normal vital signs.

OR 120

OR STEMI EMS ED 120

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

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. Short acting. mg/kg IV followed by 0.05 – 0.4

Emergency Department 246

Emergency Department ICU Critical Care ALS 246

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? If not, you probably should be. Another old drug for a new indication, right? Well not exactly. In short, yes.

Emergency Department 246

Emergency Department ICU ED OR 246

The Skeptics' Guide to EM

AUGUST 18, 2018

[display_podcast] Date: August 16th, 2018 Reference: Hohl C et al. AEM Aug 2018. display_podcast] Date: August 16th, 2018 Reference: Hohl C et al. AEM Aug 2018. Case: A 54-year-old female presents to the emergency department (ED) with abdominal pain and profuse non-bloody diarrhea for the past 24 hours.

Emergency Department 130

Emergency Department Overdose ED ALS 130

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. Is cutaneous anthrax reportable? [6,

ALS 256

ALS OR ED 256

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. Ann Emerg Med. Ann Emerg Med. Reference: Silva et al.

Emergency Department 130

Emergency Department ED ALS OR 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

Pediatric EM Morsels

AUGUST 9, 2024

Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306. Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal? Is this bloody stool concerning? Are this odd movements part of normal development? Is that umbilical area ok or concerning? May be on soles of feet !

E-9-1-1 152

E-9-1-1 Emergency Department Plasma OR 152

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

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

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

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). The pain is 10/10 in intensity, gets worse with bending, turning, and prolonged walking. million visits to U.S.

ALS 130

ALS Emergency Department ED OR 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

The Skeptics' Guide to EM

DECEMBER 23, 2023

Without strong primary care patients will eventually end up in the ED. million in 2018. million in 2018. I suspect Ontario is not the only province and Canada is not the only country struggling with these problems. million Ontarians are without a family doctor – that’s up from 1.8 million in March 2020, or up from 1.6

ED 143

ED OR 143

EMDocs

DECEMBER 19, 2023

Possible early antibiotic treatment Minor Marine Trauma Mechanism: Bites, Stings, Nematocysts Envenomation Presentation: All can cause localized pain, erythema, and warmth Dermatologic: Urticaria, burning, pruritus, localized paresthesia. Marine Trauma and Envenomation. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9e.

First Aid 92

First Aid ED OR ALS 92

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

Core EM

MARCH 12, 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

REBEL EM

DECEMBER 5, 2023

The risk of a biphasic reaction is what keeps patients in the ED while being observed for a set period of time. Thus, if the patient has complete resolution of symptoms after appropriate treatment of anaphylaxis, there is no set time period for monitoring in the ED. His vital signs are normal. The patient is given 0.5 Read More: 1.

Epinephrine 80

Epinephrine Allergic Reaction Emergency Department Emergency Manager 80

EMDocs

FEBRUARY 12, 2024

As the only respiratory therapist in the ED has been paged and is starting BiPAP for this patient, an overhead call for two incoming trauma alerts from a multivehicle collision sounds. Because the RT responsible for drawing arterial blood gases is busy caring for these patients, ABGs will be delayed.

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

The Skeptics' Guide to EM

AUGUST 14, 2021

Missy is also now the director for Difficult Airway EMS course in Washington State Case: An EMS crew arrives to your emergency department (ED) with a 58-year-old female who suffered a witnessed ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA). Date: August 12th, 2021 Reference: Daya et al. Reference: Daya et al.

CPR 130

CPR BLS ALS Paramedic 130

The Skeptics' Guide to EM

OCTOBER 19, 2019

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. Bougie use may be helpful in ED intubation.”

Firefighter 130

Firefighter Emergency Department Paramedic ALS 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

The Skeptics' Guide to EM

JANUARY 26, 2019

JAMA Pediatrics December 2018 Guest Skeptic: Dr. Samina Ali is a pediatric emergency physician, clinician-scientist, and Professor of Pediatrics & Emergency Medicine at the University of Alberta in Edmonton. Case: A 10-year-old girl presents to your emergency department (ED) after falling off a zipline at the playground.

ALS 130

ALS ED Emergency Department OR 130

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

EMDocs

JANUARY 25, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. A CBC, Chem 7m and CT of the soft tissues of the neck are ordered by the departing ED doc whose clinical info for the radiologist is “facial swelling”. To opt in to the free subscriber list, click here.

ED 72

ED ALS OR 72

Core EM

MARCH 1, 2024

Mumenthaler M , Mattle H , Taub E , ed. link] Bhattacharyya S.Spinal Cord Disorders: Myelopathy, The American Journal of Medicine, Volume 131, Issue 11, 2018, Pages 1293-1297, ISSN 0002-9343,[link] ​​Garg RK, Malhotra HS, Kumar N. Once symptoms start to improve, the frequency of injections can be reduced to once a week. 4th Edition.

Emergency Department 162

Emergency Department ED OR ALS 162

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

The Skeptics' Guide to EM

JANUARY 14, 2018

[display_podcast] Date: January 9th, 2018 Reference: Soleimanpour H et al. display_podcast] Date: January 9th, 2018 Reference: Soleimanpour H et al. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. first appeared on The Skeptics Guide to Emergency Medicine.

Emergency Department 130

Emergency Department ALS ED OR 130