The Skeptics' Guide to EM

MAY 23, 2020

The REBEL EM team reviewed this literature back in 2018 and, Endovascular thrombectomy with or without intravenous alteplase in acute stroke. Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at St. Joseph’s Regional Medical Center in Paterson, NJ. Managing editor of EM:RAP and Associate Editor at REBEL EM.

OR 100

OR ALS EMS 100

Core EM

JANUARY 25, 2024

In: rimer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 9th ed, Bilezikian JP (Ed), Wiley-Blackwell, Hoboken, NJ 2018. Diagnosis and management of hypocalcaemia. Retrieved April 29, 2022, from [link] Vantour L, Goltzman D. Regulation of calcium homeostasis. Read More

Critical Care 246

Critical Care ED ALS OR 246

Emergency Medicine Ireland

DECEMBER 3, 2020

Epub 2018 Sep 29. . * Finally there is the late phase/chronic/rehab as the patient becomes more anabolic According to this concept don’t rush to feed new admissions with increasing pressors or acute bleeding or life threatening hypoxia/acidosis. As with all ICU nutrition EN is preferred over PN. 2019 Feb;38(1):48-79. 2018.08.037.

Critical Care 52

Critical Care ICU EMS OR 52

ALiEM

SEPTEMBER 9, 2024

No peritoneal signs. Neuro : Awake, alert and oriented x3, no focal neurologic deficits. Rectum : Narrow lumen tube-like structure protruding from anus. Soft stool present at anus with no blood or melena. Non-tender rectal exam. Case Question: What is the ED management of this patient once the diagnosis has been confirmed?

Emergency Department 152

Emergency Department ED OR 152

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. A code stroke is activated, and the initial CT head shows no signs of hemorrhage or early ischemic changes. A CT angiogram shows a proximal middle cerebral artery occlusion. CT perfusion showed a 10 mL core and 189 mL penumbra.

Emergency Department 295

Emergency Department ALS OR EMS 295

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. 28,1 (2008): 105-20.

Plasma 141

Plasma ALS OR EMS 141

Pediatric EM Morsels

OCTOBER 6, 2023

Forster, 2021) Transmission is by Fecal-Oral route (Chiodini 2018) Incubation period 6-30 days after exposure (Chiodini 2018) Salmonella typhi produces an endotoxin although its clinical significance is not yet well understood (Gibani 2019) Two typhoid vaccines are available for those > 6 m/o and are 50-80% effective.

OR 161

OR EMS ED 161

ALiEM

MARCH 18, 2024

2018 Jun 27;40:1-2. Shortly after that, the finger turned purple, so she came to the Emergency Department for evaluation. She denied pain in the hand and has had no problems moving the finger. She denied trauma to the hand or finger. No other complaints or issues. References Ahmed Z, Elmallah A, Elnagar M, Dowdall J, Barry M, Sheehan SJ.

Emergency Department 306

Emergency Department ED OR 306

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Smith : this ECG is definitely not OMI, but could be mistaken for Swirl pattern, which is a septal OMI with STE in V1 and STD in V6. See these cases: Precordial Swirl -- 20 cases of Swirl or Look-Alikes Subsequent serial high sensitivity troponin I measurements were all below the level of detection. AMI was ruled out altogether.

OR 119

OR STEMI EMS ED 119

Pediatric EM Morsels

SEPTEMBER 22, 2023

2018 Oct;14(2):47-54. Epub 2018 Oct 31. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues. Thought to be a “stunning” of the spinal cord. Basics are the Best!

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

ALiEM

FEBRUARY 2, 2024

2018 Sep;40(9):631-641. It was not painful unless she touched it, and then only mildly tender. She denied any known cause, wound, prior rash, or other lesions. Her review of systems and past medical history were negative. Laboratory Data Ultrasound reveals a 1.7 cm superficial soft tissue mass inferior to the scapula on the left thorax.

Emergency Department 169

Emergency Department OR 169

ALiEM

NOVEMBER 27, 2023

Another case report from 2018 used ultrasonography to identify a thickened hepatic capsule in an 18-year-old female with RUQ pain, later confirming FHCS by CT without the need for laparotomy [3]. Yeungnam Univ J Med 35(1), 127-129 (2018). She denied fever, chills, vomiting, chest pain, shortness of breath, diarrhea, or constipation.

OR 161

OR 161

ALiEM

DECEMBER 4, 2023

2018 May 9;13:158-163. doi: 10.1515/med-2018-0025. He then noticed the pain start and grow in intensity without radiating anywhere else except the glans. He denies any discharge or pain with urination with 2-3 small volume voids daily but denies urine trapping. There is no crepitus or swelling. The rest of the physical exam is benign.

Emergency Department 152

Emergency Department OR 152

ALiEM

DECEMBER 8, 2023

2018 Apr;22(2):353-361. Epub 2018 Jan 27. He endorsed low-grade intermittent right-sided flank pain since the nephrectomy one year prior, associated with an increasingly enlarging mass extending laterally from his right abdomen. Over the course of the past several days, the mass had become larger and more painful. PMID: 32310432.

Emergency Department 152

Emergency Department OR 152

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! Get the Goop!

ALS 169

ALS OR EMS 169

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 9, 2023

Carneiro de Moura, 2018 ] Seen in 57% of cohort. Banc-Husu, 2023 ; Luoto, 2020; Carneiro de Moura, 2018 ] Basics are best (always)! Banc-Husu, 2023 ; Luoto, 2020; Carneiro de Moura, 2018 ] Basics are best (always)! 2018 Sep;67(3):371-376. When we think of severe hemorrhage in children, we typically think about trauma.

OR 152

OR Critical Care EMS 152

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

The Good, The Bad & The Ugly Paramedic

NOVEMBER 15, 2020

By the time we add reduced empathy levels, increased judgmental responses and less overall joy in life to the mix, it becomes clear to see that a negative spiral can occur, either gradually or suddenly, with every aspect further impacting on each other. So why would we want to do this to ourselves?

OR 52

OR EMS Paramedic Emergency Medical Services 52

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 171

Coronary Emergency Department ALS OR 171

The Skeptics' Guide to EM

FEBRUARY 11, 2024

This study found that between 2003 and 2018, there were 1,299 cases of AAS in Ontario, the largest province in the country. However, she is still in severe pain. A post-graduate year 2 (PGY-2) resident asks you if it could be a ruptured abdominal aortic aneurysm, aortic dissection, or angina. The annual incidence rate of AD ranges between 2.9

ED 307

ED Emergency Department ALS OR 307

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

AUGUST 18, 2023

Wirth 2018) One study including 4.4 When you read the Morsel on Perichonditis of the ear last week ( or perhaps the Plantar Puncture Morsel from many many many weeks ago ) you may have objected because of the mention that, when indicated, fluroquinolones are safe in children. Which is a risk of 1 event for 62.5 Binz 2015).

E-9-1-1 130

E-9-1-1 OR ACS ALS 130

Core EM

JANUARY 25, 2024

Supplement additional dextrose prn, if hypoglycemia occurs do not stop the insulin, increase the rate of the dextrose drip. Potassium Shifted intracellularly by insulin, total body potassium is normal Replete to goal 3-3.5

Overdose 246

Overdose ALS Epinephrine Critical Care 246

NAEMSP

FEBRUARY 1, 2023

Article Summary by James Li, MD Sinclair, Julie E., “Characteristics, prehospital management, and outcomes in patients assessed for hypoglycemia: repeat access to prehospital or emergency care.” ” Prehospital Emergency Care 23.3 2019): 364-376. Background: Diabetes is a common chronic medical condition. of the US population).

OR 52

OR Emergency Department Emergency Medical Services Paramedic 52

Pediatric EM Morsels

APRIL 5, 2024

Globally, ticks are the second most common vector to transmit illnesses after mosquitos (Parola 2018). 2018 Mar; 3(1): 8. There are species of ticks found on every continent and carrying a variety of vectors capable of infecting humans. Mortality rate is 3-5% for Kyasanur Forest disease and 0.5-3% John H, Jian J, RIchards AL.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

ALiEM

NOVEMBER 1, 2023

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? 1, 3, 5] Vin rosé urine is simply indicates the excretion of ferrioxamine and is not harmful. 2000 Jun;59(6):1233-50.

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

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

NVFC

MAY 21, 2024

In 2018, Congress passed legislation that directed the FAA to permit the use of public actively tethered unmanned aircraft systems (UAS) under certain conditions without obtaining a certificate of waiver or authorization under the FAA’s Small UAS Rule (Part 107), allowing for a streamlined authorization process for emergency use.

Public Safety 109

Public Safety Heart Attack First Responder Firefighter 109

Pediatric EM Morsels

JULY 7, 2023

Cunningham, 2018 ] Account for less than 1% of all knee injuries. Epub 2018 Apr 19. The PTF joint is inherently stable with good ligamentous support, especially when the knee is in extension. Plain films may be normal if subluxation is subtle … or may clearly show dislocation. Some cases do require CT or MRI to confirm.

OR 141

OR EMS 141

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. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism.

ALS 130

ALS EMS OR 130

Dr. Smith's ECG Blog

JUNE 5, 2024

It is unclear if the patient was pain free at this time. The ECG does not show any definite signs of ischemia. In fact, the ECG was described as normal, and without serial ECGs or prior ECGs for comparison it could be. Initial high sensitivity troponin I returned at 6ng/L (normal 0.20 As a result — an ICD may need to be considered in selected cases.

Coronary 109

Coronary ACS ALS OR 109

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. AEM Aug 2018. Prospective Validation of Clinical Criteria to Identify Emergency Department Patients at High Risk for Adverse Drug Events.

Emergency Department 130

Emergency Department Overdose ED ALS 130

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

[display_podcast] Date: September 21st, 2018 Reference: Kawano et al. Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado. display_podcast] Date: September 21st, 2018 Reference: Kawano et al.

BLS 130

BLS Defibrillator Critical Care CPR 130

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

The Skeptics' Guide to EM

DECEMBER 30, 2018

Date: December 30th, 2018 Happy New Years to all the SGEMers out there in the #FOAMed world. It is time to reflect upon 2018 and look forward to 2019. Date: December 30th, 2018 Happy New Years to all the SGEMers out there in the #FOAMed world. It is time to reflect upon 2018 and look forward to 2019.

Emergency Department 130

Emergency Department EMS OR 130