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

Pediatric EM Morsels

JUNE 16, 2023

Sometimes this can be used to our advantage, like when we need to give subcutaneous fluids to a dehydrated patient without an IV, or when we need to give SQ medications for things like Sulfonylurea overdose , Hereditary Angioedema , or DVTs. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Overdose 152

Overdose OR Critical Care ALS 152

ACEP Now

JULY 7, 2023

Heart disease and stroke statistics—2018 update: A report from the American Heart Association. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. amiodarone or lidocaine). Circulation. 2022;145(8):e153-e639.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

REBEL EM

NOVEMBER 20, 2023

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. 2 Despite these recommendations there are no randomized clinical trials to help guide practice until now.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

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

Background: The lumbar puncture (LP or spinal tap) is a procedure that has been in the medical arsenal since first described in 1891 by German physician Heinrich Quincke. Technique: Probe selection: The linear probe is more ideal for pediatric patients and adults with a leaner body habitus. High-quality images obtained in <1 minute in 87.9%

ALS 246

ALS Critical Care OR 246

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A healthy 45-year-old female presented with chest pain, with normal vitals. The computer interpretation was “ST elevation, consider early repolarization, pericarditis or injury.” What do you think? There’s normal sinus rhythm, normal conduction, borderline right axis, and normal voltages. There’s TWI in aVL but this is concordant to its QRS.

OR 66

OR STEMI ACS Coronary 66

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

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

The Skeptics' Guide to EM

OCTOBER 12, 2024

June 2024 Population: Children aged 7-17 years and their caregivers who presented to ten Canadian pediatric EDs between 2018 and 2020 Excluded: Children who remained medically unstable during their ED stay, had altered levels of consciousness, were suspected of being abused, or had a caregiver who was not their legal guardian​.

Emergency Department 229

Emergency Department ED ALS OR 229

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 287

Emergency Department ALS OR EMS 287

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

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

ALiEM

MARCH 7, 2024

The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Her mother denies any fevers, upper respiratory symptoms, sore throat, or diarrhea. She adds that her daughter has complained of 2-3 episodes of dysuria and gross hematuria over the last few days. Lay the patient supine when possible.

E-9-1-1 177

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

The Good, The Bad & The Ugly Paramedic

JULY 1, 2020

As paramedics, whilst we often take great offence at being called ambulance drivers, the question is, when it’s our turn to drive, what exactly is it that we are providing? Do we fully engage in shared patient care with our attending partner, or do we switch off so that we can simply drive the ambulance and take it easy?

Ambulance Driver 52

Ambulance Driver Paramedic Ambulance OR 52

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

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

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

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 116

OR STEMI EMS ED 116

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

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

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

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 EMS Critical Care 152

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

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

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

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 59

E-9-1-1 ACS OR Emergency Department 59

Pediatric EM Morsels

AUGUST 4, 2023

Ganss, 2018) There are additional associations with scoliosis, burn injuries, and spinal cord injuries. Ganss, 2018) At least one case of abdominal compartment syndrome noted in the literature. (England, 2021) This condition is often attributed to rapid weight loss. 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

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

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 303

ED Emergency Department ALS OR 303

Pediatric EM Morsels

JUNE 7, 2024

2018 Jun 19;6:170. This recommendation can also apply to children 12 years and older with mild persistent asthma who are already on daily ICS , to have a joint decision to instead space to intermittent ICS with SABA during times of illness or seasons when they may be higher risk for exacerbations. Moral of the Morsel Are they controlled?

Emergency Department 268

Emergency Department OR EMS 268

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 ACS OR ALS 130

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

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

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