The Skeptics' Guide to EM

AUGUST 17, 2019

Date: August 9th, 2019 Reference: Daoust et al. AEM August 2019 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Date: August 9th, 2019 Reference: Daoust et al. AEM August 2019 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Volkow et al.

Emergency Department 130

Emergency Department ALS ED OR 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.) Sagittal view of bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.)

E-9-1-1 177

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

The Skeptics' Guide to EM

FEBRUARY 18, 2023

Date: February 17, 2023 Reference: Gettel et al. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. Date: February 17, 2023 Reference: Gettel et al. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019.

Emergency Department 130

Emergency Department ALS ED EMS 130

ALiEM

APRIL 12, 2024

Case A 48 year-old male with a history of hypertension and polysubstance abuse presented to the emergency department (ED) for shortness of breath and was found to have a left sided parapneumonic pleural effusion (Figure 1). doi: [link] Broder JS, Al-Jarani B, Lanan B, Brooks K. doi: [link] Vetrugno L, Guadagnin GM, Barbariol F, et al.

E-9-1-1 183

E-9-1-1 ALS Critical Care Emergency Department 183

The Skeptics' Guide to EM

MAY 2, 2020

Date: April 24th, 2020 Reference: Watanabe et al. July 2019 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Virginia. This is Bob’s eleventh visit […] The post SGEM#291: Who’s Gonna Drive you to…the ED – with Lights & Sirens? Date: April 24th, 2020 Reference: Watanabe et al.

ED 100

ED Ambulance Medical Transportation EMS 100

The Skeptics' Guide to EM

NOVEMBER 23, 2019

Date: November 21st, 2019 Reference: Daley et al. AEM November 2019 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Date: November 21st, 2019 Reference: Daley et al. AEM November 2019 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Date: September 8th, 2021 Reference: Desch et al. He is interested and experienced in healthcare informatics, previously worked with ED-directed EMR design, and is involved in the New York City Health and Hospitals Healthcare Administration Scholars Program (HASP).

EMR 130

EMR Coronary Defibrillator Life Support 130

The Skeptics' Guide to EM

JUNE 6, 2020

Date: June 2nd, 2020 Reference: Permpikul et al. Respir Crit Care Med 2019. Date: June 2nd, 2020 Reference: Permpikul et al. Respir Crit Care Med 2019. Case: It’s another day in your emergency department (ED). The triage nurse places a 61 year-old-man with fever, hypotension, cough into the smallest room in the ED.

EMR 130

EMR ALS ICU Emergency Department 130

REBEL EM

JUNE 5, 2023

from 2019 to 2021 (from 48,000 to 81,400 annual deaths), which includes prescription opioids (natural and semi-synthetic opioids and methadone), heroin, and synthetic opioids other than methadone including fentanyl (1). Background Information: Opioid overdose deaths have been increasing in the past twenty years. PMID 33392580.

Naloxone 98

Naloxone ED Overdose Emergency Department 98

The Skeptics' Guide to EM

FEBRUARY 26, 2022

Date: February 21st 2022 Reference: Kim et al. Date: February 21st 2022 Reference: Kim et al. Case: You are in discussion with your emergency department (ED) manager about the number of patients boarding for hours to days and you are both aware that many of these patients are attending with mental health crises.

ED 130

ED ALS Emergency Department OR 130

The Skeptics' Guide to EM

APRIL 12, 2019

Date: April 10th, 2019 Guest Skeptic: Dr. Scott Weingart. He is an ED intensivist from New York City and runs the popular EMCrit blog and podcast. Date: April 10th, 2019 Guest Skeptic: Dr. Scott Weingart. He is an ED intensivist from New York City and runs the popular EMCrit blog and podcast.

ALS 130

ALS ED EMS OR 130

Core EM

MARCH 1, 2024

Mumenthaler M , Mattle H , Taub E , ed. Epub 2019 Apr 17. 2019 Jul;42(4):673-685. Epub 2019 Jan 28. McGraw-Hill Education; 2019. 2019 Oct;15(4):299-303. 2019 Oct;15(4):299-303. Epub 2019 Aug 6. References Neurology. 4th Edition. Stuttgart: Thieme; 2003. Neuroanatomy, Motor Neuron. 2020:952–9.

Emergency Department 162

Emergency Department ED OR ALS 162

ALiEM

AUGUST 9, 2023

Study N Sensitivity Specificity Comments Pereda et al., Balk et al., Tsou et al., Acad Emerg Med 2019 25 studies; 3353 patients 94% 92% Significant difference in accuracy between novice and advanced sonographers. ED Course The patient received antibiotics for pneumonia. 2019 Sep;26(9):1074-1088. Pediatrics.

E-9-1-1 246

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

EMDocs

JULY 25, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Chuck Pilcher, MD, FACEP Editor, Medical Malpractice Insights Editor, Med Mal Insights The challenge of suicide evaluation in the ED “I’ve changed my mind. Ronquillo L et al. Oct 04, 2012.

ED 82

ED ALS Emergency Department OR 82

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. Richards JE et al. NEJM 1994. [2]

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

The Skeptics' Guide to EM

OCTOBER 5, 2019

Date: September 25th, 2019 Reference: Bath PM et al. The Lancet March 2019. Date: September 25th, 2019 Reference: Bath PM et al. The Lancet March 2019. You arrive to find the patient awake and alert, with a facial droop, slurred speech and left-sided arm drift (FAST-ED score = 3). mmol/L).

Ambulance 130

Ambulance Paramedic EMS ALS 130

The Skeptics' Guide to EM

JANUARY 19, 2019

Date: January 17th , 2019 Reference: Clemency et al. Date: January 17th , 2019 Reference: Clemency et al. This teaching has been challenged by a systematic review by Willman et al 2017. We reviewed the Willman et al publication on SGEM#179 and generally agreed with the authors’ conclusions.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

The Skeptics' Guide to EM

OCTOBER 19, 2019

Date: October 17th, 2019 Reference: Driver et al. Date: October 17th, 2019 Reference: Driver et al. Reference: Driver et al. Bougie use may be helpful in ED intubation.” A Randomized Clinical Trial. Clinical Question: Does using a bougie increase first pass intubation success?

Firefighter 130

Firefighter Emergency Department Paramedic ALS 130

ALiEM

NOVEMBER 29, 2023

Notes from the Field: Xylazine Detection and Involvement in Drug Overdose Deaths – United States, 2019. PMID: 34529640 Ayub S, Parnia S, Poddar K, et al. PMID: 24769343 Ehrman-Dupre R, Kaigh C, Salzman M et al. PMID: 36148197 Love JS, Levine M, Aldy K, et al. PMID: 37014353 Ball NS, Knable BM, Relich TA et al.

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

The Skeptics' Guide to EM

NOVEMBER 16, 2019

Date: November 6th, 2019 Reference: Lascarrou et al. NEJM Oct 2019 Guest Skeptic: Dr. Laura Melville (@lmelville535) is an emergency physician in Brooklyn, New York, is a part of the New York ACEP Research Committee, ALL NYC EM, and is the NYP-Brooklyn Methodist Resident Research Director. Reference: Lascarrou et al.

ALS 100

ALS CPR ICU EMS 100

The Skeptics' Guide to EM

JULY 17, 2021

Date: July 14th, 2021 Reference: Pernica et al. Date: July 14th, 2021 Reference: Pernica et al. Case: Six-year-old Morten comes into your emergency department (ED) with what looks like pneumonia. This is because most pneumonias in this age-group are caused by viral pathogens ( Bradley et al 2011 ). Bradley et al 2011 ).

ALS 130

ALS Emergency Department ED 130

The Skeptics' Guide to EM

APRIL 25, 2020

Date: April 21st, 2020 Reference: Juergens et al. Date: April 21st, 2020 Reference: Juergens et al. Proc Baylor Univ Med Center Oct 2019 Guest Skeptic: Dr. Chuck Sheppard is an attending Emergency Department Physician at Mercy Hospital in Springfield, Missouri and the medical director for Mercy Life Line air medical service.

Emergency Department 100

Emergency Department ALS ED EMS 100

The Skeptics' Guide to EM

DECEMBER 28, 2019

Date: December 16th, 2019 Reference: Moore et al. Annals of EM, JU, and JACR 2019. Date: December 16th, 2019 Reference: Moore et al. Annals of EM , JU, and JACR 2019. Imaging in Suspected Renal Colic: Systematic Review of the Literature and Multispecialty Consensus. NEJM 2014 ).

Emergency Department 100

Emergency Department ALS EMS ED 100

ALiEM

NOVEMBER 1, 2023

In: Nelson LS, Goldfrank LR et al (eds): Goldfrank’s Toxicologic Emergencies. McGraw-Hill Education; 2019 Madiwale T, Liebelt E. 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. Iron: not a benign therapeutic drug. Deferoxamine.

E-9-1-1 161

E-9-1-1 ALS OR ED 161

The Skeptics' Guide to EM

MAY 19, 2019

Date: May 15th, 2019 Reference: Terp et al. AEM May 2019 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Date: May 15th, 2019 Reference: Terp et al. AEM May 2019 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Reference: Terp et al.

Emergency Department 100

Emergency Department ALS ED OR 100

The Skeptics' Guide to EM

JUNE 20, 2020

Reference: Kuppermann et al. Reference: Kuppermann et al. Case: A 5-week-old full term female presents to the Emergency Department (ED) for fever with rectal temp of 100.6F (38.1C). Reference: Kuppermann et al. Dennis Ren is a Pediatric Emergency Medicine fellow at Children’s National Hospital in Washington, DC.

OR 100

OR Emergency Department ALS ED 100

The Skeptics' Guide to EM

DECEMBER 21, 2019

Date: December 17th, 2019 Reference: Reeves and Reynolds. AEM Dec 2019. Date: December 17th, 2019 Reference: Reeves and Reynolds. AEM Dec 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.

OR 100

OR ALS ED 100

REBEL EM

JANUARY 9, 2024

Bottom Line Up Top: In patients with infectious processes that are stable for discharge home, there is no role for giving a first dose of antibiotics IV in the ED. PMID: 9114201 Siegel RE et al. BMJ (Clinical research ed.). PMID: 17090560 Castro-Guardiola A et al. PMID: 1664833 Addo-Yobo E, et al. Pneumonia 2017.

ALS 99

ALS ICU ED OR 99

The Skeptics' Guide to EM

MAY 11, 2019

Date: May 6th, 2019 Reference: Sceats et al. Date: May 6th, 2019 Reference: Sceats et al. Case: An 18-year-old woman presents with a Grade 1 appendicitis (Tominaga et al J Trauma Acute Care Surg 2016). Omar et al (2008) showed just how safe laparoscopic appendectomies have become. Reference: Sceats et al.

Critical Care 100

Critical Care ALS ED OR 100

Core EM

JANUARY 24, 2024

2017.09.1085 Gómez-Outes A, Alcubilla P, Calvo-Rojas G, et al. Published 2019 Jun 6. doi:10.1186/s13054-019-2492-8 Baugh CW, Levine M, Cornutt D, et al. 2019.09.001 Gilbert BW, Morton L, Huffman JB, et al. 2019.10.013 Patel IJ, Rahim S, Davidson JC, et al. Background Around 6 million people in the U.S. J Emerg Med.

FFP 130

FFP Frozen Plasma Plasma ALS 130

Broome Docs

OCTOBER 6, 2024

Turgeon AF, Fergusson DA, Clayton L,et al. PMID: 38238065 Oral vs IV ABs… another negative trial Nielsen AB, Holm M, Lindhard MS, et al. 2019 Nov 5;322(17):1722. So follow along with the papers below and read to make up your own mind about the evidence presented. Too much ‘aint enough blood? N Engl J Med.

Critical Care 112

Critical Care ALS Emergency Department EMS 112

EMDocs

AUGUST 22, 2024

6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. 6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. One cohort study in a public ED found that 84.5%

Emergency Department 82

Emergency Department ALS E-9-1-1 ED 82

Don't Forget the Bubbles

JULY 19, 2023

Olivia, a previously well 13-year-old girl, is referred to the paediatric ED from the Ophthalmology ED. When they examined her and found that she had enlarged optic discs, they sent Olivia to the ophthalmology ED. Two smaller retrospective reviews ( Elhusseiny et al., 2023 and Kovarik et al., 2020 and Hyde et al.

ALS 98

ALS Emergency Department ED OR 98

Don't Forget the Bubbles

JULY 22, 2024

Pre-school wheezers remain a poorly understood cohort of children despite seeing them every day in paediatric EDs. However, there was no difference in LOS (83 minutes for placebo vs 79 minutes for prednisolone) in participants who were discharged straight from the ED ( 32% ). Compare this with the Panickar et al.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

The Skeptics' Guide to EM

APRIL 16, 2022

Date: April 16th, 2022 Reference: Blom et al. Date: April 16th, 2022 Reference: Blom et al. Case: A 55-year-old man comes into the emergency department (ED) for increasing knee pain and decrease in function. Tricoci et al. An update was published by Fanaroff et al in JAMA 2019. Reference: Blom et al.

Emergency Department 100

Emergency Department ALS OR ED 100

ACEP Now

JULY 11, 2024

Deaths from drinking increased 25 percent from 2019 to 2020 and another 10 percent in 2021. 5,6 Only one in six ED physicians routinely screens for dangerous drinking, and only one in 36 are using a validated screening tool. Notably for ED physicians, one of the criteria is “using [alcohol] in situations that might be dangerous.”

Emergency Department 98

Emergency Department ALS ED OR 98

EMS 12-Lead

MAY 8, 2022

This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2] The following ECG was captured upon arrival at the receiving ED. The ED resulted an 8.7 An ECG is recorded.

STEMI 130

STEMI ED EMS Firefighter 130