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

Pediatric EM Morsels

JULY 26, 2024

It is commonly missed during the first few ED visits. Keep a high index of suspicion for anti-NMDAr encephalitis in children and adolescents who have had multiple ED visits for new and worsening psych/behavioral concerns, seizures, and/or movement disorders over several months. Epub 2019 Dec 19. The prevalence ranges from 12.5%-61%

Plasma 269

Plasma OR ED Critical Care 269

Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Broselow-Luten System: Supportive Data Physician estimates of weight can underdose children by 49% or overdose by up to 116%. x exp[0.02 x exp[0.02

E-9-1-1 269

E-9-1-1 Emergency Medical Services Life Support ALS 269

ALiEM

OCTOBER 4, 2023

2019 Aug;9(4):337-342. 2019 Oct;123(4):457-463. Epub 2019 Jun 24. This kit has historically been issued to US service members for treating nerve agent toxicity from agents such as soman, sarin, tabun, and VX, all of which are organophosphates and cause a cholinergic toxidrome. What are nerve agents? [1-3] Chemical terrorism.

Plasma 195

Plasma OR ED 195

ALiEM

OCTOBER 21, 2024

A 5-year-old generally healthy fully immunized boy presented to the ED with worsening left ear redness, swelling, and tenderness that his family noticed the day before presentation. 2019 Aug;276(8):2199-2203. Epub 2019 May 11. His family had also recently noticed an abrasion over that ear. Klug TE, Holm N, Greve T, Ovesen T.

ED 169

ED OR 169

The Skeptics' Guide to EM

MAY 2, 2020

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? July 2019 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Virginia.

ED 100

ED Ambulance Medical Transportation EMS 100

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. JAMA 2011).

Emergency Department 130

Emergency Department ALS ED OR 130

EMDocs

SEPTEMBER 30, 2024

Today’s video evaluates inhaled corticosteroids (ICS) for asthma in the ED setting. EBM Updates: Inhaled Corticosteroids for Asthma in the ED Background : Asthma is a common ED issue, with patient presentations ranging from needing a medication refill to severe exacerbation in respiratory failure.

ED 83

ED Emergency Department OR 83

The Skeptics' Guide to EM

FEBRUARY 18, 2023

Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. The SGEM has done two previous podcasts on APPs in the ED. Date: February 17, 2023 Reference: Gettel et al.

Emergency Department 130

Emergency Department ALS ED EMS 130

ALiEM

JUNE 15, 2023

Goldfrank’s Toxicologic Emergencies, 11e New York, NY: McGraw-Hill; 2019 Morimoto M, Tatsumi K, Yuui K, et al. Lily of the valley ( Convallaria majalis ) is a woodland perennial with a sweet scented, white bell-shaped flower. It blooms from April to June in North America and bears orange-red berries in July [1]. Retrieved Jun 5, 2023.

ALS 246

ALS ED OR 246

The Skeptics' Guide to EM

JUNE 20, 2020

Case: A 5-week-old full term female presents to the Emergency Department (ED) for fever with rectal temp of 100.6F (38.1C). A Clinical Prediction Rule to Identify Febrile Infants 60 Days and Younger at Low Risk for Serious Bacterial Infections. JAMA Pediatr. first appeared on The Skeptics Guide to Emergency Medicine. JAMA Pediatr.

OR 100

OR Emergency Department ALS ED 100

Core EM

MARCH 1, 2024

Mumenthaler M , Mattle H , Taub E , ed. Epub 2019 Apr 17. Significance of the Inverted V Sign : This MRI sign is pathognomonic for subacute combined degeneration, indicating it is a distinct marker for this condition. Once symptoms start to improve, the frequency of injections can be reduced to once a week. References Neurology.

Emergency Department 162

Emergency Department ED OR ALS 162

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 Skeptics' Guide to EM

FEBRUARY 16, 2019

Date: February 15th, 2019 Reference: Gottileb, Holladay and Peksa. AEM January 2019. Date: February 15th, 2019 Reference: Gottileb, Holladay and Peksa. AEM January 2019. Case: A 54-year-old diabetic female presents to your emergency department (ED) complaining of floaters of flashing lights and blurry vision.

ED 130

ED Emergency Department OR 130

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. Reference: Daley et al.

Emergency Department 130

Emergency Department ALS ED OR 130

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

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. If you have a story to share click here.

ED 82

ED ALS Emergency Department OR 82

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

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). The Cochrane database of systematic reviews, 2019(10), CD002312. Br J Radiol. 2000;73(871):786-790.

E-9-1-1 183

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

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

FEBRUARY 26, 2022

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 visits in the US for mental health conditions has increased by 44% from 2006 to 2014. Reference: Kim et al.

ED 130

ED ALS Emergency Department OR 130

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

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). She arrives in the emergency department (ED) with decreased level of consciousness and shock.

EMR 130

EMR Coronary Defibrillator Life Support 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

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). He has a history of hypertension.

Ambulance 130

Ambulance Paramedic EMS ALS 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

ALiEM

NOVEMBER 1, 2023

In: Nelson LS, Goldfrank LR et al (eds): Goldfrank’s Toxicologic Emergencies. In: Nelson LS, Goldfrank LR et al (eds): Goldfrank’s Toxicologic Emergencies. McGraw-Hill Education; 2019 Madiwale T, Liebelt E. For iron toxicity, what are the indications for deferoxamine? What other medications can cause orange/red/brown urine? [6-9]

E-9-1-1 161

E-9-1-1 ALS OR ED 161

The Skeptics' Guide to EM

OCTOBER 19, 2019

Date: October 17th, 2019 Reference: Driver et al. Date: October 17th, 2019 Reference: Driver et al. Bougie use may be helpful in ED intubation.” Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation.

Firefighter 130

Firefighter Emergency Department Paramedic ALS 130

Pediatric EM Morsels

OCTOBER 6, 2023

Recently, a pediatric patient presented to the ED who just returned from abroad with a gastroenteritis presentation. Banerjee 2018, Rohilla 2019) Moral of the Morsel “ Ken-ya tell me if you recently travelled?” Post-COVID everyone seems to be posting the perfect picture of their travels to the far reaches of the world.

OR 161

OR EMS ED 161

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. What do you say? Reference: Lascarrou et al.

ALS 100

ALS CPR ICU EMS 100

Dr. Smith's ECG Blog

MAY 3, 2024

But this time the Queen gets it wrong (thinks it is not OMI): There were runs of VT: Tha patient arrived in profound shock and had an ED ECG: Now there is some evolution to include the ST elevation (rather than ST depression) in V4-V6. There is STE in aVR. Thus, there is high lateral OMI with diffuse ST depression.

ACS 122

ACS ED Coronary EMS 122

The Skeptics' Guide to EM

JANUARY 19, 2019

Date: January 17th , 2019 Reference: Clemency et al. Date: January 17th , 2019 Reference: Clemency et al. They concluded: “For patients treated in the ED for opioid overdose, an observation period of one hour is sufficient if they ambulate as usual, have normal vital signs and a Glasgow Coma Scale of 15”.

Naloxone 130

Naloxone Overdose Emergency Medical Services Emergency Department 130

EMS 12-Lead

AUGUST 14, 2022

The ST changes went overlooked by both the ED physician and the on-call cardiologist, and the patient was subsequently admitted to telemetry. It was present only minimally in this case, and I can’t say with certainty if said unimpressive manifestation had any decision making influence during ED admission.

STEMI 130

STEMI MICU CAD Coronary 130

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. Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8%

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

Pediatric EM Morsels

AUGUST 9, 2024

2019, there were 1,875 and this trend has continued to increase (2,157 case in 2020; 2,855 cases in 2021). 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?

E-9-1-1 152

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

ALiEM

NOVEMBER 29, 2023

Notes from the Field: Xylazine Detection and Involvement in Drug Overdose Deaths – United States, 2019. The skin changes are thought to be secondary to xylazine’s vasoconstricting properties on local blood vessels resulting in decreased skin perfusion, impaired wound healing, and increased risk of infection [5]. 2021;70(37):1300-1302.

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

George Mastoras (Twitter @georgemastoras), written by Jesse McLaren It’s a busy day in the ED when you’re sent another ECG to sign off from a patient at triage. 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.”

OR 70

OR STEMI ACS Coronary 70

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