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

AUGUST 4, 2023

Let’s take a take a minute to review Superior Mesenteric Artery Syndrome presenting in the ED so we will be prepared when you see it! Okamoto, 2019) Superior Mesenteric Artery Syndrome: Presentation Presenting complaints are often vague but include epigastric abdominal pain, gastric distension, early satiety, and vomiting.

E-9-1-1 246

E-9-1-1 ED OR EMS 246

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 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

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

Pediatric EM Morsels

JUNE 30, 2023

I’m sure you can recall at least several parents who bring their children into the ED for concern of recurrent pneumonias. Often the parents focus on a possible underlying immunodeficiency. Fortunately, most commonly these pneumonias are due to viral infections, and we can often offer reassurances to the parent. Dec 46 (6) 999–1002, [link].

E-9-1-1 281

E-9-1-1 ED EMS OR 281

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 66

OR STEMI ACS Coronary 66

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

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

Pediatric EM Morsels

SEPTEMBER 22, 2023

Tenenbein M, Macias CG, Sharieff GQ, et al, eds. McGraw Hill Education; 2019:104-109 Dave S, DAHLSTROM JJ. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. McGraw Hill Education; 2019:125-138 Ziu E, Mesfin FB. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues. Basics are the Best!

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

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

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

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

EMDocs

JUNE 16, 2023

Podcast: Play in new window | Download (Duration: 13:57 — 19.2MB) Subscribe: Apple Podcasts | Google Podcasts | RSS Management of the child with mental health problems who is boarding in the ED In episode 1 of this series, we discussed differentiating organic vs psychiatric causes of agitation in children.

ED 52

ED Mental Health Services Emergency Department Emergency Medical Services 52

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 145

Allergic Reaction Plasma ED Epinephrine 145

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

EMDocs

SEPTEMBER 25, 2023

However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). While RSI should remain the gold standard in the vast majority of patients in the ED, FI presents an additional technique to mitigate anatomic or physiologic risk.

ED 65

ED Emergency Department ALS Paramedic 65

REBEL EM

JANUARY 23, 2023

Moreover, the FDA approved intravenous (IV) cetirizine to treat acute urticaria in 2019. Key Secondary Endpoints: 5 (3.9%) patients in the IV cetirizine group returned to any ED or clinic within 24 hours compared to 15 (11.1%) in the IV diphenhydramine group; P=0.04 Article: Abella BS et al. in the IV cetirizine group and 2.1

Allergic Reaction 52

Allergic Reaction ED E-9-1-1 Emergency Department 52

EMDocs

JUNE 3, 2023

The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. Her initial vital signs are blood pressure 76/54 mmHg, heart rate 128 bpm, temperature 37.0˚ C, respiratory rate 20 breaths per minute, and oxygen saturation 95% on room air. of pelvic fractures to be open.

ED 54

ED Operating Room ALS Frozen Plasma 54

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

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 81

Emergency Department ALS E-9-1-1 ED 81

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

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

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

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

EMDocs

NOVEMBER 19, 2024

His roommate found an empty pill bottle on the floor next to him. Second-generation antipsychotics (see Table 1 below) improve both positive and negative symptoms of schizophrenia and are less likely to be associated with EPS. 1,2 Most second-generation antipsychotics act as D 2 antagonists and inhibit the 5-HT 2A receptor.

Overdose 74

Overdose EMS Emergency Medical Services OR 74

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

Core EM

OCTOBER 2, 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 100

Allergic Reaction Plasma ED Epinephrine 100

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

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

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

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 91

First Aid ED OR ALS 91

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

ACEP Now

DECEMBER 11, 2023

The Emergency Department Benchmarking Alliance (EDBA) is a membership organization composed of high-performance emergency departments (EDs) that share a commitment to quality. Thus, the survey included data for about one-third of all patients seen in US ED’s in 2022. 1 Boarding time increases led to unprecedented ed walkaway rates.

Emergency Department 52

Emergency Department ED EMS ALS 52

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 113

ACS ED Coronary EMS 113

REBEL EM

DECEMBER 13, 2023

Goldfrank’s Toxicology 2019) Carboxyhemoglobin levels > 25% or >15% in pregnant patients are indications for hyperbarics, independent of signs/symptoms There is evidence that hyperbaric oxygenation reduces the risk of cognitive sequelae after acute carbon monoxide poisoning. Toxicity is mediated through multiple mechanisms.

OR 105

OR EMS ED 105

EMDocs

JANUARY 9, 2024

Episode 92: Marine Ingested Poisons and Infections Scombroid Pathophysiology: Fish from family Scombroidae Tuna , mackerel, skipjack, bonito Dark-meat fish Herring, bluefish , anchovy, sardine, amberjack, black marlin, and mahi mahi Histidine decarboxylase produces histamine and histamine like products Improper preservation Presentation Metallic, bitter (..)

ED 82

ED OR 82