Core EM

JANUARY 25, 2024

Patients in this trial were on relatively low doses of both dexmedetomidine and propofol and higher doses of fentanyl which may limit the ability to adequately compare the two agents well ( Hughes 2021 ). μg/kg IV Maintenance dose: 0.5 – 15 μg/kg/hr Rapid onset. Short acting. Not affected by hepatic or renal failure.

ICU 246

ICU Emergency Department Critical Care ALS 246

EMDocs

NOVEMBER 13, 2024

Literature concerning risk with PPIs is controversial. Presentation: Classic presentation is abdominal pain or tenderness, fever, and altered mental status. Literature suggests 10-33% of patients are asymptomatic or only have mild symptoms. Clinician sensitivity for SBP based on bedside assessment is between 40-75%. increase in mortality.

E-9-1-1 71

E-9-1-1 ALS OR ED 71

Pediatric EM Morsels

APRIL 5, 2024

Silva-Ramos 2021) Majority of cases arise from travel to South Africa. (Silva-Ramos 2021) Majority of cases arise from travel to South Africa. (Frean 2019) The classic triad described is fever, eschar and rash. Silva-Ramos 2021) Fever and a characteristic eschar (tache noir) are seen 90% of the time.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

Core EM

JANUARY 25, 2024

References: Yuan TH, Kerns WP, Tomaszewski CA, et al. von Lewinski D, Bruns S, Walther S, et al. Cole JB, Corcoran JN, Engebretsen KM, et al. Holger JS, Engebretsen KM, Fritzlar SJ, et al. Kerns W, Schroeder D, Williams C, et al. Kline JA, Tomaszewski CA, Schroeder JD, et al. Disposition to ICU. Circulation.

Overdose 246

Overdose ALS Epinephrine Critical Care 246

The Skeptics' Guide to EM

AUGUST 24, 2024

Date: August 19, 2024 Reference: Partyka et al. The evidence was not robust enough back in 2021 to confidently use this potential tool. Reference: Partyka et al. Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management: The SABRE Randomized Clinical Trial. We have covered rib fractures twice on the SGEM.

Emergency Department 129

Emergency Department ALS OR ED 129

Core EM

JULY 23, 2024

Author: Mallika Singh, MD Editor: Jonathan Kobles, MD Background Unintentional or intentional exposure to radiological material represents a potential threat to human health on the individual to mass-casualty scale. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. 10-Hour Flight: 0.03

ALS 130

ALS OR Emergency Department ED 130

The Skeptics' Guide to EM

NOVEMBER 20, 2021

Date: November 16th, 2021 Reference: Hammouda et al. AEM November 2021 Guest Skeptic: Dr. Kirsty Challen (@KirstyChallen) is a Consultant in Emergency Medicine and Emergency Medicine Research Lead at Lancashire Teaching Hospitals Trust (North West England). Date: November 16th, 2021 Reference: Hammouda et al.

ALS 130

ALS ED Emergency Department 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. Defibrillation is the treatment of choice in these cases but does not often result in sustained ROSC ( Kudenchuk et al 2006). The TOMAHAWK Investigators. first appeared on The Skeptics Guide to Emergency Medicine.

EMR 130

EMR Coronary Defibrillator Life Support 130

The Skeptics' Guide to EM

JANUARY 1, 2022

Date: December 21st, 2021 Guest Skeptic: Dr. Howard “Howie” Mell began his career as a firefighter / paramedic in Chicago. Reference: Grotta JC et al. NEJM 2021 […] The post SGEM#354: Everybody Walk the Dinosaur and Not Take the MSU first appeared on The Skeptics Guide to Emergency Medicine. Reference: Grotta JC et al.

Emergency Medical Services 130

Emergency Medical Services Firefighter Paramedic ALS 130

The Skeptics' Guide to EM

AUGUST 21, 2021

Date: August 19th, 2021 Reference: Pantell et al. Pediatrics 2021 Guest Skeptic: Dr. Dennis Ren is a pediatric emergency medicine fellow at Children’s National Hospital in Washington, DC. Date: August 19th, 2021 Reference: Pantell et al. Evaluation and management of well-appearing febrile infants 8 to 60 days old.

Emergency Department 130

Emergency Department ALS OR ED 130

The Skeptics' Guide to EM

OCTOBER 23, 2021

Date: October 20th, 2021 Reference: Talan et al. AEM October 2021 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. Date: October 20th, 2021 Reference: Talan et al. Reference: Talan et al.

Emergency Department 130

Emergency Department ALS OR 130

The Skeptics' Guide to EM

JANUARY 8, 2022

Date: December 28th, 2021 Reference: Kulvatunyou et al. November 2021. Date: December 28th, 2021 Reference: Kulvatunyou et al. November 2021. Reference: Kulvatunyou et al. November 2021. J Trauma and Acute Care Surgery. J Trauma and Acute Care Surgery. J Trauma and Acute Care Surgery.

ALS 130

ALS Emergency Department Paramedic OR 130

REBEL EM

JULY 1, 2024

Paper: Goren NZ et al. Balkan Med J 2021. References: Goren NZ et al. Balkan Med J 2021. PMID: 34462252 Abubacker AP et al. Cureus 2021. There are very limited studies however in the literature on the AVAPS mode of NIPPV. AVAPS: 0.07 P = 0.015 PaCO2 Excretion in 1 st Hour BPAP S/T: 4.75 AVAPS: 10.20

ED 133

ED Emergency Department ALS OR 133

The Skeptics' Guide to EM

DECEMBER 25, 2021

Date: December 21st, 2021 Guest Skeptic: Dr. Spencer Greaves is an Emergency Medicine resident at Florida Atlantic University. Date: December 21st, 2021 Guest Skeptic: Dr. Spencer Greaves is an Emergency Medicine resident at Florida Atlantic University. ” Reference: Vallentin et al. Reference: Vallentin et al.

Epinephrine 130

Epinephrine CPR ALS Emergency Department 130

Pediatric EM Morsels

MARCH 17, 2023

In the US, the venomous snakes include rattlesnakes , copperheads, cottonmouths/water moccasins , and coral snakes [ CDC, 2021 ] Rattlesnakes live all across the United State s Copperheads inhabit the eastern U.S. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ).

Frozen Plasma 130

Frozen Plasma Plasma First Aid OR 130

The Skeptics' Guide to EM

SEPTEMBER 18, 2021

Date: September 16th, 2021 Reference: Sippola et al. JAMA 2021 Guest Skeptic: Dr. Rob Leeper is an assistant professor of surgery at Western University and the London Health Sciences Center. Date: September 16th, 2021 Reference: Sippola et al. The APPAC II Randomized Clinical Trial.

ALS 130

ALS Critical Care OR 130

The Skeptics' Guide to EM

AUGUST 28, 2021

Date: August 27th, 2021 Reference: Gagnon et al. AEM 2021 Guest Skeptic: Dagny Kane-Haas is a physiotherapist who also has a master’s degree in Clinical Science in Manipulative Therapy. Date: August 27th, 2021 Reference: Gagnon et al. first appeared on The Skeptics Guide to Emergency Medicine.

ED 130

ED Emergency Department ALS OR 130

Pediatric EM Morsels

JULY 21, 2023

Gag reflex is much better predictor (45% vs 6%) [Conzelmann 2021] Positive predictive value of GCS indicating aspiration in intoxication was only 3%. 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? Inappropriate speech- No conversation.

Critical Care 246

Critical Care ALS OR Life Support 246

Pediatric EM Morsels

JUNE 2, 2023

2021 Nov 29;92(S7):e2021518. Rare diseases are not confined to the pages of a textbook or computer screen. Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! Update on Food protein-induced enterocolitis syndrome (FPIES).

Emergency Department 189

Emergency Department ALS EMS OR 189

Core EM

MARCH 12, 2024

Author: Mallika Singh, MD Editor: Jonathan Kobles, MD Background Unintentional or intentional exposure to radiological material represents a potential threat to human health on the individual to mass-casualty scale. Radioactive sources include medical isotopes, fuel rods, generators, and other industrial sources. 10-Hour Flight: 0.03

ALS 130

ALS OR Emergency Department ED 130

The Skeptics' Guide to EM

FEBRUARY 27, 2021

Date: February 18th, 2021 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. Reference: Brichko et al. Date: February 18th, 2021 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. AEM Feb 2021.

Emergency Department 130

Emergency Department ACS ALS ED 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. 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

ALiEM

SEPTEMBER 27, 2023

Hoffman et al. Koppaka V, Thompson DC, Chen Y, et al. Updated 2021 Nov 1]. Disulfiram-like reaction with ethanol consumption Coprinus atramentarius or Ink Cap mushroom is well known to cause a disulfiram-like reaction when it is consumed prior to ethanol. New York, NY. McGraw-Hill. Pharmacol Rev. 2012 Jul;64(3):520-39.

ALS 169

ALS OR ED 169

The Skeptics' Guide to EM

AUGUST 14, 2021

Date: August 12th, 2021 Reference: Daya et al. Date: August 12th, 2021 Reference: Daya et al. This was a critical appraisal of an observational study published in Annals of EM ( Kawano et al 2018 ). Reference: Daya et al. first appeared on The Skeptics Guide to Emergency Medicine.

CPR 130

CPR BLS ALS Paramedic 130

ALiEM

JUNE 15, 2023

Goldfrank’s Toxicologic Emergencies, 11e New York, NY: McGraw-Hill; 2019 Morimoto M, Tatsumi K, Yuui K, et al. 2021 Nov;7(6):2440-2444. PMID 29855084 De Silva HA, Fonseka MM, Pathmeswaran A et al. Lily of the valley ( Convallaria majalis ) is a woodland perennial with a sweet scented, white bell-shaped flower. Vet Med Sci.

ALS 246

ALS ED OR 246

The Skeptics' Guide to EM

APRIL 16, 2022

Date: April 16th, 2022 Reference: Blom et al. BMJ 2021 Guest Skeptic: Dr. Matt Schmitz, Pediatric Orthopedics, Adolescent Sports Medicine and Young Adult Hip Preservation Surgeon at San Antonio Military Medical Center in Texas. Date: April 16th, 2022 Reference: Blom et al. Tricoci et al. Reference: Blom et al.

Emergency Department 100

Emergency Department ALS OR ED 100

The Skeptics' Guide to EM

SEPTEMBER 4, 2021

Date: August 31st, 2021 Reference: McLean et al. AEM Sept 2021 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Date: August 31st, 2021 Reference: McLean et al. AEM Sept 2021 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Reference: McLean et al.

Emergency Department 100

Emergency Department ALS OR ED 100

The Skeptics' Guide to EM

FEBRUARY 19, 2022

CMAJ 2021 TRIGGER WARNING: As a warning to those listening to the podcast or […] The post SGEM Xtra: Everybody Hurts, Sometime first appeared on The Skeptics Guide to Emergency Medicine. The title of the article was “Physician, heal thyself” and was in the humanities section of the October 2021 issue. Reference: Graham T.

Emergency Department 130

Emergency Department ALS OR 130

Core EM

JANUARY 25, 2024

Deficient ADAMTS-13 activity alone typically does not result in TTP; therefore, it is essential to consider contributing precipitants, including pregnancy, HIV, acute infection, inflammation (SLE, malignancy, pancreatitis) and medication use (ex., Clinical Presentation: Classic pentad (mnemonic FAT RN) is rare and seen in less than 7% of cases.

Plasma 246

Plasma Frozen Plasma Emergency Department FFP 246

The Skeptics' Guide to EM

MARCH 11, 2023

Date: March 8, 2023 Reference: Smida et al. Date: March 8, 2023 Reference: Smida et al. Two large trials, PART by Wang et al and AIRWAYS-2 by Benger et al recently evaluated the King-LT and the iGel respectively as alternatives to endotracheal intubation (ETI) in cardiac arrest. Reference: Smida et al.

CPR 130

CPR Defibrillator BLS Paramedic 130

EMDocs

AUGUST 22, 2024

You may be more familiar with the term “limited English proficiency” (LEP), defined as: someone who does not speak English as their primary language and has a limited ability to read, speak, write, or understand English. For instance, displaying posters in multiple languages that explain the language services patients are entitled to.

Emergency Department 81

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

REBEL EM

FEBRUARY 19, 2024

The 2021 Surviving Sepsis Campaign Guidelines suggest starting vasopressors peripherally rather than delaying infusion until a CVC is placed [2]. Paper: Yerke JR et al. References: Yerke JR et al. PMID: 37611862 Evans L et al. Crit Care Med 2021. of patients not requiring CVC insertion. CHEST 2024.

ICU 137

ICU EMS ALS OR 137

The Skeptics' Guide to EM

JULY 3, 2021

Date: July 1st, 2021 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com. Reference: Dankiewicz et al: TTM2 Trial Investigators. NEJM 2021 Case: A 58-year-old man collapsed in front of his family. Reference: Dankiewicz et al: TTM2 Trial Investigators.

Paramedic 130

Paramedic Defibrillator ALS 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.) The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. 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

JANUARY 23, 2021

Date: January 20th, 2021 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. Reference: Pines et al. AEM January 2021 Case: A 50-year-old male presents to the Emergency Department (ED) with left lower quadrant abdominal pain.

ED 130

ED ALS Emergency Department OR 130

Dr. Smith's ECG Blog

MAY 27, 2024

Nikus et al. Curr Cardiol Red 2021 3. Kontos et al. Bischof et al. Meyers et al. J Am Heart Assoc 2021 6. Meyers et al. IJC Heart and Vasc 2021 8. Herman et al. Click here to sign up for Queen of Hearts Access Take away 1. Conduction disorders in the setting of acute STEMI.

STEMI 121

STEMI Coronary ALS Emergency Department 121

The Skeptics' Guide to EM

JULY 31, 2021

Date: July 29th, 2021 Reference: Azizi et al. Injury 2021 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the Air Force in Ohio. Date: July 29th, 2021 Reference: Azizi et al. Injury 2021 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the Air Force in Ohio.

ALS 130

ALS OR EMS 130