Core EM

JANUARY 25, 2024

2021 Background Prehospital trauma team activation criteria allow for prompt mobilization of personnel and resources. A narrow pulse pressure has been shown to predict the need for hemorrhage control in the ED setting but has not been assessed as a predictor in the prehospital setting. Prehospital hypotension is one of those criteria.

Operating Room 246

Operating Room EMS ED ICU 246

ALiEM

AUGUST 7, 2023

A 10-year-old male with no past medical history presents to the Emergency Department (ED) by EMS for evaluation of an injury sustained while playing tackle football. The patient was forcibly hit by another child against a tree. The patient is reluctant to abduct the right arm secondary to pain.

Emergency Department 246

Emergency Department OR EMS ED 246

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

The Skeptics' Guide to EM

FEBRUARY 13, 2021

Date: February 12th, 2021 Guest Skeptic: Dr. Dennis Ren is a paediatric emergency medicine fellow at Children’s National Hospital in Washington, DC. Pediatrics 2020 Case: A 4-year-old immunized girl presents to the emergency department (ED) with a fever and rhinorrhea for the […] The post SGEM#319: Is it Aseptic Meningitis or More Than This?

OR 130

OR Emergency Department ALS ED 130

Core EM

JANUARY 25, 2024

Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients. Short acting. mg/kg IV followed by 0.05 – 0.4

Emergency Department 246

Emergency Department ICU Critical Care ALS 246

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk. Abdel-Haq 2021).

E-9-1-1 161

E-9-1-1 ED OR Emergency Department 161

REBEL EM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

ED 129

ED E-9-1-1 Emergency Department ALS 129

Core EM

JANUARY 25, 2024

One week prior to ED arrival, the patient was becoming progressively despondent, less interactive with peers, exhibiting slow speech and movements, and was not eating. Patient Case: History: A 60-year-old male with history of schizophrenia and depression on multiple unknown antipsychotic medications presents with unresponsiveness x 1 day.

MICU 246

MICU Emergency Department OR ED 246

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. 2021 Oct 9;22(20):10911. Wu CY, Wu JD, Chen CC.

Plasma 269

Plasma OR ED Critical Care 269

The Skeptics' Guide to EM

APRIL 20, 2024

Case: You are doing great things and helping many patients during your shift in the emergency department (ED) when you hear a trauma alert being called overheard. The evidence was not robust enough back in 2021 to confidently use this potential tool. It risks stratified older patients with blunt trauma.

Emergency Department 207

Emergency Department Overdose ALS ED 207

Dr. Smith's ECG Blog

OCTOBER 1, 2023

This is a re-post of an excellent case from 2021. He called EMS who brought him to the ED. ED Diagnoses: 1. The basic principles of emergency ECG interpretation in patients who present to an ED with new symptoms include the following: Respect the History. See it again now, along with our new Queen of Hearts functionality.

OR 131

OR STEMI Coronary CAD 131

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

Core EM

OCTOBER 16, 2024

Annie: I developed an interest in EM while working as a scribe in the ED during college. In addition to what Charlotte and Nick said, I can envision myself staying calm in the stressful situations that come up in the ED. Nick: Triaging your time and priorities as an ED doc on shift is so challenging.

ED 100

ED EMS Critical Care OR 100

Core EM

SEPTEMBER 24, 2024

Annie: I developed an interest in EM while working as a scribe in the ED during college. In addition to what Charlotte and Nick said, I can envision myself staying calm in the stressful situations that come up in the ED. Nick: Triaging your time and priorities as an ED doc on shift is so challenging.

ED 100

ED EMS Critical Care OR 100

Core EM

JANUARY 25, 2024

1 2 3 4 This article will focus on three lower extremity (LE) nerve blocks commonly used for acute lower extremity pain in the ED. 1 2 3 4 This article will focus on three lower extremity (LE) nerve blocks commonly used for acute lower extremity pain in the ED. Blocks with larger volumes of anesthetic carry higher risk of LAST.

Epinephrine 246

Epinephrine ED OR Emergency Department 246

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. 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

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. 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. Reference: Brichko et al.

Emergency Department 130

Emergency Department ACS ALS ED 130

ALiEM

MARCH 1, 2024

A 24-year-old female with no pertinent PMHx presents to the ED with a chief complaint of eye pain. Her mom convinced her to go to the ED and she first went to an outside hospital, but was referred to come to our institution. McGraw Hill; 2021. She had been managing her pain with ice and had not taken any OTC medications.

ED 152

ED OR 152

ALiEM

JUNE 15, 2023

2021 Nov;7(6):2440-2444. 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]. It resembles wild leek or garlic ( Allium tricoccum ) and misidentification has led to case reports of toxicity [2].

ALS 246

ALS ED OR 246

Pediatric EM Morsels

OCTOBER 6, 2023

Recently, a pediatric patient presented to the ED who just returned from abroad with a gastroenteritis presentation. The most common countries of acquisition were Bangladesh, India, Nepal, and Pakistan (Forster 2021) For travelers, the peak incidence occurs at age 10 and those who are visiting to their country of birth.

OR 161

OR EMS ED 161

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

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain. The patient had no chest symptoms until he had been in the ED for many hours and had been undergoing management of his DKA. The patient was under the care of another ED physician. Another ECG was recorded: What do you think?

ED 111

ED Coronary CAD STEMI 111

The Skeptics' Guide to EM

APRIL 10, 2021

Date: April 6th, 2021 Guest Skeptic: Dr. Casey Parker is a Rural Generalist from the NW of Australia. Date: April 6th, 2021 Guest Skeptic: Dr. Casey Parker is a Rural Generalist from the NW of Australia. Most of the trials were done in marathon and ultra-marathon runners whom we do not see very often in the ED [5-7].

Emergency Department 130

Emergency Department Coronary ED OR 130

Core Ultrasound

MARCH 25, 2024

Old IVC Vid (2021) TEE VTI Here are Dr. Spiegel’s Notes: 1. For example a pt in the ED with sepsis, and a collapsible IVC, dry lungs and no peripheral edema is more likely to benefit from fluid than be harmed Take that same pt, with the same US and physical exam findings and make it 72-hrs later in the ICU after 6-10 L.

ICU 189

ICU ED OR 189

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

ALiEM

SEPTEMBER 11, 2023

A 29-year-old female with a past medical history of migraine headaches presented to the emergency department (ED) for several hours of bilateral eye pain, redness, and decreased visual acuity. 2021 Apr;44(2):330-367. Epub 2021 Mar 25. The patient is a contact lens wearer. CLEAR – Contact lens complications. 2021.02.010.

Emergency Department 152

Emergency Department ED OR 152

Don't Forget the Bubbles

NOVEMBER 29, 2023

Even though sedation after endotracheal intubation (ETI) reduces the risk of self-extubation, uncontrolled pain, and awakening awareness, several small single-centre studies demonstrate low rates of sedative drug administration after ETI in the emergency department (ED). This article is based on: Mayberry, H., Burgart, A.M. and Kanaris, C.,

E-9-1-1 135

E-9-1-1 Emergency Department ED CPR 135

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. Case: A 43-year-old male presents to your emergency department (ED) the day after being involved in an all-terrain vehicle (ATV) accident. November 2021.

ALS 130

ALS Emergency Department Paramedic OR 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. Background: Parents often bring their infants to the ED with concerns about fever.

Emergency Department 130

Emergency Department ALS OR ED 130

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). Early Congenital Syphilis Present before 2 years of age [ Hussain, 2023 ; Foles, 2024; Fang, 2022; Morrisroe, 2021 ] Only ~33% of newborns present with symptoms at birth and can be subtle. Is this scalp swelling normal?

E-9-1-1 152

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

The Skeptics' Guide to EM

MARCH 6, 2021

Date: March 4th, 2021 Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at St. Date: March 4th, 2021 Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at St. Ann Emerg Med 2021 Case: A 70-year-old man presents with epistaxis. Reference: Reuben A et al.

ALS 130

ALS Emergency Department EMS ED 130

The Skeptics' Guide to EM

MAY 22, 2021

Date: May 21st, 2021 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. AEM May 2021 Case: A 32-year-old female presents with headache after a low-speed motor vehicle collision as a restrained driver. Reference: Varner et al.

Emergency Department 130

Emergency Department ED ALS OR 130

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

ALiEM

AUGUST 21, 2023

McGraw Hill; 2021. Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2021 SAEM Annual Meeting | Copyrighted by SAEM 2021 – all rights reserved. Radiographs may be performed to evaluate for occult traumatic injury or foreign body. References Ritter K, Fitch R.

OR 130

OR ED 130

EMDocs

JULY 17, 2023

and is poorly tolerated by patients with obstruction, it should not be a routine part of the ED evaluation for LBO unless it is critical for another diagnosis on the differential. He describes the pain as a gradually worsening pressure-like discomfort distributed across his entire abdomen. He reports distension and the sensation of fullness.

E-9-1-1 77

E-9-1-1 ED ALS Operating Room 77

The Skeptics' Guide to EM

JUNE 26, 2021

Date: June 25th, 2021 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. Date: June 25th, 2021 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. Reference: Chinnock et al.

Emergency Department 100

Emergency Department ED ALS OR 100

ALiEM

SEPTEMBER 27, 2023

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. This results in significant nausea and vomiting and can lead to tachycardia and hypotension. doi: 10.1016/B978-0-12-386454-3.00754-5.

ALS 169

ALS OR ED 169