ACEP Now

DECEMBER 11, 2023

Patients with severe agitation are frequently encountered in the emergency department (ED) setting. Emergency departments can be crowded and chaotic, further exacerbating mental health issues. ACEP Policy statement: Use of droperidol in the emergency department. Published January, 2021. Ann Emerg Med.

Emergency Department 52

Emergency Department ALS ED OR 52

ALiEM

SEPTEMBER 20, 2024

A 50-year-old male with insulin-dependent Type 2 Diabetes presented to the emergency department with three days of pain and swelling on the right side of his neck. 2021 Oct;21(5):442-444. doi: 10.1136/practneurol-2021-002928. Epub 2021 May 7. Additional Images Physical Exam Vitals : BP 153/96; HR 110; T 100.0°F;

Emergency Department 177

Emergency Department OR 177

ALiEM

NOVEMBER 17, 2023

A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. It often presents to the emergency department with complaints of vaginal bleeding, difficulty urinating, or dysuria. link] Published 2021.

Emergency Department 250

Emergency Department OR 250

EMergucate

OCTOBER 27, 2021

A 81 year old male presents to a regional emergency department, 4 hours away from a cath lab, complaining of chest pain. Below is the patients ECG:

Emergency Department 130

Emergency Department 130

ALiEM

FEBRUARY 9, 2024

Intermediate-risk patients may be further stratified based on recent stress testing or coronary angiogram findings plus a modified HEART or Emergency Department Assessment of Chest Pain (EDACS) score. This is endorsed in the 2022 ACC pathway [1] and the 2021 AHA chest pain guidelines [7]. 2021 May 13;:]. 2021 May 13;:].

E-9-1-1 276

E-9-1-1 ED Coronary ALS 276

EMergucate

OCTOBER 24, 2021

A 81 year old male presents to a regional emergency department, 4 hours away from a cath lab, complaining of chest pain. Below is the patients ECG:

Emergency Department 100

Emergency Department 100

The Skeptics' Guide to EM

AUGUST 24, 2024

Sean Baldwin is an Emergency Physician practising in Sydney, Australia in both a large tertiary emergency department and a small regional emergency department. Case: A 67-year-old male presents to your hospital emergency department (ED) after a fall from his bicycle. Reference: Partyka et al.

Emergency Department 129

Emergency Department ALS OR ED 129

The Skeptics' Guide to EM

OCTOBER 23, 2021

Date: October 20th, 2021 Reference: Talan et al. Pathway with single-dose long-acting intravenous antibiotic reduces emergency department hospitalizations of patients with skin infections. Date: October 20th, 2021 Reference: Talan et al. He has no fever, and his white blood cell count is 12,500. Reference: Talan et al.

Emergency Department 130

Emergency Department ALS OR 130

Pediatric EM Morsels

JULY 19, 2024

If bleeding, the only lab that is needed in the Emergency Department is a type and cross. 2021 Aug;147:110807. Epub 2021 Jun 24. 2021 Aug;147:110802. Epub 2021 Jun 12. CBC, coagulation panels, von Willebrand factor etc are less useful. Int J Pediatr Otorhinolaryngol. doi: 10.1016/j.ijporl.2021.110807.

E-9-1-1 286

E-9-1-1 Epinephrine Emergency Department OR 286

Pediatric EM Morsels

JUNE 2, 2023

Today we are talking about a rare disease called FPIES (food protein induced enterocolitis syndrome) and how you might encounter these patients in the Pediatric Emergency Department. 2021 Nov 29;92(S7):e2021518. You may not make the diagnosis, but detecting the clues is important for the family! Acta Biomed.

Emergency Department 189

Emergency Department ALS EMS OR 189

The Skeptics' Guide to EM

AUGUST 28, 2021

Date: August 27th, 2021 Reference: Gagnon et al. Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial. first appeared on The Skeptics Guide to Emergency Medicine. Date: August 27th, 2021 Reference: Gagnon et al.

ED 130

ED Emergency Department ALS OR 130

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 ). Propofol may often be preferable in the emergency department due to its rapid onset, ease of titration, and reliable capacity for sedation.

ICU 246

ICU Emergency Department Critical Care ALS 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. View other cases from this Clinical Image Series on ALiEM.

Emergency Department 246

Emergency Department OR EMS ED 246

Pediatric EM Morsels

AUGUST 9, 2024

Neonates presenting to the Emergency Department often cause a lot of uncertainty. Let’s review how Congenital Syphilis may present to our Emergency Departments: Congenital Syphilis : Basics Occurs when the spirochete Treponema pallidum is transmitted from mother to fetus. 2021 Feb 5;14(2):e240532.

E-9-1-1 152

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

EM Literature of Note

SEPTEMBER 13, 2024

These are each awful, of course, in their own way from a patient- and parent-oriented standpoint, but they’re also quite awful at the population level, overburdening limited pediatric and emergency department resources. The two “COVID seasons” of 2020-21 and 2021-22 were excluded from their comparisons.

Emergency Department 85

Emergency Department ED 85

EM Literature of Note

AUGUST 25, 2024

It’s NHAMCS – so it is representative data being transformed into rough weighted estimates – between 2010-2021, but we see its use increasing from 3.5% emergency departments” [link] Tweet of asthma visits to 17.3% – and the rates are over double that in children.

Emergency Department 92

Emergency Department 92

Pediatric EM Morsels

FEBRUARY 2, 2024

Abdel-Haq 2021). Travel dates can help to exclude certain infections by their incubation periods (Abdel-Haq 2021) Physical examination can sometimes reveal concerning features including hepatomegaly , jaundice or a rash that may guide differential. A study of swiss tourists found they compromised 53.4%

E-9-1-1 161

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

EM Literature of Note

JANUARY 9, 2022

link] Pathway with single-dose long-acting intravenous antibiotic reduces emergency department hospitalizations of patients with skin infections A sponsor encouraging discharge of patients with SSTI results in discharge of patients with SSTI. the subsequent hospitalization rate was around 10%.

Emergency Department 40

Emergency Department STEMI OR 40

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.

Emergency Department 130

Emergency Department ACS ALS ED 130

REBEL EM

JULY 1, 2024

Comparison of BPAP S/T and Average Volume-Assured Pressure Support Modes for Hypercapnic Respiratory Failure in the Emergency Department: A Randomized Controlled Trial. Balkan Med J 2021. Balkan Med J 2021. Cureus 2021. There are very limited studies however in the literature on the AVAPS mode of NIPPV.

ED 133

ED Emergency Department ALS OR 133

Core EM

JANUARY 25, 2024

SUMMARY: Upon initial evaluation of patients in the emergency department with clinical signs of soft tissue infections, consider using POCUS as a valuable tool to gather more information in patients with a high suspicion for the diagnosis and/or are too unstable to undergo CT imaging. Updated 2021 Jul 27]. Wallace HA, Perera TB.

E-9-1-1 246

E-9-1-1 Emergency Department OR 246

ALiEM

NOVEMBER 10, 2023

A 33-year-old male presented to the emergency department with a diffuse pruritic rash that appeared several days after starting Trimethoprim/Sulfamethoxazole (TMP-SMX) for a dental infection. 2021 Sep 1;57(9):925. Epub 2021 Jul 1. Progression stopped after discontinuing TMP-SMX. References Anderson HJ, Lee JB.

Emergency Department 161

Emergency Department OR 161

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. He is a GP by training but works in Emergency Department, Anaesthesia, Internal Medicine and Paediatrics. Date: April 6th, 2021 Guest Skeptic: Dr. Casey Parker is a Rural Generalist from the NW of Australia.

Emergency Department 130

Emergency Department Coronary ED OR 130

Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. Pediatric Endotracheal Intubations for Airway Management in the Emergency Department.

E-9-1-1 135

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

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Date: September 20th, 2021 Reference: Litell et al. Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. Guest Skeptic: Dr. Jess Monas is a Consultant in the Department of Emergency Medicine at the Mayo Clinic Hospital, Phoenix, Arizona.

EMR 100

EMR Emergency Department ICU ALS 100

Core EM

JANUARY 25, 2024

link] ) Laboratory Evaluation: Clinical presentation and laboratory findings can help suggest TTP in the emergency department. Joly, 2017; Sawler, 2020) Fresh frozen plasma (FFP) (contains ADMTS-13) may be used to supplement ADAMTS-13 if there is a delay in initiating TPE in the emergency department (i.e. J Emerg Med.

Plasma 246

Plasma Frozen Plasma Emergency Department FFP 246

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 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.

Emergency Department 152

Emergency Department ED OR 152

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. Case: A 25-day-old, full-term boy presents to the emergency department with fever.

Emergency Department 130

Emergency Department ALS OR ED 130

Don't Forget the Bubbles

SEPTEMBER 30, 2024

In the UK, as in most developed countries, more patients are presenting to Emergency Departments (EDs) with minor illnesses or injuries. Emergency department overcrowding is a complex issue with multiple contributing factors. The 2021 census revealed an 11.8% Simpson et al. Simpson et al.

Emergency Department 89

Emergency Department ALS ED OR 89

The Skeptics' Guide to EM

NOVEMBER 20, 2021

Date: November 16th, 2021 Reference: Hammouda et al. Moving the Needle on Fall Prevention: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement. She […] The post SGEM#351: How to Stop Geriatrics from Free Fallin’ first appeared on The Skeptics Guide to Emergency Medicine.

ALS 130

ALS ED Emergency Department OR 130

The Skeptics' Guide to EM

FEBRUARY 19, 2022

Tim Graham is a Clinical Professor of emergency medicine at the University of Alberta, and Associate Chief Medical Information Officer, Edmonton Zone, of Alberta Health Services from Edmonton, Alberta. The title of the article was “Physician, heal thyself” and was in the humanities section of the October 2021 issue.

Emergency Department 130

Emergency Department ALS OR 130

The Skeptics' Guide to EM

JANUARY 29, 2022

Efficacy of empiric antibiotic management of septic olecranon bursitis without bursal aspiration in emergency department patients. AEM January 2022 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Reference: Beyde et al.

Emergency Department 130

Emergency Department ALS ED 130

The Skeptics' Guide to EM

APRIL 2, 2022

Take-Pause: Efficacy of mindfulness-based virtual reality as an intervention in the pediatric emergency department. AEM March 2022 Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. Reference: Butt et al.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

APRIL 17, 2021

Date: April 16th, 2021 Guest Skeptic: Dr. Anthony Crocco is the Deputy Chief – McMaster Department of Pediatrics, Acting Head of Pediatric Cardiology, and creator of Sketchy EBM. Reference: Schuh et al. Reference: Schuh et al. Her usual triggers are upper respiratory infections and cats.

Emergency Department 130

Emergency Department ALS ED 130

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. 2021 Jun;31(6):713-719. Epub 2021 Apr 11. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS).

E-9-1-1 183

E-9-1-1 Operating Room Emergency Department ALS 183

The Skeptics' Guide to EM

DECEMBER 18, 2021

Date: December 13th, 2021 Reference: Lee et al. Addressing gender inequities: Creation of a multi-institutional consortium of women physicians in academic emergency medicine. Date: December 13th, 2021 Reference: Lee et al. Women are paid less than men, even after accounting for potential confounders [2, 8-10].

Emergency Department 100

Emergency Department ALS ED OR 100