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. Emergency departments can be crowded and chaotic, further exacerbating mental health issues. Rapid and efficacious.

Emergency Department 52

Emergency Department ALS ED OR 52

The Skeptics' Guide to EM

APRIL 20, 2024

Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial. Background: We have covered rib fractures once before on the Skeptics’ Guide to Emergency Medicine.

Emergency Department 207

Emergency Department Overdose ALS ED 207

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. You (or someone in your department) needs to know which assay your ED has, and use the appropriate values for that assay.

E-9-1-1 276

E-9-1-1 ED Coronary ALS 276

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. first appeared on The Skeptics Guide to Emergency Medicine. Reference: Mintegi S et al. Clinical Prediction Rule for Distinguishing Bacterial from Aseptic Meningitis.

OR 130

OR Emergency Department ALS ED 130

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

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. Your support staff…depending on the amount of bleeding, you are about to have your hands full and may need IV access, medications, airway management, etc. Set up suction x2 in the room!

E-9-1-1 286

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

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

Core EM

JANUARY 25, 2024

Lipophilic with adipose deposition, withdrawal symptoms after prolonged infusion Hydromorphone 5 – 15 min 2 – 3 hr 0.5 – 3 mg/hr No active metabolites however parent drug can accumulate in renal failure Morphine 5 – 10 min 3 – 4 hr 2 – 30 mg/hr Active metabolites can accumulate in renal failure Remifentanil 1 – 3 min 3 – 10 min Loading dose: 1.5

ICU 246

ICU Emergency Department Critical Care ALS 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. Is this scalp swelling normal?

E-9-1-1 152

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

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

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. Rare diseases are not confined to the pages of a textbook or computer screen. Acta Biomed.

Emergency Department 189

Emergency Department ALS EMS OR 189

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

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

Core EM

JANUARY 25, 2024

link] ) Laboratory Evaluation: Clinical presentation and laboratory findings can help suggest TTP in the emergency department. fluoroquinolones, quinine, clopidogrel, and ticlopidine) Congenital/Familial TTP: 2% of cases occur in childhood via autosomal recessive mutations in the ADAMTS-13 gene.

Plasma 246

Plasma Frozen Plasma Emergency Department FFP 246

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

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

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

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. A 12-year-old male is being transported by ambulance after a road traffic accident. His name is Ben.

E-9-1-1 135

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

Don't Forget the Bubbles

OCTOBER 2, 2024

A previously well 6-year-old boy is brought into the emergency department at a major trauma centre via HEMS following a road traffic accident, in which he was hit by a car while crossing the road. There was also a meta-analysis on this topic in the adult population by Schwimmbeck et al [6] in 2021.

OR 49

OR Critical Care ALS Emergency Department 49

EM Literature of Note

JANUARY 9, 2022

The Annals of Emergency Medicine Podcast continues apace, with free monthly updates from the original research published in the journal: iTunes Link SoundCloud Link Likewise, the Annals of Emergency Medicine Journal Club has published several monthly installments: Predicting Outcomes in Pediatric Pneumonia: Are We Omnipotent or Incompetent?

Emergency Department 40

Emergency Department STEMI OR 40

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

An estimated 7% to 15% of acutely hospitalized psychiatric patients and psychiatric emergency department patients exhibit catatonia [4]. Malignant Catatonia (AKA “lethal catatonia”): An acute onset life-threatening subtype of catatonia that is characterized by fever, autonomic instability, delirium, and rigidity [4].

MICU 246

MICU Emergency Department OR ED 246

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. Learning about international trends sparked our curiosity about our own department.

Emergency Department 89

Emergency Department ALS ED OR 89

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

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

OCTOBER 12, 2024

doi: 10.1136/archdischild-2023-326773 Two-year-old Moyo is brought to the emergency department because her parents were concerned about noisy breathing. Most children can be discharged from the emergency department after a dose of corticosteroids and an appropriate safety net. Published Online First: 15 April 2024.

Emergency Department 85

Emergency Department ALS OR 85

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. No foreign body on lid eversion. 2021.02.010.

Emergency Department 152

Emergency Department ED OR 152

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

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

ALiEM

AUGUST 18, 2023

A middle-aged man with a past medical history of hypertension and tobacco use disorder presented to the Emergency Department after evaluation by an ophthalmologist. He complained of ten days of a right-sided headache and three days of diplopia. He denied eye pain, pain with eye movements, photophobia, and vision loss.

Emergency Department 130

Emergency Department OR 130

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? 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.

Emergency Department 81

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

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. He and his wife live in Boynton Beach, FL […] The post SGEM#353: At the COCA, COCA for OCHA first appeared on The Skeptics Guide to Emergency Medicine. ” Reference: Vallentin et al.

Epinephrine 130

Epinephrine CPR ALS Emergency Department 130

The Skeptics' Guide to EM

APRIL 24, 2021

Date: April 19th, 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). Kirsty is also the creator of the wonderful infographics called #PaperinaPic. Reference: Martel et al.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

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

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

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