The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. JAMA 2021 Guest Skeptic: Dr. Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Consultant in […] The post SGEM#347: It Don’t Matter to Me – Balanced Solution or Saline first appeared on The Skeptics Guide to Emergency Medicine.

OR 130

OR Critical Care ICU Plasma 130

Pediatric EM Morsels

AUGUST 4, 2023

England, 2021) The third portion of the duodenum courses between the SMA and the aorta, which can lead to external compression of the duodenum. England, 2021) In SMA syndrome the angle is decreased to < 22 o and the normal distance <8 mm. England, 2021) This condition is often attributed to rapid weight loss.

E-9-1-1 246

E-9-1-1 ED OR EMS 246

ALiEM

APRIL 10, 2023

Updated 2021 Jun 30]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. 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. References Diaz-Frias J, Badri T. doi: 10.1111/j.1087-0024.2004.00827.x.

OR 246

OR 246

ALiEM

AUGUST 7, 2023

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. The patient is reluctant to abduct the right arm secondary to pain. Conversely, posterior dislocations are more serious but less common.

Emergency Department 246

Emergency Department OR EMS ED 246

Pulsara

NOVEMBER 7, 2024

According to a study published in 2021, 56% of EMS workers surveyed were considered obese using body mass index standards. In the 2021 study, participants identified lack of energy, willpower and time as primary reasons for a lack of physical activity, ranking lack of resources last.

EMS 82

EMS Paramedic OR 82

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-9-1-1 105

E-9-1-1 ALS OR ED 105

Core EM

JANUARY 25, 2024

StatPearls Publishing; 2021. Accessed August 17, 2021. Treat aggressively with IVF, antibiotics (covering gram negative and anaerobic organisms), and rapid transfer to the OR to resect the affected colon A 32-60% mortality rate has been reported when stercoral colitis is associated with perforation! Stercoral Colitis. In: StatPearls.

E-9-1-1 246

E-9-1-1 OR 246

ALiEM

NOVEMBER 17, 2023

link] Published 2021. link] Published 2021. The grandmother first noted blood in the patient’s underwear the previous morning when she was helping the patient wipe and she noticed it again prior to arrival, this time saturating the patient’s underwear. The patient in this case was treated with a 4-week estrogen cream taper.

Emergency Department 250

Emergency Department OR 250

EMDocs

JANUARY 27, 2025

2021 Dec;50:335-344. Immune checkpoint inhibitors: An emergency medicine focused review. Am J Emerg Med. The post emDOCs Podcast Episode 113: Immune Checkpoint Inhibitor Adverse Events appeared first on emDOCs.net - Emergency Medicine Education.

ACS 96

ACS OR 96

ALiEM

SEPTEMBER 20, 2024

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; F; RR 16; O2 sat 97% General : Appears uncomfortable HEENT : Mild right-sided facial swelling. No trismus. No gingival inflammation or swelling or induration to suggest abscess.

Emergency Department 177

Emergency Department OR 177

Pediatric EM Morsels

MAY 10, 2024

Published 2021 Feb 4. Ask about suicidal ideation : Let’s not miss a caustic ingestion… Ask about birth control : Teens may be on OCPs and at increased risk for PE and their parents don’t know it Ask about drugs : Does your patient smoke, vape, or use cocaine? Have you ever had chest pain or shortness of breath in exercise? Equal pulses?

E-9-1-1 271

E-9-1-1 OR EMS 271

EMDocs

NOVEMBER 19, 2024

of exposures reported to poison control centers in 2021 were related to antipsychotics or sedative-hypnotics with the majority of those exposures occurring in patients 20 years of age or older. 1,2 Most second-generation antipsychotics act as D 2 antagonists and inhibit the 5-HT 2A receptor.

Overdose 110

Overdose EMS Emergency Medical Services ALS 110

The Skeptics' Guide to EM

APRIL 20, 2024

The evidence was not robust enough back in 2021 to confidently use this potential tool. An attempt was made to externally validate this tool in New Zealand by Murkerji et al 2021 [4]. Background: We have covered rib fractures once before on the Skeptics’ Guide to Emergency Medicine.

Emergency Department 215

Emergency Department Overdose ALS ED 215

Dr. Smith's ECG Blog

OCTOBER 1, 2023

This is a re-post of an excellent case from 2021. See the full post here == MY Comment , by K EN G RAUER, MD ( 10/1 /2023 ): == It is often insightful to "look back" — and see from where we have come, which Dr. Meyers skillfully does with today's repost from October 5, 2021. We've come a long way in 2 years!

OR 127

OR STEMI CAD Coronary 127

Core EM

JANUARY 25, 2024

Updated 2021 Jul 27]. EVALUATION: Scan the affected and contralateral body part for comparison with a sterile cover (or Tegaderm) overlying a high frequency linear probe. REFERENCES: Castleberg E, Jenson N, Dinh VA. Diagnosis of necrotizing faciitis with bedside ultrasound: The staff exam. Western Journal of Emergency Medicine.

E-9-1-1 246

E-9-1-1 Emergency Department OR 246

Core EM

JANUARY 25, 2024

2021 Background Prehospital trauma team activation criteria allow for prompt mobilization of personnel and resources. Read More PEMCAR iBook (Apple version) PEMCAR iBook (PDF) EMCAR – Prehospital Traumatic Narrow Pulse Pressure – J Surg Res 2021 Read More Prehospital hypotension is one of those criteria.

Operating Room 246

Operating Room EMS ED ICU 246

Pediatric EM Morsels

JULY 26, 2024

2021 Oct 9;22(20):10911. While it is important for us to maintain a safe work environment for our patients and our team, managing the agitated patient requires more of us than administering Droperidol or Ketamine. Make sure to consult your friendly neighborhood pediatric neurologist and/or rheumatologist! The prevalence ranges from 12.5%-61%

Plasma 271

Plasma OR ED Critical Care 271

ACEP Now

NOVEMBER 7, 2024

Poorly healing wounds are primarily the result of chronic venous insufficiency, peripheral (arterial) vascular disease, prolonged pressure-point skin injury, or neuropathy secondary to vascular disease or diabetes. Once identified, they must protect the skin from further injury. Examples include Adaptic, Xeroform, Telfa, and Dermagen.

ED 97

ED OR Emergency Department Ambulance 97

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 Life Support OR 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 193

Emergency Department ALS EMS OR 193

Core EM

JANUARY 25, 2024

Data was collected from August 1, 2021 – February 20, 2022. Population This study occurred in an urban academic hospital with over 90,000 annual visits. Of this group, 78 patients were placed in the SQuID protocol (subcutaneous insulin in DKA), and 99 were in the traditional cohort.

EMS 246

EMS ICU ED OR 246

Pediatric EM Morsels

MAY 5, 2023

Vegan Diets in Children: Basics Vegan Diets avoid/prohibit consumption of any animal products Exclusion of meat, eggs, honey, dairy products, etc This is often adopted due to heightened concern of animal maltreatment, but also for religious reasons or health benefits Roughly 2-5% of Western nation populations follow a vegan based diet (Sutter, 2021) (..)

E-9-1-1 130

E-9-1-1 OR EMS 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 ). 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

JANUARY 11, 2025

Up to 1/3 of adults over 60 suffer from chronic constipation. Evaluation: A good history and a high index of clinical suspicion is paramount, especially in high-risk patient populations 4 CT of the abdomen and pelvis with contrast is the best choice for diagnosis. Enemas (some studies show this may be associated with perforation risk).

E-9-1-1 97

E-9-1-1 EMS Emergency Department ALS 97

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

ALiEM

NOVEMBER 10, 2023

2021 Sep 1;57(9):925. Epub 2021 Jul 1. Management of FDE anchors on identification and discontinuation of the causative agent. Topical or systemic steroids are common adjuncts and there is limited evidence suggesting the utility of systemic cyclosporine for severe cases [1]. References Anderson HJ, Lee JB. Medicina (Kaunas).

Emergency Department 161

Emergency Department OR 161

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. Spencer completed his medical doctorate at the Medical College of Wisconsin.

Epinephrine 130

Epinephrine CPR ALS Emergency Department 130

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

Core EM

JANUARY 25, 2024

Definition: Catatonia: A behavioral motor dysregulation syndrome marked by an inability to move normally despite full physical capacity, which can occur in the context of many underlying psychiatric and general medical disorders [4]. Epidemiology : Who typically suffers from catatonia? Who typically suffers from malignant catatonia?

MICU 246

MICU Emergency Department ED OR 246

ALiEM

JANUARY 26, 2024

2021 Jan;34(1):e14591. The patient stated that she was started on Cipro eyedrops 1 or 2 days prior to presentation for a possible eye infection. A day prior to presentation she developed a purple purpuric rash on her lower extremities that gradually progressed up her legs, and was present on her buttocks thighs, and lower legs. PMID: 7711355.

EMS 183

EMS OR 183

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-9-1-1 154

E-9-1-1 Plasma Emergency Department OR 154

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. Excluded: Unstable comorbidity (e.g.

Emergency Department 130

Emergency Department ALS OR 130

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

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

JANUARY 8, 2022

Date: December 28th, 2021 Reference: Kulvatunyou et al. November 2021. Date: December 28th, 2021 Reference: Kulvatunyou et al. November 2021. November 2021. The small (14 Fr) percutaneous catheter (P-CAT) versus large (28–32 Fr) open chest tube for traumatic hemothorax: A multicenter randomized clinical trial.

ALS 130

ALS Emergency Department Paramedic OR 130

FOAMfrat

JANUARY 21, 2025

In this episode, Alec Wilcox & I discuss ECPR eligibility & preparation. ECPR, or extracorporeal cardiopulmonary resuscitation, involves taking a patient in cardiac arrest, sucking blood from their venous system, oxygenating it externally, and then pumping it back into their arterial system. link] Kopra, J., Litonius, E., Pekkarinen, P.

CPR 98

CPR OR 98

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