ACEP Now

JANUARY 5, 2025

A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. References Grasl S, Mekhail P, Janik S, et al. 2022 ;279(3):1601-1607. Wall JJ, Tay KY.

Operating Room 98

Operating Room Epinephrine ALS ED 98

EMDocs

NOVEMBER 13, 2024

Major takeaway: Consider SBP in any patient who comes into the ED with ascites. Biggins SW, Angeli P, Garcia-Tsao G, et al. Mattos AA, Wiltgen D, Jotz RF, et al. Aithal GP, Palaniyappan N, China L, et al. Angeli P, Bernardi M, Villanueva C, et al. Arvaniti V, D’Amico G, Fede G, et al. Hepatology. Hepatology.

E-9-1-1 105

E-9-1-1 ALS OR ED 105

The Skeptics' Guide to EM

MARCH 25, 2023

Date: March 22, 2023 Reference: Hilsden et al. Trauma Surg Acute Care Open 2022 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. Date: March 22, 2023 Reference: Hilsden et al. He is also now a fully-fledged “sonologist”.

ED 130

ED Critical Care Emergency Department ALS 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.

ICU 246

ICU Emergency Department Critical Care ALS 246

The Skeptics' Guide to EM

AUGUST 10, 2024

Date: July 29, 2024 Reference: Connolly SJ et al (ANNEXA-I investigators) Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage. Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table.

Emergency Medical Services 224

Emergency Medical Services ALS Emergency Department ED 224

Pediatric EM Morsels

SEPTEMBER 22, 2023

Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Updated 2022 Feb 10]. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Updated 2022 Mar 3]. They may even need atropine and/or pacing for persistent bradycardia. References Coleman-Satterfield, TT. In: Strange and Schafermeyer’s: Pediatric Emergency Medicine.

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. Zhu 2022] In Nepalese children, the Broselow correlated well at lower weights, but accuracy decreased at higher weights >18 kg. [K x exp[0.02

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

EMDocs

OCTOBER 9, 2023

Yoo, MD (Assistant Professor/Core Faculty, San Antonio, TX) // Reviewed by Brit Long, MD (@long_brit) Case An 18-year-old man with a history of asthma and medication noncompliance presents to the emergency department (ED) with acute onset shortness of breath. He states that he recently moved to Texas from Colorado. Which one do you select?

ED 109

ED Life Support Advanced Life Support CPR 109

EMDocs

OCTOBER 30, 2023

” – Musings of an American ED resident in July 2022 when US healthcare was affected simultaneously by supply chain issues from GE Healthcare (contrast media) and Abbott Laboratories (Similac baby formula). 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013.

E-9-1-1 101

E-9-1-1 Emergency Department ALS CCT 101

ALiEM

FEBRUARY 5, 2024

Reference Lin M, Phipps M, Chan TM, et al. You will need to create a free, 1-time login account. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. Ann Emerg Med. 2023;82(1):55-65. doi: 10.1016/j.annemergmed.2023.02.011

Overdose 215

Overdose Critical Care EMS Emergency Department 215

Don't Forget the Bubbles

MARCH 21, 2025

Thats exactly what Shane George et al. George S, Williams T, Humphreys S, et al. A total of eleven intensive care units (ten PICUs and one non-maternity NICU) and four emergency departments (EDs) took part in the study. Recruitment took place across ten PICUs, one NICU, and four EDs in Australia, New Zealand, and Switzerland.

ICU 108

ICU Critical Care ED OR 108

The Skeptics' Guide to EM

NOVEMBER 26, 2022

Date: November 26th, 2022 Reference: James et al. AEM November 2022 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Date: November 26th, 2022 Reference: James et al. AEM November 2022 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia.

ED 100

ED Emergency Department ALS 100

EMDocs

NOVEMBER 19, 2024

10 Table 1: Second-Generation Antipsychotics and Associated Adverse Effects Adapted from: UpToDate 8 with additional sources Micromedex 9 and Riboldi, et al 11 *SL=sublingual, IM=intramuscular, PO=oral, ODT=orally disintegrating tablets, ER=extended release, IR=immediate release. +to Gummin DD, Mowry JB, Beuhler M, et al. Juurlink D.

Overdose 111

Overdose EMS Emergency Medical Services OR 111

ALiEM

APRIL 12, 2023

Accessed April 5, 2023 Afzal S, Zahid M, Rehan ZA, et al. 2022 Jan 6;8(1):42. 20 – Local Anesthetics, Ed(s): Hugh C. Preparation and Evaluation of Polymer-Based Ultrasound Gel and Its Application in Ultrasonography. doi: 10.3390/gels8010042. PMID: 35049577 ; PMCID: PMC8774352 Suzuko S, Peter G, Philipp L.

Emergency Department 258

Emergency Department ALS ED 258

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. Article: Arvig MD, Lassen AT, Gæde PH, et al. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.

ED 129

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

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. link] [3] Morrison RS, Magaziner J, Gilbert M, et al. Door-to-block time: prioritizing acute pain management for femoral fractures in the ED. Published February 4, 2022. 2003;58(1):76-81.

Epinephrine 246

Epinephrine ED Emergency Department OR 246

The Skeptics' Guide to EM

OCTOBER 1, 2022

Date: September 28th, 2022 Reference: Hartford et al. AEM September 2022. Date: September 28th, 2022 Reference: Hartford et al. AEM September 2022. Patients with migraines often present to the ED looking for pain relief. Brown et al , Selbst and Clark ). Reference: Hartford et al.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

APRIL 2, 2022

Date: March 31st, 2022 Reference: Butt et al. 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. Date: March 31st, 2022 Reference: Butt et al. Reference: Butt et al.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

FEBRUARY 26, 2022

Date: February 21st 2022 Reference: Kim et al. AEM February 2022. Date: February 21st 2022 Reference: Kim et al. AEM February 2022. You wonder whether a model of care involving a specifically designed unit would improve their patient experience and ED boarding times. Reference: Kim et al.

ED 130

ED ALS Emergency Department OR 130

EMS 12-Lead

MARCH 30, 2024

On ED arrival ROSC is achieved. The University of Maryland found that capture occurred in only 42-78% of patients, dependent on pad positioning (Moayedi et al, 2022). They are unable to feel a pulse and resume CPR. The receiving staff suspects pulmonary embolism due to S1Q3T3 on the ECG and administers TPA.

CPR 312

CPR Paramedic Ambulance Epinephrine 312

The Skeptics' Guide to EM

MAY 14, 2022

Date: May 13th, 2022 Reference: Abril et al. J Emerg Med 2022 Guest Skeptic: Dr. Sergey Motov is an Emergency Physician in the Department of Emergency Medicine, Maimonides Medical Center in New York City. Date: May 13th, 2022 Reference: Abril et al. EDs annually (1). His twitter handle is @PainFreeED.

ALS 130

ALS Emergency Department ED OR 130

ALiEM

OCTOBER 14, 2023

Reference Lin M, Phipps M, Chan TM, et al. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

The Skeptics' Guide to EM

SEPTEMBER 10, 2022

Date: August 25th, 2022 Reference: Martin et al. 2022 Guest Skeptic: Dr. Harrison Hayward is a Pediatric Emergency Medicine fellow at Children’s National Hospital. Date: August 25th, 2022 Reference: Martin et al. Reference: Martin et al. Pediatr Emerg Care. Pediatr Emerg Care. Pediatr Emerg Care.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

JULY 30, 2022

Date: July 28th, 2022 Reference: Brower et al. AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: July 28th, 2022 Reference: Brower et al. Reference: Brower et al. She is also the creator of all those wonderful Paper in a Pictures.

ALS 130

ALS ED Emergency Department EMS 130

ALiEM

NOVEMBER 29, 2023

PMID: 34529640 Ayub S, Parnia S, Poddar K, et al. PMID: 24769343 Ehrman-Dupre R, Kaigh C, Salzman M et al. Journal of Addiction Medicine 16(5):p 595-598, 9/10 2022. Published 2022 Aug 19. PMID: 36148197 Love JS, Levine M, Aldy K, et al. PMID: 37014353 Ball NS, Knable BM, Relich TA et al. Forensic Sci Int.

Naloxone 169

Naloxone Overdose Epinephrine ALS 169

The Skeptics' Guide to EM

DECEMBER 10, 2022

Date: November 30th, 2022 Reference: Johnson et al. Date: November 30th, 2022 Reference: Johnson et al. Bone Joint J 2022 Guest Skeptic: Dr.Matt Schmitz is an Orthopaedic Surgeon specializing in Adolescent Sports Medicine and Young Adult Hip Preservation. He asks if surgery would be a better option?

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

FEBRUARY 5, 2022

Date: February 7th, 2022 Reference: Williams et al. JAMA Pediatrics 2022 Guest Skeptic: Dr. Dennis Ren is a pediatric emergency medicine fellow at Children’s National Hospital in Washington, DC. Date: February 7th, 2022 Reference: Williams et al. Reference: Williams et al.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

JULY 23, 2022

Date: July 22nd, 2022 Reference: Perry et al. Date: July 22nd, 2022 Reference: Perry et al. The Lancet 2022 Guest Skeptic: Dr. Tessa Davis is a Paediatric Emergency Consultant at the Royal London Hospital, Senior Lecturer at Queen Mary University of London, Co-founder of Don’t Forget The Bubbles ( DFTB ).

ALS 130

ALS Emergency Department ED OR 130

EMDocs

JANUARY 11, 2025

A 75-year-old woman who is bedridden after a stroke presents to the ED from a nursing facility with abdominal pain and constipation. Therefore, discharging the patient on lactulose (C) would not be recommended without additional treatment in the ED. Ahmad H, Jannat H, Khan U, et al. Al-Maharmeh, Q., Stercoral Colitis.

E-9-1-1 98

E-9-1-1 EMS Emergency Department OR 98

The Skeptics' Guide to EM

JANUARY 29, 2022

Date: January 25th, 2022 Reference: Beyde et al. AEM January 2022 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Date: January 25th, 2022 Reference: Beyde et al. AEM January 2022 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia.

Emergency Department 130

Emergency Department ALS ED 130

The Skeptics' Guide to EM

DECEMBER 17, 2022

Date: December 16th, 2022 Reference: Hohle et al. AEM December 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: December 16th, 2022 Reference: Hohle et al. years ( 2 ).

Frozen Plasma 130

Frozen Plasma FFP Emergency Medical Services Plasma 130

The Skeptics' Guide to EM

OCTOBER 8, 2022

Date: September 15, 2022 Reference: Ramnarayan P et al. JAMA July 2022 Guest Skeptic: Dr. Spyridon Karageorgos is a Pediatric Resident at Aghia Sophia […] The post SGEM #379 Heigh Ho High Flow versus CPAP in Acutely Ill Children first appeared on The Skeptics Guide to Emergency Medicine. In 2018, Ramnarayan et al.

Critical Care 130

Critical Care ALS Emergency Department ED 130

The Skeptics' Guide to EM

JANUARY 14, 2023

Date: January 13, 2023 Reference: Razi et al. AJEM 2022 Guest Skeptic: Dr. Kevan Sternberg is a urologist/endourologist. Date: January 13, 2023 Reference: Razi et al. AJEM 2022 Guest Skeptic: Dr. Kevan Sternberg is a urologist/endourologist. Reference: Razi et al.

ALS 130

ALS Emergency Department ED OR 130

The Skeptics' Guide to EM

NOVEMBER 12, 2022

Date: November 10th, 2022 Reference: de-Madaria E et al. Date: November 10th, 2022 Reference: de-Madaria E et al. Case: A 38-year-old male presents to the emergency department (ED) with acute mid epigastric abdominal pain with nausea and vomiting. Reference: de-Madaria E et al. Guest Skeptic: Dr. Salim R.

ALS 130

ALS Emergency Department OR EMS 130

Broome Docs

DECEMBER 9, 2023

Is it a good idea to keep geriatric patients in the ED overnight? Are you being irradiated by the portable Xray machines in your ED? Roussel M, Teissandier D, Yordanov Y, et al. 2022 Nov;63(5):645-650. Epub 2022 Oct 12. PMID: 36755492 Freeman JJ, Asfaw SH, Vatsaas CJ, et al. 2022 Oct 25;7(1):e000886.

Emergency Department 114

Emergency Department ED ALS 114

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. Two large, cluster-randomized trials ( SMART and SALT-ED ) showed a small benefit to the use of balanced crystalloids in preventing a composite outcome of Major Adverse Kidney Events within 30 days (aka MAKE-30).

ICU 132

ICU Plasma Critical Care ALS 132

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