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 183

Emergency Medical Services ALS Emergency Department ED 183

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.

Emergency Department 246

Emergency Department ICU Critical Care ALS 246

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

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

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 120

Emergency Department ALS ED 120

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. What additional workup is necessary in the ED?

ED 85

ED E-9-1-1 ALS OR 85

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

ALiEM

JUNE 5, 2023

ED providers are only exposed in these cases if they have direct contact with drainage from open wounds while not using PPE or there is concern for aerosolization of spores For inhalational anthrax exposure, AVA should be given in combination with antimicrobials (ciprofloxacin or doxycycline) for 60 days. Updated 2022 Jul 26].

ALS 256

ALS OR ED 256

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

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

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

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 ALS Epinephrine 169

The Skeptics' Guide to EM

AUGUST 27, 2022

Date: August 23rd, 2022 Reference: Schoenfeld et al. Just give them a choice”: Patients’ perspectives regarding starting medications for opioid use disorder in the ED. AEM August 2022 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary.

Emergency Department 100

Emergency Department Naloxone Overdose ED 100

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

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-9-1-1 268

E-9-1-1 Emergency Medical Services Life Support ALS 268

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

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

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

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

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 OR Emergency Department 246

The Skeptics' Guide to EM

FEBRUARY 18, 2023

Date: February 17, 2023 Reference: Gettel et al. Date: February 17, 2023 Reference: Gettel et al. Case: You are an administrator responsible for staffing emergency departments (EDs) in a health care system comprising both urban and rural locales. The SGEM has done two previous podcasts on APPs in the ED.

Emergency Department 130

Emergency Department ALS ED EMS 130

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-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

The Skeptics' Guide to EM

JULY 2, 2022

Date: June 30th, 2022 Reference: McGinnis et al. AEM June 2022. Date: June 30th, 2022 Reference: McGinnis et al. AEM June 2022. Case: You are working a shift in your local community emergency department (ED) when a 47-year-old male presents with chest pain. If we thought about ACS, we brought them in.

Coronary 100

Coronary Heart Attack ACS CAD 100

ALiEM

FEBRUARY 9, 2024

The 2022 American College of Cardiology (ACC) pathway provides timely guidance [1]. Encourage your ED to set up an algorithm that you can follow based on your laboratory’s assay. Low-risk patients do not routinely require stress testing in the ED. We help you translate this to your clinical practice, by illustrating with a case.

E-9-1-1 276

E-9-1-1 ED Coronary ALS 276

REBEL EM

MAY 20, 2024

A 67-year-old woman with a history of atrial fibrillation on apixaban presents to the ED for epistaxis that began 30 minutes ago. Post TW, ed. Accessed July 19, 2022. In: Tintinalli JE, Ma OJ, Yealy DM, et al., In: Tintinalli JE, Ma OJ, Yealy DM, et al., Her vital signs are within normal limits. UpToDate Inc.

ALS 57

ALS ED EMS 57

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

EMDocs

DECEMBER 19, 2023

Accessed August 25, 2022. In: Marx JA, Hockenberger RS, Biros MH, et al., Accessed August 25, 2022. McGraw Hill; 2022. Accessed August 25, 2022. Accessed August 25, 2022. Accessed August 25, 2022. Accessed August 25, 2022. Accessed August 25, 2022. Accessed August 25, 2022.

First Aid 92

First Aid ED OR ALS 92

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. Here is the ED ECG (a photo of the paper printout) What do you think? QOH ( Q ueen O f H earts ) and Dr. Smith's former resident immediately diagnosed acute OMI — but providers in the ED thought the ECG findings "looked old".

EMS 108

EMS CPR ED Coronary 108

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Reference: Cashen K, Reeder RW, Ahmed T, et al. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Reference: Cashen K, Reeder RW, Ahmed T, et al. Pediatric Crit Care Med. Pediatric Crit Care Med.

CPR 130

CPR ICU Critical Care Defibrillator 130

Don't Forget the Bubbles

JULY 3, 2024

Lastly, in this month’s issue of JAMA Pediatrics, Gemmill et al. Saranti A, et al. Barlabà A, et al. Nemetz ETA, et al. Kusumi K, et al. Crawford CM, et al. Fundora MP, et al. Roby PR, et al. Jenssen BP, et al. Auger N, et al. Brewster RCL, et al. Forster CS, et al.

ALS 105

ALS ED OR EMS 105

The Skeptics' Guide to EM

NOVEMBER 1, 2022

Date: October 27th, 2022 Reference: Hayashi et al. Date: October 27th, 2022 Reference: Hayashi et al. Comparative efficacy of sedation or analgesia methods for reduction of anterior shoulder dislocation: A systematic review and network meta-analysis.

ALS 152

ALS Emergency Department OR ED 152

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

The Skeptics' Guide to EM

MARCH 12, 2022

Date: March 3rd, 2022 Reference: Macnow et al. Date: March 3rd, 2022 Reference: Macnow et al. Dr. Varner’s research interests are in concussion and pregnancy care in the ED. The Acute Concussion Evaluation–Emergency Department (ACE-ED) Tool is used, and she scores a 2 for headache and feeling foggy.

Emergency Department 100

Emergency Department ED ALS OR 100

EMDocs

AUGUST 22, 2024

6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. 6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. One cohort study in a public ED found that 84.5%

Emergency Department 82

Emergency Department ALS E-9-1-1 ED 82

ALiEM

SEPTEMBER 27, 2023

Hoffman et al. Koppaka V, Thompson DC, Chen Y, et al. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Encyclopedia of Toxicology (Third Edition), Academic Press. doi: 10.1016/B978-0-12-386454-3.00754-5. Goldfrank L. In: Goldfrank’ s Toxicologic Emergencies. New York, NY. McGraw-Hill. Pharmacol Rev. 2012 Jul;64(3):520-39.

ALS 169

ALS OR ED 169

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 Defibrillator 312

The Skeptics' Guide to EM

DECEMBER 3, 2022

Date: November 16th, 2022 Reference: Lipsett SC, Monuteaux MC, Shanahan KH, et al. Pediatrics 2022 Guest Skeptic: Dr. Angelica DesPain is an Assistant Professor of Pediatrics and a pediatric emergency medicine physician at the Baylor College of Medicine Children’s Hospital of San Antonio in San Antonio, TX.

ALS 100

ALS Emergency Department ED OR 100