Broome Docs

OCTOBER 31, 2022

2022 Jan;48(1):78-91. The PEACH trial: No body had a fit, so… we have no clue Peter-Derex L, Philippeau F, Garnier P, et al. 2022 Sep;21(9):781-791. PMID: 30206143 Less is more when it comes to intravenous fluids de-Madaria E, Buxbaum JL, Maisonneuve P, et al. 2022 Sep 15;387(11):989-1000. 2022 Sep 18.

E-9-1-1 52

E-9-1-1 Defibrillator ICU Critical Care 52

ALiEM

FEBRUARY 5, 2024

Reference Lin M, Phipps M, Chan TM, et al. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Please go to the above link. You will need to create a free, 1-time login account. Ann Emerg Med. 2023;82(1):55-65.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

Pediatric EM Morsels

OCTOBER 27, 2023

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 Reduces dosing errors during resus, up to 33.88%. Recommended by ATLS and PALS. Krug 2007] What If the Child is Obese or Emaciated?

E-9-1-1 268

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

ALiEM

OCTOBER 14, 2023

Reference Lin M, Phipps M, Chan TM, et al. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Please go to the above link. You will need to create a free, 1-time login account.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

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

Emergency Department 246

Emergency Department ICU Critical Care ALS 246

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. Reference: de-Madaria E et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Guest Skeptic: Dr. Salim R. Guest Skeptic: Dr. Salim R.

ALS 130

ALS Emergency Department OR EMS 130

ALiEM

MARCH 11, 2024

In July 2022, a 32-year-old male with a past medical history of HIV (on antiretroviral therapy, CD4 390, viral load undetectable) presented to the emergency department with constitutional symptoms and a rash for 4-5 days. Epub 2022 Jul 27. The 2022 outbreak and the pathobiology of the monkeypox virus. 2022 Jul;131:102855.

Emergency Department 141

Emergency Department ALS OR 141

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

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. The Relative Efficacy of Seven Skeletal Muscle Relaxants.

ALS 130

ALS Emergency Department ED OR 130

The Skeptics' Guide to EM

JANUARY 28, 2023

Date: January 22, 2022 Reference: Samuels-Kalow M et al. Date: January 22, 2022 Reference: Samuels-Kalow M et al. The ruling of the US Supreme Court on June 24, 2022 in Dobbs v Jackson Women’s Health Organization overturned Roe v Wade and allowed individual US states to determine their own restrictions on abortion.

ALS 130

ALS OR 130

The Skeptics' Guide to EM

JANUARY 6, 2024

Reference: Remick KE, et al. Reference: Remick KE, et al. Background: Back in August of 2022, we announced the start of #SGEMPeds for SGEM Season 11. Reference: Remick KE, et al. National Assessment of Pediatric Readiness of US Emergency Departments during the Covid-19 Pandemic. JAMA Netw Open. JAMA Netw Open.

Emergency Department 268

Emergency Department Emergency Medical Services ALS ED 268

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

JULY 28, 2023

Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 or serum bicarbonate between 11-17 mmol/L Moderate : venous pH < 7.2 or serum bicarbonate between 5-10 mmol/ L Severe : venous pH < 7.1 Neuroimaging is NOT required. GCS score is not sensitive enough.

E-9-1-1 245

E-9-1-1 ALS OR Critical Care 245

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. The evidence had a substantial amount of heterogeneity (3).

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

OCTOBER 22, 2022

Date: October 18th, 2022 Reference: Moore et al. Resuscitation 2022 Guest Skeptic: Clay Odell is a Paramedic, Firefighter, and registered nurse (RN). Date: October 18th, 2022 Reference: Moore et al. Resuscitation 2022 Guest Skeptic: Clay Odell is a Paramedic, Firefighter, and registered nurse (RN).

CPR 130

CPR Defibrillator Epinephrine Firefighter 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

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]. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Moral of the Morsel Anatomy Matters!

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

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

JANUARY 7, 2023

Date: January 4th, 2023 Reference: Hasbrouck et al. Date: January 4th, 2023 Reference: Hasbrouck et al. AJEM 2022 Guest Skeptics: Dr. Timlin Glaser currently a fourth-year resident in emergency medicine at Lehigh Valley Health Network and future medical toxicology fellow at the University of Arizona College of Medicine – Phoenix.

Emergency Department 100

Emergency Department OR ALS Ambulance 100

ALiEM

NOVEMBER 3, 2023

Reference Lin M, Phipps M, Chan TM, et al. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Please go to the above link. You will need to create a free, 1-time login account. Ann Emerg Med. 2023;82(1):55-65.

Critical Care 211

Critical Care EMS Emergency Department ALS 211

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. Reference: Finfer et al. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. Early work suggested potential harm from 0.9%

ICU 132

ICU Plasma Critical Care ALS 132

Pediatric EM Morsels

APRIL 5, 2024

CDC 2022) Testing for many of these illnessess can take time during the acute phase as many are ELISA or PCR tests. CDC 2022) Divided into Soft tick relapsing fever and Hard tick relapsing fever , depending on what type of ticks carry the Borrelia sp (CDC 2022) There is also a louse which carries a Borrelia sp.

E-9-1-1 161

E-9-1-1 ALS OR EMS 161

Pediatric EM Morsels

MARCH 17, 2023

Since we all inhabit the same beautiful world , and sometimes we humans overtake previous habitats of animals, we inevitably will cross paths with an animal that bites us. Usually, animals bite from fear or defense of their offspring ( ex, Brown Recluse ). Sometimes it’s a beloved pet who gets surprised or has an “off” day ( Dog Bites and PTSD ).

Frozen Plasma 130

Frozen Plasma First Aid Plasma 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

Core EM

JANUARY 25, 2024

Written By: Kaitlynn Tracy, MD Edited By: Sean Schnarr, MD and Gregg Chesney, MD Definition/Background: Burns are classified as being major, moderate, or minor in severity. 4 Survival rate for all burn injuries is around 97%, which is a notable increase from 75% in the 1960’s.

ED 246

ED E-9-1-1 OR First Aid 246

REBEL EM

APRIL 29, 2024

A study by Lee et al ( 7) compared femoral CVC placement to IO and demonstrated a first-pass success pass rate with IO of 90.3% Over the years emergency and critical care physicians have tried many ways to establish IV access in emergencies including the “crash” or “dirty” central line. compared to only 37.5% in the CVC group.

ALS 104

ALS Epinephrine Critical Care Emergency Department 104

Core EM

JANUARY 25, 2024

link] [3] Morrison RS, Magaziner J, Gilbert M, et al. Published February 4, 2022. Accessed September 29, 2022, [link] [6] Pepe J, Ausman C, Madhani NB. 2022, Accessed September 29, 2022, [link] [8] Luftig J, Dreyfuss A, Mantuani D, Howell K, White A, Nagdev A. 2012;5(1):28-32. Ultrasound-Guided Nerve Blocks.

Epinephrine 246

Epinephrine ED OR Emergency Department 246

ALiEM

SEPTEMBER 27, 2023

Hoffman et al. Koppaka V, Thompson DC, Chen Y, et al. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Disulfiram-like reaction with ethanol consumption Coprinus atramentarius or Ink Cap mushroom is well known to cause a disulfiram-like reaction when it is consumed prior to ethanol. Goldfrank L. New York, NY. McGraw-Hill.

ALS 169

ALS OR ED 169

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

The Skeptics' Guide to EM

JANUARY 21, 2023

Reference: Babl et al. Neurology 2022 Date: January 3, 2023 Guest Skeptic: Dr. Jennifer Harmon is an MD, Ph.D Reference: Babl et al. Neurology 2022 Date: January 3, 2023 Guest Skeptic: Dr. Jennifer Harmon is an MD, Ph.D Reference: Babl et al. at Children’s National Hospital in Washington, DC.

Emergency Department 100

Emergency Department ALS OR ED 100

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

Pediatric EM Morsels

APRIL 7, 2023

References: Al Kasab S, Lynn MJ, Turan TN, Derdeyn CP, Fiorella D, Lane BF, Janis LS, Chimowitz MI; SAMMPRIS Investigators. Observation, interaction with patient, as well as parent information is key to bring the whole picture together! Increase the Adult Percent!

ALS 130

ALS OR Critical Care EMS 130

The Skeptics' Guide to EM

AUGUST 20, 2022

Date: August 18th, 2022 Reference: Munn et al. Date: August 18th, 2022 Reference: Munn et al. Fragility Index Meta-Analysis of Randomized Controlled Trials Shows Highly Robust Evidential Strength for Benefit of The post SGEM Xtra: Are tPA Stroke Trials Really Fragile?

Critical Care 130

Critical Care ALS EMS OR 130

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. Reference: McGinnis et al. AEM June 2022. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter?

Coronary 100

Coronary Heart Attack ACS CAD 100

ALiEM

OCTOBER 30, 2023

After spending her first year acclimating to the new department and achieving board certification, Dr. Garcia finds herself at a bit of a crossroad. She likes teaching, but are not sure residency or medical student education leadership is for her. And as study after study tells us, everyone is susceptible to burnout. In short, no.

E-9-1-1 161

E-9-1-1 ALS OR 161

EMDocs

SEPTEMBER 8, 2024

Paper: Brown CS, Oliveira J E Silva L, Mattson AE, et al. Anderson CS, Heeley E, Huang Y, et al; INTERACT2 Investigators. Qureshi AI, Palesch YY, Barsan WG, et al; ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network. 2022 May 17:101161STR0000000000000407. Neurocrit Care. 2022;37(2):435-446.

ALS 81

ALS OR 81

Dr. Smith's ECG Blog

DECEMBER 12, 2022

Comment by K EN G RAUER, MD ( 12/12 /2022 ): = I will summarize in 4 words the important message conveyed by Dr. Meyers in today's post = "Be Aware of Pseudo-Normalization!" In other words, to get from hyperacute T waves and STE to terminal T wave inversion, the ST and T wave must pass transiently through a state of near-normal.

OR 52

OR ACS STEMI Coronary 52