The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth. Case: It is a steady Saturday afternoon in your rural emergency department (ED). Reference: Snelling et al. He is also a fully-fledged ultrasonographer.

Critical Care 316

Critical Care ALS ED Emergency Department 316

Pediatric EM Morsels

AUGUST 23, 2024

Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport-Amsterdam, October 2022. It does NOT have structural brain damage visible on standard neuroimaging. Br J Sports Med.

Emergency Department 243

Emergency Department OR ED EMS 243

The Skeptics' Guide to EM

AUGUST 10, 2024

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. When he arrives at your ED, the family tells you he was doing fine until dinner. He was confused, slurring his speech, and had trouble moving his right side.

Emergency Medical Services 183

Emergency Medical Services ALS Emergency Department ED 183

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

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. Is cutaneous anthrax reportable? [6,

ALS 256

ALS OR ED 256

ALiEM

FEBRUARY 5, 2024

Take the AIR Toxicology Module at ALiEMU Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link. You will need to create a free, 1-time login account. Reference Lin M, Phipps M, Chan TM, et al.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

ALiEM

OCTOBER 14, 2023

These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score. Take the AIR Respiratory Module at ALiEMU Interested in taking the AIR quiz for fun or asynchronous (Individualized Interactive Instruction) credit? Please go to the above link.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

ACEP Now

SEPTEMBER 13, 2023

ACEP sent a letter to the President in November 2022 asking the White House to host a summit that would bring together everyone affected to discuss collaborative solutions. Many of the causes of ED boarding are out of the control of the individual hospital or ED team—collaborative system-wide solutions are the only way to address this crisis.”

ED 52

ED Emergency Department OR 52

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. 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. Published February 4, 2022. Am J Emerg Med. 2014;32(7):801-803.

Epinephrine 246

Epinephrine ED OR Emergency Department 246

Pediatric EM Morsels

AUGUST 9, 2024

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. Neonates presenting to the Emergency Department often cause a lot of uncertainty. Is this scalp swelling normal? Is this bloody stool concerning?

E-9-1-1 152

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

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. Short acting. mg/kg IV followed by 0.05 – 0.4

Emergency Department 246

Emergency Department ICU Critical Care ALS 246

The Skeptics' Guide to EM

JANUARY 6, 2024

Case: After your shift in the emergency department (ED) one day, the medical director pulls you aside. Background: Back in August of 2022, we announced the start of #SGEMPeds for SGEM Season 11. July 2023 * Population: ED leadership across the United States. She is nationally known for her work as an EMS researcher and educator.

Emergency Department 268

Emergency Department Emergency Medical Services ALS ED 268

Pediatric EM Morsels

JULY 26, 2024

It is commonly missed during the first few ED visits. Keep a high index of suspicion for anti-NMDAr encephalitis in children and adolescents who have had multiple ED visits for new and worsening psych/behavioral concerns, seizures, and/or movement disorders over several months. 2022 Jul 6;9(5):e200013. doi: 10.1212/NXI.0000000000200013.

Plasma 265

Plasma OR ED Critical Care 265

EMDocs

DECEMBER 19, 2023

Accessed August 25, 2022. Possible early antibiotic treatment Minor Marine Trauma Mechanism: Bites, Stings, Nematocysts Envenomation Presentation: All can cause localized pain, erythema, and warmth Dermatologic: Urticaria, burning, pruritus, localized paresthesia. Marine Trauma and Envenomation. McGraw Hill; 2020. link] Edward OJ.

First Aid 92

First Aid ED OR ALS 92

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. The right ankle is swollen and tender.

Emergency Department 130

Emergency Department ALS ED OR 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

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" On arrival to the ED, while waiting for cath lab team, he obtained another ECG: You can now see the full voltage of the high-voltage QRS, likely with some degree of LVH. Both were awake and alert with normal vital signs.

OR 120

OR STEMI EMS ED 120

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

The Skeptics' Guide to EM

JANUARY 14, 2023

AJEM 2022 Guest Skeptic: Dr. Kevan Sternberg is a urologist/endourologist. AJEM 2022 Guest Skeptic: Dr. Kevan Sternberg is a urologist/endourologist. Case: A 38-year-old female presents to the emergency department (ED) with a five-hour history of acute onset left flank pain. Date: January 13, 2023 Reference: Razi et al.

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

EMDocs

JANUARY 9, 2024

Episode 92: Marine Ingested Poisons and Infections Scombroid Pathophysiology: Fish from family Scombroidae Tuna , mackerel, skipjack, bonito Dark-meat fish Herring, bluefish , anchovy, sardine, amberjack, black marlin, and mahi mahi Histidine decarboxylase produces histamine and histamine like products Improper preservation Presentation Metallic, bitter (..)

ED 83

ED OR 83

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. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL).

ALS 130

ALS Emergency Department OR EMS 130

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. 2022, August 16). The patient is a contact lens wearer. For the eye dryness and mild irritation, she rinsed her eyes with her contact solution.

Emergency Department 152

Emergency Department ED OR 152

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). An Analysis of Data From Randomized Studies.

ALS 130

ALS Emergency Department 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

Pediatric EM Morsels

JUNE 30, 2023

I’m sure you can recall at least several parents who bring their children into the ED for concern of recurrent pneumonias. Often the parents focus on a possible underlying immunodeficiency. Fortunately, most commonly these pneumonias are due to viral infections, and we can often offer reassurances to the parent. Dec: 9 (12): 1830.

E-9-1-1 258

E-9-1-1 ED EMS OR 258

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

NOVEMBER 19, 2022

Date: November 19th, 2022 Reference: Khatib N, and Sampsel K. Intimate partner violence (IPV) in the Emergency Department (ED). 2022 Nov Guest Skeptics: Dr. Nour Khatib is an emergency physician in Toronto working in community sites Markham Stouffville Hospital and Lakeridge health.

Emergency Department 101

Emergency Department ED OR 101

The Skeptics' Guide to EM

JANUARY 7, 2023

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. Date: January 4th, 2023 Reference: Hasbrouck et al. Be critical and evaluate what you believe in.”

Emergency Department 100

Emergency Department OR ALS Ambulance 100

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. He is also the CME editor for Academic Emergency Medicine.

Coronary 100

Coronary Heart Attack ACS CAD 100

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

Don't Forget the Bubbles

MAY 31, 2023

2023 May 17:archdischild-2022-325280. doi: 10.1136/archdischild-2022-325280. The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved.

Emergency Department 135

Emergency Department ED OR ALS 135

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk.

E-9-1-1 161

E-9-1-1 ED OR Emergency Department 161

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

REBEL EM

SEPTEMBER 21, 2023

Up to 80% of patients will have at least one troponin sent ( Gabrielli 2022 ). Type 2 MI is common in the ED and can result from vigorous exercise (common in athletes after marathons), sepsis, trauma and tachydysrhythmias including SVT. Additionally, they found that up to 30% of the troponins sent are positive. Cardiol Rev.

Coronary 143

Coronary ACS ED OR 143

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

Pulsara

JANUARY 25, 2024

With a new protocol and Pulsara, Metropolitan Emergency Medical Services can now transport eligible pediatric behavioral health patients directly to behavioral health facilities—resulting in a 44% decrease of pediatric behavioral health patients transported to the ED. Download the case study or read on to learn more!

Emergency Medical Services 104

Emergency Medical Services EMS STEMI Emergency Department 104