The Skeptics' Guide to EM

AUGUST 24, 2024

Date: August 19, 2024 Reference: Partyka et al. JAMA Surg 2024 Guest Skeptic: Dr. Sean Baldwin is an Emergency Physician practising in Sydney, Australia in both a large tertiary emergency department and a small regional emergency department. Reference: Partyka et al.

Emergency Department 127

Emergency Department ALS OR ED 127

Don't Forget the Bubbles

MAY 8, 2024

2024 Apr 27. 2024 Apr 16:archdischild-2024-326876. Arch Dis Child Fetal Neonatal Ed. 2024 Apr 11 Why all newborn hip screening programs have same results-a mini review. Arch Dis Child Fetal Neonatal Ed. 2024 Apr 11 Why all newborn hip screening programs have same results-a mini review. 2024 Apr 9.

E-9-1-1 69

E-9-1-1 ALS Emergency Department Epinephrine 69

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Date: September 12, 2024 Reference: Anderson et al. Full dose challenge of moderate, severe and unknown beta-lactam allergies in the emergency department. AEM August 2024. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. A pivotal study by Raja et al.

ICU 113

ICU Emergency Department ALS ED 113

Broome Docs

FEBRUARY 22, 2024

Welcome to the first episode for 2024 – and we have a range of papers covering the big life threatening issues to the tiniest pinky finger injuries and a lot in between. Should anybody be doing REBOA in 2024? MRIs may be warranted in a small subset of patients, but those MRIs do not need to occur in an emergency department.

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Emergency Department ALS OR ED 103

The Skeptics' Guide to EM

APRIL 13, 2024

NEJM Feb 2024 Date: April 12, 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA. When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago.

Emergency Department 295

Emergency Department ALS OR EMS 295

The Skeptics' Guide to EM

JUNE 1, 2024

2024 Date: May 29, 2024 Guest Skeptic: Dr. Caleb Ward is a pediatric emergency medicine attending and Associate Professor of Pediatrics and Emergency Medicine at Children’s National Hospital and The George Washington School of Medicine and Health Sciences in Washington, DC. Reference: Tavender E, et al.

Emergency Medical Services 207

Emergency Medical Services Emergency Department EMS ALS 207

ALiEM

JUNE 10, 2024

A 10-year-old boy presents to the emergency department (ED) after a high-speed motor vehicle collision. The study enrolled 22,430 children, aged 0–17 years, presenting with blunt trauma across 18 PECARN-affiliated ED in the US. Case Scenario: What would you do? He complains of neck pain and is reluctant to move his head.

Emergency Department 317

Emergency Department ED OR 317

CanadiEM

MARCH 12, 2024

Welcome back to the 2024 CJEM year! In this issue, we collaborated with the CJEM team to present “Hypotension and respiratory events related to electrical cardioversion for atrial fibrillation or atrial flutter in the emergency department” in a visual abstract format​1​.

Emergency Department 52

Emergency Department OR ED 52

ACEP Now

MAY 9, 2024

Complications of Gluteal AFT The pale, prone patient with multiple surgical drains and a constrictive faja has become a common site in the Jackson Memorial Hospital Emergency Department. Nearly half of all post-AFT patients presenting to our emergency departments required admission and six percent required ICU admission.

Emergency Department 52

Emergency Department Operating Room Critical Care ALS 52

Pediatric EM Morsels

AUGUST 9, 2024

Neonates presenting to the Emergency Department often cause a lot of uncertainty. Let’s review how Congenital Syphilis may present to our Emergency Departments: Congenital Syphilis : Basics Occurs when the spirochete Treponema pallidum is transmitted from mother to fetus. Is this scalp swelling normal?

E-9-1-1 152

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

The Skeptics' Guide to EM

JULY 20, 2024

Noninvasive Ventilation for Preoxygenation during Emergency Intubation (The PREOXI trial). NEJM June 2024. Date: July 17, 2024 Guest Skeptic: Dr. Aine Yore is an Emergency Physician, practicing in the Seattle, Washington area for over twenty years. NEJM June 2024. Reference: Gibbs et al. Reference: Gibbs et al.

ALS 234

ALS Emergency Department ED OR 234

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. NEJM May 2024 Guest Skeptic: Dr. Vasisht Srinivasan is an Emergency Medicine physician and neurointensivist at the University of Washington and Harborview Medical Center in Seattle, WA.

Emergency Medical Services 183

Emergency Medical Services ALS Emergency Department ED 183

Don't Forget the Bubbles

FEBRUARY 5, 2024

2024 Jan 8. 2024 Jan 1;43(1):e11-e13. 2024 Jan 12:archdischild-2023-326225. 2024 Jan 23:archdischild-2023-325984. 2024 Jan 9. 2024 Jan 8:e2023063654. 2024 Jan 8:e2023063801. 2024 Jan 6. 2024 Jan 2. 2024 Jan 1;153(1):e2022060119. 2024 Jan 1;153(1):e2023063039. Eur J Pediatr.

E-9-1-1 52

E-9-1-1 ALS ED Emergency Department 52

The Skeptics' Guide to EM

APRIL 27, 2024

Prehospital Emergency Care. February 2024. Date: April 25, 2024 Guest Skeptic: Missy Carter is a PA working in an ICU in the Tacoma area and an adjunct faculty member with the Tacoma Community College paramedic program. Prehospital Emergency Care. February 2024. Prehospital Emergency Care. February 2024.

ICU 195

ICU Defibrillator CPR Paramedic 195

EMDocs

JUNE 29, 2024

2024 May;198:110186. Epub 2024 Mar 24. Source Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial. Ann Emerg Med. 2024 May 1:S0196-0644(24)00171-9.

Defibrillator 69

Defibrillator Emergency Department ED OR 69

EMDocs

JUNE 15, 2024

Non-rebreather Mask Spoon Feed Noninvasive ventilation (NIV) was superior to a standard non-rebreather (NRB) oxygen mask for preoxygenation of critically ill ED or ICU patients requiring intubation, with a NNT of 11 to prevent 1 episode of hypoxemia <85%. Source Noninvasive Ventilation for Preoxygenation during Emergency Intubation.

ICU 75

ICU Emergency Department ED OR 75

EMDocs

AUGUST 3, 2024

He Was Right Spoon Feed This systematic review found that approximately 4%-27% of patients presenting to the ED with presyncope experienced serious outcomes within a 30-day period. Source Serious outcomes among emergency department patients with presyncope: A systematic review. Acad Emerg Med. 2024 Jun 9.

Emergency Department 75

Emergency Department ED OR 75

The Skeptics' Guide to EM

FEBRUARY 3, 2024

March 2023 Date: January 30, 2024 Guest Skeptic: Dr. Alexandra (Ali) Espinel is an Associate professor of pediatrics and otolaryngology at Children’s National Hospital and George Washington University. Case: You’re working the morning shift in the emergency department (ED) when you encounter a 3-year-old boy and his family.

ALS 163

ALS Emergency Department OR ED 163

ACEP Now

JULY 7, 2024

1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). 2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus).

Emergency Department 52

Emergency Department Critical Care ALS ED 52

The Skeptics' Guide to EM

APRIL 6, 2024

2023 Date: March 29, 2024 Guest Skeptic: Dr. Michael Cosimini is a pediatrician in Portland Oregon. 2023 Date: March 29, 2024 Guest Skeptic: Dr. Michael Cosimini is a pediatrician in Portland Oregon. Case: A 4-month-old twin girl is brought by her parents to the emergency department (ED) for respiratory distress.

ALS 127

ALS Emergency Department ED 127

ACEP Now

AUGUST 13, 2024

Dr. Kendall is the chief of clinician engagement at US Acute Care Solutions and has 15 years of emergency department leadership experience. Accessed July 15, 2024. Accessed July 15, 2024. Accessed July 15, 2024. Published March 25, 2024. Accessed July 15, 2024. Accessed July 15, 2024.

ALS 111

ALS Emergency Department OR ED 111

Pediatric EM Morsels

AUGUST 23, 2024

Concussions are commonly encountered in the Emergency Department. Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. We have previously discussed an approach to the question of when a patient “ can return to sport.”

Emergency Department 243

Emergency Department OR ED EMS 243

ACEP Now

SEPTEMBER 5, 2024

Creation of an accurate database of emergency physicians living and working within a state, as well as a network of each states’ EM groups and ED medical directors would help chapter leaders disseminate relevant information, strengthen advocacy efforts, and plan regional solutions summits to focus on unique challenges.

EMS 52

EMS OR Emergency Department ED 52

Core EM

MARCH 1, 2024

Mumenthaler M , Mattle H , Taub E , ed. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Goldfrank’s Toxicologic Emergencies, 11e. Accessed February 27, 2024. References Neurology.

Emergency Department 162

Emergency Department ED OR ALS 162

Handtevy

FEBRUARY 27, 2024

Every year, countless young lives are impacted by the split-second decisions made in emergency departments across the United States. Only 14% of emergency departments are adequately ready to manage pediatric emergencies, a statistic that speaks volumes about the silent risks our children face. Florida Senate.

Emergency Department 52

Emergency Department Emergency Medical Services CPR ED 52

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Accessed May 28, 2024. What do you think? Labs obtained and notable for an elevated troponin I to 0.10

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E-9-1-1 ACS Emergency Department ALS 139

ACEP Now

JUNE 13, 2024

This fall, ACEP will participate in the Agency for Healthcare Research and Quality (AHRQ) Director’s summit on emergency department boarding. ACEP helped make the summit possible by mobilizing Congress to request action from the Department of Health and Human Services (HHS) during the Leadership and Advocacy Conference in 2023.

Emergency Medical Technician 52

Emergency Medical Technician ED Emergency Department OR 52

ACEP Now

FEBRUARY 11, 2024

A 25-year-old Venezuelan male presented to a Chicago area emergency department (ED) in early November 2023. He had traveled with his family through Panama, Costa Rica, Nicaragua, Honduras, Guatemala, Mexico, and Texas before arriving in Chicago approximately one month prior to his ED visit. Accessed January 15, 2024.

Emergency Department 52

Emergency Department ED ALS OR 52

Don't Forget the Bubbles

JUNE 19, 2024

A 2024 Cochrane systematic review compared available clinical decision rules (CDRs) (NEXUS, Canadian C-Spine Rule, PECARN retrospective criteria, NICE guidelines CG56 and CG176, Leonard de novo model, and PEDSPINE) for the evaluation of potential cervical spine injury following blunt trauma in children. 2024 Jun 3:S2352-4642(24)00104-4.

CPR 121

CPR Operating Room OR Emergency Department 121

EMDocs

JULY 9, 2024

What can we do about this in the pediatric ED? Social Emergency Medicine: Capitalizing on the Pediatric Emergency Department Visit to Screen and Connect Patients and Families to Community Resources. Community Resource Needs Assessment Among Families Presenting to a Pediatric Emergency Department. Pediatrics.

Emergency Department 71

Emergency Department Emergency Medical Services ED EMS 71

ACEP Now

APRIL 5, 2024

A 68-year-old man presents to the emergency department (ED) with altered mental status and fever. The study found a mean increase in time to intubation of 13 seconds in the ED setting. Techniques, success, and adverse events of emergency department adult intubations [published correction appears in Ann Emerg Med.

OR 73

OR ALS Emergency Department Critical Care 73

ACEP Now

FEBRUARY 13, 2024

A 77-year-old man presented to the emergency department (ED) with hip pain following a fall. On ED presentation, he was experiencing 10 out of 10 pain level. Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use. Ann Emerg Med. 2024 Jan;83(1):14-21. N Engl J Med. Pain Pract.

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E-9-1-1 Emergency Department ED ALS 52

EMDocs

SEPTEMBER 27, 2023

Below we discuss three that will likely have the greatest impact on emergency medicine physicians and our patients. The 2024 proposed physician fee schedule would decrease the conversion factor from $33.89 “Inside the proposed 2024 Medicare physician pay schedule.” References American Medical Association.

Emergency Department 63

Emergency Department ALS OR ED 63

ACEP Now

FEBRUARY 11, 2024

A 95-year-old female with a history of stage III chronic kidney disease (CKD), heart failure with reduced ejection fraction (HFrEF), and dementia with baseline orientation only to person and place, presented to the emergency department (ED) for upper extremity myoclonic jerking for one day. Accessed January 8, 2024.

Emergency Department 52

Emergency Department ALS ED OR 52

EMDocs

JUNE 27, 2024

An 8-year old male with a history of sickle cell anemia presents to the ED for evaluation of fever for 2 days and “feeling like I can’t get a full breath”. 768: Epidemiology of Hospital Based ED Visits due to Sickle Cell Crisis and Acute Chest Syndrome in Kids. 2024 Mar 12;14(1):5978. 2024 Jul;71(7):e31002. 2024 Apr 5.

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E-9-1-1 ICU ACS EMS 75

ACEP Now

JULY 8, 2024

Recently published experiments with LLMs in the emergency department fall into a handful of primary areas of interest. In a similar vein, another study evaluated the ability of an LLM to assess “clinical acuity” in the emergency department. J Am Coll Emerg Physicians Open. Health Informatics ; 2024.

Emergency Department 52

Emergency Department ALS ED OR 52

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. Am J Emerg Med.

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