REBEL EM

AUGUST 30, 2023

REBEL Core Cast 107.0 – Vertebral Osteomyelitis Click here for Direct Download of the Podcast Definition Inflammation of the vertebrae due to a pyogenic, fungal or mycobacterial organism. Graphics Image 1: [link] Image 2: [link] References Berbari EF, Kanj SS, et al. PMID: 26316526 Boody B, et al. In: Sherman SC eds.

E-9-1-1 103

E-9-1-1 ALS ED OR 103

The Skeptics' Guide to EM

NOVEMBER 1, 2022

Date: October 27th, 2022 Reference: Hayashi et al. Date: October 27th, 2022 Reference: Hayashi et al. There have been a few randomized control trials (RCTs) of peripheral nerve blocks for shoulder dislocation, but without definitive results (Raeyat Doost 2017; Blaivas 2011).

ALS 152

ALS Emergency Department OR ED 152

ACEP Now

MAY 9, 2024

It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergency department (ED). percent of ED visits resulted in preventable death as result of diagnostic error. References Newman-Toker DE, Peterson SM, Badihian S, et al.

Emergency Department 52

Emergency Department ICU ALS ACS 52

Don't Forget the Bubbles

OCTOBER 4, 2023

Formentin C, et al. Jørgensen RM, et al. Harris J, et al. Bhatia S, et al. Vivarelli M, et al. Morello W, et al. McGowan EC, et al. Hirata K, et al. Arch Dis Child Fetal Neonatal Ed. Shaikh N, et al. Determining the Best Definition for a Positive Urine Culture in Young Children.

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

Broome Docs

FEBRUARY 22, 2024

PMID: 36946338 Bottom line: This is a well done RCT that demonstrates pretty convincingly that you should not bother trying to but fingernails back on after nail bed repair (and my guess is you definitely shouldn’t be removing them either). Carson JL, Brooks MM, Hébert PC, et al; MINT Investigators. N Engl J Med. 2023 Nov 11.

Emergency Department 103

Emergency Department ALS OR ED 103

REBEL EM

JUNE 22, 2023

However, the medical community is only just starting to understand long-COVID (WHO Definition: the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation). Article: Bramante CT et al. References: Bramante CT et al.

ALS 145

ALS OR EMS ED 145

EMDocs

NOVEMBER 1, 2023

A 39-year-old male with history of achalasia with recent endoscopic dilation 24 hours prior presents to the ED for progressively worsening chest pain with radiation to his left shoulder. If there will be a delay in definitive management and there is evidence of intra-thoracic gastric contents, consider chest tube placement.

Critical Care 67

Critical Care ED EMS OR 67

EMS 12-Lead

MAY 8, 2022

They are definitely high in amplitude and, intermittently, appear to disproportionately tower over the respective QRS. This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2]

STEMI 130

STEMI ED EMS Firefighter 130

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. Very rarely are the ED team allowed to stand, in silence, with a purpose. Kapoor et al. This gives rise to feelings of failure alongside the feelings of grief. Psychological harm occurs. Southern Medical Journal. 112 (9),pp. Newell, J. &

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

Don't Forget the Bubbles

MAY 31, 2023

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. This meant 2746 ED presentations by 2618 individuals. Which patients were involved?

Emergency Department 135

Emergency Department ED OR ALS 135

The Skeptics' Guide to EM

JULY 25, 2020

Reference: Carley et al. The bottom line from that episode on skin glue for peripheral intravenous lines was: “Skin glue does appear to decrease the failure rate of IVs in patients admitted to hospital from the ED at 48 hours. It was great that it started with a definition of evidence-based medicine (EBM).

ED 130

ED ALS OR 130

REBEL EM

MARCH 8, 2023

REBEL Core Cast 97.0 – Acute Vision Loss II Click here for Direct Download of the Podcast Definition: Decrease of visual acuity due to a non-traumatic cause. et al, Emergency Medicine Clinical Essentials ed 2. Ophthalmology, in Marx J et al (eds): Rosens Emergency Medicine: Concepts and Practice, ed 9.

Emergency Department 52

Emergency Department ALS ED OR 52

REBEL EM

FEBRUARY 22, 2023

Open angle Closed angle Definitions Increased resistance to aqueous outflow through the trabecular meshwork. et al, Emergency Medicine Clinical Essentials ed 2. Ophthalmology, in Marx J et al (eds): Rosens Emergency Medicine: Concepts and Practice, ed 9. Bagheri 2015 ). 209-225 Walker R, Adhikari S.:

Emergency Department 52

Emergency Department ALS ED Coronary 52

EMDocs

AUGUST 12, 2023

Çalışkan Uçkun A, Yurdakul FG, Ergani HM, et al. link] Alkandari A F, Alawadhi A, Alawadhi F A, et al. doi:10.1055/s-0032-1327007 Zhao W, Wang G, Chen B, et al. 0000000000017823 Rosskopf AB, Martinoli C, Sconfienza LM, et al. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e. J Ultrason.

EMS 69

EMS ALS Emergency Department OR 69

EMDocs

DECEMBER 4, 2023

Johnson, MD ( Community EM, Salina Regional Health Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (Cleveland Clinic Foundation, EM-CCM); Brit Long, MD (@long_brit) Case A 40-year-old woman presents to a rural emergency department (ED) with left leg pain and swelling for the past 5 days. Ultrasound.

ALS 71

ALS Emergency Department ED OR 71

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

[link] Case continued She arrived in the ED and here is the first ED ECG. Lindahl et al. From Gue at al. Lindahl B, Baron T, Erlinge D, et al. I don't know if her pain was getting better or not. The downsloping ST depression is very suspicious for OMI, but not diagnostic. The Queen no longer thinks it is OMI.

Coronary 104

Coronary E-9-1-1 STEMI ACS 104

REBEL EM

JULY 20, 2022

REBEL Core Cast 85.0 – Superficial Venous Thrombosis Click here for Direct Download of the Podcast Definition: The presence of a clot in a superficial vein. References: Frappe P, et al the STEPH Study Group. PMID: 12814979 Blumenberg RM, et al.: PMID: 9510288 Coon WW et al. PMID: 25903684 Guyatt GH et al.

ALS 52

ALS OR ED EMS 52

ACEP Now

JANUARY 9, 2024

A 3-year-old male was brought to the emergency department (ED) by his mother, who reported the sudden onset of a rash (hives) covering his entire body, with no rash on his palms and soles. Nakhaee S, Amirabadizadeh A, Brent J, et al. Ruckart PZ, Jones RL, Courtney JG, et al. Zardast M, Khorashadi-Zadeh SS, Nakhaee S, et al.

E-9-1-1 52

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

ACEP Now

JUNE 7, 2023

The performance of EDs in 2020 and into 2021 changed abruptly, and that carried through into 2022. EDs weathered attacks from a variety of sources in recent years. ED leaders worked to develop new physician documentation and coding guidelines that needed to be implemented at the beginning of 2023.

Emergency Department 52

Emergency Department ED EMS Ambulance 52

REBEL EM

MARCH 22, 2023

REBEL Core Cast 98.0 – AVNRT Click here for Direct Download of the Podcast Definition: A regular, narrow-complex rhythm with a ventricular rate that is typically > 160 bpm. PMID: 2022022 Appleboam A et al. PMID: 1595533 Ben Yedder N et al. PMID: 21329868 Carlberg DJ et al. Circulation 1991; 83: 1649-59.

ALS 52

ALS EMS ED OR 52

REBEL EM

APRIL 17, 2023

Article: Kim DJ et al. We need high-quality evidence to provide a definite conclusion. The neck and thyroid are particularly vulnerable to radiation (Tipnis et al.). Additionally, potential increases in resource utilization, healthcare expense, and ED length of stay are also essential considerations. Acad Emerg Med.

OR 128

OR ALS ED EMS 128

EMS 12-Lead

AUGUST 22, 2022

They are not premature, by definition. Chou’s Electrocardiography in Clinical Practice (6th ed). The blue arrows show RBBB morphology, and it’s tempting to deploy a compulsory diagnosis of PVC’s, but remember: these wide QRS complexes arrive subsequent to a regularly timed P wave. The green arrows, however, do show premature complexes.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

ACEP Now

OCTOBER 10, 2023

Once there is an anion gap, the horse has left the barn and the remaining definitive treatment is hemodialysis. Winter, et al., Winter, et al., References Gummin DD, Mowry JB, Beuhler MC, et al. Hoffman RS, Smilkstein MJ, Howland MA, et al. Boyer EW, Mejia M, Woolf A, et al. Winter ML, et al.

ALS 52

ALS OR ED 52

REBEL EM

FEBRUARY 8, 2023

PMID: 3652623 Wilhelmus KR et al. PMID: 4739528 Weiner et al. Link McDonald et al. Link Welder et al. Link Wilhelmus KR et al. PMID: 7997324 Chan RV et al. Link White et al. Herpes simplex epithelial and stromal keratitis: an epidemiologic update. Surv Ophthalmol 2012; 57(5):448-462.

ALS 52

ALS OR EMS ED 52

FOAMfrat

JULY 3, 2024

If they are not already there, get ALS-level care to the patient as soon as possible. I personally know of 2 ALS providers who were exposed to chlorine gas in a pool incident on the job and both ended up retiring from their service and still have lifelong breathing problems as a result. Thomas, Eds.) Bronstein, A. Fernandez, M.

Life Support 105

Life Support ALS Emergency Response OR 105

ACEP Now

JULY 6, 2023

Of course, the bill for any episode of emergency department (ED) care can be substantial, exceeding the billed charges for equivalent care provided in some primary care offices. Now, many acute pyelonephritis patients receive an IV antibiotic, analgesia, and an antiemetic in the ED. 6–11 All perform with high accuracy and validity.

ALS 52

ALS Emergency Department STEMI ED 52

The Skeptics' Guide to EM

DECEMBER 21, 2019

Outside of his academic duties, he works clinically in the adult ED at Spectrum Health in Grand Rapids, Michigan, the tertiary care center for Western Michigan. Only then would there be definitive evidence for the efficacy of parachutes. It was published last year in the 2018 BMJ holiday edition ( Yeh et al BMJ Dec 2018 ).

OR 100

OR ALS ED 100

The Skeptics' Guide to EM

FEBRUARY 2, 2018

[display_podcast] Date: January 31st, 2018 Reference: Frohlich LC, et al. display_podcast] Date: January 31st, 2018 Reference: Frohlich LC, et al. Ultrasound imaging of the scrotum is the gold standard for diagnosis of testicular torsion, however can lead to delays in definitive care. Reference: Frohlich LC, et al.

Operating Room 100

Operating Room Emergency Department ALS ED 100

REBEL EM

OCTOBER 19, 2022

Treat moderate to severe symptoms and any EKG changes with IV calcium salts Always search for and treat the underlying cause of hypocalcemia REBEL Core Cast 88.0 – Hypocalcemia Click here for Direct Download of the Podcast Definition: A serum calcium level < 8.5 Louis, Mosby, Inc., 2014, (Ch) 125: p 1636-53. 2013, July 2).

ED 52

ED ALS EMS OR 52

EMDocs

NOVEMBER 18, 2023

A 32-year-old female with a history of hypertension and autoimmune hepatitis status post liver transplant 6 weeks prior on tacrolimus and mycophenolate presents to the ED with abdominal discomfort. What are the complications of liver transplant that we see in the ED? doi:10.1007/s00247-020-04811-0 2) Kwong AJ, Ebel NH, Kim WR, et al.

EMS 69

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

ACEP Now

MAY 10, 2024

A 59-year-old man presents to your community emergency department (ED) with chest pain that is radiating to his back. Reference Gibbons RC, Smith D, Feig R, et al. However, the diagnostic accuracy of SPEED is not good enough to fully exclude the diagnosis and you order a CTA to definitively rule out an AoD in this man.

ALS 52

ALS OR Emergency Department ED 52

REBEL EM

DECEMBER 5, 2023

The risk of a biphasic reaction is what keeps patients in the ED while being observed for a set period of time. This varied incidence can be due to inconsistent definitions or inclusion of mild reactions. The American Journal of Emergency Medicine 2018 Aug;36(8):1480-1485 Shaker M, et al.

Epinephrine 80

Epinephrine Allergic Reaction Emergency Department Emergency Manager 80

EMDocs

JUNE 3, 2023

A 53-year-old female with a past medical history significant for hypertension presents to the ED with headache and dizziness. Definitive diagnosis of cerebellar infarction is made with MRI of the brain, as CT imaging (both non-contrast and IV contrast) is often unremarkable and has poor sensitivity for cerebellar stroke.

EMS 74

EMS ALS OR ED 74

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. Hayakawa A, Tsukahara K, Miyagawa S, et al. Written by Nathanael Franks MD, reviewed by Meyers, Smith, Grauer, etc. Am J Emerg Med.

ACS 87

ACS Coronary ALS CAD 87

ACEP Now

NOVEMBER 16, 2023

8 Following initial stabilization, unstable patients should be admitted to the intensive care unit for definitive management. 10 Given the difficulty of obtaining history from these patients, we recommend the empiric use of octreotide in the ED for UGIB, consistent with earlier studies. Jeong N, Kim KS, Jung YS, et al.

Frozen Plasma 52

Frozen Plasma FFP ALS Plasma 52

Don't Forget the Bubbles

MAY 15, 2023

Although hypoglycaemia is one of the most common paediatric emergencies, consensus on a definition and investigations have not been reached. Even the definition of hypoglycaemia itself is a contentious subject. How do I measure hypoglycaemia in the ED? Again, this is a general guide only. Frontiers in Endocrinology.

ED 101

ED Plasma OR ALS 101

EMDocs

JULY 30, 2024

On arrival to the ED, the patient was agitated, disoriented, tachycardic, and his blood glucose was > 600 mg/dL. As no definitive testing could be performed on the material ingested, it could not be confirmed whether the patient’s symptoms were related to a PNU exposure or new onset diabetes, however, PNU exposure was highly suspected.

Overdose 56

Overdose ED Emergency Department OR 56