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 122

ALS Emergency Department OR ED 122

Dr. Smith's ECG Blog

JANUARY 27, 2024

Deutch et al. Figure-1: I've labeled the initial ECG in the ED. KEY Point: All patients who present to the ED for new CP should promptly have a triage ECG recorded, that is then immediately interpreted by the ED physician. West J Emerg Med 2024). For clarity — I've labeled this initial ECG in Figure-1.

STEMI 116

STEMI Coronary ACS ED 116

Don't Forget the Bubbles

SEPTEMBER 6, 2023

14-year-old Katy presents to the paediatric Emergency Department (ED), alone, complaining of suicidal ideation. Mental health-related ED visits for children and young people are common and have been on the rise during the last decade. What is the problem? It can be difficult to diagnose and may require detailed investigation.

Emergency Department 119

Emergency Department ED ALS Overdose 119

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. References Tsao CW, et al. Benjamin EJ, et al. Kimblad H, et al. Sakai T, et al. Kudenchuk PJ, et al. Lee YH, et al. Benjamin EJ, et al. Hajjar K, et al. Circulation.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

ACEP Now

NOVEMBER 8, 2024

Historically, the endotracheal tube (ETT) has been considered the definitive airway of choice in both the prehospital and in-hospital setting. Benger JR, Kirby K, Black S, et al. Wang HE, Schmicker RH, Daya MR, et al. In: Cone DC, Brice JH, Delbridge TR, Myers B, eds. Ramaiah R, Das D, Bhananker SM, et al.

E-9-1-1 40

E-9-1-1 Emergency Medical Services Emergency Medical Technician AEMT 40

ACEP Now

AUGUST 14, 2024

Rate Versus Rhythm in the ED The 2023 AHA/ACC guideline doesn’t give explicit recommendations or preference regarding initial rate or rhythm control strategy for new-onset AF patients who are hemodynamically stable. based care of ED patients with AFRVR. References Joglar JA, Chung MK, Armbruster AL, et al. Circulation.

ALS 105

ALS Emergency Department ED OR 105

ALiEM

NOVEMBER 8, 2023

The RegiSCAR (Registry of Severe Cutaneous Adverse Reactions) group suggested the following criteria for diagnosing DRESS syndrome and a point scoring system determining negative, possible, probable, or definitive DRESS syndrome [ MDCalc ]: Fever >38.5⸰C In: Nelson L, Howland MA, Lewin NA, Goldfrank LR, Hoffman RS, eds.

OR 161

OR ALS ED 161

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

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

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 96

E-9-1-1 ALS ED OR 96

ACEP Now

NOVEMBER 8, 2024

9 Here are some of the key conditions that are considered neurodivergent and that emergency physicians are likely to encounter: Autism Spectrum Disorder (ASD): Although the definition of autism has changed over time, in general, it refers to a group of complex developmental brain disorders. Maenner MJ, Warren Z, Williams AR, et al.

Emergency Department 52

Emergency Department ED OR ALS 52

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 96

Critical Care ED EMS OR 96

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.

ALS 129

ALS OR ED EMS 129

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

Dr. Smith's ECG Blog

OCTOBER 30, 2023

Here is the first prehospital ECG (time 0, after one hour of pain): I do not see evidence of OMI, and neither did the Queen of Hearts Here is the 2nd prehospital ECG (time 10 minutes, after 70 minutes of pain): No change On arrival, the first ED ECG was recorded 20 minutes after the last one (90 minutes after pain onset): What do you think?

STEMI 122

STEMI ED ALS OR 122

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 97

EMS ALS Emergency Department ED 97

Dr. Smith's ECG Blog

JUNE 5, 2023

Here is his initial ED ECG: What do you think? Then the ED doc would be dependent on that first ECG. It must have re-occluded between the ED and the cath lab) --Lesion was stented. Aside on ECG Research: 20% of Definite diagnostic STEMI (Cox et al.) Or had not had a prehospital ECG on the ambulance.

STEMI 96

STEMI Coronary ED Ambulance 96

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? The initial ECG in today's case was recognized as definitely abnormal — but the question arose as to whether this ECG indicated old infarction vs a new acute event.

EMS 113

EMS CPR ED Coronary 113

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

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. This study chose a relevant topic to analyze that could influence acute management in the ED and has a fairly larger sample size of patients to do so. References: Singer S, et al. PMID: 36108346 Cole JB, et al. PMID: 31270748 Maheshwari K, et al. PMID: 29872882 Jones AE, et al.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

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 97

ALS Emergency Department ED OR 97

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 109

Coronary E-9-1-1 STEMI ACS 109

EMDocs

APRIL 27, 2024

A 68-year-old male with a history of poorly controlled diabetes presents to the ED with increasing right-sided ear and facial pain, swelling, and difficulty hearing for two weeks. CT and MRI can be synergistic in diagnosis of management, though CT is the ideal imaging modality in the ED. link] Al Aaraj MS, Kelley C. The Lancet.

EMS 106

EMS ED OR ALS 106

REBEL EM

JANUARY 23, 2023

Article: Abella BS et al. Key Secondary Endpoints: 5 (3.9%) patients in the IV cetirizine group returned to any ED or clinic within 24 hours compared to 15 (11.1%) in the IV diphenhydramine group; P=0.04 Anecdotally, the persistence of urticaria often has little influence on the decision to discharge a patient from the ED.

Allergic Reaction 52

Allergic Reaction ED E-9-1-1 Emergency Department 52

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Consider the following: We become attuned to looking for acute coronary occlusion in patients who present with acute symptoms to the ED ( E mergency D epartment ). But the History in today's case was acute shortness of breath with dizziness and lightheadedness — and, essentially without chest pain!

E-9-1-1 126

E-9-1-1 Coronary STEMI ALS 126

Don't Forget the Bubbles

MARCH 4, 2024

This study retrospectively identified 1,414 children, presenting to 15 UK EDs (2016 -2017), who had been screened for malaria. Children were included if they had a malaria screen in ED. It provides an estimate of illness prevalence in this cohort rather than a definitive assessment. Schlapbach LJ, Watson RS, Sorce LR, et al.

Emergency Department 78

Emergency Department Critical Care ALS OR 78

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." The original term " benign early repolarization" has fallen out of favor since the seminal paper by Haïssaguerre et al. In an attempt to clarify language, a consensus definition was developed.

E-9-1-1 129

E-9-1-1 OR Coronary ACS 129

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 106

Life Support ALS Emergency Response OR 106

EMDocs

JULY 1, 2023

A 3-year-old male with no past medical history presents to the ED with one week of daily fevers >102°F associated with four days of rash on the trunk. In: Post TW, ed. In: Post TW, ed. In: Post TW, ed. In: Post TW, ed. We’ll keep it short, while you keep that EM brain sharp. C) for the past week. Lakhani, N.

EMS 95

EMS Coronary ED OR 95

EMDocs

NOVEMBER 6, 2023

This post will focus on the key parts of the guideline that affect ED evaluation and management. Editorial Comment : Use standard BLS/ALS measures, especially if in cardiac arrest. Top 10 Take Home Pearls 1. COR 1, LOE C-LD. COR 2a, LOE B-NR. Give naloxone for suspected opioid overdose and respiratory compromise/arrest.

Naloxone 116

Naloxone OR BLS Overdose 116

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 81

Epinephrine Allergic Reaction Emergency Department Emergency Manager 81

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

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

Dr. Smith's ECG Blog

MAY 23, 2023

But the paramedic and the ED physician in this case did not subscribe to this idea. In that same year we collect approximately 24,000 ECGs in our ED, of which 20% are called “Normal” by the computer. Existing computerized ECG interpretation programs are ( and have always been ) by definition faulty!

STEMI 98

STEMI Coronary Paramedic OR 98

REBEL EM

AUGUST 22, 2022

Background: Traumatic lacerations presenting to the emergency department are, by definition, contaminated (ie non-sterile). There is almost no literature on this topic, with really only one ED study [2], with a small sample size showing no difference in infection rates between sterile versus non-sterile gloves in traumatic wound repair.

Emergency Department 58

Emergency Department ALS ED EMS 58

REBEL EM

JULY 3, 2023

Background: Atrial fibrillation and atrial flutter with rapid ventricular rate (AF/AFL with RVR) are the most common subtypes of SVT, comprising a large number of ED visits in aging populations. Article: Rossi N et al. Currently, rhythm and rate control are the mainstays of therapy in acute settings. Am J Emerg Med.

E-9-1-1 96

E-9-1-1 EMR Emergency Department ED 96