The Skeptics' Guide to EM

OCTOBER 1, 2022

Date: September 28th, 2022 Reference: Hartford et al. Date: September 28th, 2022 Reference: Hartford et al. Brown et al , Selbst and Clark ). It is not well documented, whether gaps in pain assessment and treatment exist in conditions in which opioids are not indicated, such as migraine headaches. AEM September 2022.

Emergency Department 130

Emergency Department ALS ED OR 130

Pediatric EM Morsels

JULY 5, 2024

We collected data directly from the bedside clinician which enabled us to gather pertinent patient symptoms and physical examination findings that may not be well documented in the medical record, but more accurately identify the child’s injuries.” Baumann F, Ernstberger T, Neumann C, et al. Leonard JC, Harding M, Cook LJ, et al.

ALS 161

ALS OR ED Emergency Department 161

The Skeptics' Guide to EM

MARCH 31, 2023

Date: March 28, 2023 Reference: Fowler et al. Date: March 28, 2023 Reference: Fowler et al. You find her at the desk, asleep with her face on the keyboard, patient documentation half finished. Reference: Fowler et al. Objective assessment of sleep and fatigue risk in emergency medicine physicians.

ALS 130

ALS Emergency Department 130

Pediatric EM Morsels

JULY 28, 2023

A critical MORSEL is that every child you treat for DKA needs to have an initial thorough neuro exam including cranial nerves and then frequent neuro reassessments … and document it ( so your colleagues who take over care for the kid can know if there has been a change )! PubMed] [Read by QxMD] Rosenbloom AL. 2013 Sep;163(3):761-6.

E-9-1-1 246

E-9-1-1 ALS OR Critical Care 246

The Curious Clinicians

OCTOBER 2, 2024

Growdon ME, Jing B, Morris EJ, Deardorff WJ, Boscardin WJ, Byers AL, Boockvar KS, Steinman MA. Sponsor Freed is an AI scribe that listens, transcribes, and writes medical documentation for you. It turns clinicians’ patient conversations into accurate documentation – instantly. J Am Geriatr Soc. 2024 Jun;72(6):1728-1740.

ACS 105

ACS ALS OR 105

ALiEM

MARCH 11, 2024

There is limited literature documenting eye involvement and pictographic examples of its presentation. The patient’s eye lesion and symptoms resolved and he was discharged on hospital day eight. Ocular lesions are a rare presentation of the monkeypox virus. The 2022 outbreak and the pathobiology of the monkeypox virus. J Autoimmun.

Emergency Department 141

Emergency Department ALS OR 141

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Studies such as those by Moise et al 14 and Ellis et al 39 have shown that the relative risk of developing an acute myocardial infarction in the territory supplied by an artery with a 70%. We documented that the majority of stenotic lesions had compensatory enlargement and thus exhibited remodeling.

Coronary 115

Coronary ACS OR EMR 115

The Skeptics' Guide to EM

JANUARY 16, 2021

Date: January 5th, 2021 Reference: Shipman et al. Date: January 5th, 2021 Reference: Shipman et al. The first documented use of topical ophthalmologic anesthetics was in 1818. We covered and randomized control trial by Waldman et al on topical tetracaine for simple corneal abrasions on SGEM#83.

ALS 130

ALS Emergency Department EMS ED 130

EMDocs

NOVEMBER 6, 2024

285.6340.478 Gummin DD, Mowry JB, Beuhler MC, et al. doi:10.1080/15563650.2023.2268981 Wood DM, Webster E, Martinez D, Dargan PI, Jones AL. doi:10.1016/s0966-842x(03)00210-5 Schiavo G, Benfenati F, Poulain B, et al. Farrar J, Yen L, Cook T, et al. Thwaites CL, Yen LM, Cordon SM, et al. Br Med J Clin Res Ed.

E-9-1-1 77

E-9-1-1 ALS EMS OR 77

The Skeptics' Guide to EM

NOVEMBER 21, 2020

Reference: Pines et al. Reference: Pines et al. The American College of Emergency Physicians ( ACEP ) has a number of documents discussing APPs in the ED. Reference: Pines et al. Date: November 19th, 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. AEM November 2020. AEM November 2020.

Emergency Department 130

Emergency Department ALS ED OR 130

EMDocs

DECEMBER 4, 2023

Document a risk and benefit discussion with the patient regarding empiric anticoagulation, perhaps even including the HAS-BLED score in the documentation [10]. References Kraaijpoel N, Carrier M, Le Gal G, et al. 0228788 Wells PS, Anderson DR, Rodger M, et al. Goldin Y, Pasvolsky O, Rogowski O, et al. Ultrasound.

ALS 70

ALS Emergency Department ED OR 70

EMDocs

SEPTEMBER 23, 2023

Brugada sign refers to the findings on ECG, while Brugada syndrome is the combination of ECG findings with one of the following: documented ventricular tachycardia or fibrillation, syncope, family history of sudden cardiac death at < 45 years old, or inducible ventricular tachycardia with programmed electrical stimulation. Circulation.

E-9-1-1 83

E-9-1-1 EMS ALS Defibrillator 83

ACEP Now

APRIL 2, 2024

His neurological exam on arrival is documented as normal. Conclusion We have never reviewed a missed posterior circulation stroke where all elements of neurological exam were documented. Diagnosis of posterior circulation stroke requires an astute clinician who performs and documents an detailed neurologic examination.

ALS 40

ALS ED Emergency Department OR 40

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. References: Jaff MR et al. PMID: 21422387 Wan S et al. PMID: 15262836 Sharifi M et al. PMID: 27422214 Wang C et al. PMID: 19741062 Kucher N et al. PMID: 24226805 Piazza G et al. PMID: 26315743 Tapson VF et al. CHEST 2010.

ALS 137

ALS ACS OR CPR 137

The Skeptics' Guide to EM

OCTOBER 28, 2017

[display_podcast] Date: October 24th, 2017 Reference: Harrison et al. display_podcast] Date: October 24th, 2017 Reference: Harrison et al. That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015. Reference: Harrison et al.

ALS 130

ALS Emergency Department OR ED 130

EMDocs

JANUARY 25, 2024

The patient’s last INR should be documented, and one obtained if not recent. For patients on warfarin, documenting a reason for not checking an INR is a worthwhile practice. Baek BS et al. Vranckx P et al. This is a classic case of “anchoring bias” (i.e., References : 1. Spontaneous Spinal Epidural Hematoma.

ED 72

ED ALS OR 72

The Skeptics' Guide to EM

JANUARY 23, 2021

Reference: Pines et al. The American College of Emergency Physicians ( ACEP ) also has a number of documents discussing APPs in the ED. Reference: Pines et al. Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain.

ED 130

ED ALS Emergency Department OR 130

ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented. References Lulla A, et al. J Safety Res.

Emergency Medical Services 98

Emergency Medical Services EMS OR Overdose 98

Don't Forget the Bubbles

NOVEMBER 20, 2023

Document the size, consistency and location in the notes to compare if they represent. References Al-Khateeb T, Al Zoubi F. 2006.11.039 Fanous A, Morcrette G, Fabre M et al. 2017.12.003 Machado De Carvalho G, Silva de Lavor M et al. They may grow again with subsequent upper respiratory tract infections.

ALS 124

ALS Emergency Department OR 124

REBEL EM

NOVEMBER 30, 2023

Kuttab et al’s findings, constituting 45% of the review’s weight, suggest that administering <30cc/kg IVF is associated with increased odds of mortality, delayed hypotension, and increased ICU utilization. Uchel et al’s contribution (21% weight) indicates that ≥30cc/kg IVF is linked to 2.5 2020;4(5):537-541.

E-9-1-1 122

E-9-1-1 ALS ACS ICU 122

ACEP Now

NOVEMBER 7, 2024

Reference Nordstrom K, Berlin JS, Nash SS, et al. Boarding of mentally ill patients in emergency departments: American Psychiatric Association resource document. McEnany FB, Ojugbele O, Doherty JR, et al. Malas N, Hindman D, Mroczkowski M, et al. West J Emerg Med. 2019;20(5):690-695. Pediatric mental health boarding.

ED 59

ED Emergency Department ALS OR 59

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. References: Singer S, et al. PMID: 36108346 Cole JB, et al. PMID: 31270748 Maheshwari K, et al. PMID: 29872882 Jones AE, et al. PMID: 17035422 Holler JG, et al. PMID: 25789927 Schwartz MB, et al. The safety and efficacy of push dose vasopressors in critically ill adults.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

Dr. Smith's ECG Blog

JANUARY 5, 2024

The documentation does not describe any additional details of the history. They also documented "Reproducible chest tenderness." Heitner et al. Written by Willy Frick A 46 year old man with a history of type 2 diabetes mellitus presented to urgent care with complaint of "chest burning." The following ECG was obtained.

ACS 107

ACS ALS OR STEMI 107

The Skeptics' Guide to EM

MAY 11, 2019

Date: May 6th, 2019 Reference: Sceats et al. Date: May 6th, 2019 Reference: Sceats et al. Case: An 18-year-old woman presents with a Grade 1 appendicitis (Tominaga et al J Trauma Acute Care Surg 2016). Background: The first documented appendectomy was done by Claudius Amyand in 1735. Reference: Sceats et al.

Critical Care 130

Critical Care ALS OR ED 130

The Skeptics' Guide to EM

DECEMBER 18, 2021

Date: December 13th, 2021 Reference: Lee et al. Date: December 13th, 2021 Reference: Lee et al. Unfortunately, sexual harassment is also still widely documented in emergency medicine and has a major impact on career advancement and attrition [11-13].

Emergency Department 100

Emergency Department ALS ED OR 100

The Skeptics' Guide to EM

DECEMBER 5, 2020

Date: November 30th, 2020 Reference: Ohle R et al. Date: November 30th, 2020 Reference: Ohle R et al. Over the past decade, some emergency physicians have adopted this examination into their own bedside clinical assessment and documentation. Reference: Ohle R et al. A Systematic Review and Meta-analysis.

ALS 100

ALS Emergency Department ED OR 100

The Skeptics' Guide to EM

APRIL 24, 2021

Reference: Martel et al. Reference: Martel et al. Exclusions: Prisoners or those in police custody, pregnant or breast-feeding, or with documented allergy to any study medications. Exclusions: Prisoners or those in police custody, pregnant or breast-feeding, or with documented allergy to any study medications.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

ACEP Now

APRIL 2, 2024

4 The association between ackee ingestion and the illness was initially recognized in 1875 and officially documented in 1904. 5 Despite being endemic to Jamaica, cases of THS have been reported across the world, with the first case in the United States documented in 1993. References Katibi OS, Olaosebikan R, et al. Clin Toxicol.

Plasma 40

Plasma ALS Emergency Department ED 40

REBEL EM

AUGUST 22, 2024

Paper: Lema GMC, De Leacy R, Fara MG, et al. Documented at the following time points: Before treatment. Follow Me: References: Mac Grory B, Nackenoff A, Poli S, et al. PMID: 32568646 Wang X, Liu Y, Suo Y, et al. PMID: 33156166 Sobol EK, Sakai Y, Wheelwright D, et al. Ophthalmology. 1 week after treatment.

ALS 85

ALS ED OR EMS 85

Dr. Smith's ECG Blog

JUNE 17, 2024

In fact, Kosuge et al. Stein et al. This is a paper worth reading : Marchik et al. Kosuge et al. Witting et al. This does not contradict the conclusions of Kosuge et al. found normal ECGs in only 3 of 50 patients with massive PE, and 9 of 40 with submassive PE. of patients with PE and 3.3% of controls.

E-9-1-1 137

E-9-1-1 ACS Emergency Department Coronary 137

REBEL EM

JUNE 22, 2023

Article: Bramante CT et al. Population: Adults aged 30-85 years of age with BMI > 25 ( > 23 in those identifying as Asian or Latino) who had COVID-19 symptoms for fewer than 7 days and a documented SARS-CoV-2 positive PCR or antigen test within 3 days of enrollment without prior SARS-CoV-2 infection.

ALS 145

ALS OR EMS ED 145

The Skeptics' Guide to EM

MAY 2, 2020

Date: April 24th, 2020 Reference: Watanabe et al. Date: April 24th, 2020 Reference: Watanabe et al. Reference: Watanabe et al. Is Use of Warning Lights and Sirens Associated With Increased Risk of Ambulance Crashes? A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. Annals of Emergency Medicine.

ED 100

ED Ambulance Medical Transportation EMS 100

Critical Care Scenarios

NOVEMBER 15, 2020

Yes, temporize with supportive care while you go through the process, but do the work—find a legitimate representative or documentation of the patient’s wishes to determine what they’d want before you commit them to lengthy, aggressive life support. References Patel KK, Young L, Howell EH, et al. JAMA Intern Med.

ICU 100

ICU Life Support Emergency Department ED 100

ACEP Now

JULY 8, 2024

3 Taking a different approach, this study did not utilize information available at triage, but instead used full-note text from completed documentation of history, examination, and assessment. References Jiang LY, Liu XC, Nejatian NP, et al. Franc JM, Cheng L, Hart A, et al. Williams CYK, Zack T, Miao BY, et al.

Emergency Department 52

Emergency Department ALS ED OR 52

EMDocs

JUNE 9, 2023

We’re defining “protocol” here as a written document that provides oversight from the medical director about how to assess and treat patients. Reassessment and Documentation After any type of restraint is instituted, careful assessment, re-assessment, and documentation is required. Was the documentation complete?

Emergency Medical Services 76

Emergency Medical Services EMS Emergency Department Ambulance 76

Don't Forget the Bubbles

JULY 26, 2023

Stredder et al, Archives of Disease in Childhood 2016 we see that 58% were not asked about triggers, 30% were not asked about duration and, importantly for risk stratification, 59% were not asked for a family history of cardiac disease. Where there are a number of unexplained deaths, start to be more critical about what this could mean.

ALS 98

ALS ED OR CPR 98

NAEMSP

MARCH 5, 2024

Article Summary by Sarah Fabiano, MD, FACEP, FAAEM Lyng JW, Braithwaite S, Abraham H, et al. Appropriate air medical services utilization and recommendations for integration of air medical services resources into the EMS system of care: a joint position statement and resource document of NAEMSP, ACEP, and AMPA.

Critical Care 52

Critical Care Medical Transportation CPR EMS 52