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

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

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

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

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

EMDocs

AUGUST 22, 2024

13 Interventions may include: Ascertaining a patient’s preferred language early in the clinical encounter (during registration, for instance), and clearly documenting this preference in a place that is visible to all providers. Utilizing certified interpreters and documenting their use. Lion KC, et al. Regenstein M, et al.

Emergency Department 82

Emergency Department ALS E-9-1-1 ED 82

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 100

Critical Care ALS ED OR 100

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 136

ALS ACS OR CPR 136

EMDocs

JULY 25, 2024

The nurse completes the Columbia-Suicide Severity Rating Scale (C-SSRS) and documents that the patient’s recent thoughts of killing himself and his detailed plan makes him “High Risk” for suicide. There is no documented handoff to the on-coming emergency physician (EP) who assumes care. Ronquillo L et al. Applebaum PS.

ED 82

ED ALS Emergency Department OR 82

The Skeptics' Guide to EM

MARCH 4, 2018

[display_podcast] Date: February 27th, 2018 Reference: Moran et al. display_podcast] Date: February 27th, 2018 Reference: Moran et al. Reference: Moran et al. Exclusions: There were 26 exclusions in their supplemental documentation. . Exclusions: There were 26 exclusions in their supplemental documentation.

ALS 100

ALS OR EMS 100

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

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 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

EMDocs

SEPTEMBER 26, 2024

An unknown EP reviews the report, determines that there is no reason to notify the patient, and documents nothing. It wasn’t, so you weren’t called, nor did the doc need to document anything. This patient’s history was either poorly taken or poorly documented. Baccei SJ et al. Tyler W et al. Volume 80, no.

Emergency Department 75

Emergency Department ED Coronary ALS 75

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

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 116

Coronary ACS OR EMR 116

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

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

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-9-1-1 121

E-9-1-1 ALS ACS ICU 121

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-9-1-1 138

E-9-1-1 ACS Emergency Department Coronary 138

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

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

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

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

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

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 85

E-9-1-1 EMS ALS Defibrillator 85

ACEP Now

DECEMBER 17, 2024

One of the first documented strikes among house staff officers took place in 1974 at Howard University here in Washington, D.C., Ahmed AM, Kadakia K, Ahmed A, et al. Historically, labor unionization among health care workers is uncommon, 5 including among resident physicians, 6 and the prospect of striking even more so. Beresford L.

E-9-1-1 105

E-9-1-1 Emergency Department ALS OR 105

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 73

ED ALS OR 73

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 71

ALS Emergency Department ED OR 71

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

ACEP Now

DECEMBER 6, 2024

This case report documents the first known instance of using NTG during an emergency department resuscitation to treat a patient in cardiac arrest due to severe coronary artery vasospasm. Cardiac arrest secondary to myocardial ischemia from coronary vasospasm is well documented. References Prinzmetal M, Kennamer R, Merliss R, et al.

Coronary 52

Coronary Life Support ALS Emergency Department 52

ACEP Now

OCTOBER 30, 2023

Krahn, et al., 3 The need for this type of investigation was further highlighted in an article by York, et al. Krahn, et al., 3 The need for this type of investigation was further highlighted in an article by York, et al.—an Rotoli J, Backster A, Sapp RW, et al. Click to enlarge.) Am J Public Health.

ED 98

ED ALS OR EMS 98

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 78

Emergency Medical Services EMS Emergency Department Ambulance 78

Don't Forget the Bubbles

JUNE 19, 2024

Well-designed multicentre large studies in children were warranted; cue Leonard et al. A proportion of the patients who were initially missed using the CDR were found to actually have risk factors documented in EMS reports or the medical record. In practice, questions remain about who applies the CDR and the inter-rater reliability.

CPR 124

CPR Operating Room OR Emergency Department 124

ACEP Now

JUNE 6, 2023

A medical student reports a murmur, not documented by either the emergency physician or the cardiologist. References Hansen MS, et al. Von Kodolitsch Y, et al, Clinical predictors of acute aortic dissection. Rogers AM, et al. Cecconi M, et al. Trap #1: Walks like a duck, quacks like a duck, but it’s not a duck.

ACS 85

ACS ALS ED Coronary 85

ACEP Now

DECEMBER 11, 2023

A recent article documents 56 additional U.S. Watson PW, Norman SB, Maguen S, et al. The wave of increasing hospital closures and service line cutbacks continues to sweep the U.S. hospitals that are closing clinical departments or ending or reducing services. End restrictions on physician-owned hospitals to expand quality care.

OR 98

OR ALS 98