The Skeptics' Guide to EM

NOVEMBER 21, 2020

Reference: Pines et al. Reference: Pines et al. Case: You are the medical director of a medium sized urban emergency department (ED). The American College of Emergency Physicians ( ACEP ) has a number of documents discussing APPs in the ED. Reference: Pines et al. AEM November 2020. AEM November 2020.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

JANUARY 23, 2021

Reference: Pines et al. AEM January 2021 Case: A 50-year-old male presents to the Emergency Department (ED) with left lower quadrant abdominal pain. That SGEMHOP episode asked how the productivity of APPs compare to emergency physicians and what is its impact on ED operations? Reference: Pines et al.

ED 130

ED ALS Emergency Department OR 130

Pediatric EM Morsels

JULY 5, 2024

Using this decision rule would have cut down on ED CT C-spine ordering by >50% in this derivation cohort. I am hopeful it will also improve the flow in the ED.” While plain films for C-spine injury had previously fallen out of routine ED practice, we now have more evidence to support their use in intermediate risk patients.

ALS 161

ALS OR ED Emergency Department 161

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

The Skeptics' Guide to EM

JANUARY 16, 2021

Date: January 5th, 2021 Reference: Shipman et al. Date: January 5th, 2021 Reference: Shipman et al. In the emergency department (ED), tetracaine drops are applied prior to slit lamp examination and the pain is completely resolved. The first documented use of topical ophthalmologic anesthetics was in 1818.

ALS 130

ALS Emergency Department EMS ED 130

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 98

Coronary Life Support ALS Emergency Department 98

EMDocs

AUGUST 22, 2024

6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. 6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. One cohort study in a public ED found that 84.5%

Emergency Department 82

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

Critical Care Scenarios

NOVEMBER 15, 2020

Takeaway lessons Many decisions in the ED are less about what to do, and more about when to do it. Takeaway lessons * Many decisions in the ED are less about what to do, and more about when to do it. Goals of care starts in the ED, and not with lip service. ICU time and ED time are different. JAMA Intern Med.

ICU 100

ICU Life Support Emergency Department ED 100

EMDocs

SEPTEMBER 26, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Patient not informed of enlarged heart, dies 3 weeks post ED visit Miscommunicated radiology findings are a hot topic. Someone should have – either the first ED doc, the second ED doc, or my PCP.

Emergency Department 75

Emergency Department ED Coronary ALS 75

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

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. AEM April 2021 * Population: Emergency department (ED) patients 18 years or old where the treating physician determined the need for parenteral sedation for acute agitation (it needed a patient or staff safety concern, not purely a high agitation score).

Emergency Department 100

Emergency Department ALS Ambulance ED 100

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

male presents to the ED at 6:45 AM with left sided chest dull pressure that woke him up from sleep at 3am. He arrived to the ED at around 6:45am, and stated the pain has persisted. Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. The pain radiated to both shoulders.

Coronary 116

Coronary ACS OR EMR 116

The Skeptics' Guide to EM

DECEMBER 18, 2021

Date: December 13th, 2021 Reference: Lee et al. Date: December 13th, 2021 Reference: Lee et al. She has worked in five EDs so far, and a man has filled almost every leadership position. Addressing gender inequities: Creation of a multi-institutional consortium of women physicians in academic emergency medicine.

Emergency Department 100

Emergency Department ALS ED OR 100

Don't Forget the Bubbles

OCTOBER 10, 2024

This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. Cochrane Database Syst Rev.

ED 75

ED Emergency Department OR ALS 75

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

ACEP Now

NOVEMBER 7, 2024

About three percent of emergency department (ED) visits are due to skin and soft tissue infections, but data are lacking on the contribution of chronic wounds to this number. Wound management in the ED is only a starting point, and appropriate referral and follow-up are key to an improved outcome.

ED 97

ED OR Emergency Department Ambulance 97

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

EMDocs

JANUARY 25, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. A CBC, Chem 7m and CT of the soft tissues of the neck are ordered by the departing ED doc whose clinical info for the radiologist is “facial swelling”. Baek BS et al. An INR is not done. References : 1.

ED 73

ED ALS OR 73

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

JUNE 16, 2023

Podcast: Play in new window | Download (Duration: 13:57 — 19.2MB) Subscribe: Apple Podcasts | Google Podcasts | RSS Management of the child with mental health problems who is boarding in the ED In episode 1 of this series, we discussed differentiating organic vs psychiatric causes of agitation in children.

ED 52

ED Mental Health Services Emergency Department Emergency Medical Services 52

ACEP Now

OCTOBER 30, 2023

The care of patients with disabilities in the ED requires more attention, as not much data is available. Krahn, et al., highlight some discrepancies in experiences that may result in ED visits. 3 The need for this type of investigation was further highlighted in an article by York, et al. Krahn, et al.,

ED 98

ED ALS OR EMS 98

Don't Forget the Bubbles

JULY 26, 2023

Prioritise listening to the first 30 minutes which given a good overview of aetiology and treatment (53 mins) Basics of cardiac rhythm problems in the ED Palpitations are a common reason for children to present to the emergency department, the majority of these will be benign from a cardiac perspective and instead related to stress or anxiety.

ALS 98

ALS ED OR CPR 98

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. I am hopeful it will also improve the flow in the ED.”

CPR 124

CPR Operating Room OR Emergency Department 124

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.

ALS 71

ALS Emergency Department ED OR 71

ACEP Now

JUNE 6, 2023

A medical student reports a murmur, not documented by either the emergency physician or the cardiologist. In the ED, his troponin, ECG, and chest X-ray (CXR) are normal. An aortic dissection is discovered when he bounces back to the ED. He arrives in the ED stating, “I can’t move my legs.” References Hansen MS, et al.

ACS 85

ACS ALS ED OR 85

EMDocs

SEPTEMBER 23, 2023

A 36-year-old female presents to the ED after experiencing an episode of sudden syncope. Rosh Review Website Link References Antzelevitch C, Brugada P, Borggrefe M, et al. Priori SG, Napolitano C, Gasparini M, et al. Chen Q, Kirsch GE, Zhang D, et al. Wilde AA, Antzelevitch C, Borggrefe M, et al. Circulation.

E-9-1-1 85

E-9-1-1 EMS ALS Defibrillator 85

REBEL EM

AUGUST 22, 2024

Paper: Lema GMC, De Leacy R, Fara MG, et al. The protocol involved collaboration between the ophthalmology service, ED, and stroke service, including neurology and neuroendovascular teams. Outside eye care providers could refer patients directly to the ED for expedited evaluation. PMID: 32568646 Wang X, Liu Y, Suo Y, et al.

ALS 85

ALS ED OR EMS 85

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. The study was dependent on EMR documentation which is prone to error. Am J Emerg Med.

E-9-1-1 98

E-9-1-1 EMR Emergency Department ED 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

Dr. Smith's ECG Blog

OCTOBER 18, 2023

Dr. Smith’s ECG Blog has published a growing list of over 40 cases of ECGs falsely labeled ‘normal’ by the computer which are diagnostic of Occlusion MI, and Smith et al. Patient 1 : anterior OMI Compared with baseline (first ECG), the initial ED ECG (second ECG) has mild ST elevation and hyperacute T waves V2-3 and mild ST depression in V6.

STEMI 120

STEMI Emergency Department Coronary OR 120

Dr. Smith's ECG Blog

MARCH 19, 2024

The Queen of Hearts agrees: Here the Queen explains why: However, it was not interpreted correctly by the providers: ED interpretation of ECG: "paced rhythm, LBBB but no STEMI pattern." Available from: [link] If you are wondering about the Barcelona rule, then you should read the above paper by Khawaja et al. 2021;23:187.

CAD 90

CAD STEMI ACS ALS 90

REBEL EM

MARCH 27, 2023

Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. The result of this ED capacity strain and less than ideal patient to staff ratios has led to delays in interventions, treatments and care adjustments. Paper: Owyang CG, et al. J Crit Care.

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

ACEP Now

APRIL 2, 2024

3 Case 1: Posterior Stroke Presenting as Food Poisoning A 42-year-old man presents to the emergency department (ED) with sudden onset of severe vertigo, headache, nausea, and vomiting after eating Italian food. On arrival in the ED, symptoms have resolved except for the headache. References Kattah JC, Talkad AV, Wang DZ, et al.

ALS 40

ALS ED Emergency Department OR 40

ACEP Now

FEBRUARY 11, 2024

1,2 In the emergency department (ED), the focus of treatment is pain control and immobilization unless there is a clear indication for surgery, such as open fractures, skin tenting, or neurovascular compromise. Conclusion Clavicular fractures are common injuries in the ED. for the ED clinician. for the ED clinician.

E-9-1-1 52

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

Dr. Smith's ECG Blog

MARCH 4, 2024

Algorithm: Marquette 12 SL (GE) The Queen gets it right Case 9 (prehospital and ED ECGs). The Queen gets it right First ED ECG: Hyperacute T-waves persist. Echocardiography, even (or especially) with Speckle Tracking, can get you in trouble. The ECG told the story. 30 yo woman with trapezius pain. HEART Pathway = 0.

STEMI 110

STEMI OR ED ALS 110

Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Reviewed by: Sarah Gentle and Owen Hibberd Article 2: Second attempt success in neonatal intubation Johnson MD, Tingay DG, Perkins EJ et al. Arch Dis Child Fetal Neonatal Ed.

E-9-1-1 75

E-9-1-1 Emergency Department OR ALS 75