Pediatric EM Morsels

JULY 5, 2024

It seems like just yesterday ( or maybe ~ a month ago ) when we served up a tasty morsel on the PECARN decision rule for intra-abdominal traumatic injuries in children. Our friends at the PECARN injury group have remained busy this spring with generating more externally validated clinical decision rules. High Risk (12.8% High Risk (12.8%

ALS 161

ALS OR ED Emergency Department 161

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

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 )! or serum bicarbonate between 5-10 mmol/ L Severe : venous pH < 7.1

E-9-1-1 246

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

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. ” 0700 : The PA-C goes off-shift.

ED 82

ED ALS Emergency Department OR 82

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. However, one cascade is a little less obvious.

ACS 105

ACS ALS OR 105

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

Dr. Smith's ECG Blog

APRIL 17, 2023

His HEAR score (before troponin resulted) was documented at 3, with documentation stating "low suspicion for ACS." Chest pain is documented as ongoing. Repeat 0157 with ongoing chest pain: Basically the same features diagnostic of LAD occlusion. QOH: "OMI High confidence". Physician interpretation: "No STEMI."

OR 52

OR STEMI ACS Emergency Department 52

ALiEM

MARCH 11, 2024

There is limited literature documenting eye involvement and pictographic examples of its presentation. He also noticed fluid-filled vesicles on his face, neck, trunk, and extremities. He denied travel outside the U.S. but reported a recent trip to New Orleans. Additional Images Physical Exam Vitals : BP 135/83; Pulse 104; Temp 100.2 °F

Emergency Department 141

Emergency Department ALS OR 141

EMDocs

NOVEMBER 6, 2024

Exam is notable for tremulous extremities. Shortly after labs are obtained, he yells and arches his back. He becomes rigid in all extremities and his abdomen. There is no convulsive activity or eye deviation, and the patient is yelling in pain. Questions: What is the differential diagnosis for toxicologic causes of severe muscle spasm and tetany?

E-9-1-1 78

E-9-1-1 ALS EMS OR 78

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

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety profile [3][4]. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

ALS 137

ALS ACS OR CPR 137

EMDocs

SEPTEMBER 23, 2023

On arrival, vital signs are stable with a HR of 71, BP of 121/71 mmHg, RR of 17 bpm, and SpO2 of 97% on room air. Physical exam reveals a well-appearing female in no acute distress. Cardiac exam is unremarkable with normal S1/S2 without rubs, gallops or murmurs. Neurological exam is also unremarkable. Her presenting EKG is shown below.

E-9-1-1 84

E-9-1-1 EMS ALS Defibrillator 84

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

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.

Emergency Medical Services 98

Emergency Medical Services EMS OR Overdose 98

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 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

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. This waxing and waning course is normal, and families should be reassured and given red flag features that necessitate further assessment.

ALS 124

ALS Emergency Department OR 124

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. I felt really distressed that these kids weren’t getting good care.”

ED 59

ED Emergency Department ALS OR 59

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

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. An INR is not done. Straightening of the normal cervical lordosis.” On exam he is quadriplegic. His INR is now checked and is 13.

ED 72

ED ALS OR 72

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 2.89, p = 0.01.

E-9-1-1 122

E-9-1-1 ALS ACS ICU 122

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. Prior literature primarily focused on safety and medication errors, and while this study did the same, they also assessed variables associated with PDP response. The safety and efficacy of push dose vasopressors in critically ill adults. Am J Emerg Med. 2022 Sep 5.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

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

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

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 110

ACS ALS OR STEMI 110

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. Alpha dominant: 7.9%

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

Dr. Smith's ECG Blog

JUNE 17, 2024

In fact, Kosuge et al. Stein 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. incomplete RBBB 1.7

E-9-1-1 138

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

REBEL EM

AUGUST 12, 2024

The authors of this study sought to test the hypothesis that intravenous amino acid therapy would lead to a lower occurrence of postoperative AKI when compared to placebo. Paper: Landoni G. Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial.

ICU 81

ICU Operating Room Critical Care ALS 81

REBEL EM

AUGUST 22, 2024

Paper: Lema GMC, De Leacy R, Fara MG, et al. Documented at the following time points: Before treatment. Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Timely recognition of RAO is challenging. A Remote Consult Retinal Artery Occlusion Diagnostic Protocol.

ALS 85

ALS ED OR EMS 85

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. Protocols Every EMS agency should have protocols for dealing with agitated or violent patients. Sometimes these can also be referred to as guidelines, standing orders, policies, or procedures.

Emergency Medical Services 77

Emergency Medical Services EMS Emergency Department Ambulance 77

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 ED OR 130

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. What is the problem? What did previous studies show? What were the results?

CPR 124

CPR Operating Room OR Emergency Department 124

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 highlight some discrepancies in experiences that may result in ED visits.

ED 98

ED ALS OR EMS 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

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

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. References Cass A. 56 hospitals closing departments or ending services.

OR 98

OR ALS 98