The Skeptics' Guide to EM

JUNE 8, 2024

Reference: Kruse et al. Case: A 16-year-old nonbinary youth on testosterone blockers and oestrogen has come into your emergency department (ED) having twisted their ankle while playing soccer. Reference: Kruse et al. You learn they are ordering hormones online as they do not have any gender-affirming primary care.

Emergency Department 308

Emergency Department ED ALS Paramedic 308

EMDocs

JULY 25, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Chuck Pilcher, MD, FACEP Editor, Medical Malpractice Insights Editor, Med Mal Insights The challenge of suicide evaluation in the ED “I’ve changed my mind. Ronquillo L et al. Applebaum PS.

ED 82

ED ALS Emergency Department OR 82

The Skeptics' Guide to EM

DECEMBER 16, 2023

Reference: Punches et al. Reference: Punches et al. Case: A 57-year-old Chinese woman presents to the emergency department (ED) with chest pain. Background: Patient experiences of care are associated with health outcomes and may impact perspectives of ED care and the patient recovery process.(1-5) AEM Dec 2023.

Emergency Department 299

Emergency Department ED ALS OR 299

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. What additional workup is necessary in the ED?

ED 86

ED E-9-1-1 ALS OR 86

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

Core EM

JANUARY 25, 2024

More than 1/3 of geriatric trauma patients presenting to the ED after a fall return to the ED or die within one year of initial evaluation. 4 Elderly patients, who comprise only 8-12% of total ED major trauma cases, represent a disproportionate 15-30% of trauma mortalities and costs. Perdue &al. Caterino &al.

ALS 246

ALS ED ICU OR 246

The Skeptics' Guide to EM

JULY 6, 2024

Reference: Tjan et al. The emergency department (ED) evaluation reveals an unremarkable chemistry panel with normal renal function and a white blood cell count of 10,000. Background: We have discussed agitation in the ED on the SGEM several times. Reference: Tjan et al. Conflict in emergency medicine: A systematic review.

ED 208

ED ALS Emergency Department OR 208

The Skeptics' Guide to EM

OCTOBER 21, 2023

Date: October 20, 2023 Reference: Cai et al. Case: You are in your group meeting and have heard about a case at a nearby emergency department (ED) where the […] The post SGEM#418: I Ain’t Missing You – Spinal Epidural Abscess first appeared on The Skeptics Guide to Emergency Medicine. Date: October 20, 2023 Reference: Cai et al.

Emergency Department 269

Emergency Department ALS ED OR 269

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Reference: Snelling et al. Reference: Snelling et al. Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth. Case: It is a steady Saturday afternoon in your rural emergency department (ED).

Critical Care 315

Critical Care ALS ED Emergency Department 315

EMDocs

JULY 17, 2023

and is poorly tolerated by patients with obstruction, it should not be a routine part of the ED evaluation for LBO unless it is critical for another diagnosis on the differential. doi:10.3390/cancers13092025 Pisano M, Zorcolo L, Merli C, et al. 2021.03.001 Bauman BD, Witt JE, Vakayil V, et al. 2018.07.045 Gorgens et al.,

E-9-1-1 77

E-9-1-1 ED Operating Room ALS 77

The Skeptics' Guide to EM

SEPTEMBER 28, 2024

Date: September 23, 2024 Reference: Essat et al. Case: You are working a busy shift in a rural emergency department (ED) and your excellent Family Medicine trainee presents a case of a 63-year-old woman with chest pain and some intermittent radiation into the inter-scapular region. Reference: Essat et al.

Emergency Department 205

Emergency Department ACS Coronary ALS 205

The Skeptics' Guide to EM

DECEMBER 30, 2023

Reference: Roussel et al. McG) presents to your emergency department (ED) after being found by family on the […] The post SGEM#424: Ooh-Ooh, I Can’t Wait – To Be Admitted to Hospital first appeared on The Skeptics Guide to Emergency Medicine. Reference: Roussel et al. Case: An 85-year-old patient (Ms.

Emergency Department 273

Emergency Department ED ALS OR 273

The Skeptics' Guide to EM

JANUARY 6, 2024

Reference: Remick KE, et al. Reference: Remick KE, et al. Case: After your shift in the emergency department (ED) one day, the medical director pulls you aside. Reference: Remick KE, et al. July 2023 * Population: ED leadership across the United States. JAMA Netw Open. JAMA Netw Open. JAMA Netw Open.

Emergency Department 266

Emergency Department Emergency Medical Services ALS ED 266

The Skeptics' Guide to EM

APRIL 14, 2019

Date: April 11th, 2019 Reference: Brucker et al. This is a warning to those listening to the podcast or reading […] The post SGEM#252: Blue Monday- Screening Adult ED Patients for Risk of Future Suicidality first appeared on The Skeptics Guide to Emergency Medicine. Date: April 11th, 2019 Reference: Brucker et al.

ED 130

ED Emergency Department ALS OR 130

Core EM

JANUARY 25, 2024

A quick primer on hypocalcemia in the ED. Pfenning CL, Slovis CM: Electrolyte Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. Hypocalcemia in the critically ill patient. J Intensive Care Med 2013; 28:166. Louis, Mosby, Inc., Swaminathan, A.

Critical Care 246

Critical Care ED ALS OR 246

REBEL EM

JUNE 5, 2023

These statistics make the ED a crucial treatment initiation point to prevent further morbidity and mortality from opioid overdoses. The benefit of accessibility, availability, and safety of buprenorphine compared to methadone makes it a viable option for opioid use disorder treatment initiation in the ED. PMID 33392580.

Naloxone 98

Naloxone ED Overdose Emergency Department 98

Core EM

JANUARY 25, 2024

Hosts: Joe Offenbacher, MD Audrey Bree Tse, MD [link] Download Leave a Comment Tags: Anticoagulation , Critical Care , Resuscitation Show Notes Coagulation Cascade: Algorithm for Anticoagulated Bleeding Patient in the ED: Indications for Anticoagulation Reversal: References: Baugh CW, Levine M, Cornutt D, et al. Ann Emerg Med.

Frozen Plasma 246

Frozen Plasma FFP Plasma Critical Care 246

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Date: September 12, 2024 Reference: Anderson et al. Case: It’s another day, another dollar in the emergency department (ED). You wonder if she could have an allergy challenge dose of ceftriaxone in the ED. Emergency Physicians frequently encounter ED patients with self-reported penicillin allergies. AEM August 2024.

ICU 136

ICU Emergency Department ALS ED 136

The Skeptics' Guide to EM

OCTOBER 28, 2023

Date: October 26, 2023 Reference: Jones et al. Date: October 26, 2023 Reference: Jones et al. Case: A 37-year-old man without a significant past medical history presents to the emergency department (ED) with a chief complaint of lower back pain that started three days prior to the ED visit after unloading a truck with furniture.

ALS 226

ALS Emergency Department ED OR 226

Core EM

JANUARY 25, 2024

Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients.

ICU 246

ICU Emergency Department Critical Care ALS 246

The Skeptics' Guide to EM

MARCH 2, 2024

Reference: Gibbons et al. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Reference: Gibbons et al. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY.

Operating Room 305

Operating Room Emergency Department ALS ED 305

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Date: September 18, 2024 Reference: Dillon et al. He currently practices emergency medicine in New Mexico in the ED, in the field with EMS and with the UNM Lifeguard Air Emergency Services. Reference: Dillon et al. Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. JAMA Network Open.

Naloxone 245

Naloxone NARCAN Overdose CPR 245

The Skeptics' Guide to EM

JUNE 24, 2023

Date: June 16, 2023 Reference: Reed et al. Date: June 16, 2023 Reference: Reed et al. Case: A 27-year-old right hand dominant patient presents to the emergency department (ED) with a 2.5 Reference: Reed et al. cm left forearm abscess. They have no fever, chills, or signs of compartment syndrome.

Overdose 187

Overdose Emergency Department ALS ED 187

EMS 12-Lead

MAY 15, 2024

After 13 minutes of ALS resuscitation, pulses were palpated indicating a return of spontaneous circulation. Crew notifies the received ED of an incoming post-arrest patient and notes a sinus bradycardia on their monitor, as seen in Figure 2. Pacing was continued in the ED, with identical settings. Several learning points here.

Epinephrine 331

Epinephrine Paramedic CPR ED 331

The Skeptics' Guide to EM

AUGUST 10, 2024

Date: July 29, 2024 Reference: Connolly SJ et al (ANNEXA-I investigators) Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage. Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table.

Emergency Medical Services 181

Emergency Medical Services ALS Emergency Department ED 181

The Skeptics' Guide to EM

APRIL 13, 2024

Reference: Albers GW et al. Reference: Albers GW et al. When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. TIMELESS Investigators. Tenecteplase for Stroke at 4.5

ALS 293

ALS Emergency Department OR EMS 293

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics.

ICU 206

ICU ED Critical Care ALS 206

The Skeptics' Guide to EM

JUNE 1, 2024

Reference: Tavender E, et al. Dr. Caleb Ward Case: A 4-year-old boy is brought to the emergency department (ED) by Emergency Medical Services (EMS) after falling from a tall tree. Reference: Tavender E, et al. Triage tools for detecting cervical spine injury in paediatric trauma patients. Cochrane Database Syst Rev.

Emergency Medical Services 210

Emergency Medical Services Emergency Department EMS ALS 210

The Skeptics' Guide to EM

NOVEMBER 25, 2023

Date: November 22, 2023 Reference: Stopyra et al. Date: November 22, 2023 Reference: Stopyra et al. We looked at 101 STEMI patients from two rural EDs. Reference: Stopyra et al. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. AEM November 2023. AEM November 2023.

Heart Attack 283

Heart Attack STEMI Emergency Medical Services Coronary 283

The Skeptics' Guide to EM

MAY 2, 2020

Date: April 24th, 2020 Reference: Watanabe et al. This is Bob’s eleventh visit […] The post SGEM#291: Who’s Gonna Drive you to…the ED – with Lights & Sirens? This is Bob’s eleventh visit […] The post SGEM#291: Who’s Gonna Drive you to…the ED – with Lights & Sirens? Date: April 24th, 2020 Reference: Watanabe et al.

ED 100

ED Ambulance Medical Transportation EMS 100

The Skeptics' Guide to EM

JULY 20, 2024

Reference: Gibbs et al. Case: A 70-year-old man presents to the emergency department (ED) with an exacerbation of COPD. Reference: Gibbs et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation (The PREOXI trial). NEJM June 2024. He is hypoxic on arrival with an oxygen saturation of 80% on room air.

ALS 232

ALS Emergency Department ED OR 232

The Skeptics' Guide to EM

NOVEMBER 18, 2017

[display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Outside his family and work, Jesse pours […] The post SGEM#195: Some Like It Hot – ED Temperature and ICU Survival first appeared on The Skeptics Guide to Emergency Medicine. display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al.

ICU 130

ICU ED Emergency Department Critical Care 130

ALiEM

SEPTEMBER 25, 2024

A 24-year-old male with a history of microscopic hematuria presented to the emergency department (ED) with left lower quadrant abdominal pain. He decided to come to the ED today because of the persistent nature of the pain. Zubaidi A, Al-Saif F, Silverman R. His pain started about two weeks ago and has been intermittent.

Emergency Department 141

Emergency Department ED ALS OR 141

Don't Forget the Bubbles

OCTOBER 2, 2024

Children often spend many hours in the emergency department (ED) before being sent home or admitted. The average waiting time for the first assessment was only a few minutes shorter when going through the ED. Still, treatment initiation was significantly faster (up to one hour) than admission through the ED. Pecenka C, et al.

ALS 52

ALS Emergency Department ED ACS 52

Don't Forget the Bubbles

JULY 3, 2024

Lastly, in this month’s issue of JAMA Pediatrics, Gemmill et al. Saranti A, et al. Barlabà A, et al. Nemetz ETA, et al. Kusumi K, et al. Crawford CM, et al. Fundora MP, et al. Roby PR, et al. Jenssen BP, et al. Auger N, et al. Brewster RCL, et al. Forster CS, et al.

ALS 105

ALS ED OR EMS 105

The Skeptics' Guide to EM

JUNE 17, 2023

Date: June 15, 2023 Reference: Rees CA et al. Date: June 15, 2023 Reference: Rees CA et al. Case: A 14-year-old male with sickle cell disease (SCD) presents to your emergency department (ED) with a vaso-occlusive pain episode (VOE) of his bilateral legs and back. Reference: Rees CA et al. Opioids are the primary therapy.

Emergency Department 182

Emergency Department ALS ED OR 182

The Skeptics' Guide to EM

FEBRUARY 18, 2023

Date: February 17, 2023 Reference: Gettel et al. Date: February 17, 2023 Reference: Gettel et al. Case: You are an administrator responsible for staffing emergency departments (EDs) in a health care system comprising both urban and rural locales. The SGEM has done two previous podcasts on APPs in the ED.

Emergency Department 130

Emergency Department ALS ED EMS 130