The Skeptics' Guide to EM

APRIL 13, 2024

Reference: Albers GW et al. Reference: Albers GW et al. Case: A 70-year-old woman was brought into the emergency department by EMS after her family reported she was having trouble talking. When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago. TIMELESS Investigators.

ALS 343

ALS Emergency Department OR EMS 343

ALiEM

OCTOBER 30, 2024

Case A patient arrives via EMS from the bus station complaining of fever, vomiting, and back pain. Our experience: It was not long ago that we instructed our staff that: ‘COWS >8, give ’em 8 (mg of buprenorphine).’ Our experience: Traditionally, ED physicians do not like ordering urine drug screens (UDS).

E-9-1-1 161

E-9-1-1 Naloxone Emergency Department ALS 161

The Skeptics' Guide to EM

OCTOBER 19, 2024

Date: October 7, 2024 Reference: Nguyen et al. Annals of EM 2024. Case: You’re working your usual day shift in the emergency department (ED) from 9 am to 5 pm on a Tuesday. In recent years, ketamine has gained popularity in the ED, particularly for treating acute pain. Reference: Nguyen et al. Annals of EM 2024.

OR 248

OR Emergency Department ED ALS 248

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Date: September 18, 2024 Reference: Dillon et al. August 20, 2024 Guest Skeptic: Dr. Chris Root is an emergency medicine and emergency medicine service (EMS) physician at the University of New Mexico, Albuquerque. Chris completed his emergency medicine residency and EMS fellowship at UNM. Reference: Dillon et al.

Naloxone 260

Naloxone NARCAN Overdose CPR 260

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 329

Operating Room Emergency Department ALS ED 329

ACEP Now

JANUARY 5, 2025

A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. References Grasl S, Mekhail P, Janik S, et al. Dharmawardana N, Chandran D, Elias A, et al.

Operating Room 98

Operating Room Epinephrine ALS ED 98

Core EM

JANUARY 25, 2024

How and when to reverse anticoagulation in the bleeding EM patient. Fariborz Farsad B, Golpira R, Najafi H, et al. Fariborz Farsad B, Golpira R, Najafi H, et al. Anticoagulant Reversal Strategies in the Emergency Department Setting: Recommendations of a Multidisciplinary Expert Panel. Iran J Pharm Res. 2015;14(3):877-885.

Frozen Plasma 246

Frozen Plasma FFP Plasma Critical Care 246

The Skeptics' Guide to EM

JULY 8, 2023

Date: July 6, 2023 Reference: Hanula R et al. Managing editor of EM:RAP and Associate Editor at REBEL EM. Date: July 6, 2023 Reference: Hanula R et al. Managing editor of EM:RAP and Associate Editor at REBEL EM. JAMA Int Med 2023. JAMA Int Med 2023.

ALS 270

ALS Emergency Department EMS ED 270

The Skeptics' Guide to EM

JULY 29, 2023

Date: July 21, 2023 Reference: McDonald et al. Date: July 21, 2023 Reference: McDonald et al. Emergency Medical Services (EMS) is called and on arrival the patient is walking but has obvious facial trauma and is complaining of some neck pain. Reference: McDonald et al.

Emergency Medical Services 246

Emergency Medical Services ALS EMS Emergency Department 246

The Skeptics' Guide to EM

APRIL 27, 2024

Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care.

ICU 231

ICU Defibrillator Paramedic CPR 231

Pediatric EM Morsels

APRIL 19, 2024

Trauma season is at hand and like all other pediatric emergency departments in the country, we find our ED breaking ( pun intended ) at the seams with orthopedic injuries. Davidson JS, Brown DJ, Barnes SN, et al. West S, Andrews J, Bebbington A, et al. Symons S, Rowsell M, Bhowal B, et al. J Pediatr Orthop. Pediatrics.

ALS 290

ALS ACS Emergency Department ED 290

REBEL EM

JULY 1, 2024

Paper: Goren NZ et al. The AVAPS mode is as effective and safe as BPAP S/T in treating patients with hypercapnic respiratory failure in the ED.” Clinical Take Home Point: I n patients presenting to the ED with hypercapnic respiratory failure, AVAPS did lead to a faster improvement in pH and PaCO2 levels compared to BPAP S/T.

ED 132

ED Emergency Department ALS OR 132

The Skeptics' Guide to EM

JUNE 1, 2024

Reference: Tavender E, et al. His research focuses on the pre-hospital care of children by EMS. He is the principal investigator for EMSC State Partnership in Washington, DC and is also involved in various multi-center EMS studies with the Pediatric Emergency Care Applied Research Network (PECARN). Reference: Tavender E, et al.

Emergency Medical Services 219

Emergency Medical Services Emergency Department EMS ALS 219

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 EMT 331

EMDocs

MAY 11, 2024

We’ll keep it short, while you keep that EM brain sharp. A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. link] Sharma R, Gaillard F, Bell D, et al.

EMS 110

EMS E-9-1-1 ALS OR 110

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 224

Emergency Medical Services ALS Emergency Department ED 224

Pediatric EM Morsels

SEPTEMBER 22, 2023

To celebrate the end of trauma season ( is it ever really over? ), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Never fear.

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

EMDocs

JUNE 22, 2024

We’ll keep it short, while you keep that EM brain sharp. A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. According to EMS, she was in labor at home and delivered the newborn shortly after they had loaded her into the ambulance. Electronic address, p. link] j.ajog.2016.03.012

EMS 111

EMS Ambulance FFP ICU 111

ALiEM

FEBRUARY 5, 2024

Reference Lin M, Phipps M, Chan TM, et al. Alex Rogers MD, J.D. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

The Skeptics' Guide to EM

JANUARY 9, 2021

Date: January 5th, 2021 Reference: Grunau et al. JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC?

EMS 130

EMS Emergency Medical Services CPR Critical Care 130

EMDocs

NOVEMBER 19, 2024

10 Table 1: Second-Generation Antipsychotics and Associated Adverse Effects Adapted from: UpToDate 8 with additional sources Micromedex 9 and Riboldi, et al 11 *SL=sublingual, IM=intramuscular, PO=oral, ODT=orally disintegrating tablets, ER=extended release, IR=immediate release. +to Gummin DD, Mowry JB, Beuhler M, et al. Juurlink D.

Overdose 111

Overdose EMS Emergency Medical Services OR 111

ACEP Now

JUNE 21, 2023

emergency medicine (EM) residency training length has been a decades-long dilemma: four vs. three years. First, is three years enough time to become an EM physician? But critical questions remain unanswered when it comes to specialization, career trajectory, and actual competence as an EM physician. 11 What should we take away?

EMS 114

EMS ALS Emergency Medical Services OR 114

EMDocs

MARCH 2, 2024

We’ll keep it short, while you keep that EM brain sharp. A 58-year-old female with a history of diabetes, hypertension, and chronic back pain presents to the ED with severe headache and nausea.  An Pediatr (Engl Ed). 2019 Bernstein AL, Cassidy J, Duchynski R, Eisenberg SS. Int J Crit Illn Inj Sci. 2017 Surg Neurol Int. 

EMS 119

EMS E-9-1-1 OR ED 119

EMDocs

APRIL 27, 2024

We’ll keep it short, while you keep that EM brain sharp. A 68-year-old male with a history of poorly controlled diabetes presents to the ED with increasing right-sided ear and facial pain, swelling, and difficulty hearing for two weeks. link] Al Aaraj MS, Kelley C. He says the pain is worse at night and when he is chewing.

EMS 105

EMS ED OR ALS 105

REBEL EM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. Article: Arvig MD, Lassen AT, Gæde PH, et al. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.

ED 129

ED E-9-1-1 Emergency Department ALS 129

The Skeptics' Guide to EM

MAY 2, 2020

Date: April 24th, 2020 Reference: Watanabe et al. A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. 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. Reference: Watanabe et al.

ED 100

ED Ambulance Medical Transportation EMS 100

EMDocs

SEPTEMBER 23, 2023

We’ll keep it short, while you keep that EM brain sharp. 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.

E-9-1-1 105

E-9-1-1 EMS ALS Defibrillator 105

EMDocs

MAY 25, 2024

We’ll keep it short, while you keep that EM brain sharp. link] Haidar H, Menon A, Al Duhirat E. The post EM@3AM: Sialadenitis appeared first on emDOCs.net - Emergency Medicine Education. She is breathing comfortably but seems to experience significant pain at the associated site of swelling. Am Fam Physician. Sialadenitis.

EMS 98

EMS E-9-1-1 OR ED 98

EMDocs

JUNE 8, 2024

We’ll keep it short, while you keep that EM brain sharp. A 27-year-old male presents to the ED for left eye pain after being hit in the face with a spare car part while working under the hood of his car. What is the diagnosis, and how do we manage it from the ED? Lu, Kevin, et al. Review of Optometry , 15 Jan.

EMS 98

EMS Allergic Reaction Emergency Department ED 98

ALiEM

OCTOBER 26, 2023

The Problem: Emergency Medicine (EM) in Pakistan has moved from developing to developed stage in the last decade [1]. It is an innovation that is based on a community of practice merged with the need-based assessment of a young EM residency program in a developing country. Originally developed by Marsh et al.,

EMS 161

EMS Emergency Department ALS ED 161

EMDocs

APRIL 13, 2024

We’ll keep it short, while you keep that EM brain sharp. A 24-year-old male presents to the ED from a mixed marital arts competition after being struck on the side of the right head by a fist earlier today. Brickman K, Adams DZ, Akpunonu P, et al. Roy S, Smith LP. Am J Otolaryngol 2010; 31:21. Published online April 19, 2004.

EMS 104

EMS E-9-1-1 OR Emergency Department 104

Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. 2020) The Times & Tapes Are a-Changin’: The Latest Broselow-Luten Tape for EMS , EMS World. link] Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. and Seaver, M. Rosenberg, M.S.

E-9-1-1 271

E-9-1-1 Emergency Medical Services Life Support ALS 271

EMDocs

NOVEMBER 18, 2023

We’ll keep it short, while you keep that EM brain sharp. A 32-year-old female with a history of hypertension and autoimmune hepatitis status post liver transplant 6 weeks prior on tacrolimus and mycophenolate presents to the ED with abdominal discomfort. What are the complications of liver transplant that we see in the ED?

EMS 95

EMS E-9-1-1 ALS Emergency Department 95

EMDocs

JUNE 3, 2023

We’ll keep it short, while you keep that EM brain sharp. A 53-year-old female with a past medical history significant for hypertension presents to the ED with headache and dizziness. Rosh Review Website Link Further Reading [link] [link] [link] [link] [link] References: Stanislavsky A, Baba Y, Hacking C, et al. 2018;155:301-312.

EMS 97

EMS ALS OR ED 97

EMDocs

AUGUST 12, 2023

We’ll keep it short, while you keep that EM brain sharp. Çalışkan Uçkun A, Yurdakul FG, Ergani HM, et al. link] Alkandari A F, Alawadhi A, Alawadhi F A, et al. doi:10.1055/s-0032-1327007 Zhao W, Wang G, Chen B, et al. 0000000000017823 Rosskopf AB, Martinoli C, Sconfienza LM, et al. McGraw Hill; 2021. J Ultrason.

EMS 95

EMS ALS Emergency Department ED 95

EMDocs

OCTOBER 21, 2023

We’ll keep it short, while you keep that EM brain sharp. Median time from ED arrival to diagnosis was 8 hours 24 min in one study, with only 19% being diagnosed within the 4.5-hour References: Gaillard F, Glick Y, Tatco V, et al. Post TW, ed. 61.4.496 Navi BB, Kamel H, Shah MP, et al. hour IV thrombolytic window.

EMS 97

EMS ALS OR ACS 97

REBEL EM

JULY 17, 2023

REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? Click here for Direct Download of the Podcast Paper: Knack SKS et al. PMID: Clinical Question: Does a single dose of ketamine or etomidate used for rapid sequence intubation (RSI) of critically adults in the ED impact the SOFA score within 3 days of hospitalization?

ED 97

ED ICU Emergency Department Overdose 97