The Skeptics' Guide to EM

NOVEMBER 16, 2024

Date: October 28, 2024 Reference: Verma et al. Case: The Chief of Emergency Medicine (EM) at a large urban hospital recently approached the AI Committee at Unity Health, intrigued by the CMAJ article describing the apparent success of CHARTWatch in detecting early signs of patient deterioration. Reference: Verma et al.

ICU 142

ICU Emergency Department ALS EMS 142

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 242

Naloxone NARCAN Overdose CPR 242

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 95

EMS Ambulance FFP ICU 95

The Skeptics' Guide to EM

JANUARY 6, 2024

Reference: Remick KE, et al. Reference: Remick KE, et al. She is an executive lead for the EMS for Children Innovation and Improvement Center. She is the co-Principal Investigator for the EMS for Children Data Center. She is nationally known for her work as an EMS researcher and educator. JAMA Netw Open.

Emergency Department 261

Emergency Department Emergency Medical Services ALS ED 261

The Skeptics' Guide to EM

NOVEMBER 25, 2023

Date: November 22, 2023 Reference: Stopyra et al. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. Date: November 22, 2023 Reference: Stopyra et al. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI.

Heart Attack 278

Heart Attack STEMI Emergency Medical Services Coronary 278

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

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 113

EMS E-9-1-1 OR ED 113

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 210

Emergency Medical Services Emergency Department EMS ALS 210

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 130

ED E-9-1-1 Emergency Department ALS 130

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 79

EMS E-9-1-1 OR ED 79

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

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 80

EMS Allergic Reaction Emergency Department ED 80

REBEL EM

DECEMBER 18, 2023

Post TW, ed. In: Tintinalli JE, Ma OJ, Yealy DM, et al., Rezaie, MD (Twitter/X: @srrezaie ) The post Rosh Review EM Scholar Monthly Question appeared first on REBEL EM - Emergency Medicine Blog. Peritoneal catheter exit-site and tunnel infections in peritoneal dialysis in adults. UpToDate Inc. link] Calvert JH, Cline DM.

EMS 59

EMS ED ALS 59

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 83

EMS ED OR ALS 83

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 98

ED ICU Emergency Department Overdose 98

EMDocs

SEPTEMBER 9, 2023

We’ll keep it short, while you keep that EM brain sharp. He presents to the ED with profound difficulty extending his middle and ring finger. A 35-year-old right handed male with no significant past medical history presents with a deep hand laceration. The patient states they suffered a cut with a box cutter at a construction site.

EMS 77

EMS ED ALS Emergency Department 77

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Here is the case: Report from EMS was witnessed syncope, his son did CPR, but the patient had pulses when EMS arrived. When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. Here is the ED ECG (a photo of the paper printout) What do you think?

EMS 106

EMS CPR ED Coronary 106

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. Published 2021 Apr 22. 2018;13:36.

E-9-1-1 76

E-9-1-1 ED Operating Room ALS 76

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 301

Operating Room Emergency Department ALS ED 301

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 83

E-9-1-1 EMS ALS Defibrillator 83

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 69

EMS E-9-1-1 ALS Emergency Department 69

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 189

ICU Defibrillator CPR Paramedic 189

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.

Emergency Department 287

Emergency Department ALS OR EMS 287

REBEL EM

OCTOBER 23, 2023

His parent noticed a dental problem and immediately brought the patient to the ED. Rezaie, MD (Twitter: @srrezaie ) The post Rosh Review EM Scholar Monthly Question appeared first on REBEL EM - Emergency Medicine Blog. The patient was walking his dog when it ran after a squirrel. The physical exam is shown below.

EMS 59

EMS ACS ALS ED 59

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 81

EMS E-9-1-1 OR Emergency Department 81

REBEL EM

AUGUST 17, 2023

In: Walls RM, Hockberger RS, Gausche-Hill M, et al., Post TW, ed. Rezaie, MD (Twitter: @srrezaie ) The post Rosh Review EM Scholar Monthly Question appeared first on REBEL EM - Emergency Medicine Blog. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Elsevier; 2023:(Ch) 47. Von Fange TJ. UpToDate Inc.

EMS 52

EMS Emergency Department ED ALS 52

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

EMDocs

FEBRUARY 26, 2024

Authors: Kamoga Dickson, MD (EM Resident Physician, Makerere University of Health Sciences); Jessica Pelletier, DO (EM Education Fellow, Washington University in St. A recent study by Gaborit et al. 16 In another study, a series of six HIV patients with confirmed PJP that were analyzed by Limonta et al.

E-9-1-1 87

E-9-1-1 ED ALS OR 87

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

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 73

EMS ALS OR ACS 73

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 69

EMS ALS Emergency Department OR 69

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

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 286

ALS ACS Emergency Department ED 286

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 193

Emergency Medical Services ALS EMS Emergency Department 193

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 176

Emergency Medical Services ALS Emergency Department ED 176

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 73

EMS ALS OR ED 73

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