The Skeptics' Guide to EM

OCTOBER 10, 2020

Reference: Friedman et al. Date: October 9th, 2020 Guest Skeptic: Dr. Reference: Friedman et al. Background: Pain is one of the most frequent reasons to attend an ED. of all ED visits resulting in 2.6 million visits each year in the USA ( Friedman et al Spine 2010 ). His twitter handle is @PainFreeED.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

APRIL 2, 2022

Date: March 31st, 2022 Reference: Butt et al. Date: March 31st, 2022 Reference: Butt et al. Case: A 15-year-old male presents to the pediatric emergency department (ED) with right ankle pain sustained while twisting his ankle during dance practice. Reference: Butt et al. The right ankle is swollen and tender.

Emergency Department 130

Emergency Department ALS ED OR 130

REBEL EM

FEBRUARY 15, 2024

Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. Paper: Freund Y et al. References: Freund Y et al. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits.

ICU 141

ICU ALS ED OR 141

The Skeptics' Guide to EM

JULY 27, 2019

Date: July 22nd, 2019 Reference: Yadav et al. Date: July 22nd, 2019 Reference: Yadav et al. AEM July 2019 Guest Skeptic: Dr. Background: Inappropriate antibiotic use exposes patients to opportunistic infections, accelerates the development of antibiotic resistant bacteria and leads to adverse drug events [1].

Emergency Department 130

Emergency Department ED ALS 130

Broome Docs

DECEMBER 9, 2023

Is it a good idea to keep geriatric patients in the ED overnight? Are you being irradiated by the portable Xray machines in your ED? Roussel M, Teissandier D, Yordanov Y, et al. Metronidazole-associated Neurologic Events: A Nested Case-control Study. PMID: 36755492 Freeman JJ, Asfaw SH, Vatsaas CJ, et al.

Emergency Department 120

Emergency Department ED ALS 120

REBEL EM

MAY 25, 2023

mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. Richards JE et al. NEJM 1994. [2]

E-9-1-1 145

E-9-1-1 Plasma ALS OR 145

The Skeptics' Guide to EM

JULY 2, 2022

Date: June 30th, 2022 Reference: McGinnis et al. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Date: June 30th, 2022 Reference: McGinnis et al. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Reference: McGinnis et al.

Coronary 100

Coronary Heart Attack ACS CAD 100

The Skeptics' Guide to EM

JANUARY 14, 2018

[display_podcast] Date: January 9th, 2018 Reference: Soleimanpour H et al. display_podcast] Date: January 9th, 2018 Reference: Soleimanpour H et al. A study from Bindman et al. Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

JANUARY 20, 2018

[display_podcast] Date: January 15th, 2018 Reference: Sadeghirad B, et al. display_podcast] Date: January 15th, 2018 Reference: Sadeghirad B, et al. Background: Patients present commonly to their primary care providers (PCPs) and to the emergency department (ED) with complaints of a sore throat. Reference: Sadeghirad B, et al.

Emergency Department 130

Emergency Department ALS EMS ED 130

The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. Date: September 28th, 2021 Reference: Zampieri et al. JAMA 2021 Guest Skeptic: Dr. Some bench work, observational studies, and now two large, unblinded, cluster-randomized single-center trials ( SMART and SALT-ED ) suggested a benefit to using balanced crystalloids (i.e.

OR 130

OR Critical Care ICU Plasma 130

The Skeptics' Guide to EM

NOVEMBER 1, 2022

Date: October 27th, 2022 Reference: Hayashi et al. Date: October 27th, 2022 Reference: Hayashi et al. Although minor adverse events, such as brief apnea or hypoxia, are common, significant adverse events are very rare, and the benefits are clear (Bellolio 2016).

ALS 118

ALS Emergency Department OR ED 118

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. Two large, cluster-randomized trials ( SMART and SALT-ED ) showed a small benefit to the use of balanced crystalloids in preventing a composite outcome of Major Adverse Kidney Events within 30 days (aka MAKE-30).

ICU 132

ICU Plasma Critical Care ALS 132

EMDocs

SEPTEMBER 25, 2023

The trade off to using FI for these challenging airways is the consideration of an aspiration event, the initial indication for RSI. However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). To date, ketamine has been the agent of choice (12).

ED 66

ED Emergency Department ALS Paramedic 66

The Skeptics' Guide to EM

SEPTEMBER 1, 2018

[display_podcast] Date: August 22nd, 2018 Reference: Riskin A, Erez A, Foulk TA, et al. display_podcast] Date: August 22nd, 2018 Reference: Riskin A, Erez A, Foulk TA, et al. Case: You are working in the emergency department (ED) and have just been involved in a difficult case in the resuscitation room. Pediatrics. Pediatrics.

ALS 130

ALS Emergency Department OR EMS 130

Don't Forget the Bubbles

JULY 22, 2024

Pre-school wheezers remain a poorly understood cohort of children despite seeing them every day in paediatric EDs. However, there was no difference in LOS (83 minutes for placebo vs 79 minutes for prednisolone) in participants who were discharged straight from the ED ( 32% ). Compare this with the Panickar et al.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. From a safety standpoint this is a great thing, but also could be the reason we see such few adverse events Discussion: There is a recent “push” to utilize “Push dose pressors” as the correction of acute hypotension in a variety of clinical scenarios. Am J Emerg Med. 2022 Sep 5.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

REBEL EM

OCTOBER 2, 2023

One solution to decrease ICU admission is to treat these patients in the ED until their anion gap is closed and the patient can be transitioned from IV insulin infusion to SQ insulin. Paper: Griffey RT et al. The SQuID Protocol (Subcutaneous Insulin in /diabetic Ketoacidosis): Impacts on ED Operational Metrics. tests/hr (0.8

ICU 102

ICU ED ALS OR 102

Don't Forget the Bubbles

AUGUST 23, 2023

This simple intervention aims to acknowledge the tragic and unexpected event humanely and respectfully. The Pause creates an opportunity for loved ones and healthcare workers to respectfully honour the patient and the significant event they have been involved in before moving on to the next task ahead. Kapoor et al. 23 (2), pp.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

The Skeptics' Guide to EM

JUNE 12, 2021

Reference: McLaren SH, et al. Reference: McLaren SH, et al. Clinical Question: What is the prevalence of invasive bacterial infections and adverse events in afebrile infants ≤ 90 days of age with acute otitis media? Reference: McLaren SH, et al.

Emergency Department 100

Emergency Department ALS ED OR 100

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. After all these considerations and thinking about receptors, you feel that Ed is most likely to have a problem with low vascular tone. Ed has been fairly drowsy, enough to allow an arterial line to be sited.

Advanced Life Support 143

Advanced Life Support ED ALS OR 143

REBEL EM

SEPTEMBER 21, 2023

There are other reasons aside from ACO for troponin elevations: Type 1: MI due to a spontaneous coronary atherosclerotic event. Type 2 MI is common in the ED and can result from vigorous exercise (common in athletes after marathons), sepsis, trauma and tachydysrhythmias including SVT. Type 5: MI associated with coronary bypass surgery.

Coronary 143

Coronary ACS ED OR 143

ALiEM

OCTOBER 26, 2023

In order to avoid connectivity issues with Wifi, the event administrators broadcasted from an ethernet-connected computer. Topics were selected based on disease prevalence in Pakistani EDs, published literature describing gaps in resident education and expertise, and gaps identified during academic core meetings.

EMS 161

EMS Emergency Department ALS ED 161

REBEL EM

OCTOBER 30, 2023

Paper: Davenport R et al. References: Davenport R et al. Fibrinogen products may also be needed to stabilize clots and stem bleeding. The optimal approach to fibrinogen administration in massive hemorrhage protocols is unknown. Cryoprecipitate Group: 25.3% OR 0.96; 95% CI 0.75 to 1.23; p = 0.74 vs 10%; OR 1.74; 95% CI 1.20

FFP 127

FFP ALS OR EMS 127

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

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 114

Coronary ACS OR EMR 114

Core EM

JULY 23, 2024

Because most radiation injuries are not immediately life-threatening, patients with isolated radiation injuries will not require immediate attention in mass casualty events. 2021, [link] Shen, J, et al. 2020, [link] Shen, J, et al. Patients should be triaged based on the severity of acute traumatic injuries and medical symptoms.

ALS 130

ALS OR Emergency Department ED 130

Core EM

MARCH 12, 2024

Because most radiation injuries are not immediately life-threatening, patients with isolated radiation injuries will not require immediate attention in mass casualty events. 2021, [link] Shen, J, et al. 2020, [link] Shen, J, et al. Patients should be triaged based on the severity of acute traumatic injuries and medical symptoms.

ALS 130

ALS OR Emergency Department ED 130

REBEL EM

SEPTEMBER 13, 2023

Read More EMCrit: Podcast 145 – Awake Intubation Lecture from SMACC ERCast: Angioedema References: Baş M et al. PMID 25629740 Hassen GW et al. PMID 23062323 Kostis JB et al. PMID 16043683 McCormick M et al. PMID 20954277 Sinnert R et al. Zuraw et al. In: UptoDate, Feldweg AM (ed.) N Engl J Med.

Frozen Plasma 104

Frozen Plasma Allergic Reaction FFP Plasma 104

EMS 12-Lead

APRIL 28, 2022

This particular facility is situated for independent living, thus no medical providers are on site to provide pertinent details for medical history, medication intake, or remarkable events prior to the incident at hand. Josephson’s Clinical Cardiac Electrophysiology: Techniques and Interpretations (6th ed). 2] Viskin, S., 8] Liu, E.,

E-9-1-1 130

E-9-1-1 ALS Coronary EMS 130

EMDocs

JUNE 3, 2023

The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. This is less critical in ED management of the unstable pelvic fracture, as the optimal site for identification of rectal or vaginal tears is the operating room.

ED 54

ED Operating Room ALS Frozen Plasma 54

Don't Forget the Bubbles

JULY 17, 2023

Sethi SK, et al. Agostino H, et al. Rassekh SR, et al. Goulet K, et al. McClellan JM, et al. Arneitz C, et al. Van Rossem EJD, et al. Smyrnaios A, et al. Satir AN, et al. Cortés J, et al. Al Dhaheri FA, et al. Rivacoba MC, et al. Feldman PM, et al.

E-9-1-1 98

E-9-1-1 ALS Emergency Department Emergency Medical Services 98

EMS 12-Lead

AUGUST 22, 2022

Beats 9-12 : Continuation of the previously described events, all inducible by the pause (and thus, prolongation of refractoriness) created by the PVC of Beat 8. Chou’s Electrocardiography in Clinical Practice (6th ed). Beat 4 abruptly halts this repetitious cycle via Peel Back. References Chiale, P. JACC, Vol 23, No 3; 724-32.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

Don't Forget the Bubbles

MAY 24, 2023

A 5-year-old boy with a past medical history of Crouzon syndrome presents in the Pediatric ED. Airway complications are also more likely to occur in the emergency department (ED) than in the operating theatre. One large observational study found a 35-fold higher increase in events leading to death or brain damage in ED intubations.

Emergency Department 98

Emergency Department ED ALS OR 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

REBEL EM

JANUARY 23, 2023

Article: Abella BS et al. Key Secondary Endpoints: 5 (3.9%) patients in the IV cetirizine group returned to any ED or clinic within 24 hours compared to 15 (11.1%) in the IV diphenhydramine group; P=0.04 Anecdotally, the persistence of urticaria often has little influence on the decision to discharge a patient from the ED.

Allergic Reaction 52

Allergic Reaction ED E-9-1-1 Emergency Department 52

ACEP Now

DECEMBER 6, 2024

Attention was turned to the consideration of severe coronary vasospasm as the inciting event for cardiopulmonary arrest and the nidus for refractory ventricular fibrillation. Dr. Rad is ED faculty at Wellstar Kennestone Regional Medical Center in Marietta, Ga., References Prinzmetal M, Kennamer R, Merliss R, et al. N Engl J Med.

Coronary 98

Coronary Life Support ALS Emergency Department 98

EMDocs

JUNE 22, 2024

A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. The absence of preeclampsia symptoms prior to the acute event makes eclampsia less likely. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in. Electronic address, p.

EMS 96

EMS Ambulance FFP ICU 96