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

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

Pediatric EM Morsels

SEPTEMBER 22, 2023

Pathophysiology Primary injury happens at the time of the traumatic event or shortly after in the high cervical to mid-thoracic spine. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Main symptoms include hypotension and bradycardia. 5 th Edition. Neurogenic Shock.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

ACEP Now

JANUARY 14, 2024

Many common presentations to the emergency department (ED) are related to drug interactions that are commonly missed and largely preventable. 1-3 We may be unaware of potentially dangerous drug interactions when we order and prescribe medications in the ED. References Hohl CM, Robitaille C, Lord V, et al. Acad Emerg Med.

E-9-1-1 52

E-9-1-1 ALS Emergency Department ED 52

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

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

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? The initial ECG in today's case was recognized as definitely abnormal — but the question arose as to whether this ECG indicated old infarction vs a new acute event.

EMS 108

EMS CPR ED Coronary 108

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 152

ALS Emergency Department OR ED 152

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

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

ACEP Now

JULY 7, 2024

1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). 2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus). Neurocrit Care.

Emergency Department 52

Emergency Department Critical Care ALS ED 52

Don't Forget the Bubbles

MAY 8, 2024

Dell KM, et al. Eisen S et al. Fielder AR, et al. Arch Dis Child Fetal Neonatal Ed. Arch Dis Child Fetal Neonatal Ed. Bm MV, et al. Toepfner N, et al. Toniutti M, et al. Meoli M, et al. Ashton JJ, et al. Ding G et al. Tanti DC, et al. Ahlqvist VH, et al.

E-9-1-1 69

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

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

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

Don't Forget the Bubbles

FEBRUARY 5, 2024

Anagnostou A, et al. Rodgers O, et al. Schoeffl I, et al. Garfinkle J, et al. Peprah P, et al. Pehlivanturk Kizilkan M, et al. Pigdon L, et al. Yildirim I, et al. DaFonte TM, et al. Teague WJ, et al. Arnett AB, et al. de Visme S, et al. de Visme S, et al.

E-9-1-1 52

E-9-1-1 ALS ED Emergency Department 52

EMDocs

NOVEMBER 7, 2023

For more on the ED evaluation of diverticulitis, please see Part 1. The DIABLO trial: Daniels L, Ünlü Ç, de Korte N, et al; Dutch Diverticular Disease (3D) Collaborative Study Group. Randomized vs. 12%), adverse events (48.5 van Dijk ST, Daniels L, Ünlü Ç, et al; Dutch Diverticular Disease (3D) Collaborative Study Group.

ACPE 88

ACPE ALS OR ED 88

EMDocs

FEBRUARY 22, 2024

A 43-year-old male, with no significant medical history, presents to the ED for right eye pain. Evaluation Ask specifically about patients’ work environment, materials involved, and if they are aware of the inciting event Consider open globe in those with high-speed mechanism of injury (i.e. In: Tintinalli JE, Ma OJ, Yealy DM, et al.,

ALS 77

ALS ED EMS OR 77

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

OCTOBER 4, 2023

Formentin C, et al. Jørgensen RM, et al. Harris J, et al. Bhatia S, et al. Vivarelli M, et al. Morello W, et al. McGowan EC, et al. Hirata K, et al. Arch Dis Child Fetal Neonatal Ed. Shaikh N, et al. Wald ER, et al. Poddighe D, et al. Greenhow TL, et al.

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

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

Dr. Smith's ECG Blog

JUNE 8, 2023

According to the STEMI paradigm, the patient doesn’t have an acute coronary occlusion and doesn't need emergent reperfusion, so the paramedics can bring them to the ED for assessment, without involving cardiologists. paramedic transportation to the ED as “chest pain, STEMI negative” 2. Kontos et al. Welsh et al.

STEMI 63

STEMI Coronary Paramedic ALS 63

ACEP Now

APRIL 5, 2024

A 68-year-old man presents to the emergency department (ED) with altered mental status and fever. The study found a mean increase in time to intubation of 13 seconds in the ED setting. References von Hellmann R, Fuhr N, et al. Koh LK, Kong CE, et al. Driver BE, Prekker ME, et al. Waldron O, Sena R, et al.

OR 73

OR ALS Emergency Department Critical Care 73

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

Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. Reviewed by: Sarah Gentle and Owen Hibberd Article 2: Second attempt success in neonatal intubation Johnson MD, Tingay DG, Perkins EJ et al. Arch Dis Child Fetal Neonatal Ed. Acad Pediatr. 2024;24(1):111-118. doi:10.1016/j.acap.2023.06.023

E-9-1-1 75

E-9-1-1 Emergency Department OR ALS 75

The Overrun Podcast

MAY 5, 2021

Ed and Dan are back, this time talking about care of burn patients outside of the hospital. Burn injuries are high-acuity, low occurrence events (HALO), and it’s easy to miss things that may have a bigger impact on your patient than previously thought.

ALS 52

ALS ED 52

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

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

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

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

MAY 11, 2024

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. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al.

EMS 89

EMS E-9-1-1 ALS OR 89

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

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

[link] Case continued She arrived in the ED and here is the first ED ECG. Even in patients whose moderate stenosis undergoes thrombosis, most angiograms show greater than 50% stenosis after the event. Lindahl et al. From Gue at al. I don't know if her pain was getting better or not.

Coronary 104

Coronary E-9-1-1 STEMI ACS 104

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

ECG 1 at time zero EARLY REPOLARIZATION ABNORMAL ECG ED final official overread: "early repol vs hyperacute T, minimal changes from previous (previous shown below)" What do YOU think? Lemkes et al. See these casese (and I have many others): First ED ECG is Wellens' (pain free). A 70-something y.o. Eur Heart J 2018.

STEMI 116

STEMI ACS Critical Care OR 116

REBEL EM

SEPTEMBER 8, 2022

Background: Hypoxemia is a commonly encountered adverse event during rapid sequence intubation (RSI) in the ED. Critically ill patients in the ED often have a lack of physiologic reserve, decreased cardiac output, increased shunting, and reduced pulmonary reserves. References: Chua MT et al. NRB + NC: 22.6% NRB + NC: 83.9%

ED 52

ED Emergency Department ALS OR 52

ACEP Now

NOVEMBER 13, 2023

Physicians, nurses, and staff in emergency departments (EDs) across the country have encountered workplace violence for years. While staff exposure to this violence varies, literature shows nurses are most frequently exposed, with up to 90 percent having experienced workplace violence in their ED careers.

Emergency Department 52

Emergency Department Emergency Response ED ALS 52

Don't Forget the Bubbles

JANUARY 17, 2024

After Meshram et al, 2020 When Orbeez are exposed to water, the water molecules diffuse into the polymer network through osmosis. Image adapted from Mullens et al., The vast majority were managed at home, with no adverse events reported. ” ( Ed. After Darracq et al., A recent literature review by Caré et al.

E-9-1-1 111

E-9-1-1 ALS Emergency Department OR 111

ACEP Now

JANUARY 9, 2024

A 3-year-old male was brought to the emergency department (ED) by his mother, who reported the sudden onset of a rash (hives) covering his entire body, with no rash on his palms and soles. Nakhaee S, Amirabadizadeh A, Brent J, et al. Ruckart PZ, Jones RL, Courtney JG, et al. Zardast M, Khorashadi-Zadeh SS, Nakhaee S, et al.

E-9-1-1 52

E-9-1-1 ALS Emergency Department ED 52

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