EMDocs

OCTOBER 9, 2023

Yoo, MD (Assistant Professor/Core Faculty, San Antonio, TX) // Reviewed by Brit Long, MD (@long_brit) Case An 18-year-old man with a history of asthma and medication noncompliance presents to the emergency department (ED) with acute onset shortness of breath. He states that he recently moved to Texas from Colorado. Which one do you select?

ED 108

ED Life Support Advanced Life Support CPR 108

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-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

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

First Responder Wellness

FEBRUARY 25, 2025

Given the high propensity for police officers to be exposed to such events, it is not surprising that we see a higher rate of PTSD in officers than in the general population (Lewis-Schroeder et al., PTSD is a unique mental health condition as it is one of the only disorders that specifically requires a precipitating event.

First Responder 78

First Responder Public Safety ALS OR 78

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 92

ED Emergency Department ALS Paramedic 92

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

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

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 114

Emergency Department ED ALS 114

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

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 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

SEPTEMBER 26, 2020

Reference: Warren et al. Reference: Warren et al. Background: Patients presenting to emergency departments (EDs) with epigastric pain are typically treated with an antacid, either alone or combined with other medications. The conclusion from Berman et al was to recommend antacid monotherapy (5). Reference: Warren et al.

Emergency Department 130

Emergency Department ALS ED OR 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 123

ALS Emergency Department OR ED 123

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 133

ICU Plasma Critical Care ALS 133

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

ACEP Now

MARCH 9, 2025

As hospital boarding, increased emergency department (ED) volumes, and complexity of patients have increased, so have wait times. 1 When space is limited, patients medical history is rarely protected from the vision or hearing of other patients and guests in the ED. The sensitivity of the details of an ankle sprain may seem minor.

Emergency Department 95

Emergency Department ED ALS OR 95

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 104

ICU ED ALS OR 104

The Skeptics' Guide to EM

MARCH 22, 2019

Research by Hill et al (1) demonstrated that an ED shift can have 4,000 clicks. SGEM#159 looked at the implementation of an EMR in a tertiary care ED. The EMR tasks we undertake are expanding rapidly, far beyond simply documenting history and physical examination and every implementation slows us down.

EMR 130

EMR Emergency Department Ambulance ED 130

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 113

ACPE ALS OR ED 113

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

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

AUGUST 30, 2023

Higher rates of adverse events have not been seen in Emergency Departments where the use of imaging is lower. Take home points References Allie EH, Dingle HE, Johnson WN, et al. ED chest radiography for children with asthma exacerbation is infrequently associated with change of management. Which children need a chest X-ray?

E-9-1-1 131

E-9-1-1 Emergency Department ALS OR 131

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

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 122

Coronary ACS OR EMR 122

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 128

FFP ALS OR EMS 128

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 111

EMS FFP Ambulance ICU 111

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

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

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 105

Frozen Plasma Allergic Reaction FFP Plasma 105

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