EMDocs

JULY 25, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Chuck Pilcher, MD, FACEP Editor, Medical Malpractice Insights Editor, Med Mal Insights The challenge of suicide evaluation in the ED “I’ve changed my mind. If you have a story to share click here.

ED 81

ED ALS Emergency Department OR 81

Don't Forget the Bubbles

OCTOBER 10, 2024

This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. BMJ Paediatr Open.

ED 75

ED Emergency Department OR ALS 75

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

REBEL EM

JUNE 5, 2023

Background Information: Opioid overdose deaths have been increasing in the past twenty years. These statistics make the ED a crucial treatment initiation point to prevent further morbidity and mortality from opioid overdoses. The national number of overdose deaths from any opioid has increased 62.5% PMID 33392580.

Naloxone 98

Naloxone ED Overdose Emergency Department 98

Core EM

JANUARY 25, 2024

Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients. mg/kg over several minutes 0.02 – 0.1 up to 1.5)

ICU 246

ICU Emergency Department Critical Care ALS 246

The Skeptics' Guide to EM

NOVEMBER 11, 2023

Date: November 2, 2023 Reference: Coventry et al. Date: November 2, 2023 Reference: Coventry et al. Case: A 24-year-old manual labourer presents to the emergency department (ED) after drinking a few too many beers, having a disagreement with another beer drinker and gets knocked down. Reference: Coventry et al.

ALS 244

ALS Emergency Department ED OR 244

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

EMS 12-Lead

MAY 15, 2024

We will be using redacted information from different cases where paramedics attempted TCP in the field. After 13 minutes of ALS resuscitation, pulses were palpated indicating a return of spontaneous circulation. Pacing was continued in the ED, with identical settings. Patient was transferred to comfort care and died in the ED.

Epinephrine 331

Epinephrine Paramedic CPR ED 331

The Skeptics' Guide to EM

JUNE 24, 2023

Date: June 16, 2023 Reference: Reed et al. Date: June 16, 2023 Reference: Reed et al. Case: A 27-year-old right hand dominant patient presents to the emergency department (ED) with a 2.5 Individuals can then use that information to decide if or how much of the drug to use. Reference: Reed et al.

Overdose 187

Overdose Emergency Department ALS ED 187

The Skeptics' Guide to EM

NOVEMBER 9, 2024

Date: October 28, 2024 Reference: Woelfle T et al. In addition to finding ways to use technology in emergency department (ED) care, she is interested in how health systems work and how patients move through the healthcare system. Previously, she has been an ED medical director, quality chair, and regional hospital director.

Emergency Department 140

Emergency Department ED ALS OR 140

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

FEBRUARY 26, 2024

A recent study by Gaborit et al. The ED clinician should inquire about a relevant history of HIV infection, malignancy, high-dose corticosteroid use, chemotherapy, organ transplant, or use of immunosuppressive drugs for other indications. She reports occasional central chest pain exacerbated by coughing. and specificity of 71.4%).

E-9-1-1 87

E-9-1-1 ED ALS OR 87

ALiEM

SEPTEMBER 25, 2024

A 24-year-old male with a history of microscopic hematuria presented to the emergency department (ED) with left lower quadrant abdominal pain. He decided to come to the ED today because of the persistent nature of the pain. Zubaidi A, Al-Saif F, Silverman R. His pain started about two weeks ago and has been intermittent.

Emergency Department 141

Emergency Department ED ALS OR 141

EMDocs

AUGUST 22, 2024

6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. 6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. One cohort study in a public ED found that 84.5%

Emergency Department 81

Emergency Department ALS E-9-1-1 ED 81

ALiEM

JUNE 15, 2023

Goldfrank’s Toxicologic Emergencies, 11e New York, NY: McGraw-Hill; 2019 Morimoto M, Tatsumi K, Yuui K, et al. PMID 29855084 De Silva HA, Fonseka MM, Pathmeswaran A et al. Retrieved Jun 5, 2023. Nelson LS, Goldfrank LR. In: Nelson LS, Howland M, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS. Lancet 2003; 361 (9373): 1935-8.

ALS 246

ALS ED OR 246

ALiEM

NOVEMBER 18, 2024

In: Mattu A and Swadron S, ed. Munawar K, Nayak G, Fatterpekar GM, et al. Author information Veda Ravishankar, MD Resident Physician Cook County Health | The post SAEM Clinical Images Series: A Rash with Cranial Nerve Deficits appeared first on ALiEM. References Anderson Erik, Do-Nguyen Amy. Varicella-Zoster Virus (VZV).

Emergency Department 161

Emergency Department ALS OR ED 161

The Skeptics' Guide to EM

AUGUST 24, 2024

Date: August 19, 2024 Reference: Partyka et al. Interests include information systems and digital health, research and education. Interests include information systems and digital health, research and education. Case: A 67-year-old male presents to your hospital emergency department (ED) after a fall from his bicycle.

Emergency Department 129

Emergency Department ALS OR ED 129

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

ALiEM

MARCH 7, 2024

Transvere ultrasound views of the bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.) Sagittal view of bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.)

E-9-1-1 177

E-9-1-1 Emergency Department ALS ED 177

ALiEM

FEBRUARY 5, 2024

Reference Lin M, Phipps M, Chan TM, et al. You will need to create a free, 1-time login account. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. Ann Emerg Med. 2023;82(1):55-65. doi: 10.1016/j.annemergmed.2023.02.011

Overdose 215

Overdose Critical Care EMS Emergency Department 215

The Skeptics' Guide to EM

FEBRUARY 26, 2022

Date: February 21st 2022 Reference: Kim et al. Date: February 21st 2022 Reference: Kim et al. Case: You are in discussion with your emergency department (ED) manager about the number of patients boarding for hours to days and you are both aware that many of these patients are attending with mental health crises.

ED 130

ED ALS Emergency Department OR 130

Pediatric EM Morsels

JULY 5, 2024

Using this decision rule would have cut down on ED CT C-spine ordering by >50% in this derivation cohort. I am hopeful it will also improve the flow in the ED.” While plain films for C-spine injury had previously fallen out of routine ED practice, we now have more evidence to support their use in intermediate risk patients.

ALS 161

ALS OR ED Emergency Department 161

ALiEM

APRIL 12, 2024

Case A 48 year-old male with a history of hypertension and polysubstance abuse presented to the emergency department (ED) for shortness of breath and was found to have a left sided parapneumonic pleural effusion (Figure 1). doi: [link] Broder JS, Al-Jarani B, Lanan B, Brooks K. doi: [link] Vetrugno L, Guadagnin GM, Barbariol F, et al.

E-9-1-1 183

E-9-1-1 ALS Critical Care Emergency Department 183

EMDocs

SEPTEMBER 26, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Patient not informed of enlarged heart, dies 3 weeks post ED visit Miscommunicated radiology findings are a hot topic. Baccei SJ et al. Tyler W et al. Volume 80, no. 3 : September 2022.

Emergency Department 74

Emergency Department ED ALS Coronary 74

ALiEM

APRIL 12, 2023

Accessed April 5, 2023 Afzal S, Zahid M, Rehan ZA, et al. 20 – Local Anesthetics, Ed(s): Hugh C. Author information Ivan Ivanov, DO Resident Physician Emergency Department South Brooklyn Health | The post Trick of the Trade: Gel-free ultrasound-guided peripheral IV technique appeared first on ALiEM. 2022 Jan 6;8(1):42.

Emergency Department 258

Emergency Department ALS ED 258

ALiEM

OCTOBER 14, 2023

Reference Lin M, Phipps M, Chan TM, et al. Author information Chris Belcher, MD Editor, ALiEM AIR Series Assistant Professor and Assistant Program Director Department of Emergency Medicine University of Kentucky College of Medicine | Twitter | The post ALiEM AIR Series | Respiratory 2023 Module appeared first on ALiEM. Ann Emerg Med.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

ALiEM

NOVEMBER 29, 2023

PMID: 34529640 Ayub S, Parnia S, Poddar K, et al. PMID: 24769343 Ehrman-Dupre R, Kaigh C, Salzman M et al. PMID: 36148197 Love JS, Levine M, Aldy K, et al. PMID: 37014353 Ball NS, Knable BM, Relich TA et al. How do you treat xylazine toxicity? MMWR Morb Mortal Wkly Rep. 2021;70(37):1300-1302. Published 2021 Sep 17.

Naloxone 169

Naloxone Overdose ALS Epinephrine 169

ALiEM

SEPTEMBER 27, 2023

Hoffman et al. Koppaka V, Thompson DC, Chen Y, et al. Author information Kylee Brooks, MD Emergency Medicine Resident Department of Emergency Medicine Carolinas Medical Center | The post ACMT Toxicology Visual Pearls: Mushroom Mishap appeared first on ALiEM. Encyclopedia of Toxicology (Third Edition), Academic Press.

ALS 169

ALS OR ED 169

Don't Forget the Bubbles

OCTOBER 2, 2024

Children often spend many hours in the emergency department (ED) before being sent home or admitted. The average waiting time for the first assessment was only a few minutes shorter when going through the ED. Still, treatment initiation was significantly faster (up to one hour) than admission through the ED. Pecenka C, et al.

ALS 52

ALS Emergency Department ED ACS 52

ALiEM

JANUARY 29, 2024

Case Question: What treatments can you perform in the ED for this diagnosis and do they improve outcomes? Nedelmann, Matt et al. 2015;46:2322–2324 [link] Smith, Austin T et al. This has the potential to expedite consultations with specialty teams and treatment. Ultraschall Med. 2012 Dec;33(7):E263-E267. Epub 2012 Sep 21.

ALS 161

ALS ED OR 161

ACEP Now

JULY 11, 2024

The United States Preventive Services Task Force (USPSTF) recommends screening for problem drinking in the primary setting, but we know that patients who present to the ED are twice as likely to engage in dangerous drinking, so arguably the ED is an important venue for screening as well. Pilar MR, Eyler AA, Moreland-Russell S, et al.

Emergency Department 98

Emergency Department ALS ED OR 98

ALiEM

JUNE 5, 2023

ED providers are only exposed in these cases if they have direct contact with drainage from open wounds while not using PPE or there is concern for aerosolization of spores For inhalational anthrax exposure, AVA should be given in combination with antimicrobials (ciprofloxacin or doxycycline) for 60 days. Pathophysiology of anthrax.

ALS 256

ALS OR ED 256

EMS 12-Lead

MARCH 30, 2024

We will be using redacted information from different cases where paramedics attempted TCP in the field. On ED arrival ROSC is achieved. The University of Maryland found that capture occurred in only 42-78% of patients, dependent on pad positioning (Moayedi et al, 2022). They are unable to feel a pulse and resume CPR.

CPR 312

CPR Paramedic Ambulance Defibrillator 312

ACEP Now

AUGUST 22, 2023

Regardless of the domain, somewhere an expert panel has convened to issue a pronouncement informing all of the ideal care of patients under their specialty umbrella, indirectly extending to their care in the emergency department. There is no shortage of guidelines, protocols, or quality measures across emergency medicine.

Emergency Department 98

Emergency Department ALS ED OR 98

REBEL EM

AUGUST 22, 2024

Paper: Lema GMC, De Leacy R, Fara MG, et al. The protocol involved collaboration between the ophthalmology service, ED, and stroke service, including neurology and neuroendovascular teams. Outside eye care providers could refer patients directly to the ED for expedited evaluation. PMID: 32568646 Wang X, Liu Y, Suo Y, et al.

ALS 85

ALS ED OR EMS 85

The Skeptics' Guide to EM

APRIL 8, 2023

In Ontario alone there have been approximately 160 emergency departments (ED) temporarily closed since the beginning of 2022. The SGEM advocated for having the evidence to inform/guide our decisions.

Emergency Department 139

Emergency Department ED Ambulance ALS 139

ALiEM

NOVEMBER 1, 2023

In: Nelson LS, Goldfrank LR et al (eds): Goldfrank’s Toxicologic Emergencies. Author information Allison Frazure, MD Emergency Medicine Resident Carolinas Medical Center | The post ACMT Toxicology Visual Pearl: Who Doesn’t Like a Nice Rosé? The post was peer reviewed on behalf of ACMT by Drs. Iron: not a benign therapeutic drug.

E-9-1-1 161

E-9-1-1 ALS OR ED 161