The Skeptics' Guide to EM

JULY 6, 2024

Reference: Tjan et al. The emergency department (ED) evaluation reveals an unremarkable chemistry panel with normal renal function and a white blood cell count of 10,000. Background: We have discussed agitation in the ED on the SGEM several times. Reference: Tjan et al. Conflict in emergency medicine: A systematic review.

ED 210

ED ALS Emergency Department OR 210

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 82

ED ALS Emergency Department OR 82

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Reference: Snelling et al. Reference: Snelling et al. Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth. Case: It is a steady Saturday afternoon in your rural emergency department (ED).

Critical Care 316

Critical Care ALS ED Emergency Department 316

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Date: September 12, 2024 Reference: Anderson et al. Case: It’s another day, another dollar in the emergency department (ED). You wonder if she could have an allergy challenge dose of ceftriaxone in the ED. Emergency Physicians frequently encounter ED patients with self-reported penicillin allergies. AEM August 2024.

ICU 109

ICU Emergency Department ALS ED 109

The Skeptics' Guide to EM

AUGUST 28, 2021

Date: August 27th, 2021 Reference: Gagnon et al. Case: A forty-year-old woman presents to the emergency department […] The post SGEM#342: Should We Get Physical, Therapy for Minor Musculoskeletal Disorders in the ED? Date: August 27th, 2021 Reference: Gagnon et al. first appeared on The Skeptics Guide to Emergency Medicine.

ED 130

ED Emergency Department ALS OR 130

Core EM

JANUARY 25, 2024

A quick primer on hypocalcemia in the ED. Pfenning CL, Slovis CM: Electrolyte Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. Diagnosis and management of hypocalcaemia. BMJ 2008; 336:1298. Desai TK, Carlson RW, Geheb MA. Louis, Mosby, Inc.,

Critical Care 246

Critical Care ED ALS OR 246

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. What additional workup is necessary in the ED?

ED 85

ED E-9-1-1 ALS OR 85

Core EM

JANUARY 25, 2024

More than 1/3 of geriatric trauma patients presenting to the ED after a fall return to the ED or die within one year of initial evaluation. 4 Elderly patients, who comprise only 8-12% of total ED major trauma cases, represent a disproportionate 15-30% of trauma mortalities and costs. Perdue &al. Caterino &al.

ALS 246

ALS ED ICU OR 246

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. Short acting. mg/kg IV followed by 0.05 – 0.4

Emergency Department 246

Emergency Department ICU Critical Care ALS 246

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 306

Operating Room Emergency Department ALS ED 306

The Skeptics' Guide to EM

OCTOBER 21, 2023

Date: October 20, 2023 Reference: Cai et al. Case: You are in your group meeting and have heard about a case at a nearby emergency department (ED) where the […] The post SGEM#418: I Ain’t Missing You – Spinal Epidural Abscess first appeared on The Skeptics Guide to Emergency Medicine. Date: October 20, 2023 Reference: Cai et al.

Emergency Department 271

Emergency Department ALS ED OR 271

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. He describes the pain as a gradually worsening pressure-like discomfort distributed across his entire abdomen. He reports distension and the sensation of fullness.

E-9-1-1 77

E-9-1-1 ED ALS Operating Room 77

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 183

Emergency Medical Services ALS Emergency Department ED 183

The Skeptics' Guide to EM

OCTOBER 28, 2023

Date: October 26, 2023 Reference: Jones et al. Date: October 26, 2023 Reference: Jones et al. Case: A 37-year-old man without a significant past medical history presents to the emergency department (ED) with a chief complaint of lower back pain that started three days prior to the ED visit after unloading a truck with furniture.

ALS 228

ALS Emergency Department ED OR 228

The Skeptics' Guide to EM

DECEMBER 30, 2023

Reference: Roussel et al. McG) presents to your emergency department (ED) after being found by family on the […] The post SGEM#424: Ooh-Ooh, I Can’t Wait – To Be Admitted to Hospital first appeared on The Skeptics Guide to Emergency Medicine. Reference: Roussel et al. Case: An 85-year-old patient (Ms.

Emergency Department 275

Emergency Department ED ALS OR 275

The Skeptics' Guide to EM

APRIL 14, 2019

Date: April 11th, 2019 Reference: Brucker et al. This is a warning to those listening to the podcast or reading […] The post SGEM#252: Blue Monday- Screening Adult ED Patients for Risk of Future Suicidality first appeared on The Skeptics Guide to Emergency Medicine. Date: April 11th, 2019 Reference: Brucker et al.

ED 130

ED Emergency Department ALS OR 130

The Skeptics' Guide to EM

APRIL 13, 2024

Reference: Albers GW et al. Reference: Albers GW et al. When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. TIMELESS Investigators. Tenecteplase for Stroke at 4.5

Emergency Department 295

Emergency Department ALS OR EMS 295

The Skeptics' Guide to EM

JANUARY 6, 2024

Reference: Remick KE, et al. Reference: Remick KE, et al. Case: After your shift in the emergency department (ED) one day, the medical director pulls you aside. Reference: Remick KE, et al. July 2023 * Population: ED leadership across the United States. JAMA Netw Open. JAMA Netw Open. JAMA Netw Open.

Emergency Department 268

Emergency Department Emergency Medical Services ALS ED 268

EMS 12-Lead

MAY 15, 2024

After 13 minutes of ALS resuscitation, pulses were palpated indicating a return of spontaneous circulation. Crew notifies the received ED of an incoming post-arrest patient and notes a sinus bradycardia on their monitor, as seen in Figure 2. Pacing was continued in the ED, with identical settings. Several learning points here.

Epinephrine 331

Epinephrine Paramedic CPR ED 331

The Skeptics' Guide to EM

JUNE 1, 2024

Reference: Tavender E, et al. Dr. Caleb Ward Case: A 4-year-old boy is brought to the emergency department (ED) by Emergency Medical Services (EMS) after falling from a tall tree. Reference: Tavender E, et al. Triage tools for detecting cervical spine injury in paediatric trauma patients. Cochrane Database Syst Rev.

Emergency Medical Services 207

Emergency Medical Services Emergency Department EMS ALS 207

The Skeptics' Guide to EM

DECEMBER 2, 2023

Reference: Shaikh N, et al. Reference: Shaikh N, et al. Case: A 4-year-old girl presents to your emergency department (ED) with fever and nasal drainage. Identifying children likely to benefit from antibiotics for acute sinusitis: a randomized clinical trial. Her vaccinations are all up to date.

Emergency Department 305

Emergency Department ALS OR ED 305

REBEL EM

JUNE 5, 2023

These statistics make the ED a crucial treatment initiation point to prevent further morbidity and mortality from opioid overdoses. The benefit of accessibility, availability, and safety of buprenorphine compared to methadone makes it a viable option for opioid use disorder treatment initiation in the ED. PMID 33392580.

Naloxone 95

Naloxone ED Overdose Emergency Department 95

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 Reference: Reed et al. cm left forearm abscess. They have no fever, chills, or signs of compartment syndrome.

Overdose 184

Overdose Emergency Department ALS ED 184

The Skeptics' Guide to EM

NOVEMBER 25, 2023

Date: November 22, 2023 Reference: Stopyra et al. Date: November 22, 2023 Reference: Stopyra et al. We looked at 101 STEMI patients from two rural EDs. Reference: Stopyra et al. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. AEM November 2023. AEM November 2023.

Heart Attack 286

Heart Attack STEMI Emergency Medical Services Coronary 286

The Skeptics' Guide to EM

DECEMBER 21, 2019

Outside of his academic duties, he works clinically in the adult ED at Spectrum Health in Grand Rapids, Michigan, the tertiary care center for Western Michigan. It was published last year in the 2018 BMJ holiday edition ( Yeh et al BMJ Dec 2018 ). Laupacis A et al NEJM 1988 ). It would be a cross over trial.

OR 100

OR ALS ED 100

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics.

ICU 209

ICU ED Critical Care ALS 209

The Skeptics' Guide to EM

JULY 27, 2024

Reference: Knack et al. They were randomized to ceftriaxone 2gm intravenous (IV) in the ambulance or usual cares (fluids and supplementary oxygen) until arrive to the ED. A similar review by Sanders et al 2015 concludes that clinica. A randomized control trial (RCT) done in the prehospital setting enrolled 2,698 patients.

ICU 192

ICU ALS Ambulance OR 192

The Skeptics' Guide to EM

JULY 20, 2024

Reference: Gibbs et al. Case: A 70-year-old man presents to the emergency department (ED) with an exacerbation of COPD. Reference: Gibbs et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation (The PREOXI trial). NEJM June 2024. He is hypoxic on arrival with an oxygen saturation of 80% on room air.

ALS 234

ALS Emergency Department ED OR 234

EMDocs

NOVEMBER 6, 2023

This post will focus on the key parts of the guideline that affect ED evaluation and management. Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. COR Harm, LOE B-R.

Naloxone 94

Naloxone OR Overdose BLS 94

Dr. Smith's ECG Blog

JUNE 17, 2023

EMS recorded this ECG during active symptoms and transmitted it to the ED: I had no information when I was shown the ECG. mm of STE in II and III, or III and aVF, or V4 and V5, so some might say it fulfills STEMI criteria (remember, the interrater reliability of STEMI criteria is poor as shown in references below): McCabe et al.

OR 52

OR STEMI ALS EMS 52

The Skeptics' Guide to EM

AUGUST 24, 2024

Date: August 19, 2024 Reference: Partyka et al. Case: A 67-year-old male presents to your hospital emergency department (ED) after a fall from his bicycle. Reference: Partyka et al. Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management: The SABRE Randomized Clinical Trial.

Emergency Department 127

Emergency Department ALS OR ED 127

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 82

Emergency Department ALS E-9-1-1 ED 82

The Skeptics' Guide to EM

JUNE 22, 2024

Reference: Peters MJ, et al. Dr. Anireddy Reddy Case: A 3-year-old girl presents to the emergency department (ED) with fever and respiratory distress. Your ED team quickly intubates her and places her on a ventilator. Reference: Peters MJ, et al. Her oxygen saturation is 78% on room air. It’s unbalanced.

Critical Care 132

Critical Care ICU ALS Emergency Department 132

The Skeptics' Guide to EM

JUNE 17, 2023

Date: June 15, 2023 Reference: Rees CA et al. Date: June 15, 2023 Reference: Rees CA et al. Case: A 14-year-old male with sickle cell disease (SCD) presents to your emergency department (ED) with a vaso-occlusive pain episode (VOE) of his bilateral legs and back. Reference: Rees CA et al. Opioids are the primary therapy.

Emergency Department 181

Emergency Department ALS ED OR 181

The Skeptics' Guide to EM

JUNE 20, 2020

Reference: Kuppermann et al. Reference: Kuppermann et al. Case: A 5-week-old full term female presents to the Emergency Department (ED) for fever with rectal temp of 100.6F (38.1C). Reference: Kuppermann et al. Dennis Ren is a Pediatric Emergency Medicine fellow at Children’s National Hospital in Washington, DC.

OR 100

OR Emergency Department ALS ED 100

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

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