The Skeptics' Guide to EM

JULY 22, 2023

Date: July 21, 2023 Reference: Prekker et al. Date: July 21, 2023 Reference: Prekker et al. Intubation FPS is associated with fewer adverse events, most importantly hypoxia, hypotension, and cardiac arrest. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults.

Emergency Medical Services 245

Emergency Medical Services Defibrillator CPR EMS 245

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Studies such as those by Moise et al 14 and Ellis et al 39 have shown that the relative risk of developing an acute myocardial infarction in the territory supplied by an artery with a 70%. Furthermore, if this occurs at all, it is a rare event. years, with the interval as long as 12 or 18 years in some studies.

Coronary 121

Coronary ACS OR EMR 121

The Skeptics' Guide to EM

DECEMBER 7, 2019

Date: October 2nd, 2019 Reference: Ramgopal et al. Changes in the Management of Children With Brief Resolved Unexplained Events (BRUEs). Date: October 2nd, 2019 Reference: Ramgopal et al. Changes in the Management of Children With Brief Resolved Unexplained Events (BRUEs).

CPR 130

CPR ALS OR 130

ACEP Now

OCTOBER 29, 2024

Coming into triage, I see a young man—Georgian-speaking—bracing himself with a hand against the wall and holding his lower abdomen. With what I can only describe as a “grimace” by a singular word, his face conveyed so much more. Without talking or touching the patient, the triage nurse picked up on a deep pain.

Emergency Department 59

Emergency Department ALS Emergency Medical Services OR 59

REBEL EM

FEBRUARY 19, 2024

Paper: Yerke JR et al. of cases) ≤24hrs vs >24hrs Infusion Duration: 3.8hrs vs 42.4hrs Max Dose: 10mcg/min vs 10mcg/min Extravasation Events: 24 (4.7%) vs 11 (8.7%) Extravasation incidence/1000d of Peripheral Infusion: 176.4 No Extravasation Event vs Extravasation Event Age: 63 vs 67 years BMI: 28.3 CHEST 2024.

ICU 137

ICU EMS ALS OR 137

The Skeptics' Guide to EM

MAY 19, 2018

[display_podcast] Date: May 16, 2018 Reference: Freund et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events
 Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. display_podcast] Date: May 16, 2018 Reference: Freund et al. Reference: Freund et al.

Emergency Department 130

Emergency Department ALS Coronary OR 130

ACEP Now

APRIL 5, 2024

References von Hellmann R, Fuhr N, et al. Koh LK, Kong CE, et al. A study in the February issue of Annals conducted a meta-analysis of 18 studies and concluded that bougie use was associated with increased first-attempt intubation success. Some important limitations of this analysis should be recognized. Ann Emerg Med.2024;83(2):132-144.

OR 73

OR ALS Emergency Department Critical Care 73

ALiEM

OCTOBER 11, 2024

Common inciting events include viral infections, autoimmune diseases, or immunodeficiency syndromes [1]. Provan D, Arnold DM, Bussel JB, et al. On the day of presentation, she developed a painful, intermittently bleeding “blood blister” to the left lower cheek that had increased in size, as well as new red spots on her arms and legs.

OR 152

OR ALS 152

The Skeptics' Guide to EM

OCTOBER 10, 2020

Reference: Friedman et al. Reference: Friedman et al. million visits each year in the USA ( Friedman et al Spine 2010 ). However, their use is associated with increased adverse events. These include: acetaminophen ( Williams et al Lancet 2014), muscle relaxants ( Friedman et al JAMA 2015), NSAIDs ( Machado et al

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

SEPTEMBER 26, 2020

Reference: Warren et al. Reference: Warren et al. The conclusion from Berman et al was to recommend antacid monotherapy (5). Reference: Warren et al. Date: September 22nd, 2020 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician in Calgary. A randomized double-blind clinical trial. AEM Sept 2020.

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. Reference: Sadeghirad B, et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials.

Emergency Department 130

Emergency Department ALS EMS ED 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 122

ALS Emergency Department OR ED 122

The Skeptics' Guide to EM

APRIL 2, 2022

Date: March 31st, 2022 Reference: Butt et al. Date: March 31st, 2022 Reference: Butt et al. Children represent one group of patients that are less likely to receive adequate analgesia ( Brown et al , Selbst and Clark ). Reference: Butt et al.

Emergency Department 130

Emergency Department ALS ED OR 130

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

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

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. Reference: Riskin A, Erez A, Foulk TA, et al. Rudeness and Medical Team Performance. Pediatrics. Rudeness and Medical Team Performance. Pediatrics.

ALS 130

ALS Emergency Department OR EMS 130

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

Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Musculoskeletal Adverse Events include: Articular cartilage damage causing arthralgias or arthritis , Tendonitis , and Tendon rupture. Which is a risk of 1 event for 62.5

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

ALiEM

NOVEMBER 8, 2023

Patients with DRESS syndrome are at risk of developing systemic autoimmune sequelae, which can appear anywhere from months to 4 years after the initial event [1]. PMID: 37082745 Sasidharanpillai S, Ajithkumar K, Jishna P, et al. [1-3] Cutaneous manifestations typically consist of an urticarial, maculopapular eruption.

OR 161

OR ALS ED 161

EMDocs

SEPTEMBER 3, 2024

EBM Update: ANNEXA-1 and DOAC Reversal in ICH Article: Connolly SJ, Sharma M, Cohen AT, et al; ANNEXA-I Investigators. Increased thrombotic events with Andexanet alpha. Secondary outcome: determine which of the two reverting strategies is less affected by thromboembolic events. N Engl J Med. 2024 May 16;390(19):1745-1755.

ALS 98

ALS OR 98

Don't Forget the Bubbles

NOVEMBER 22, 2023

A systematic review examined 69 articles (mostly cohort studies and clinical trials) looking at the common adverse events (not just PRIS) following the use of propofol in children and neonates. Mortality associated with PRIS has been estimated to be around 33% and becomes even higher if the diagnosis is delayed. References Bray RJ.

E-9-1-1 126

E-9-1-1 Critical Care Operating Room ALS 126

EMDocs

FEBRUARY 7, 2024

GLP-1 agonists are also associated with improved ejection fraction, coronary blood flow, and cardiac output while reducing the risk of cardiovascular events, infarction size, and all-cause mortality. Adverse events are common in those using GLP-1 agonists, but the vast majority of these are minor. Take for example semaglutide.

Allergic Reaction 98

Allergic Reaction ALS CAD OR 98

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. Prior literature primarily focused on safety and medication errors, and while this study did the same, they also assessed variables associated with PDP response. The safety and efficacy of push dose vasopressors in critically ill adults. Am J Emerg Med. 2022 Sep 5.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

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. Each article will take a deeper dive into each recommendation’s supporting evidence and practical implications. Do not obtain radiographs in children with bronchiolitis , croup, asthma, or first-time wheezing.

E-9-1-1 131

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

REBEL EM

MAY 29, 2024

EMRAP HD: Epistaxis Posterior Pack References Cassisi NJ et al. PMID: 5569677 Zeyyan E et al. Take Home Points: Posterior epistaxis is a rare, life-threatning presentation. The key is in identifying and rapidly gaining control with a posterior pack or foley catheter. Laryngoscope 1971; 81(8): 1261-6.

ICU 102

ICU ALS ACS EMS 102

EMDocs

OCTOBER 9, 2023

12 Weight gain (up to 70%), development of cataracts (up to 15%), fractures (up to 12%), and neuropsychiatric events (up to 10%) are the most common adverse events. 12 Weight gain (up to 70%), development of cataracts (up to 15%), fractures (up to 12%), and neuropsychiatric events (up to 10%) are the most common adverse events.

ED 108

ED Life Support Advanced Life Support CPR 108

EMDocs

OCTOBER 25, 2024

The authors found that the 1 year rate of major adverse cardiovascular events (MACE) was 15.5%. We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter. Originally published at JournalFeed , a site that provides daily or weekly literature updates. West J Emerg Med. 2024;25(5):680-689. #3:

Defibrillator 95

Defibrillator Emergency Department ALS OR 95

Pediatric EM Morsels

NOVEMBER 17, 2023

Cuffed Endotracheal Tubes show no difference in immediate post-extubation adverse events (i.e On this 10 year anniversary, we chose to throw this one back in the oven to include some even more delicious data on cuffed endotracheal tube (ETT) use. In a systematic review of 10 RCTs comparing cuffed vs. uncuffed ETTs. 1.70) and 0.78 (0.46–1.35),

E-9-1-1 190

E-9-1-1 Operating Room Emergency Department ALS 190

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. A 12 Lead ECG was recorded secondary to bizarre telemetry findings at bedside. Said differently, it’s a mess. The reason for this is Phase III block. slowing of the heart rate).

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

EMDocs

MAY 11, 2024

Some refer to an ischemic event in this territory with clinical findings as posterior inferior cerebellar artery syndrome. Central causes of vertigo include ischemic stroke, demyelinating conditions, cerebellar hemorrhage, vertebrobasilar insufficiency, vertebral artery dissection, multiple sclerosis, malignancy, and vestibular migraine.

EMS 111

EMS E-9-1-1 ALS OR 111

ACEP Now

NOVEMBER 8, 2024

Because EGAs do not isolate the trachea as the ETT does, the risk of aspiration events increases, and due to the blind placement of many of these devices, unidentified airway occlusion can occur. Benger JR, Kirby K, Black S, et al. Wang HE, Schmicker RH, Daya MR, et al. Ramaiah R, Das D, Bhananker SM, et al. 3rd Edition.

E-9-1-1 40

E-9-1-1 Emergency Medical Services Emergency Medical Technician AEMT 40

REBEL EM

SEPTEMBER 13, 2023

of people who take NSAIDs ( Nzeako 2010 ). patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the Emergency Department) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 of people who take NSAIDs ( Nzeako 2010 ). Typically involves the mouth, larynx, pharynx, and subglottic tissue ( Kostis 2005 ).

Frozen Plasma 104

Frozen Plasma Allergic Reaction FFP Plasma 104

ALiEM

AUGUST 16, 2023

PMID 7073040 Moore TJ, Walsh CS, Cohen MR. Reported adverse event cases of methemoglobinemia associated with benzocaine products. Nelson, et al., Nelson, et al., Background Methemoglobinemia is a disorder of hemoglobin in which the iron atom has been oxidized from the normal Fe 2+ to Fe 3+. Methemoglobinemia. Ann Emerg Med.

E-9-1-1 130

E-9-1-1 ALS OR 130

ALiEM

OCTOBER 26, 2023

In order to avoid connectivity issues with Wifi, the event administrators broadcasted from an ethernet-connected computer. Originally developed by Marsh et al., Deploying our security teams, a robust registration system, and the waiting room function in Zoom were important strategies for avoiding disturbances to the event.

EMS 161

EMS Emergency Department ALS ED 161

Don't Forget the Bubbles

NOVEMBER 27, 2023

The seven studies in children included a meta-analysis of four studies, which included 388 children and demonstrated a pooled incidence of adverse events of 3.3%. Shock is defined as a type of circulatory failure where lack of oxygen leads to dysfunction of vital organs. This is beyond the scope of this blog post.

Advanced Life Support 143

Advanced Life Support ED ALS OR 143

Don't Forget the Bubbles

OCTOBER 2, 2024

Severe TBI is broadly defined as a Glasgow Coma Score (GCS) of less than 8 following a traumatic event. Kochanek et al… Kochanek PM, Tasker RC, Carney N, Totten AM, Adelson PD, Selden NR, et al. There was also a meta-analysis on this topic in the adult population by Schwimmbeck et al [6] in 2021.

OR 49

OR Critical Care ALS Emergency Department 49

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. References Prinzmetal M, Kennamer R, Merliss R, et al. Myerburg RJ, Kessler KM, Mallon SM et al. Magid DJ, Aziz K, Cheng A, et al. Angina pectoris.

Coronary 98

Coronary Life Support ALS Emergency Department 98