Core EM

JANUARY 25, 2024

A study by Duniec et al. Here are a handful of these studies and their conclusions: Nomura et al., Here are a handful of these studies and their conclusions: Nomura et al., of scans conducted and in <5 minutes in 100% of scans Ferre et al., times more attempts when adjusted for BMI Gottlieb et al.,

ALS 246

ALS Critical Care OR 246

The Skeptics' Guide to EM

JUNE 8, 2024

Reference: Kruse et al. Reference: Kruse et al. Systematic Review, Quality Assessment, and Synthesis of Guidelines for Emergency Department Care of Transgender and Gender-diverse People Recommendations for Immediate Action to Improve Care. It included both medical and paramedical care within these groups.

Emergency Department 307

Emergency Department ED ALS Paramedic 307

EMDocs

NOVEMBER 6, 2023

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. This post will focus on the key parts of the guideline that affect ED evaluation and management. Top 10 Take Home Pearls 1.

Naloxone 94

Naloxone OR Overdose BLS 94

The Skeptics' Guide to EM

DECEMBER 21, 2019

It was published last year in the 2018 BMJ holiday edition ( Yeh et al BMJ Dec 2018 ). Laupacis A et al NEJM 1988 ). Mathew Reeves is a Professor and Interim Chair of the Department of Epidemiology and Biostatistics at the College of Human Medicine at MSU. Date: December 17th, 2019 Reference: Reeves and Reynolds.

OR 100

OR ALS ED 100

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Reference: Snelling et al. Reference: Snelling et al. Reference: Snelling et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. He is also a fully-fledged ultrasonographer. Ultrasonography or radiography for suspected pediatric distal forearm fractures.

Critical Care 310

Critical Care ALS ED Emergency Department 310

The Skeptics' Guide to EM

DECEMBER 15, 2018

Date: December 13th , 2018 Reference: Murata et al. Date: December 13th , 2018 Reference: Murata et al. They published an epic paper to determine the transit time of a Lego head ( Tagg et al ). Acetaminophen and febrile seizure recurrences during the same fever episode. Pediatrics. Pediatrics.

OR 130

OR Emergency Department ALS 130

The Skeptics' Guide to EM

APRIL 13, 2024

Reference: Albers GW et al. Reference: Albers GW et al. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. TIMELESS Investigators. Tenecteplase for Stroke at 4.5 to 24 Hours with Perfusion-Imaging Selection. A CT angiogram shows a proximal middle cerebral artery occlusion.

Emergency Department 289

Emergency Department ALS OR EMS 289

Dr. Smith's ECG Blog

JUNE 17, 2023

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. Carley et al. Tandberg et al. Journal of the American Heart Association 2013;2:e000268. What’s the point of ST elevation?

OR 52

OR STEMI ALS EMS 52

The Skeptics' Guide to EM

OCTOBER 28, 2023

Date: October 26, 2023 Reference: Jones et al. Date: October 26, 2023 Reference: Jones et al. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial placebo-controlled trial. He denies any weakness or numbness of the lower extremities or bowel or bladder dysfunction.

Emergency Department 223

Emergency Department ALS ED OR 223

The Skeptics' Guide to EM

DECEMBER 16, 2023

Reference: Punches et al. Reference: Punches et al. Reference: Punches el al. Patient Perceptions of Microaggressions and Discrimination Towards Patients During Emergency Department Care. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM. AEM Dec 2023.

Emergency Department 293

Emergency Department ED ALS OR 293

Core EM

JANUARY 25, 2024

References: Yuan TH, Kerns WP, Tomaszewski CA, et al. von Lewinski D, Bruns S, Walther S, et al. Cole JB, Corcoran JN, Engebretsen KM, et al. Holger JS, Engebretsen KM, Fritzlar SJ, et al. Kerns W, Schroeder D, Williams C, et al. Kline JA, Tomaszewski CA, Schroeder JD, et al. Disposition to ICU. Circulation.

Overdose 246

Overdose ALS Epinephrine Critical Care 246

Core EM

JANUARY 25, 2024

Perdue &al. Caterino &al. Sterling &al. Liu &al. Gill &al. Demetriades D &al. Goode &al. Hasegawa &al. Heffernan &al. Li &al. Konda &al. 6 Assessment and Initial Evaluation: What’s different? 1998;45:805. Am J Emerg Med.

ALS 246

ALS ED ICU OR 246

EMOttawa

JUNE 24, 2024

5 Usefulness: 2/5 Nasr Isfahani M, et al. Methodology: 3.5/5 BMC Emerg Med. 2024 Jan 25;24(1):15. Question and Methods: This triple blinded RCT of 158 patients with isolated closed limb fractures assessed pain scores at 1-hour following the administration of intravenous acetaminophen, acetaminophen plus ibuprofen, or morphine.

OR 52

OR ALS 52

The Skeptics' Guide to EM

JUNE 20, 2020

Reference: Kuppermann et al. Reference: Kuppermann et al. Several criteria have been developed previously, including the Rochester ( Jaskiewicz et al 1994 ), Boston ( Baskin et al 1992 ) and Philadelphia ( Baker et al 1993 ) criteria to help clinicians stratify the risk of serious bacterial infections (SBI).

OR 100

OR Emergency Department ALS ED 100

The Skeptics' Guide to EM

DECEMBER 2, 2023

Reference: Shaikh N, et al. Reference: Shaikh N, et al. Identifying children likely to benefit from antibiotics for acute sinusitis: a randomized clinical trial. Identifying children likely to benefit from antibiotics for acute sinusitis: a randomized clinical trial. However, in the interest of antibiotic stewardship.

Emergency Department 299

Emergency Department ALS OR ED 299

Core EM

JANUARY 25, 2024

Lipophilic with adipose deposition, withdrawal symptoms after prolonged infusion Hydromorphone 5 – 15 min 2 – 3 hr 0.5 – 3 mg/hr No active metabolites however parent drug can accumulate in renal failure Morphine 5 – 10 min 3 – 4 hr 2 – 30 mg/hr Active metabolites can accumulate in renal failure Remifentanil 1 – 3 min 3 – 10 min Loading dose: 1.5

Emergency Department 246

Emergency Department ICU Critical Care ALS 246

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. Reversal of Warfarin: Freeman et al. Reversal of Warfarin: Freeman et al. Blood Pressure Control: There is a lot of debate about the aggressiveness of blood pressure lowering.

Emergency Medical Services 179

Emergency Medical Services Emergency Department ALS ED 179

The Skeptics' Guide to EM

JULY 6, 2024

Reference: Tjan et al. Reference: Tjan et al. Conflict in emergency medicine: A systematic review. AEM June 2024 Date: July 5, 2024 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate.

ED 205

ED Emergency Department ALS OR 205

The Skeptics' Guide to EM

JULY 27, 2024

Reference: Knack et al. A similar review by Sanders et al 2015 concludes that clinica. Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients. A randomized control trial (RCT) done in the prehospital setting enrolled 2,698 patients.

ICU 187

ICU ALS Ambulance OR 187

The Skeptics' Guide to EM

NOVEMBER 25, 2023

Date: November 22, 2023 Reference: Stopyra et al. Date: November 22, 2023 Reference: Stopyra et al. Reference: Stopyra et al. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. AEM November 2023. first appeared on The Skeptics Guide to Emergency Medicine. AEM November 2023.

Heart Attack 279

Heart Attack STEMI Emergency Medical Services Coronary 279

The Skeptics' Guide to EM

MARCH 2, 2024

Reference: Gibbons et al. Reference: Gibbons et al. The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol): A multicenter, prospective, observational study. AEM February 2024. AEM February 2024. The pain is often described as tearing or ripping.

Operating Room 300

Operating Room Emergency Department ALS ED 300

ALiEM

APRIL 12, 2024

If the catheter appears correctly positioned on AP chest x-ray but is malfunctioning, consider obtaining additional imaging to confirm placement [11]: Lateral view chest-xray, or Chest CT (can also help characterize the pleural effusion) References Gammie JS, Banks MC, Fuhrman CR, et al. doi: [link] Broder JS, Al-Jarani B, Lanan B, Brooks K.

E-9-1-1 183

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

The Skeptics' Guide to EM

SEPTEMBER 6, 2020

Reference: Brown et al. Reference: Brown et al. Malthaner is the Chair/Chief of the Division of Thoracic Surgery, Director of Thoracic Surgery Research and Simulation, and Professor in the Departments of Surgery, Oncology, and Epidemiology and Biostatistics at the Schulich School of Medicine and Dentistry and Western University.

OR 100

OR ALS Emergency Department 100

The Skeptics' Guide to EM

AUGUST 24, 2024

Date: August 19, 2024 Reference: Partyka et al. Reference: Partyka et al. Serratus Anterior Plane Blocks for Early Rib Fracture Pain Management: The SABRE Randomized Clinical Trial. Interests include information systems and digital health, research and education.

Emergency Department 125

Emergency Department ALS OR ED 125

The Skeptics' Guide to EM

JUNE 1, 2024

Reference: Tavender E, et al. Reference: Tavender E, et al. Triage tools for detecting cervical spine injury in paediatric trauma patients. Cochrane Database Syst Rev. Background: Pediatric cervical spine injuries (CSI), though rare, can have devastating consequences if missed. Imaging studies include X-rays, CT scans, and MRIs.

Emergency Medical Services 202

Emergency Medical Services Emergency Department EMS ALS 202

The Skeptics' Guide to EM

JUNE 4, 2017

[display_podcast] Date: June 3rd, 2017 Reference: Sierink et al. display_podcast] Date: June 3rd, 2017 Reference: Sierink et al. Huber-Wagner et al ( Lancet 2009 ) showed a mortality reduction in a retrospective database study of patients who have had a pan scan. Reference: Sierink et al. Lancet August 2016.

OR 130

OR ALS CPR ICU 130

Emergency Medicine Education

OCTOBER 12, 2023

A recent study by Savage et al., utilizing propensity score matching, revealed that children under 17 years of age diagnosed with acute sinusitis demonstrated no significant difference in the rate of treatment failure between those receiving amoxicillin and those receiving augmentin.

OR 40

OR ALS 40

The Skeptics' Guide to EM

JUNE 22, 2019

Date: June 20th, 2019 Reference: Pluymaeker et al. Date: June 20th, 2019 Reference: Pluymaeker et al. Reference: Pluymaeker et al. Early or Delayed Cardioversion in Recent-Onset Atrial Fibrillation. Dave is also residency-trained and boarded in internal medicine. Dave is also residency-trained and boarded in internal medicine.

OR 100

OR Emergency Department ALS 100

The Skeptics' Guide to EM

JANUARY 20, 2024

Reference: Zaoutis T, et al. Reference: Zaoutis T, et al. Reference: Zaoutis T, et al. Short-course Therapy for Urinary Tract Infections in Children: the SCOUT randomized clinical trial. JAMA Pediatr. Short-course Therapy for Urinary Tract Infections in Children: the SCOUT randomized clinical trial. JAMA Pediatr. JAMA Pediatr.

Emergency Department 172

Emergency Department ALS ICU OR 172

EMDocs

AUGUST 10, 2023

Reference: Yang P, Zhang Y, Zhang L, et al. Today we look at the DIRECT MT trial. Inclusion criteria: Enrolled patients over the age of 18 with acute ischemic stroke with CTA confirmed occlusion of ICA, or M1 or M2 segment of MCA Within 4.5 1.30) Intracranial hemorrhage Asymptomatic 33% vs. 36%, RR 0.92 (0.75-1.14) N Engl J Med.

OR 67

OR Critical Care ALS 67

Pediatric EM Morsels

JULY 28, 2023

Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 or serum bicarbonate between 11-17 mmol/L Moderate : venous pH < 7.2 or serum bicarbonate between 5-10 mmol/ L Severe : venous pH < 7.1 Neuroimaging is NOT required. GCS score is not sensitive enough.

E-9-1-1 245

E-9-1-1 ALS OR Critical Care 245

The Skeptics' Guide to EM

JULY 20, 2024

Reference: Gibbs et al. Reference: Gibbs et al. Noninvasive Ventilation for Preoxygenation during Emergency Intubation (The PREOXI trial). NEJM June 2024. Date: July 17, 2024 Guest Skeptic: Dr. Aine Yore is an Emergency Physician, practicing in the Seattle, Washington area for over twenty years. However, oxygen masks have limitations.

Emergency Department 229

Emergency Department ALS ED OR 229

Core EM

JANUARY 25, 2024

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. link] Kelly A, Levine MA. Hypocalcemia in the critically ill patient. J Intensive Care Med 2013; 28:166. Louis, Mosby, Inc., Hypocalcemia.

Critical Care 246

Critical Care ED ALS OR 246

Don't Forget the Bubbles

JULY 3, 2024

Lastly, in this month’s issue of JAMA Pediatrics, Gemmill et al. Saranti A, et al. Barlabà A, et al. Nemetz ETA, et al. Kusumi K, et al. Crawford CM, et al. Fundora MP, et al. Roby PR, et al. Jenssen BP, et al. Auger N, et al. Brewster RCL, et al. Forster CS, et al.

ALS 105

ALS ED OR EMS 105

Core EM

JANUARY 25, 2024

Renal injury: isolated proteinuria or hematuria, moderate acute kidney injury with serum creatinine levels <2 mg/dL Skin: petechiae and purpura Despite severe thrombocytopenia, clinically significant bleeding is rare Figure 1.

Plasma 246

Plasma Frozen Plasma Emergency Department FFP 246

The Skeptics' Guide to EM

APRIL 27, 2024

Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care.

ICU 191

ICU Defibrillator CPR Paramedic 191

Chicago EMT Training

NOVEMBER 8, 2023

A quick breakdown on the differences between an EMT-B(asic) and an EMT-P(aramedic) Basic Life Support (BLS) vs Advanced Life Support (ALS) So there it is. Most of the 911 calls are BLS rather than ALS. The two main levels of care you would probably see in the prehospital setting. Don't get me wrong, an EMT-Bs can do A LOT.

Advanced Life Support 130

Advanced Life Support BLS EMT EMT 130