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.

ALS 337

ALS Emergency Department EMS OR 337

High Performance EMS

AUGUST 9, 2024

In fact, sending advanced life support (ALS) providers that are in short supply to one of these calls can leave citizens exposed when a critical request is received after that resource is committed. If available, the supervisor is added to effectively create an ALS transport ambulance.

BLS 264

BLS CAD Advanced Life Support Life Support 264

ACEP Now

JANUARY 5, 2025

Her vital signs are normal, except for a heart rate of 115 bpm. Its going to take time to get her to a tertiary center. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. A patient’s mouth packed with gauze after tonsillectomy surgery. CREDIT: Dr. P.

Operating Room 98

Operating Room Epinephrine ALS ED 98

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 333

Heart Attack STEMI Emergency Medical Services Coronary 333

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 318

Emergency Department ED ALS OR 318

EMDocs

DECEMBER 18, 2024

fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold

E-9-1-1 104

E-9-1-1 Emergency Department ICU ED 104

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.

ALS 261

ALS Emergency Department ED OR 261

Pediatric EM Morsels

APRIL 19, 2024

Davidson JS, Brown DJ, Barnes SN, et al. This area of transition is ripe for fracture (Light, 1984) Fracture of only part of the cortex leads to plastic deformity and buckling , giving us the torus (buckle) fracture Fracture and plastic deformity of one side of the cortex give us the greenstick fracture. J Pediatr Orthop. 0000000000001169.

ALS 290

ALS ACS Emergency Department ED 290

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

ALiEM

FEBRUARY 9, 2024

Low-risk patients do not routinely require stress testing in the ED. Intermediate-risk patients may be further stratified based on recent stress testing or coronary angiogram findings plus a modified HEART or Emergency Department Assessment of Chest Pain (EDACS) score. That’s because these values are assay specific. She does not smoke.

E-9-1-1 276

E-9-1-1 ED Coronary ALS 276

The Skeptics' Guide to EM

FEBRUARY 11, 2023

Date: February 7, 2023 Reference: Cheskes et al. Date: February 7, 2023 Reference: Cheskes et al. Reference: Cheskes et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. first appeared on The Skeptics Guide to Emergency Medicine. Defibrillation Strategies for Refractory Ventricular Fibrillation.

Defibrillator 141

Defibrillator Medical Transportation OR CPR 141

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 328

Operating Room Emergency Department ALS ED 328

The Skeptics' Guide to EM

OCTOBER 21, 2023

Date: October 20, 2023 Reference: Cai et al. Date: October 20, 2023 Reference: Cai et al. Reference: Cai et al. Implementation of a Clinical Management Tool for Spinal Epidural Abscess Early Diagnosis. AEM October 2023. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals.

Emergency Department 321

Emergency Department ALS ED OR 321

REBEL EM

MAY 27, 2024

What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy. This absence of detail leaves the study open to bias. Evidence suggests that a weight-based dosing approach (0.1

OR 134

OR E-9-1-1 ED ALS 134

The Skeptics' Guide to EM

NOVEMBER 11, 2023

Date: November 2, 2023 Reference: Coventry et al. Date: November 2, 2023 Reference: Coventry et al. One of the best systematic reviews and meta-analyses on the topic discussing the diagnostic accuracy of the history, physical examination and imaging is by Carpenter et al from AEM 2014 [1]. Reference: Coventry et al.

ALS 301

ALS Emergency Department ED OR 301

The Skeptics' Guide to EM

JANUARY 6, 2024

Reference: Remick KE, et al. Reference: Remick KE, et al. Reference: Remick KE, et al. National Assessment of Pediatric Readiness of US Emergency Departments during the Covid-19 Pandemic. JAMA Netw Open. Pediatric Readiness of Emergency Departments first appeared on The Skeptics Guide to Emergency Medicine. JAMA Netw Open.

Emergency Department 318

Emergency Department Emergency Medical Services ALS ED 318

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Date: September 18, 2024 Reference: Dillon et al. Reference: Dillon et al. Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. JAMA Network Open. August 20, 2024 Guest Skeptic: Dr. Chris Root is an emergency medicine and emergency medicine service (EMS) physician at the University of New Mexico, Albuquerque.

Naloxone 259

Naloxone NARCAN Overdose CPR 259

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 Epinephrine ALS ICU 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

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

ICU 246

ICU Emergency Department Critical Care ALS 246

The Skeptics' Guide to EM

FEBRUARY 11, 2024

Reference: McLatchie et al and DAShED investigators. Reference: McLatchie et al and DAShED investigators. Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. EMJ Nov 2023.

ED 326

ED Emergency Department ALS OR 326

FOAMfrat

SEPTEMBER 24, 2024

It’s probably safe to assume that your patient has a traumatic brain injury, so at what point in your treatment pathway do you reach for an antiepileptic drug (AED)? Are you carrying antiepileptics on your truck or aircraft? To give an AED or not to give an AED, that is the question. (Bet Bet you thought you left Shakespeare in high school).

OR 105

OR ALS 105

The Skeptics' Guide to EM

OCTOBER 5, 2024

Date: October 2, 2024 Reference: Paxton et al. Reference: Paxton et al. Headpulse measurement can reliably identify large-vessel occlusion stroke in prehospital suspected stroke patients: Results from the EPISODE-PS-COVID study. The son reported she seemed fine yesterday evening when they went to dinner, perhaps more tired than usual.

Emergency Medical Services 287

Emergency Medical Services ALS EMS Paramedic 287

The Skeptics' Guide to EM

SEPTEMBER 28, 2024

Date: September 23, 2024 Reference: Essat et al. Reference: Essat et al. Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes: Systematic Review and Meta-Analysis. Annals of Emergency Medicine, May 2024 Guest Skeptic: Dr. Casey Parker is a Rural Generalist from Australia who is also an ultrasounder. Her pain seems to have settled.

Emergency Department 231

Emergency Department ACS Coronary ALS 231

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-9-1-1 246

E-9-1-1 ALS OR Critical Care 246

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 237

ED ALS Emergency Department OR 237

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.

ALS 284

ALS Emergency Department ED OR 284

The Skeptics' Guide to EM

OCTOBER 14, 2023

Reference: Brennan L et al. Reference: Brennan L et al. That episode reviewed the 2011 Fleming et al systematic review for the normal ranges of HR and RR in children from birth to 18 years of age. Time to change the reference ranges of children’s physiological observations in emergency care? A prospective study.

Life Support 258

Life Support Advanced Life Support Emergency Department ALS 258

The Skeptics' Guide to EM

JANUARY 13, 2024

Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Reference: Snyder BD, Van Dyke MR, Walker RG, et al. Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. Resuscitation 2023. Resuscitation 2023.

CPR 264

CPR Defibrillator First Responder Epinephrine 264

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 231

ICU ALS Ambulance OR 231

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 226

ICU Defibrillator Paramedic CPR 226

The Skeptics' Guide to EM

JULY 29, 2023

Date: July 21, 2023 Reference: McDonald et al. Date: July 21, 2023 Reference: McDonald et al. Reference: McDonald et al. Patterns of change in prehospital spinal motion restriction: a retrospective database review. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM.

Emergency Medical Services 239

Emergency Medical Services ALS EMS Emergency Department 239

EMDocs

DECEMBER 23, 2024

Now lets walk through them quickly: Ho et al (4) looked at termination of VT in 15 min or hemodynamic deterioration. Gorgels et al (5) looked at procainamide vs lidocaine and again and primary outcome was VTach termination. Manz et al (6) looked at ajmaline vs lidocaine for the termination of VT. Coolest part of this trial?

ALS 75

ALS OR STEMI EMS 75

This Podcast Will Kill You

FEBRUARY 11, 2025

Now imagine that your tongue suddenly shriveled up and fell off and that in its place is a tongue-sized isopod aka rollie pollie aka pillbug. Just there, hanging out, forever. How are you feeling? Hey, we get it. But at least youll never be alone again. Believe it or not, this is not some bad creative writing exercise. This is a very real parasite.

E-9-1-1 97

E-9-1-1 ALS OR 97

ALiEM

AUGUST 9, 2023

Ultrasound Technique Background The lungs were traditionally considered poorly accessible to ultrasound, as ultrasound waves cannot penetrate air-filled structures; however, lung POCUS relies on the interpretation of patterns of artifacts to evaluate the normal, air-filled lungs. Warm gel helps with the child’s comfort.

E-9-1-1 246

E-9-1-1 Emergency Department ALS OR 246

Pediatric EM Morsels

SEPTEMBER 22, 2023

Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Spinal shock is a phenomenon of transient, physiologic (rather than anatomic) complete loss of spinal cord function inferior to an injury. Refers to the Spinal Cord Function and Reflexes, not specifically hemodynamic issues.

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

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 217

Emergency Medical Services ALS Emergency Department ED 217