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 137

OR E-9-1-1 ED ALS 137

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 139

Defibrillator Medical Transportation OR CPR 139

ACEP Now

JULY 7, 2023

References Tsao CW, et al. Benjamin EJ, et al. Kimblad H, et al. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. amiodarone or lidocaine). Circulation. 2022;145(8):e153-e639. Circulation.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

Dr. Smith's ECG Blog

NOVEMBER 23, 2024

Additional review of ECG artifacts by Pérez-Riera et al ( Ann Noninvasic Electrocardiol 23:e12494, 2018 ) VT Artifact — by Knight et al: NEJM 341:1270-1274, 1999. The January 30, 2018 post — for PTA. Brief review by Tom Bouthillet on some common causes of artifact. Artifact simulating VFib — CLICK HERE.

OR 63

OR Critical Care ALS STEMI 63

The Skeptics' Guide to EM

FEBRUARY 13, 2021

Reference: Mintegi S et al. Reference: Mintegi S et al. Combinations of variables have been tried in the past as part of clinical scoring systems such as the Bacterial Meningitis Score (BMS) to identify children with CSF pleocytosis at low risk for bacterial meningitis ( Nigrovic et al 2002 ). On exam, she is febrile to 38.5

OR 130

OR Emergency Department ALS ED 130

The Skeptics' Guide to EM

OCTOBER 3, 2021

Date: September 28th, 2021 Reference: Zampieri et al. Date: September 28th, 2021 Reference: Zampieri et al. Reference: Zampieri et al. Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill Patients: The BaSICS Randomized Clinical Trial.

OR 130

OR Critical Care ICU Plasma 130

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

Don't Forget the Bubbles

OCTOBER 2, 2024

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. Pediatric Critical Care Medicine. They received 2494 boluses of either mannitol or 3% hypertonic saline. 2023 [cited 2024 Apr 10].

OR 48

OR Critical Care ALS Emergency Department 48

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The original term " benign early repolarization" has fallen out of favor since the seminal paper by Haïssaguerre et al. linking the finding with long term risk of idiopathic ventricular fibrillation. The link is quite modest, increasing the chance of VF from 3.4 per 100,000 to 11 per 100,000 [Rosso].

E-9-1-1 120

E-9-1-1 OR Coronary ACS 120

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%. Thus, the lumen observed may actually still be the same size as the original, normal lumen. Nor was there a challenge to look for coronary spasm.

Coronary 117

Coronary ACS OR EMR 117

EMOttawa

MAY 31, 2024

5 Carson JL, et al. Methodology: 4/5 Usefulness: 3.5/5 N Engl J Med. 2023 Dec 28;389(26):2446-2456. doi: 10.1056/NEJMoa2307983. Questions and methods: This multicenter, open-label, RCT of 3604 patients with MI with anemia compared 30-day all-cause mortality and recurrent nonfatal MI between liberal vs restrictive transfusion thresholds.

OR 60

OR ALS 60

EMOttawa

MAY 6, 2024

Methodology: 4/5 Usefulness: 3/5 Zi W, et al. N Engl J Med. 2023 Jun 1;388(22):2025-2036. Editorial: Expanding Treatment for Acute Ischemic Stroke beyond Revascularization.

OR 60

OR ALS 60

REBEL EM

NOVEMBER 20, 2023

Paper: Jansen JO, Hudson J, Cochran C, et al. Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. 2023;e2320850. 97% of patients sustained blunt trauma.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

The Skeptics' Guide to EM

MAY 23, 2020

Date: May 19th, 2020 Reference: Yang P et al. Date: May 19th, 2020 Reference: Yang P et al. Guest Skeptic: Dr. This led to a pro/con publication in the Canadian Journal of Emergency Medicine (CJEM) tPA should be the initial treatment in eligible patients presenting with an acute ischemic stroke ( Milne et al CJEM April 2020 ).

OR 100

OR ALS EMS 100

The Skeptics' Guide to EM

JANUARY 30, 2021

Reference: George et al. Reference: George et al. Steve is currently an Assistant Professor in the Department of Family Medicine at Western University (London, Ontario) […] The post SGEM#317: Dese Bones Gonna Heal Again – With or Without a Non-Selective NSAID first appeared on The Skeptics Guide to Emergency Medicine.

OR 130

OR ALS 130

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

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 95

Naloxone OR Overdose BLS 95

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 303

Critical Care ALS ED Emergency Department 303

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

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

OCTOBER 12, 2024

Reference: Ma K et al. Reference: Ma K et al. A national survey of children’s experiences and needs when attending Canadian pediatric emergency departments. June 2024 Date: Oct 1, 2024 Guest Skeptic: Dr. Andrew (Andy) Tagg is an Emergency Physician with a special interest in education and lifelong learning.

Emergency Department 223

Emergency Department ED ALS OR 223

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

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 286

ALS ACS Emergency Department ED 286

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 289

Emergency Department ED ALS OR 289

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

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 280

Emergency Department ALS OR EMS 280

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 216

ALS Emergency Department ED OR 216

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 238

Naloxone NARCAN Overdose CPR 238

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

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 195

Emergency Department ACS Coronary ALS 195

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 290

Emergency Department ALS OR ED 290

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

Paramedics Unlimited

APRIL 19, 2018

What is the difference between ALS and BLS Medical Care? In Advanced Life support (ALS) emergencies, a “single” paramedic or ER doctor can not deliver necessary care. And it becomes impossible to treat multi-system injuries, such as doing chest compression (CPR) while trying to open an airway or control bleeding.

BLS 52

BLS ALS Emergency Medical Technician Advanced Life Support 52

The Skeptics' Guide to EM

NOVEMBER 16, 2024

Date: October 28, 2024 Reference: Verma et al. Reference: Verma et al. Clinical evaluation of a machine learning–based early warning system for patient deterioration. CMAJ September 2024 Guest Skeptic: Michael Page is currently the Director of Artificial Intelligence (AI) Commercialization at Unity Health Toronto.

ICU 211

ICU Emergency Department ALS EMS 211

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