The Skeptics' Guide to EM

SEPTEMBER 21, 2024

He currently practices emergency medicine in New Mexico in the ED, in the field with EMS and with the UNM Lifeguard Air Emergency Services. Background: We’ve discussed out-of-hospital cardiac arrest (OHCA) at least once or twice on the SGEM (see long list at end of blog). Your partner asks if you want to administer naloxone as well.

Naloxone 262

Naloxone NARCAN Overdose CPR 262

ALiEM

FEBRUARY 5, 2024

8 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. More specifically, we identified 3 AIR and 5 Honorable Mentions. Please go to the above link.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

Broome Docs

JANUARY 27, 2025

Full blog post here. European Journal of Internal Medicine , [link] You can listen to my 27-minute rant on Youtube here: [link] This multinational trial looked at a three-pronged diagnostic protocol in the ED for adults with suspected acute aortic syndromes. If you could achieve this process in your ED – then great.

ED 101

ED OR ACS Critical Care 101

REBEL EM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.

ED 129

ED E-9-1-1 Emergency Department ALS 129

ALiEM

APRIL 14, 2023

6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 2 AIR and 4 Honorable Mentions. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score.

EMS 246

EMS Emergency Department ED OR 246

Dr. Smith's ECG Blog

MARCH 28, 2024

Here is the prehospital ECG: First ED ECG What do you think? Here is the prehospital ECG: First ED ECG What do you think? He states that he maybe missed a dose or two during recent illness. On EMS arrival, patient's oxygen saturation was in the high 80s and improved on 4L O2 via nasal cannula. SVT with aberrancy?

OR 128

OR Emergency Department Ambulance EMS 128

EMOttawa

NOVEMBER 14, 2024

Urine drug (or toxicologic) screens are a fairly standard tool used in addictions, psychiatry and the Emergency Department (ED), often employed to detect substance use in patients presenting with altered mental status, trauma, psychiatric or abnormal behaviour.

Emergency Department 78

Emergency Department ED OR 78

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

male presents to the ED at 6:45 AM with left sided chest dull pressure that woke him up from sleep at 3am. He arrived to the ED at around 6:45am, and stated the pain has persisted. Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. The pain radiated to both shoulders.

Coronary 121

Coronary ACS OR EMR 121

EMOttawa

JANUARY 25, 2024

There is certainly a need for more practical application for the ED doc or initial setup of patients on the vent. With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog.

ICU 143

ICU ED OR Critical Care 143

EMS 12-Lead

MARCH 30, 2024

Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the first installment of a blog series showing how transcutaneous pacing (TCP) can be difficult, and how you can improve your skills. On ED arrival ROSC is achieved. They are unable to feel a pulse and resume CPR.

CPR 312

CPR Paramedic Ambulance Defibrillator 312

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain. The patient had no chest symptoms until he had been in the ED for many hours and had been undergoing management of his DKA. The patient was under the care of another ED physician. Another ECG was recorded: What do you think?

ED 118

ED Coronary CAD STEMI 118

ALiEM

OCTOBER 14, 2023

6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. More specifically, we identified 3 AIR and 3 Honorable Mentions. Please go to the above link.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" On arrival to the ED, while waiting for cath lab team, he obtained another ECG: You can now see the full voltage of the high-voltage QRS, likely with some degree of LVH. Both were awake and alert with normal vital signs.

OR 125

OR STEMI EMS ED 125

Core EM

SEPTEMBER 24, 2024

Annie: I developed an interest in EM while working as a scribe in the ED during college. In addition to what Charlotte and Nick said, I can envision myself staying calm in the stressful situations that come up in the ED. Nick: Triaging your time and priorities as an ED doc on shift is so challenging.

ED 100

ED EMS Critical Care OR 100

REBEL EM

JULY 17, 2023

REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? PMID: Clinical Question: Does a single dose of ketamine or etomidate used for rapid sequence intubation (RSI) of critically adults in the ED impact the SOFA score within 3 days of hospitalization? Click here for Direct Download of the Podcast Paper: Knack SKS et al.

ED 98

ED ICU Emergency Department Overdose 98

Dr. Smith's ECG Blog

OCTOBER 1, 2023

He called EMS who brought him to the ED. ED Diagnoses: 1. The basic principles of emergency ECG interpretation in patients who present to an ED with new symptoms include the following: Respect the History. He had active chest pain at the time of triage at 0137 at night, with this triage ECG: What do you think? Epigastric pain 2.

OR 127

OR STEMI Coronary CAD 127

REBEL EM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Back on June 1st, 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? Below you will find some of the points we discussed.

CPR 145

CPR ICU EMS ALS 145

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 97

Naloxone ED Overdose Emergency Department 97

The Skeptics' Guide to EM

AUGUST 18, 2018

Chris also has his own #FOAMed blog called Standing on the Corner Minding My Own Business ( SOCMOB ). Case: A 54-year-old female presents to the emergency department (ED) with abdominal pain and profuse non-bloody diarrhea for the past 24 hours. Her vital signs are within normal limits and she is tolerating oral fluids. AEM Aug 2018.

Emergency Department 130

Emergency Department Overdose ED ALS 130

REBEL EM

NOVEMBER 20, 2023

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. 2 Despite these recommendations there are no randomized clinical trials to help guide practice until now.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

The Skeptics' Guide to EM

APRIL 10, 2021

He has a wonderful #FOAMed blog and podcast called Broomedocs and also work […] The post SGEM#326: The SALSA Study: Hypertonic Saline to Treat Hyponatremia first appeared on The Skeptics Guide to Emergency Medicine. He has a wonderful #FOAMed blog and podcast called Broomedocs and also work with me on the Primary Care RAP team.

Emergency Department 130

Emergency Department Coronary ED OR 130

Dr. Smith's ECG Blog

OCTOBER 8, 2024

I interpreted this tracing knowing only that the patient was a woman in her 60s, with a prior history of proximal LAD OMI — who now presented to the ED with a history of new chest discomfort and shortness of breath. For more on Precordial Swirl — See the October 15, 2022 post in Dr. Smith's ECG Blog ).

OR 122

OR STEMI ICU Coronary 122

The Skeptics' Guide to EM

JANUARY 20, 2018

She has contributed to the Academic Life in Emergency Medicine and EM PharmD blogs, […] The post SGEM#203: Let Me Clear My Sore Throat with a Corticosteroid first appeared on The Skeptics Guide to Emergency Medicine. She has contributed to the Academic Life in Emergency Medicine and EM PharmD blogs, and is a part of the ALiEM Capsules Team.

Emergency Department 130

Emergency Department ALS EMS ED 130

Dr. Smith's ECG Blog

MARCH 10, 2025

Our data corroborate that immediate management of a patient with a normal automated triage ECG reading is not modified by real-time ED physician ECG interpretation." The ED physicians ECG interpretation of her first ECG was ST elevation in II-aVF and V5-V6,()concave, no reciprocal changes. See > 50 cases on Dr. Smiths EGC Blog.

STEMI 89

STEMI OR Coronary Emergency Department 89

The Skeptics' Guide to EM

APRIL 12, 2019

He is an ED intensivist from New York City and runs the popular EMCrit blog and podcast. He is an ED intensivist from New York City and runs the popular EMCrit blog and podcast. Date: April 10th, 2019 Guest Skeptic: Dr. Scott Weingart. Scott is attempting to bring upstairs care, downstairs one podcast at a time.

ALS 130

ALS ED EMS OR 130

The Skeptics' Guide to EM

FEBRUARY 8, 2020

He also has this amazing #FOAMed blog called EM Nerd. He also has this amazing #FOAMed blog called EM Nerd. Population: Neurologically intact adult presenting to the ED with a chief complaint of a nontraumatic, acute headache, or syncope associated with a headache. first appeared on The Skeptics Guide to Emergency Medicine.

Emergency Department 130

Emergency Department Critical Care ALS EMS 130

EMOttawa

FEBRUARY 22, 2024

In 2013, in the United States there were 7 million visits to the emergency department (ED) for lacerations making up a total of 5.2% of ED visits(1).

Emergency Department 93

Emergency Department ED OR 93

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

He was intubated on arrival at the ED for mental status and airway protection due to vomiting. See our other blog posts of hypothermia and Osborn waves -- Massive Osborn Waves of Severe Hypothermia (23.6 There is also large T wave inversion and long QT. Initial vitals included heart rate 109 bpm and BP 145/92 mmHg.

ICU 137

ICU OR ALS ED 137

The Skeptics' Guide to EM

DECEMBER 10, 2022

DISCLAIMER: THE VIEWS AND OPINIONS OF THIS BLOG AND PODCAST DO NOT REPRESENT THE UNITED STATES GOVERNMENT OR THE US MILITARY. DISCLAIMER: THE VIEWS AND OPINIONS OF THIS BLOG AND PODCAST DO NOT REPRESENT THE UNITED STATES GOVERNMENT OR THE US MILITARY. Date: November 30th, 2022 Reference: Johnson et al.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

JULY 25, 2020

Emlyn’s blog and podcast. Emlyn’s blog and podcast. The bottom line from that episode on skin glue for peripheral intravenous lines was: “Skin glue does appear to decrease the failure rate of IVs in patients admitted to hospital from the ED at 48 hours.

ED 130

ED ALS OR 130

Dr. Smith's ECG Blog

MARCH 4, 2024

Algorithm: Marquette 12 SL (GE) The Queen gets it right Case 9 (prehospital and ED ECGs). The Queen gets it right First ED ECG: Hyperacute T-waves persist. I have often written about how an ECG interpreted as "normal" by a conventional algorithm may well be manifesting OMI, or even long QT or hyperkalemia. 2 cases at once!

STEMI 127

STEMI OR ED ALS 127

Dr. Smith's ECG Blog

APRIL 14, 2024

A 56 year old male with PMHx significant for hypertension had chest pain for several hours, then presented to the ED in the middle of the night. He reported chest pain that developed several hours prior to arrival and was 5/10 in intensity. The pain was located in the mid to left chest and developed after riding his bike.

ED 119

ED OR EMS 119

REBEL EM

FEBRUARY 15, 2024

Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. PMID: 38019968 Post Peer Reviewed By: Anand Swaminathan, MD (Twitter/X: @EMSwami ) The post The NICO Trial: NIV in Comatose Patients with Acute Poisoning appeared first on REBEL EM - Emergency Medicine Blog.

ICU 141

ICU ALS ED OR 141

Dr. Smith's ECG Blog

JUNE 27, 2024

By Sofiya Diurba MD, reviewed by Meyers, Grauer A woman in her 50s with PMH known RBBB and prior syncopal events presents to the ED for five syncopal events over the last 24 hours. This is her first ECG in the ED: What do you see? See these blog posts. Vital signs were within normal limits at the time of triage.

ED 120

ED OR Emergency Department Emergency Manager 120

Don't Forget the Bubbles

NOVEMBER 29, 2023

Even though sedation after endotracheal intubation (ETI) reduces the risk of self-extubation, uncontrolled pain, and awakening awareness, several small single-centre studies demonstrate low rates of sedative drug administration after ETI in the emergency department (ED). What are the only exceptions? How can we prevent this?

E-9-1-1 135

E-9-1-1 Emergency Department ED CPR 135

Dr. Smith's ECG Blog

OCTOBER 3, 2024

While statistical likelihood of acute OMI is clearly lower in younger adults — nothing is ruled out by age alone ( as per My Comment in the January 9, 2023 and December 5, 2023 posts in Dr. Smith's ECG Blog ). This was sent to me from Sam Ghali ( @EM_Resus ) with no other information. I assumed it was a patient with acute chest pain.

E-9-1-1 123

E-9-1-1 Coronary ALS ED 123

REBEL EM

SEPTEMBER 11, 2023

However, many institutions’ surgical teams still require or request a formal study over a bedside exam, likely due to a lack of confidence in the accuracy of POCUS, resulting in longer ED stays. Background: Point of care ultrasound (POCUS) has a demonstrated sensitivity of 89.8% and specificity of 88.0%

ED 68

ED ACS Emergency Department OR 68