The Skeptics' Guide to EM

OCTOBER 20, 2018

Part of the difficulty with this topic is the inconsistent definition of contrast-induced nephropathy. A common definition is an increase in creatinine level by 25% or an absolute increase of 0.3 Multiple observational studies have been published demonstrating that AKI in the modern era does not exist. mg/dL within 3 days.

Coronary 181

Coronary Emergency Department ALS OR 181

EMDocs

DECEMBER 1, 2024

Definitive diagnosis is often made using serologic testing , typically by detecting a fourfold rise in antibody titers between acute and convalescent samples. PCR tests are also available but not widely used due to sensitivity issues.

EMS 104

EMS E-9-1-1 OR ED 104

Core EM

JULY 23, 2024

Hosts: Jonathan Kobles, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Agitation , psychiatry , Toxicology Show Notes Background/Epidemiology • Definition and Scope : Agitation encompasses behaviors from restlessness to severe altered mental states.

Emergency Department 233

Emergency Department OR 233

Core EM

JANUARY 25, 2024

Definition: Catatonia: A behavioral motor dysregulation syndrome marked by an inability to move normally despite full physical capacity, which can occur in the context of many underlying psychiatric and general medical disorders [4].

MICU 246

MICU Emergency Department ED OR 246

EMS 12-Lead

APRIL 9, 2024

Many of the changes seen are reminiscent of LVH with “strain,” and downstream Echo may very well corroborate such a suspicion, but since the ECG isn’t the best tool for definitively establishing the presence of LVH, we must favor a subendocardial ischemia pattern, instead. This was deemed “non-specific” by the ED physicians.

Coronary 290

Coronary ACS CAD ED 290

Dr. Smith's ECG Blog

MAY 7, 2024

My response: "Definitely not polymorphic VT. Definitely atrial fibrillation. Here is the post cardioversion ECG: Definite pre-excitation (delta waves due to accessory pathway, "bypass tract"). Probably WPW but is very slow for atrial fib withWPW. I would just cardiovert electrically."

ALS 131

ALS OR 131

American Ambulance Association

JULY 11, 2024

The Centers for Medicare & Medicaid Services (CMS) has released the Calendar Year (CY) 2025 proposed rule that proposes changes to the CY 2025 definitions of ALS-2 services to include […] The post CMS Proposed Expansion of ALS-2 to include Low-Tier O+ Whole Blood Transfusions Fails to Include Additional Funding for the Services appeared first (..)

ALS 130

ALS Ambulance 130

Critical Care Scenarios

SEPTEMBER 18, 2024

“Definitive” TRALI (there is no longer a less definite category) is defined as: * No evidence of lung injury prior to transfusion * Onset within 6 hours after end of transfusion * P/F ratio <300 or SaO2 <92% on room air * Radiographic evidence of bilateral infiltrates with n.

OR 150

OR 150

Core EM

JANUARY 25, 2024

Differentiating between the two is difficult as multiple proposed diagnostic criteria have yet to demonstrate sufficient sensitivity or specificity for a definitive diagnosis. The differential diagnosis for this patient includes Ventricular Tachycardia (VT) and Supraventricular Tachycardia (SVT) with aberrancy.

Coronary 246

Coronary Emergency Department ED OR 246

Don't Forget the Bubbles

JUNE 19, 2023

However, there are no agreed-upon definitions for growth restriction, and there are significant knowledge gaps. Refer to your local or national guidelines to decide whether a patient is SGA or not, but remember that, depending on which definition is used, both over- and underdiagnosis can occur. Literature list Beune IM et al.

ALS 143

ALS OR 143

Core Ultrasound

JANUARY 10, 2023

This is definitely not something that needs to be done all the time, but is a great adjunct in the appropriate clinical setting! Airway ultrasound is something that can be quite complex but at its most basic, it can be used to help determine if you have endotracheal versus endobronchial intubation.

130

130

Pediatric EM Morsels

AUGUST 23, 2024

Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. Mild traumatic brain injury also includes a larger group of injuries that may have evidence of structural injury.

Emergency Department 281

Emergency Department OR ED EMS 281

Emergency Medicine Cases

JUNE 29, 2021

Was CRASH-2 enough to be definitive, or does the classic EBM mantra of "we need more studies" remain true? Should we be using TXA for epistaxis, postpartum hemorrhage, hyphema or hemoptysis? Is it a miracle drug that stops all bleeding? Or has it been drastically overhyped?

OR 130

OR EMS 130

High Performance EMS

AUGUST 9, 2024

No matter how you decide to distinguish the priority of each request, it is triaged to standardize the rules for a consistent response definition. It is the mid-level acuity demand that may be the most complicated, as well as the most rewarding, to properly model.

BLS 264

BLS CAD Advanced Life Support Life Support 264

Critical Care Scenarios

MAY 3, 2023

Reflections on the definition of a central line, whether it’s arbitrary, and the clinical implications of making the distinction. Reflections on the definition of a central line, whether it’s arbitrary, and the clinical implications of making the distinction.

100

100

Pediatric EM Morsels

JUNE 7, 2024

Difficult vs. Severe Asthma: Definition and Limits of Asthma Control in the Pediatric Population. If we can reduce exacerbations, it is worth the extra few minutes to sit, discuss, and make these changes with family. References Licari A, Brambilla I, Marseglia A, De Filippo M, Paganelli V, Marseglia GL. Front Pediatr. 2018 Jun 19;6:170.

Emergency Department 208

Emergency Department EMS OR 208

Core EM

NOVEMBER 1, 2023

We discuss Electrical Storm (VT storm) and how to care for the very irritable heart.

OR 130

OR 130

Emergency Medicine Cases

JANUARY 4, 2022

What are the best strategies to efficiently get the patient in cardiogenic shock to definitive care, whether that be the cath lab or the operating room? In which patients would dobutamine be preferred over milrinone and vice versa? How can we best pick up occult cardiogenic shock before it floured shock kicks in?

Operating Room 130

Operating Room OR EMS 130

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

What lowered my confidence in calling ECG #1 a definite OMI — was the finding of somewhat similar-appearing , upright T waves with slight-but-real J-point ST elevation in so many leads ( ie, leads I,II,aVF; V2-thru-V6 ). Once I identified leads V4 and V5 as definitely abnormal — I looked closer at neighboring leads.

OR 131

OR STEMI Coronary 131

First 10 EM

OCTOBER 21, 2024

Let’s see if I can get myself cancelled by a group of physicians that are definitely smarter than me.) I love toxicologists, but it’s time for someone to call them out. (I I also love ranting. I am sick of the anti-science rhetoric.

OR 105

OR 105

Pediatric EM Morsels

SEPTEMBER 22, 2023

Definition A series of hemodynamic changes related to autonomic denervation and loss of sympathetic tone. Whereas spinal shock is a temporary change in spinal physiology after a profound spinal cord injury, neurogenic shock is a more immediate cardiovascular life threat that is important to recognize immediately in the trauma bay.

E-9-1-1 304

E-9-1-1 Epinephrine ALS EMS 304

St. Emlyn's

APRIL 2, 2024

Anisa Jafar @EMergeMedGlobal takes us through why definitions really matter. St.Emlyn's - Emergency Medicine #FOAMed The ARC-H principle: re-defining global health & shifting the balance. The post The ARC-H principle: re-defining global health & shifting the balance. appeared first on St.Emlyn's.

99

99

Pediatric EM Morsels

JULY 19, 2024

The definitions, typical healing course, timing of bleed, indications for tonsillectomy and the procedure itself have not changed much since our original morsel.

E-9-1-1 290

E-9-1-1 Epinephrine Emergency Department OR 290

FOAMfrat

JANUARY 21, 2025

Identifying ECMO Candidates Early ECMO can serve as a vital bridge to definitive treatment for patients in cardiac arrest, especially those with shockable rhythms such as ventricular fibrillation (V-Fib) or ventricular tachycardia (V-Tach).

CPR 98

CPR OR 98

ALiEM

SEPTEMBER 29, 2023

In cases where the nature of the missile is known, plain films or POCUS may be a reasonable first step, but CT imaging would be definitive. Penetrating wounds can be deceptively innocuous, and a high index of suspicion is required.

ALS 177

ALS OR 177

The Skeptics' Guide to EM

DECEMBER 9, 2023

SGEM listeners are probably familiar with the placebo effect, but can you give us a brief definition or description? I don’t want this to be another thing where we realize in 50 years’ time that we were harming not helping.

ALS 206

ALS OR 206

REBEL EM

AUGUST 7, 2023

Background: Getting a definitive airway in a critically ill trauma patient can be a stressful situation. PMID: 37058727 Clinical Question: Does delayed sequence intubation decrease peri-intubation hypoxia in trauma patients requiring definitive airway control compared to rapid sequence intubation? Anesth Analg 2023.

ALS 96

ALS OR EMS 96

EMS 12-Lead

APRIL 2, 2022

1, 2] The most clinically useful definition to account for this entire constellation is intraventricular conduction delay. You will see that they were initially ischemic, by definition, because of the subsequent voltage attenuation. Additional findings include a patently leftward frontal plane axis, an intriniscoid deflection (i.e.,

ALS 130

ALS STEMI Coronary OR 130

Dr. Smith's ECG Blog

MARCH 31, 2024

I simply texted back: "Definite posterior OMI." The person I was texting knows implicitly based on our experience together that I mean "Definite posterior OMI, assuming the patient's clinical presentation is consistent with ACS." The patient was a middle-aged female who had acute chest pain of approximately 6 hours duration.

STEMI 111

STEMI ACS ED 111

First 10 EM

SEPTEMBER 23, 2024

I definitely talk to people about smoking, but aside from brief counseling and occasionally prescribing nicotine replacement for […] The post Smoking cessation in the emergency department (The COSTED trial) appeared first on First10EM.

Emergency Department 92

Emergency Department OR EMS 92

Dr. Smith's ECG Blog

JANUARY 27, 2024

Over the years — various definitions have been proposed for what should constitute a " significant " Q wave , based on width and/or depth of the Q wave. BOTTOM Line: In my opinion — there is no perfect definition for what constitutes a "significant" Q wave ( ie, a Q wave that indicates infarction has occurred at some point in time ).

STEMI 117

STEMI Coronary ACS ED 117

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Definitive diagnosis that ECG #1 is in fact VT is more than academic. This is clinically relevant — because obtaining hard copy of what happened immediately after synchronized shock was delivered ( even if the WCT rhythm resumes quickly thereafter ) will often provide ECG clues to a definitive rhythm diagnosis.

Coronary 139

Coronary OR EMS ED 139

Core EM

JULY 23, 2024

We review Acute Respiratory Distress Syndrome Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Critical Care , Pulmonary Show Notes Definition of ARDS: Non-cardiogenic pulmonary edema characterized by acute respiratory failure.

Critical Care 130

Critical Care OR 130

Core EM

APRIL 1, 2024

We review Acute Respiratory Distress Syndrome Hosts: Sadakat Chowdhury, MD Brian Gilberti, MD [link] Download Leave a Comment Tags: Critical Care , Pulmonary Show Notes Definition of ARDS: Non-cardiogenic pulmonary edema characterized by acute respiratory failure.

Critical Care 130

Critical Care OR 130

EMDocs

OCTOBER 19, 2024

2][3] Definitive diagnosis is made by laryngoscopy or bronchoscopy showing normal or mildly erythematous epiglottis and an erythematous, edematous trachea with thick mucopurulent exudates. [3] Labs and x-ray can be nonspecific, and definitive diagnosis is made with direct visualization. ampicillin-sulbactam).

EMS 109

EMS E-9-1-1 Epinephrine OR 109

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 107

E-9-1-1 ACS OR Emergency Department 107

Core Ultrasound

SEPTEMBER 18, 2023

Learn how to effectively perform the exam definitely within the reach of the non-radiologist clinician. Timely and accurate diagnosis is crucial for effective treatment. Bedside ultrasound has become a valuable tool for diagnosing pyloric stenosis quickly and non-invasively.

100

100