The Skeptics' Guide to EM

DECEMBER 28, 2024

Emergency departments (EDs) are often the first point of contact for patients experiencing opioid-related crises, ranging from overdose to withdrawal. This positions EDs as critical spaces for intervention, offering a chance to initiate treatment, provide education, and connect patients with long-term resources.

Emergency Department 158

Emergency Department Overdose ED ALS 158

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 278

Emergency Department OR ED EMS 278

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. Before attending medical school, he was a New York City Paramedic. Chris completed his emergency medicine residency and EMS fellowship at UNM.

Naloxone 239

Naloxone NARCAN Overdose CPR 239

The Skeptics' Guide to EM

NOVEMBER 16, 2024

With emergency department (ED) volumes rising, administrators are eager to explore AI-driven solutions to improve patient safety and reduce staff burnout. They want to know how CHARTWatch integrates with electronic health records (EHRs), whether it can adapt to their patient ED population, and how clinicians respond to using the tool.

ICU 214

ICU Emergency Department ALS EMS 214

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 103

ED Coronary CAD STEMI 103

Pediatric EM Morsels

SEPTEMBER 22, 2023

Definition A series of hemodynamic changes related to autonomic denervation and loss of sympathetic tone. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Tenenbein M, Macias CG, Sharieff GQ, et al, eds. Main symptoms include hypotension and bradycardia. They may even need atropine and/or pacing for persistent bradycardia.

E-9-1-1 300

E-9-1-1 Epinephrine ALS EMS 300

Dr. Smith's ECG Blog

DECEMBER 3, 2024

This was written by one of our fine residents, who will soon be an EMS fellow: Michael Perlmutter Case A mid-50s male came to the ED with a burning sensation that was acutely worse while at home. He came to the ED at the urging of his wife. The Patient developed AV Block , "Mobitz Type II" during the Night.

ED 96

ED Coronary ACS STEMI 96

EMDocs

JULY 17, 2023

Evaluation Imaging A definitive diagnosis of LBO requires imaging, most often a computed tomography (CT) scan with intravenous (IV) contrast. and is poorly tolerated by patients with obstruction, it should not be a routine part of the ED evaluation for LBO unless it is critical for another diagnosis on the differential. Adv Cancer Res.

E-9-1-1 78

E-9-1-1 ED ALS Operating Room 78

ALiEM

OCTOBER 28, 2024

A 2-year, 11-month-old female with a history of constipation was brought to the ED by her mother for abdominal pain. The patient had two episodes of unprovoked, non-bloody, non-bilious vomiting the morning prior to the ED visit. Case Question: What is the definitive management for a nephroblastoma?

ED 161

ED OR 161

The FllightBridge ED

SEPTEMBER 11, 2023

Since the 2012 Berlin Definition of the Acute Respiratory Distress Syndrome (ARDS), several developments have supported the need for an expansion of the definition, including…

40

40

EMergucate

MAY 30, 2016

Definition Transient LOC and loss of posture secondary to insufficient cerebral perfusion. Common – >25% lifetime incidence, 1% ED presentations … Continue reading →

EMS 100

EMS ED 100

Core EM

OCTOBER 16, 2024

Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% In: Marx J, ed. In: Wolfson A, ed.

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

EMDocs

FEBRUARY 26, 2024

The ED clinician should inquire about a relevant history of HIV infection, malignancy, high-dose corticosteroid use, chemotherapy, organ transplant, or use of immunosuppressive drugs for other indications. She reports occasional central chest pain exacerbated by coughing. Int J STD AIDS. 2019;30(2):188-193. Am J Emerg Med. 2013;31(2):401-405.

E-9-1-1 88

E-9-1-1 ED ALS OR 88

ACEP Now

DECEMBER 6, 2024

By some definitions, you could call former Maryland state legislator Dan Morhaim, MD, FACEP, a retired emergency physician. His health care focus included hospital efficiency, physician and patient satisfaction, and emergency department (ED) wait times, as well as a host of nonhealth issues. He thinks of it as re-deployed.

Emergency Department 98

Emergency Department ED Ambulance OR 98

EMDocs

JUNE 3, 2023

Figure 1: The Young-Burgess classification of pelvic ring fractures (source: [link] 3 It is paramount to differentiate the definitions of “hemodynamically unstable” and “mechanically unstable” pelvic fractures. The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED.

ED 54

ED Operating Room ALS Frozen Plasma 54

Dr. Smith's ECG Blog

JANUARY 27, 2024

Figure-1: I've labeled the initial ECG in the ED. KEY Point: All patients who present to the ED for new CP should promptly have a triage ECG recorded, that is then immediately interpreted by the ED physician. For clarity — I've labeled this initial ECG in Figure-1.

STEMI 102

STEMI Coronary ACS ED 102

REBEL EM

FEBRUARY 15, 2024

Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. These patients can be at risk of vomiting and aspiration and often prompts clinicians to pursue definitive airway management to avoid pneumonia and other complications.

ICU 141

ICU ALS ED OR 141

The Skeptics' Guide to EM

JULY 25, 2020

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. It was great that it started with a definition of evidence-based medicine (EBM).

ED 130

ED ALS OR 130

EMDocs

SEPTEMBER 25, 2023

Also known as Facilitated intubation (FI), the use of intubating with only a sedative was an accepted alternative intubation technique prior to those definitive studies in the late 1990s but quickly was abandoned for RSI in all emergent endotracheal intubations (ETI) (8,9). To date, ketamine has been the agent of choice (12).

ED 66

ED Emergency Department ALS Paramedic 66

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. Chou’s Electrocardiography in Clinical Practice, 6th ed. second as the beginning of “wide”?

ALS 130

ALS STEMI Coronary OR 130

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. This meant 2746 ED presentations by 2618 individuals. Which patients were involved?

Emergency Department 135

Emergency Department ED OR ALS 135

EMS 12-Lead

JULY 24, 2023

David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic (ret) @DidlakeDW Expert commentary and peer review by Dr. Steve Smith [link] @smithECGBlog A 57 y/o Female with PMHx HTN, HLD, DM, and current use of tobacco products, presented to the ED with chest discomfort. A 12 Lead ECG was captured on her arrival.

Coronary 130

Coronary ACS CAD ED 130

REBEL EM

JUNE 22, 2023

However, the medical community is only just starting to understand long-COVID (WHO Definition: the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation). Blinding procedures were well constructed as to mask group allocation.

ALS 145

ALS OR EMS ED 145

Dr. Smith's ECG Blog

MAY 3, 2024

But this time the Queen gets it wrong (thinks it is not OMI): There were runs of VT: Tha patient arrived in profound shock and had an ED ECG: Now there is some evolution to include the ST elevation (rather than ST depression) in V4-V6. Figure-1: I've labeled the initial EMS ECG and the 1st 12-lead tracing done on arrival in the ED.

ACS 114

ACS ED Coronary EMS 114

EMS 12-Lead

MAY 8, 2022

They are definitely high in amplitude and, intermittently, appear to disproportionately tower over the respective QRS. This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2]

STEMI 130

STEMI ED EMS Firefighter 130

Critical Care Scenarios

JULY 11, 2021

pneumatically), then definitively addressed by Orthopedics at their convenience. Traction splinting is usually not done in the ED. Ultrasound (eFAST) and plain x-rays (chest and pelvis) are useful tools for rapid evaluation in the ED. Orthopedic injuries should be manually reduced and perfusion ensured, splinted (e.g.

Operating Room 100

Operating Room ICU ED OR 100

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

The paramedic called the EM physician ahead of arrival and discussed the case and ECGs, and both agreed upon activating "Code STEMI" (even though of course it is not STEMI by definition), so that the acute LAD occlusion could be treated as fast as possible. So the cath lab was activated. Long term outcome is unavailable.

STEMI 117

STEMI EMS ACS ED 117

Pulsara

AUGUST 1, 2024

They've created a new protocol that allows them to bypass the ED and take qualified patients directly to definitive care. Teams in Arkansas are finding new ways to improve outcomes for pediatric behavioral health patients.

ED 89

ED 89

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 92

STEMI ACS ED 92

Dr. Smith's ECG Blog

MARCH 13, 2023

An ED ECG, if recorded with pain, should show LAD OMI. So this ECG was immediately recorded: Indeed, as predicted, a patient with previous Wellens' waves who now definitely has chest pain has acute Occlusion, with new ST elevation in I, aVL, V2-V5. The Cath lab was activated.

ED 52

ED ACS Coronary Paramedic 52

REBEL EM

NOVEMBER 13, 2024

Obtain emergency orthopedics consultation for all open joints and administer antibiotics and update tetanus in all patients REBEL Core Cast 131.0 – Traumatic Arthrotomy Click here for Direct Download of the Podcast. cefazolin or cefuroxime) If risk factors for MRSA present, use agent with activity against MRSA (i.e.

ED 105

ED OR EMS 105

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Initial ED ECG: What do you think? Definitive diagnosis that ECG #1 is in fact VT is more than academic. That said — We can definitively diagnose AV dissociation in today's tracing! Once I knew that at least 1 definite underlying P wave was present — I diligently looked for more. Why did I say that?

Coronary 136

Coronary OR EMS ED 136

Dr. Smith's ECG Blog

OCTOBER 30, 2023

Here is the first prehospital ECG (time 0, after one hour of pain): I do not see evidence of OMI, and neither did the Queen of Hearts Here is the 2nd prehospital ECG (time 10 minutes, after 70 minutes of pain): No change On arrival, the first ED ECG was recorded 20 minutes after the last one (90 minutes after pain onset): What do you think?

STEMI 112

STEMI ED ALS OR 112

The Skeptics' Guide to EM

NOVEMBER 1, 2022

AEM October 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: A 19-year-old man presents to the emergency department (ED) with his first time anterior should dislocation after trying to recreate one of his favourite scenes in the movie Lethal Weapon.

ALS 118

ALS Emergency Department OR ED 118

Dr. Smith's ECG Blog

MARCH 8, 2019

See the learning points in that case == Comment by K EN G RAUER, MD ( 3/8/2019 ): == Superb teaching case presented by Dr. Smith regarding this middle-aged man who was transported to the ED after new-onset chest pain. Similarly — the ST segment in lead aVL of complex B is inappropriately FLAT, which is definitely abnormal.

ED 52

ED STEMI ACS OR 52

EMDocs

DECEMBER 31, 2023

Without further ado, here is our list of top posts from 2023 based on viewership from you, the readers: Neurogenic Shock: Definition, Identification, and Management in the ED We start off the list with a clinical post from Kira Brayan and Jenny Beck-Esmay on diagnosing and managing neurogenic shock! This post from Mary E.

ED 75

ED EMS OR 75

REBEL EM

APRIL 17, 2023

We need high-quality evidence to provide a definite conclusion. Additionally, potential increases in resource utilization, healthcare expense, and ED length of stay are also essential considerations. However, there simply is not enough high-quality evidence to provide a definite conclusion.

ALS 129

ALS OR ED EMS 129