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

Pediatric EM Morsels

JUNE 7, 2024

Lucky for us, in 2020 there were some updates made to the NIH Asthma Management Guidelines and we’re going to discuss which ones can help us in the Emergency Department! You’re probably asking yourself… is this really important for us in the Emergency Department to know? No more SABA ! Front Pediatr. 2018 Jun 19;6:170.

Emergency Department 208

Emergency Department EMS OR 208

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]. Epidemiology : Who typically suffers from catatonia? Who typically suffers from malignant catatonia?

MICU 246

MICU Emergency Department ED OR 246

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

Pediatric EM Morsels

AUGUST 23, 2024

Concussions are commonly encountered in the Emergency Department. Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. We have previously discussed an approach to the question of when a patient “ can return to sport.”

Emergency Department 281

Emergency Department OR ED EMS 281

ACEP Now

NOVEMBER 8, 2024

First, research suggests a higher number of emergency department visits among individuals with ASD. About 30 percent of children with ASD need treatment in an emergency department, and this number increases to nearly 70 percent for those aged 15–18. Seeing the unseen: neurodiversity in the emergency department.

Emergency Department 52

Emergency Department ED OR ALS 52

The Skeptics' Guide to EM

MAY 12, 2018

Case: A 24-year-old male is brought into the emergency department by police. He is brought to the emergency department extremely agitated and despite being held down by two police and three security guards he is still trying to bite the staff. Reference: Gonin P et al. Excited Delirium: A Systematic Review. AEM May 2018.

Emergency Department 130

Emergency Department ALS OR 130

ACEP Now

JUNE 7, 2023

The preliminary results of the 2022 Emergency Department Benchmarking Alliance performance measures survey found a significant deterioration in patient processing due to inpatient boarding. Preliminary results of the survey are being released to help emergency physicians understand that current challenges are occurring nationwide.

Emergency Department 52

Emergency Department ED EMS Ambulance 52

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. If bleeding, the only lab that is needed in the Emergency Department is a type and cross. CBC, coagulation panels, von Willebrand factor etc are less useful.

E-9-1-1 290

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

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. Anatomy, Shoulder and Upper Limb, Radial Nerve. 2023 Nov 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30521261 Gottlieb M, Schiebout J. 2018 Jun;54(6):849-854. doi: 10.1016/j.jemermed.2018.02.011.

E-9-1-1 116

E-9-1-1 ACS OR Emergency Department 116

ACEP Now

MAY 9, 2024

Complications of Gluteal AFT The pale, prone patient with multiple surgical drains and a constrictive faja has become a common site in the Jackson Memorial Hospital Emergency Department. 9 PFE is only definitively diagnosed on autopsy and a high clinical suspicion must be maintained in high-risk patients. units per patient.

Emergency Department 52

Emergency Department Operating Room Critical Care ICU 52

ALiEM

DECEMBER 18, 2023

A 19-year-old female with a past medical history of epilepsy presented to the emergency department for evaluation of rash and fever. The regiSCAR diagnostic criteria is the most used diagnostic criteria and is based on a scoring system for possible, probable, or definite diagnosis.

Emergency Department 177

Emergency Department OR 177

ALiEM

MARCH 22, 2024

A 53-year-old woman with no significant past medical history presented to the emergency department with a 3-day history of double vision on leftward gaze. Hence, it is critical that a definitive workup is carried out to determine the etiology of the INO. A case series revealed that 1 in 5 patients failed to recover from an INO.

Emergency Department 169

Emergency Department OR 169

REBEL EM

MARCH 27, 2023

Background Information: Obtaining definitive control of the airway, when indicated, is the responsibility of the emergency medicine physician. Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. Paper: Owyang CG, et al. J Crit Care. N Engl J Med. Crit Care Explor.

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

Case: You are working the afternoon shift in the paediatric emergency department. Your shift is almost over and the department finally seems to be under control. Emlyn’s blog and podcast since 2012. We appeared on stage at SMACC Chicago doing a parody of Jimmy Fallon’s Tight Pants skit.

Emergency Department 130

Emergency Department ALS OR 130

Don't Forget the Bubbles

MAY 31, 2023

Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. During the COVID-19 pandemic , we noticed a change in the type of patients presenting to the Emergency Department. Arch Dis Child.

Emergency Department 135

Emergency Department ED OR ALS 135

REBEL EM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). Amiodarone versus digoxin for acute rate control of atrial fibrillation in the emergency department. Am J Emerg Med. Am J Emerg Med. 2022 Sep 7.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

Don't Forget the Bubbles

SEPTEMBER 6, 2023

14-year-old Katy presents to the paediatric Emergency Department (ED), alone, complaining of suicidal ideation. Another study observed that children and young people who received unnecessary medical screening laboratory investigations would have received definitive psychiatric care on average 6.8 Acad Emerg Med.

Emergency Department 119

Emergency Department ED ALS Overdose 119

Core EM

JUNE 3, 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 130

Emergency Department OR 130

EMDocs

DECEMBER 11, 2023

In October 2022, the American College of Cardiology released an updated expert consensus decision regarding the evaluation of chest pain in the emergency department. This included the addition several new STEMI equivalents [4] on ECG that warrant “prompt evaluation for emergency coronary angiography.” J Am Coll Cardiol.

STEMI 119

STEMI Coronary Emergency Department OR 119

The Skeptics' Guide to EM

MARCH 2, 2019

JAMA 2018 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a physician assistant practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program. They had a difficult time getting a definitive airway pre-hospital.

CPR 130

CPR Firefighter Paramedic Defibrillator 130

Don't Forget the Bubbles

AUGUST 23, 2023

In most Emergency Departments, staff are allotted little of that scarce resource, time, to begin processing what has just occurred. Definitive emotional support is critical to our emotional and psychological well-being. The Pause Jonathon Bartels worked as an Emergency Nurse in America in 2009. Psychological harm occurs.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

Dr. Smith's ECG Blog

JANUARY 27, 2024

, tells us that we physicians do not need to even look at this ECG until the patient is placed in a room because the computer says it is normal: Validity of Computer-interpreted “Normal” and “Otherwise Normal” ECG in Emergency Department Triage Patients I reviewed this article for a different journal and recommended rejection and it was rejected.

STEMI 117

STEMI Coronary ACS ED 117

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 123

ALS Emergency Department OR ED 123

The Skeptics' Guide to EM

FEBRUARY 15, 2020

Only then would we have definitive evidence that a parachute was effective in preventing death and major trauma related to gravitational challenges. Quality Checklist for Randomized Clinical Trials: * The study population included or focused on those in the emergency department.

ALS 130

ALS Emergency Department OR 130

The Skeptics' Guide to EM

FEBRUARY 2, 2018

In her spare time, Melissa also enjoys being the fellowship director to an amazing group of PEM trainees. Case: Brian is a 14-year-old male who presents to the emergency department (ED) complaining of acute onset testicular pain. He has vomited twice, but there is no history of any fever or trauma.

Operating Room 100

Operating Room Emergency Department ALS ED 100

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. Click to enlarge.)

Emergency Department 98

Emergency Department ED Ambulance OR 98

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The children’s Emergency department sees approximately 50,000 presentations per year. Without a clear definition, tailoring research and audit is difficult.

Emergency Department 78

Emergency Department Critical Care ALS OR 78

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting." To Emphasize: The reason definitive diagnosis is important in today's case — is that the senior ED physician interpreted ECG #1 as "nothing too exciting".

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

Broome Docs

FEBRUARY 22, 2024

PMID: 36946338 Bottom line: This is a well done RCT that demonstrates pretty convincingly that you should not bother trying to but fingernails back on after nail bed repair (and my guess is you definitely shouldn’t be removing them either). Carson JL, Brooks MM, Hébert PC, et al; MINT Investigators. JAMA Psychiatry. 2023 Sep 27:e233582.

Emergency Department 89

Emergency Department ALS OR ED 89

Dr. Smith's ECG Blog

SEPTEMBER 8, 2023

A 50 year old presented to the emergency department of a remote rural community (where the nearest cath lab is a plane ride away) with one hour of mild chest pain radiating to the back and jaw, and an ECG labeled ‘normal’ by the computer interpretation.

OR 130

OR STEMI Coronary Emergency Department 130

The Skeptics' Guide to EM

DECEMBER 16, 2017

Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. He is also a Faculty member of the Emergency Medicine and Acute Care Series 1986 to present. Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure.

ALS 100

ALS ICU Emergency Department Paramedic 100

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

Defibrillator 135

Defibrillator Coronary STEMI CPR 135

REBEL EM

JUNE 8, 2023

If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist. Clinical Bottom Line: Acute hypotension must be treated emergently in order to decrease morbidity and mortality. J Med Toxicol. Epub 2019 Jul 3. Intensive Care Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

ACEP Now

AUGUST 14, 2024

grams of IV magnesium to placebo, doses considerably higher than the two grams of magnesium often administered in the emergency department (ED). Second, the outcomes definitions rate and rhythm control at four and 24 hours are far beyond times relevant in emergency medicine in the U.S. J Emerg Med. Circulation.

ALS 105

ALS Emergency Department ED OR 105

EMDocs

MARCH 30, 2024

Answer : Thoracic and Lumbar Spine Trauma Epidemiology: Approximately half of the vertebral injuries that are seen in the emergency department are thoracic and lumbar injuries. A 27-year-old man was brought into the emergency department via EMS after being stabbed. J Emerg Med. and 100%, respectively.

EMS 105

EMS E-9-1-1 Emergency Department Ambulance 105

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. A 41-year-old male with no significant past medical history presents with a deep hand laceration. Examination reveals the following: What is the diagnosis?

EMS 96

EMS ALS Emergency Department ED 96