The Skeptics' Guide to EM

JULY 27, 2024

They were randomized to ceftriaxone 2gm intravenous (IV) in the ambulance or usual cares (fluids and supplementary oxygen) until arrive to the ED. That document tells us “Before widespread implementation, CDRs should be compared to clinical judgement.” [3] It needs to change physician practice for the better.

ICU 184

ICU ALS Ambulance OR 184

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." Smith comment: But the tests (ECG and troponin) are extremely specific and so the post test probability is nearly 100%. Repeat cTnI drawn at around 8 AM was 3.910 ng/mL. This patient was not one of the lucky 6.4%

E-9-1-1 117

E-9-1-1 OR Coronary ACS 117

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk.

E-9-1-1 161

E-9-1-1 ED OR Emergency Department 161

The Skeptics' Guide to EM

MAY 2, 2020

This is Bob’s eleventh visit […] The post SGEM#291: Who’s Gonna Drive you to…the ED – with Lights & Sirens? July 2019 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Virginia. first appeared on The Skeptics Guide to Emergency Medicine. Date: April 24th, 2020 Reference: Watanabe et al.

ED 100

ED Ambulance Medical Transportation EMS 100

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Case: It’s another day, another dollar in the emergency department (ED). You wonder if she could have an allergy challenge dose of ceftriaxone in the ED. These “allergies” are often poorly documented and could potentially be more accurately described as intolerance [1]. AEM August 2024. A pivotal study by Raja et al.

ICU 136

ICU Emergency Department ALS ED 136

The Skeptics' Guide to EM

JANUARY 23, 2021

AEM January 2021 Case: A 50-year-old male presents to the Emergency Department (ED) with left lower quadrant abdominal pain. That SGEMHOP episode asked how the productivity of APPs compare to emergency physicians and what is its impact on ED operations? There has been a concern about post-graduate training of NPs and PAs in the ED.

ED 130

ED ALS Emergency Department OR 130

The Skeptics' Guide to EM

NOVEMBER 21, 2020

Case: You are the medical director of a medium sized urban emergency department (ED). The American College of Emergency Physicians ( ACEP ) has a number of documents discussing APPs in the ED. There has been a concern about post-graduate training of NPs and PAs in the ED. AEM November 2020. AEM November 2020.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

OCTOBER 1, 2022

That includes an episode on steroids to prevent bounce back visits to the ED ( SGEM#28 ), ketorolac for acute treatment ( SGEM#66 ), acupuncture for prophylaxis ( SGEM#211 ) and a calcitonin gene-related peptide antagonist ( SGEM#279 ). Patients with migraines often present to the ED looking for pain relief. Reference: Hartford et al.

Emergency Department 130

Emergency Department ALS ED OR 130

Pediatric EM Morsels

JULY 5, 2024

Using this decision rule would have cut down on ED CT C-spine ordering by >50% in this derivation cohort. It seems like just yesterday ( or maybe ~ a month ago ) when we served up a tasty morsel on the PECARN decision rule for intra-abdominal traumatic injuries in children. The following factors, if negative, had a sensitivity of 94.3%

ALS 161

ALS OR ED Emergency Department 161

Critical Care Scenarios

NOVEMBER 15, 2020

Takeaway lessons Many decisions in the ED are less about what to do, and more about when to do it. Takeaway lessons * Many decisions in the ED are less about what to do, and more about when to do it. Goals of care starts in the ED, and not with lip service. ICU time and ED time are different.

ICU 100

ICU Life Support Emergency Department ED 100

The Skeptics' Guide to EM

OCTOBER 28, 2017

Stevens and colleagues updated their review in 2016 and concluded “sucrose is effective for reducing procedural pain” and “no serious side effects or harms have been documented with this intervention”. That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015.

ALS 130

ALS Emergency Department OR ED 130

EMDocs

MAY 9, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Facts : A 24-year-old male is taken to the ED by his parents after “passing out” and being “unconscious for a few seconds.” Defense : The EP did address the seizure when he documented “not post-ictal.”

ED 83

ED EMS OR 83

ACEP Now

NOVEMBER 7, 2024

About three percent of emergency department (ED) visits are due to skin and soft tissue infections, but data are lacking on the contribution of chronic wounds to this number. Wound management in the ED is only a starting point, and appropriate referral and follow-up are key to an improved outcome.

ED 97

ED OR Emergency Department Ambulance 97

Don't Forget the Bubbles

OCTOBER 10, 2024

This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. 2023 Mar 30;110(4):432-438.

ED 75

ED Emergency Department OR ALS 75

REBEL EM

MAY 15, 2023

You are working in a rural ED, and an older woman from a local assisted care facility arrives via ambulance in obvious respiratory distress. EMS is able to tell you that she is currently being treated for pneumonia. The patient is on a nonrebreather mask, and vital signs on arrival are BP 110/50 mm Hg, HR 120 bpm, RR 40/min, T 98.6°F

EMS 98

EMS Ambulance ED OR 98

EMDocs

OCTOBER 3, 2023

This is also where keeping up with documentation starts to slip. You’ll need to put the following tasks in a rank order list: new patient evaluations, dispositions, managing critical or potentially critical patients, results review, team huddle, running the board, calling consults, doing procedures, and documentation.

EMR 98

EMR EMS OR Emergency Department 98

The Skeptics' Guide to EM

JANUARY 16, 2021

In the emergency department (ED), tetracaine drops are applied prior to slit lamp examination and the pain is completely resolved. The first documented use of topical ophthalmologic anesthetics was in 1818. He was giving his 9-month-old a hug and got poked in the eye with a sharp little fingernail.

ALS 130

ALS Emergency Department EMS ED 130

EMDocs

SEPTEMBER 26, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Patient not informed of enlarged heart, dies 3 weeks post ED visit Miscommunicated radiology findings are a hot topic. Someone should have – either the first ED doc, the second ED doc, or my PCP.

Emergency Department 75

Emergency Department ED Coronary ALS 75

EMDocs

AUGUST 22, 2024

6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. 6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. One cohort study in a public ED found that 84.5%

Emergency Department 82

Emergency Department ALS E-9-1-1 ED 82

ACEP Now

DECEMBER 6, 2024

This case report documents the first known instance of using NTG during an emergency department resuscitation to treat a patient in cardiac arrest due to severe coronary artery vasospasm. Cardiac arrest secondary to myocardial ischemia from coronary vasospasm is well documented. and at Naples Community Hospital in Naples, Fla.

Coronary 98

Coronary Life Support ALS Emergency Department 98

The Skeptics' Guide to EM

APRIL 24, 2021

AEM April 2021 * Population: Emergency department (ED) patients 18 years or old where the treating physician determined the need for parenteral sedation for acute agitation (it needed a patient or staff safety concern, not purely a high agitation score). Reference: Martel et al.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

Don't Forget the Bubbles

JUNE 19, 2024

A proportion of the patients who were initially missed using the CDR were found to actually have risk factors documented in EMS reports or the medical record. A proportion of participants were missed because the ED provider refused enrollment or said “Other,” but this is not well described. What is the problem? What were the results?

CPR 124

CPR Operating Room OR Emergency Department 124

REBEL EM

JUNE 22, 2023

Population: Adults aged 30-85 years of age with BMI > 25 ( > 23 in those identifying as Asian or Latino) who had COVID-19 symptoms for fewer than 7 days and a documented SARS-CoV-2 positive PCR or antigen test within 3 days of enrollment without prior SARS-CoV-2 infection. Alpha dominant: 7.9% Delta dominant 8.3%

ALS 145

ALS OR EMS ED 145

EMDocs

JUNE 28, 2023

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. EMS is called, and he is brought to the ED for a reported “slip and fall” with associated facial abrasions. EMS report includes concern for CVA, with variable documentation of face and extremity weakness.

EMS 69

EMS ED OR 69

EMDocs

JUNE 13, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. difficile enterocolitis post antibiotic treatment Facts : An adult female presents to the ED with dental pain. We just don’t document it. Documenting our warnings should be standard care.

Emergency Department 78

Emergency Department ED EMS OR 78

The Skeptics' Guide to EM

DECEMBER 5, 2020

You perform the HINTS exam and the results are reassuring, but the patient’s symptoms persist… Background: Up to 25% of patients presenting to the ED with acute vestibular syndrome (AVS) have a central cause of their vertigo – commonly posterior stroke. You wonder, “Why can’t I just rule out stroke with the HINTS exam?

ALS 100

ALS Emergency Department ED OR 100

EMDocs

OCTOBER 11, 2023

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. She is seen briefly by the ED physician who orders “ wound cleansing” and an elbow x-ray for “elbow pain.” ” The tech cleans the wound and documents it as 2cm long and “ dirty.”

ED 69

ED EMS OR 69

EM Literature of Note

OCTOBER 9, 2024

While most demonstrations of generative AI applied to the ED involve summarization of records, digital scribing, or composing discharge letters, this attempts clinical decision-support. Likewise, there are other clinical notes of value potentially available, including nursing and triage documentation.

Emergency Department 84

Emergency Department OR ED 84

EMDocs

OCTOBER 10, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Exam is normal except for tenderness as documented in the diagram. She is diagnosed with “groin pain” and advised to return the next day for US or x-ray if not improved or to go to the ED if worse.

ED 75

ED OR ICU 75

REBEL EM

JULY 3, 2023

Background: Atrial fibrillation and atrial flutter with rapid ventricular rate (AF/AFL with RVR) are the most common subtypes of SVT, comprising a large number of ED visits in aging populations. The study was dependent on EMR documentation which is prone to error. Hypotension in these patients can complicate management.

E-9-1-1 98

E-9-1-1 EMR Emergency Department ED 98

EMDocs

JANUARY 25, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. A CBC, Chem 7m and CT of the soft tissues of the neck are ordered by the departing ED doc whose clinical info for the radiologist is “facial swelling”. To opt in to the free subscriber list, click here.

ED 73

ED ALS OR 73

Dr. Smith's ECG Blog

MARCH 7, 2024

I’ve attached an article and an abstract (that article is in Japanese unfortunately … ) that do document that you CAN however on occasion find AIVR in otherwise healthy children — and I suppose that IS what we have here. It is not fast (cannot be VT). There is no atrial activity to suggest atrial fibrillation.

ED 115

ED OR 115

EMDocs

JUNE 16, 2023

Podcast: Play in new window | Download (Duration: 13:57 — 19.2MB) Subscribe: Apple Podcasts | Google Podcasts | RSS Management of the child with mental health problems who is boarding in the ED In episode 1 of this series, we discussed differentiating organic vs psychiatric causes of agitation in children.

ED 52

ED Mental Health Services Emergency Department Emergency Medical Services 52

The Skeptics' Guide to EM

MAY 11, 2019

Background: The first documented appendectomy was done by Claudius Amyand in 1735. His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. Case: An 18-year-old woman presents with a Grade 1 appendicitis (Tominaga et al J Trauma Acute Care Surg 2016).

Critical Care 100

Critical Care ALS ED OR 100

ACEP Now

JULY 7, 2024

Sometimes there is a risk management staff member on call to support you in navigating challenging outcomes, including your immediate documentation. Add on the daily frustrations we all face during ED shifts: the challenging consultant, high volumes, time intensive laceration, etc. We are all human. Keep an open mind.

OR 98

OR ED Ambulance 98

ACEP Now

OCTOBER 30, 2023

The care of patients with disabilities in the ED requires more attention, as not much data is available. highlight some discrepancies in experiences that may result in ED visits. highlight some discrepancies in experiences that may result in ED visits. Krahn, et al., Krahn, et al.,

ED 98

ED ALS OR EMS 98

The Skeptics' Guide to EM

DECEMBER 18, 2021

Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: At the completion of her 1-month elective in your rural emergency department (ED), you are discussing career plans with a medical student. She has worked in five EDs so far, and a man has filled almost every leadership position.

Emergency Department 100

Emergency Department ALS ED OR 100