The Skeptics' Guide to EM

OCTOBER 19, 2024

Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial. Annals of EM 2024. Annals of EM 2024. It is used at lower doses than those required for anesthesia (0.1–0.3

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OR Emergency Department ED ALS 193

Core EM

SEPTEMBER 24, 2024

To get a sense of how medical students feel about emergency medicine, we interviewed three students who are interested in EM: Nick, a graduating M4 pre-matched into EM residency, Charlotte, an M2 currently planning to pursue EM, and Annie, an M1 considering EM. What sparked your interest in emergency medicine?

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ED EMS Critical Care OR 100

ACEP Now

DECEMBER 11, 2023

The Emergency Department Benchmarking Alliance (EDBA) is a membership organization composed of high-performance emergency departments (EDs) that share a commitment to quality. Thus, the survey included data for about one-third of all patients seen in US ED’s in 2022.

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Emergency Department ED EMS ALS 52

ACEP Now

JUNE 7, 2023

The role of emergency physicians has been made dramatically more important due to the pandemic. The performance of EDs in 2020 and into 2021 changed abruptly, and that carried through into 2022. EDs weathered attacks from a variety of sources in recent years. This necessarily increased ED walkaway rates.

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Emergency Department ED EMS Ambulance 52

REBEL EM

JULY 1, 2024

Comparison of BPAP S/T and Average Volume-Assured Pressure Support Modes for Hypercapnic Respiratory Failure in the Emergency Department: A Randomized Controlled Trial. Comparison of BPAP S/T and Average Volume-Assured Pressure Support Modes for Hypercapnic Respiratory Failure in the Emergency Department: A Randomized Controlled Trial.

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ED Emergency Department ALS OR 133

ACEP Now

JULY 7, 2023

Last month’s article focused on ACEP’s efforts and resources to support EDs and patients with psychiatric emergencies. Emergency departments (EDs) focus on rapid initiation of medical treatment. Future articles will highlight solutions and success stories. Patients with sepsis get antibiotics.

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Emergency Department ED Naloxone ALS 52

REBEL EM

MAY 11, 2023

Background: The emergency department is frequently visited by patients suffering from symptomatic alcohol withdrawal, and the traditional management has been dominated by repeated doses of benzodiazepines. Return Encounters in Emergency Department Patients Treated with Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal.

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Emergency Department ED EMR OR 98

The Skeptics' Guide to EM

NOVEMBER 16, 2024

Case: The Chief of Emergency Medicine (EM) at a large urban hospital recently approached the AI Committee at Unity Health, intrigued by the CMAJ article describing the apparent success of CHARTWatch in detecting early signs of patient deterioration. Background: There are many ways to define artificial intelligence.

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ICU Emergency Department ALS EMS 142

International Journal of Paramedicine

APRIL 3, 2024

Background : Emergency Department (ED) overcrowding limits patient care in the prehospital and hospital system. A program was implemented to decrease the time to patient handoff from EMS arrival to ED staff, also known as the delivery interval and total turnaround interval.

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Emergency Department Ambulance Paramedic ED 52

REBEL EM

MARCH 27, 2023

Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. The result of this ED capacity strain and less than ideal patient to staff ratios has led to delays in interventions, treatments and care adjustments. Paper: Owyang CG, et al. J Crit Care. J Crit Care.

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Emergency Department ICU Critical Care EMR 52

The Skeptics' Guide to EM

MARCH 2, 2024

The sonographic protocol for the emergent evaluation of aortic dissections (SPEED protocol): A multicenter, prospective, observational study. Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. AEM February 2024.

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Operating Room Emergency Department ALS ED 301

Pulsara

JANUARY 25, 2024

With a new protocol and Pulsara, Metropolitan Emergency Medical Services can now transport eligible pediatric behavioral health patients directly to behavioral health facilities—resulting in a 44% decrease of pediatric behavioral health patients transported to the ED. Download the case study or read on to learn more!

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Emergency Medical Services EMS STEMI Emergency Department 109

The Skeptics' Guide to EM

JUNE 1, 2024

His research focuses on the pre-hospital care of children by EMS. He is the principal investigator for EMSC State Partnership in Washington, DC and is also involved in various multi-center EMS studies with the Pediatric Emergency Care Applied Research Network (PECARN). EMS placed him in a C-collar and brought him to you.

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Emergency Medical Services Emergency Department EMS ALS 210

EMDocs

JUNE 8, 2024

We’ll keep it short, while you keep that EM brain sharp. A 27-year-old male presents to the ED for left eye pain after being hit in the face with a spare car part while working under the hood of his car. What is the diagnosis, and how do we manage it from the ED? Overview of Eye Injuries in the Emergency Department.”

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EMS Allergic Reaction Emergency Department ED 80

Emergency Medicine Cases

NOVEMBER 5, 2019

If a lack of translation can have tragic consequences, the obligation of an ED to set a new and better standard of care for communicating with patients is now painfully clear. The post WTBS 19 Does Poor Access to Language Services Leave Emergency Departments Primed for Tragedy? appeared first on Emergency Medicine Cases.

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Emergency Department ED EMS 130

Medic Mindset

NOVEMBER 13, 2024

Dr. Casey Patrick is the EMS medical director of Montgomery County Hospital District (Texas). As an EM physician, he shares how he decides to care for his own patients in the ED who present with rapid atrial fibrillation. There should be a 2-hour limit before you can give Diltiazem, or rate control, in the Emergency Department.

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Paramedic Emergency Department EMS ED 98

EMOttawa

AUGUST 22, 2024

Assessing patients with pleural effusions in the emergency department (ED) can be challenging and nuanced. This is largely due to the lack of guidelines around pleural effusions in the ED. In part one we focused on imaging, diagnosis, and management of parapneumonic effusions.

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ED Emergency Department Critical Care EMS 60

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. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

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ED E-9-1-1 Emergency Department ALS 130

Core EM

JANUARY 25, 2024

How and when to reverse anticoagulation in the bleeding EM patient. Anticoagulant Reversal Strategies in the Emergency Department Setting: Recommendations of a Multidisciplinary Expert Panel. Ann Emerg Med. 2020;76(4):470-485. doi:10.1016/j.annemergmed.2019.09.001 2019.09.001 Eikelboom JW, Quinlan DJ, van Ryn J, Weitz JI.

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Frozen Plasma FFP Plasma Critical Care 246

REBEL EM

JULY 17, 2023

Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? appeared first on REBEL EM - Emergency Medicine Blog. Range 5 to 9) Etomidate: 7.0

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ED ICU Emergency Department Overdose 98

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. Paper: Mason JM, et al.

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Emergency Department ALS Critical Care ED 52

The Skeptics' Guide to EM

DECEMBER 8, 2017

A Prospective Randomized, Double-Dummy Trial Comparing Intravenous Push Dose of Low Dose Ketamine to Short Infusion of Low Dose Ketamine for Treatment of Moderate to Severe Pain in the Emergency Department. Guest Skeptic: Dr. Salim Rezaie is a faculty physician at Greater San Antonio Emergency Physicians (GSEP) in San Antonio, Texas.

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Emergency Department ALS OR EMS 130

ALiEM

OCTOBER 26, 2023

The Problem: Emergency Medicine (EM) in Pakistan has moved from developing to developed stage in the last decade [1]. It is an innovation that is based on a community of practice merged with the need-based assessment of a young EM residency program in a developing country. Read more publications from the series. 2022;38(6):1717.

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EMS Emergency Department ALS ED 161

REBEL EM

JUNE 5, 2023

One study from a county in Massachusetts found that of all nonfatal opioid doses seen in the emergency department from 2011-2015, 1 in 20 patients subsequently died within one year of initial visit with 66% of these deaths being directly related to an opioid overdose (4). PMID 33392580.

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Naloxone ED Overdose Emergency Department 98

ALiEM

FEBRUARY 5, 2024

After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Digital Impact Factor [1], the ALiEM AIR Team is proud to present the highest quality online content related to related to toxicology in the Emergency Department. More specifically, we identified 3 AIR and 5 Honorable Mentions.

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Overdose Critical Care EMS Emergency Department 215

EMDocs

MAY 11, 2024

We’ll keep it short, while you keep that EM brain sharp. A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. Ann Emerg Med. Available at: [link].

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EMS E-9-1-1 ALS OR 88

ALiEM

APRIL 14, 2023

After carefully reviewing all relevant posts in the past 12 months from the top 50 sites of the Social Media Index, the ALiEM AIR Team is proud to present the highest quality online content related to related to procedures in the Emergency Department. More specifically, we identified 2 AIR and 4 Honorable Mentions.

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EMS Emergency Department ED OR 246

REBEL EM

AUGUST 17, 2023

A 24-year-old woman presents to the emergency department with persistent severe pain in her right thigh following a direct blow during a soccer match 2 weeks ago. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Post TW, ed. In: Walls RM, Hockberger RS, Gausche-Hill M, et al., Elsevier; 2023:(Ch) 47.

EMS 52

EMS Emergency Department ED ALS 52

EMDocs

APRIL 27, 2024

We’ll keep it short, while you keep that EM brain sharp. A 68-year-old male with a history of poorly controlled diabetes presents to the ED with increasing right-sided ear and facial pain, swelling, and difficulty hearing for two weeks. He says the pain is worse at night and when he is chewing. and Staphylococcus spp.

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EMS ED OR ALS 83

EMDocs

APRIL 13, 2024

We’ll keep it short, while you keep that EM brain sharp. A 24-year-old male presents to the ED from a mixed marital arts competition after being struck on the side of the right head by a fist earlier today. A 21-year-old man presents to the emergency department for pain and swelling in his ear beginning 3 days ago.

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EMS E-9-1-1 OR Emergency Department 81

EMDocs

SEPTEMBER 9, 2023

We’ll keep it short, while you keep that EM brain sharp. He presents to the ED with profound difficulty extending his middle and ring finger. A 35-year-old right handed male with no significant past medical history presents with a deep hand laceration. The patient states they suffered a cut with a box cutter at a construction site.

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EMS ED ALS Emergency Department 77

The Skeptics' Guide to EM

FEBRUARY 18, 2023

Chris Bond is an emergency medicine physician and Assistant Professor at the University of Calgary. Case: You are an administrator responsible for staffing emergency departments (EDs) in a health care system comprising both urban and rural locales. The SGEM has done two previous podcasts on APPs in the ED.

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Emergency Department ALS ED EMS 130

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.

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ED Mental Health Services Emergency Department Emergency Medical Services 52

EMDocs

SEPTEMBER 25, 2023

However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). While RSI should remain the gold standard in the vast majority of patients in the ED, FI presents an additional technique to mitigate anatomic or physiologic risk.

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ED Emergency Department ALS Paramedic 65

EMDocs

NOVEMBER 18, 2023

We’ll keep it short, while you keep that EM brain sharp. A 32-year-old female with a history of hypertension and autoimmune hepatitis status post liver transplant 6 weeks prior on tacrolimus and mycophenolate presents to the ED with abdominal discomfort. What are the complications of liver transplant that we see in the ED?

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EMS E-9-1-1 ALS Emergency Department 69

The Skeptics' Guide to EM

APRIL 13, 2024

He is an assistant professor in Emergency Medicine, Neurology, and Neurosurgery at the School of Medicine at the University of Washington. Case: A 70-year-old woman was brought into the emergency department by EMS after her family reported she was having trouble talking.

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Emergency Department ALS OR EMS 287

Emergency Medicine Cases

JANUARY 15, 2019

We often face violence in the ED. Yet the ED is a sanctuary for care and support. Many EDs have a zero-tolerance policy for violence. In this Waiting to Be Seen blog Dr. Howard Ovens examines the issues we face in Emergency Departments as we try to make staff feel safe and ensure patients can access the care they need.

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ED Emergency Department EMS 130