The Skeptics' Guide to EM

APRIL 27, 2024

Prehospital Emergency Care. Date: April 25, 2024 Guest Skeptic: Missy Carter is a PA working in an ICU in the Tacoma area and an adjunct faculty member with the Tacoma Community College paramedic program. When emergency department (ED) staff roll her to remove her clothing her humeral intraosseous (IO) is dislodged.

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ICU Defibrillator Paramedic CPR 231

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Full dose challenge of moderate, severe and unknown beta-lactam allergies in the emergency department. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: It’s another day, another dollar in the emergency department (ED). AEM August 2024.

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ICU Emergency Department ALS ED 141

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? Click here for Direct Download of the Podcast Paper: Knack SKS et al. Range 5 to 9) Diff -0.2;

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ED ICU Emergency Department Overdose 97

REBEL EM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. 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. J Crit Care.

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Emergency Department ICU Critical Care EMR 52

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Reference: Cashen K, Reeder RW, Ahmed T, et al. Pediatric Crit Care Med.

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CPR ICU Critical Care Defibrillator 130

EMDocs

JUNE 15, 2024

. #1: PREOXI RCT – Preoxygenation with Noninvasive Ventilation vs. Non-rebreather Mask Spoon Feed Noninvasive ventilation (NIV) was superior to a standard non-rebreather (NRB) oxygen mask for preoxygenation of critically ill ED or ICU patients requiring intubation, with a NNT of 11 to prevent 1 episode of hypoxemia <85%.

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ICU Emergency Department ED OR 98

ACEP Now

JANUARY 4, 2025

Clarke had begun an emergency medicine residency at what was then known as LA CountyUSC Hospital, Los Angeles. I was about two months into a family practice internship when I went to visit my uncle whose neighbor happened to be an ED resident, Dr. Clarke said. ED resident Dr. Steve Hui doing a pericardiocentesis on a trauma patient.

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ED Emergency Department Ambulance CPR 52

The Skeptics' Guide to EM

JUNE 6, 2020

Max is then going to Georgetown to be an attending in both EM and ICU. Case: It’s another day in your emergency department (ED). The triage nurse places a 61 year-old-man with fever, hypotension, cough into the smallest room in the ED. You scan through the EMR and see the blood pressure is 60/40.

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EMR ALS ICU Emergency Department 130

ACEP Now

MARCH 13, 2024

Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. ED crowding impairs this mission. 2 This article discusses the practical and ethical issues of interhospital transfer of these patients.

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Emergency Department ED ALS Critical Care 52

The Skeptics' Guide to EM

MARCH 27, 2021

2020 Case: A 74-year-old woman who suffered a fall earlier today presents to the emergency department (ED) and is found to have five rib fractures to her right thorax, but no other injury. His team found grip strength was weakly correlated with frailty in older ED patients [6]. J Trauma Acute Care Surg.

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ICU ALS Emergency Department ED 100

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). 2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Am J Emerg Med. 2022 Sep 7.

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Emergency Department ALS Critical Care ED 52

Broome Docs

SEPTEMBER 3, 2024

CJEM debate series: #StillTheOne-while more challenging than ever, emergency medicine is still the best career path available for medical students. PMID: 38592662 Bottom line: Would you be happy if you kid follow-ed your footsteps into emergency medicine? As loud as a construction site: Noise levels in the emergency department.

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E-9-1-1 Emergency Department ICU ALS 95

ACEP Now

OCTOBER 15, 2023

Intravenous insulin infusions typically require treatment in highly monitored settings, such as an intensive care unit (ICU) or step-down unit for safety and due to the frequency and intensity of monitoring. ICU and step-down beds are a limited resource and generate higher hospital charges. Acad Emerg Med. JAMA Netw Open.

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ICU ALS ED Emergency Department 80

The Skeptics' Guide to EM

NOVEMBER 16, 2019

Case: A 59-year-old woman comes is brought into your emergency department (ED) by EMS in cardiac arrest. The patient achieved return of spontaneous circulation (ROSC) on arrival to the ED. She had a witnessed arrest, and CPR was initiated by bystanders.

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ALS CPR ICU EMS 100

EMDocs

SEPTEMBER 19, 2023

On ED arrival GCS is 3, there are rapid eye movements to the right but no other apparent seizure activity. Propofol utilized for sedation; patient admitted to ICU for EEG monitoring. Official diagnosis requires EEG, which is not something we can typically obtain in the ED. They administer two doses of 10 mg midazolam IM.

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STEMI Coronary Emergency Department ICU 102

REBEL EM

JUNE 8, 2023

This study chose a relevant topic to analyze that could influence acute management in the ED and has a fairly larger sample size of patients to do so. If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist. Am J Emerg Med.

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Epinephrine Emergency Department ALS Critical Care 98

ACEP Now

JULY 7, 2024

1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). 2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus).

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Emergency Department Critical Care ALS ICU 52

Dr. Smith's ECG Blog

OCTOBER 19, 2022

A patient had 3rd degree AV block in the ED. A transvenous pacer was placed in the Emergency Department by the emergency physicians. and the 2021 YouTube Review by ICU Advantage on "Temporary Pacemakers: Modes and Basic Settings".

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ED ICU OR Emergency Department 52

EMDocs

FEBRUARY 9, 2024

Authors: Adam Roussas, MD, MBA, MSE // Reviewed by: Jamie Santistevan, MD ( @jamie_rae_EMdoc, EM Physician, Presbyterian Hospital, Albuquerque, NM); Manpreet Singh, MD ( @MPrizzleER ); and Brit Long, MD ( @long_brit ) Case A 40-year-old female presents to the emergency department for palpitations and lightheadedness. What do you do?

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Defibrillator OR ED ALS 98

Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. The junior staff member remains silent throughout the debrief and does not attend their shift the following day.

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E-9-1-1 Critical Care CPR ICU 105

Don't Forget the Bubbles

AUGUST 28, 2023

Five-year-old Ginny presents to the Emergency Department with a syncopal episode. You contact ICU, anaesthetics, ENT, and oncology with a plan to attempt more definitive imaging in the prone position (which Ginny tells you is much comfier) What’s the evidence for our emergent management? RadioGraphics.

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Emergency Management Emergency Manager E-9-1-1 Critical Care 97

AAEM RSA

JUNE 30, 2021

Many triple-certified physicians choose to divide their time between the emergency department (ED) and intensive care unit (ICU) for extra variability in their careers, staying sharp in both the high acuity and physiological management of the most ill and complex patients.

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EMS Critical Care ICU ED 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. The pacing rate was increased without clinical improvement and the patient was transferred to the ICU for closer monitoring/treatment. This patient presented to the ED “after a couple of days of chest discomfort”.

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Coronary ACS ED OR 118

REBEL EM

NOVEMBER 3, 2022

In this post, we critically appraise the first systematic review and meta-analysis to compare the safety and efficacy of etomidate and ketamine as induction agents for RSI in the ED and prehospital setting. Pooled data from ED and prehospital were evaluated using an odds ratio with a 95% confidence interval. Article: Sharda SC et al.

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ALS ICU ED Emergency Department 52

EMDocs

OCTOBER 21, 2023

Median time from ED arrival to diagnosis was 8 hours 24 min in one study, with only 19% being diagnosed within the 4.5-hour All patients who receive thrombolytics for ischemic stroke should be admitted to a neurosurgical, neurologic, or medical ICU for management and monitoring, as this is shown to decrease mortality and length of stay.

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EMS ALS OR ACS 98

ACEP Now

MAY 4, 2023

A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). Click to enlarge.)

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EMS Operating Room ICU Emergency Department 52

EMDocs

DECEMBER 18, 2024

A 36-year-old male presents to the emergency department after being found down at home by his spouse. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. Per the mans wife, the patient is a heavy drinker often consuming two to three pints of vodka daily.

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E-9-1-1 Emergency Department ICU ED 106

Core EM

JANUARY 25, 2024

Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients. mg/kg 0.01 – 0.1 up to 1.5)

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ICU Emergency Department Critical Care ALS 246

Don't Forget the Bubbles

MARCH 21, 2025

set out to explore in the Kids THRIVE study investigating whether NHF apnoeic oxygenation could improve intubation outcomes in critically unwell children needing emergency airway management. A total of eleven intensive care units (ten PICUs and one non-maternity NICU) and four emergency departments (EDs) took part in the study.

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ICU Critical Care ED OR 108

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. We don’t want to go backwards!

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ED Emergency Department ALS Paramedic 95

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. Am J Emerg Med. She reports occasional central chest pain exacerbated by coughing. Int J STD AIDS. 2019;30(2):188-193.

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The Skeptics' Guide to EM

APRIL 22, 2023

Michael Falk is a Pediatric Emergency Medicine attending at Mount Sinai Medical Center and Associate Professor of Emergency Medicine at the Icahn School of Medicine in New York. Case: A 14-month-old boy presents to the emergency department (ED) with two days of upper respiratory symptoms and respiratory distress.

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ICU Emergency Department ALS ED 130

The Skeptics' Guide to EM

JUNE 22, 2024

Anireddy Reddy is a pediatric intensive care attending physician in the Department of Anesthesiology and Critical Care Medicine at Children’s Hospital of Philadelphia. Dr. Anireddy Reddy Case: A 3-year-old girl presents to the emergency department (ED) with fever and respiratory distress.

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Critical Care ICU ALS Emergency Department 139

Critical Care Scenarios

NOVEMBER 15, 2020

A few rapid-fire cases from the emergency department, with Dr. Seth Trueger (@mdaware), emergency physician at Northwestern University and digital media editor for JAMA Network Open. Takeaway lessons Many decisions in the ED are less about what to do, and more about when to do it. Emergency staff have limited bandwidth.

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ICU Life Support Emergency Department ED 100

The Skeptics' Guide to EM

JULY 16, 2022

Case: A 59-year-old woman presents to the emergency department (ED) with fever, tachycardia, and hypotension. She is admitted to the intensive care unit (ICU) for septic shock. The ICU team is considering using Vitamin C therapy for this patient. She is found to have a urinary tract infection.

ICU 100

ICU ALS Critical Care Emergency Department 100

EMDocs

DECEMBER 18, 2023

On arrival to the ED, her blood pressure is 84/36 mmHg with a heart rate of 110 beats per minute. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. 8,9 Recently, monocyte distribution width (MDW) has shown promise in a large meta-analysis as a useful screening tool in the ED.

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E-9-1-1 ALS Emergency Department Plasma 95

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. Nearly half of all post-AFT patients presenting to our emergency departments required admission and six percent required ICU admission.

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Emergency Department Operating Room Critical Care ICU 52