The Skeptics' Guide to EM

NOVEMBER 11, 2023

Case: A 24-year-old manual labourer presents to the emergency department (ED) after drinking a few too many beers, having a disagreement with another beer drinker and gets knocked down. Background: Fractures of the scaphoid are the most common carpal fractures presenting to the ED. However, the x-rays read as “normal” by radiology.

ALS 327

ALS Emergency Department ED OR 327

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. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.

ED 128

ED E-9-1-1 Emergency Department ALS 128

ALiEM

APRIL 14, 2023

Highlighted Quality Posts: Procedures Site Article Author Date Label Rebel EM Intra Articular Lidocaine vs Sedation in Shoulder Reductions Nordia Matthews, MD 30 Jan 2023 AIR EM Docs Video Laryngoscopy in the ED Cameron Jones, MD 8 Aug 2022 AIR First 10 EM Lacerations: Does closure technique matter?

EMS 246

EMS Emergency Department ED OR 246

ALiEM

OCTOBER 27, 2023

A 26-year-old male with no significant past medical history presented to the ED after slipping on wet pavement and hitting his head on the ground three hours prior. He endorsed a constant, achy 7/10 headache accompanied by nausea and photophobia. He denied vomiting, dizziness, diplopia, loss of consciousness, or seizures.

OR 278

OR ED 278

ALiEM

MARCH 18, 2024

A 30-year-old female with a past medical history of Crohn’s Disease presented to the ED for evaluation of an acutely bruised right 4th finger. Author information Cassandra Bradby, MD Residency Program Director East Carolina University | The post SAEM Clinical Images Series: Purple Finger appeared first on ALiEM.

Emergency Department 306

Emergency Department ED OR 306

EMOttawa

AUGUST 15, 2024

Assessing patients with pleural effusions in the emergency department (ED) can be challenging and unclear. This is largely due to the lack of guidelines around pleural effusions in the ED. In this post, I’ve tried to highlight some key information about an approach to patients presenting with a new pleural effusion.

ED 78

ED Emergency Department Critical Care 78

The Skeptics' Guide to EM

MAY 2, 2020

A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. This is Bob’s eleventh visit […] The post SGEM#291: Who’s Gonna Drive you to…the ED – with Lights & Sirens? A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. Annals of Emergency Medicine. Annals of Emergency Medicine.

ED 100

ED Ambulance Medical Transportation EMS 100

ALiEM

MAY 24, 2023

In: Fleisher and Ludwig’s Textbook of Pediatric Emergency Medicine, 7th ed, Shaw K, Bachur RG (Eds), Lippincott Williams & Wilkins, Philadelphia 2015. Author information Meraj Fatima, MBBS Resident Emergency Medicine Aga Khan University | The post Trick of Trade: Removal of Entrapped Metal Zipper appeared first on ALiEM.

ED 233

ED OR 233

Core EM

OCTOBER 16, 2024

Annie: I developed an interest in EM while working as a scribe in the ED during college. In addition to what Charlotte and Nick said, I can envision myself staying calm in the stressful situations that come up in the ED. Nick: Triaging your time and priorities as an ED doc on shift is so challenging.

ED 100

ED EMS Critical Care OR 100

Core EM

SEPTEMBER 24, 2024

Annie: I developed an interest in EM while working as a scribe in the ED during college. In addition to what Charlotte and Nick said, I can envision myself staying calm in the stressful situations that come up in the ED. Nick: Triaging your time and priorities as an ED doc on shift is so challenging.

ED 100

ED EMS Critical Care OR 100

ALiEM

JUNE 15, 2023

PMID 12801736 Author information Sheila Goertemoeller, PharmD, DABAT, ICPS Clinical Toxicologist and Educator Drug and Poison Information Center Cincinnati Children's Hospital Medical Center | The post ACMT Toxicology Visual Pearl: The Heart Won’t Go On and On appeared first on ALiEM. Invasive Plant Atlas of the United States.

ALS 246

ALS ED OR 246

REBEL EM

JULY 17, 2023

REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? PMID: Clinical Question: Does a single dose of ketamine or etomidate used for rapid sequence intubation (RSI) of critically adults in the ED impact the SOFA score within 3 days of hospitalization? Click here for Direct Download of the Podcast Paper: Knack SKS et al.

ED 97

ED ICU Emergency Department Overdose 97

ALiEM

APRIL 12, 2023

20 – Local Anesthetics, Ed(s): Hugh C. Author information Ivan Ivanov, DO Resident Physician Emergency Department South Brooklyn Health | The post Trick of the Trade: Gel-free ultrasound-guided peripheral IV technique appeared first on ALiEM. 2022 Jan 6;8(1):42. doi: 10.3390/gels8010042. Hemmings, Talmage D.

Emergency Department 258

Emergency Department ALS ED 258

ACEP Now

NOVEMBER 8, 2024

Neurodivergence refers to the unique way in which an individual’s brain processes and responds to certain information, differing from the typical or average brain. One common myth is that neurodivergent individuals are intellectually disabled or incapable of understanding complex information. bandwidth” and “deep dive”).

Emergency Department 52

Emergency Department ED OR ALS 52

ALiEM

AUGUST 7, 2023

A 10-year-old male with no past medical history presents to the Emergency Department (ED) by EMS for evaluation of an injury sustained while playing tackle football. The patient was forcibly hit by another child against a tree. View other cases from this Clinical Image Series on ALiEM.

Emergency Department 246

Emergency Department OR EMS ED 246

ACEP Now

MAY 5, 2023

Introduction Law enforcement officers frequently accompany emergency department (ED) trauma patients or patients who are under arrest or require assistance. At times, law enforcement officers may request assistance from ED staff to gather information or evidence. What is your role as the emergency physician?

Emergency Department 52

Emergency Department ED Public Safety OR 52

ACEP Now

NOVEMBER 7, 2023

Background As Electronic Health Information (EHI) has increased in prominence, the U.S. The 2015 Edition Cures Act sought to promote “transparency, modern standards, and enhanced health IT capabilities by fostering innovation in the health care technology ecosystem to deliver better information to patients, clinicians, and other users.”

ED 52

ED ALS OR Emergency Department 52

ALiEM

JUNE 1, 2023

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? Is phenobarbital safe for the treatment of EtOH withdrawal in the ED? Author information T. If not, you probably should be. Another old drug for a new indication, right?

Emergency Department 246

Emergency Department ICU ED OR 246

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. BMJ Paediatr Open.

ED 75

ED Emergency Department OR ALS 75

Core EM

OCTOBER 16, 2024

In: Marx J, ed. In: Wolfson A, ed. 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%

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

ALiEM

FEBRUARY 5, 2024

2023.02.011 , PMID 36967275 Author information Chris Belcher, MD Editor, ALiEM AIR Series Assistant Professor and Assistant Program Director Department of Emergency Medicine University of Kentucky College of Medicine | Twitter | The post ALiEM AIR Series | Toxicology Module appeared first on ALiEM. Ann Emerg Med. 2023;82(1):55-65.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

ALiEM

OCTOBER 21, 2024

A 5-year-old generally healthy fully immunized boy presented to the ED with worsening left ear redness, swelling, and tenderness that his family noticed the day before presentation. His family had also recently noticed an abrasion over that ear. View other cases from this Clinical Image Series on ALiEM.

ED 169

ED OR 169

ALiEM

NOVEMBER 22, 2023

Pagel, Mark (ed.). “Evolution of Dietary Specialization and Chemical Defense in Poison Frogs (Dendrobatidae): A Comparative Analysis” The American Naturalist. The poison Dart frog’s batrachotoxin modulates Nav1.8. 2004;577(1-2):245-248. PMID: 15527793 Darst, Catherine R.; Menéndez-Guerrero, Pablo A.; Coloma, Luis A.;

ALS 284

ALS ED OR 284

ALiEM

MARCH 1, 2024

A 24-year-old female with no pertinent PMHx presents to the ED with a chief complaint of eye pain. Her mom convinced her to go to the ED and she first went to an outside hospital, but was referred to come to our institution. She reported a 10-day history of worsening right eye pain following being punched in that eye. Iridodialysis.

ED 152

ED OR 152

REBEL EM

SEPTEMBER 11, 2023

However, many institutions’ surgical teams still require or request a formal study over a bedside exam, likely due to a lack of confidence in the accuracy of POCUS, resulting in longer ED stays. Rezaie, MD (Twitter/X: @srrezaie ) The post POCUS in the ED: Is Confirmatory RUQ US Still Necessary?

ED 68

ED ACS Emergency Department OR 68

ALiEM

AUGUST 30, 2024

A 5-year-old female presented to the emergency department (ED) with a one-year history of gradually increasing anterior neck swelling. She was discharged from the ED on levothyroxine 25 mcg daily with endocrinology outpatient follow-up. The patient had no significant past medical history.

ACS 161

ACS Emergency Department ED OR 161

The Skeptics' Guide to EM

FEBRUARY 26, 2022

Case: You are in discussion with your emergency department (ED) manager about the number of patients boarding for hours to days and you are both aware that many of these patients are attending with mental health crises. ED visits in the US for mental health conditions has increased by 44% from 2006 to 2014. Reference: Kim et al.

ED 130

ED ALS Emergency Department OR 130

ALiEM

SEPTEMBER 25, 2024

A 24-year-old male with a history of microscopic hematuria presented to the emergency department (ED) with left lower quadrant abdominal pain. He decided to come to the ED today because of the persistent nature of the pain. His pain started about two weeks ago and has been intermittent. He describes the pain as stabbing. PMID 16990978.

Emergency Department 141

Emergency Department ED ALS OR 141

Don't Forget the Bubbles

SEPTEMBER 6, 2023

14-year-old Katy presents to the paediatric Emergency Department (ED), alone, complaining of suicidal ideation. Mental health-related ED visits for children and young people are common and have been on the rise during the last decade. Recognising and acknowledging the child’s stress and traumatic experience in the ED is important.

Emergency Department 119

Emergency Department ED ALS Overdose 119

ALiEM

SEPTEMBER 9, 2024

A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today.

Emergency Department 152

Emergency Department ED OR 152

ALiEM

MARCH 15, 2024

A 28-year-old male presented to the ED for evaluation of an injury to his right eye. Author information Thelmari Raubenheimer, DO Resident Physician Grand Strand Medical Center | The post SAEM Clinical Images Series: Workout Gone Wrong appeared first on ALiEM. The patient also developed gross blood over the front of the eye.

ED 161

ED OR 161

ALiEM

OCTOBER 14, 2023

Author information Chris Belcher, MD Editor, ALiEM AIR Series Assistant Professor and Assistant Program Director Department of Emergency Medicine University of Kentucky College of Medicine | Twitter | The post ALiEM AIR Series | Respiratory 2023 Module appeared first on ALiEM. Ann Emerg Med. 2023;82(1):55-65. doi: 10.1016/j.annemergmed.2023.02.011

Critical Care 169

Critical Care EMS Emergency Department ALS 169

EMergucate

MAY 31, 2021

A 55 year old male presents to ED confused and combative. No further information is known. VBG: pH 7.07 … Continue reading →

ED 100

ED 100

EMergucate

JUNE 9, 2021

A 35 year old male presents to ED confused and combative. No further information is known. VBG: pH 7.07 … Continue reading →

ED 100

ED 100

ALiEM

JANUARY 8, 2024

She then presented again to the ED with two weeks of worsening shortness of breath, intermittent fevers (Tmax 101°F), nausea/vomiting, fatigue, and arthralgias. She underwent a brief admission of six days for shortness of breath but did not have an oxygen requirement at that time. C (99 °F); Resp 44; SpO2 84%; BMI 28.25 kg/m2; Wt 79.4

ED 152

ED OR 152

ALiEM

SEPTEMBER 11, 2023

A 29-year-old female with a past medical history of migraine headaches presented to the emergency department (ED) for several hours of bilateral eye pain, redness, and decreased visual acuity. The patient is a contact lens wearer. She denied any foreign body sensation, known trauma, or experiencing similar symptoms previously.

Emergency Department 152

Emergency Department ED OR 152

ALiEM

SEPTEMBER 13, 2024

A 32-year-old male with no significant past medical history presented to the emergency department (ED) from an outside hospital for further management of right eye pain and vision loss sustained after he was struck by a metal wire while at work. View other cases from this Clinical Image Series on ALiEM. appeared first on ALiEM.

Emergency Department 161

Emergency Department OR ED 161