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

The Skeptics' Guide to EM

OCTOBER 12, 2024

Andrew Tagg Case: You are working with a medical trainee on her first clinical rotation through the emergency department (ED). Working with children in the ED adds another layer of complexity as we are often trying to explain to them and their caregivers what is going to happen during their time in the ED.

Emergency Department 229

Emergency Department ED ALS OR 229

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

REBEL EM

MAY 27, 2024

Clinical Question: Does simultaneously performing the modified valsalva maneuver and administering intravenous adenosine, compared to either treatment alone, have greater success in achieving normal sinus rhythm in patients presenting to the ED with PSVT? This absence of detail leaves the study open to bias.

OR 137

OR E-9-1-1 ED ALS 137

ALiEM

FEBRUARY 28, 2024

References Iverson C, ed. Clinical photograph for: Ludwig Angina. CorePendium. For Media Without an Associated Publication: This type of citation may be helpful if the image is used in multiple places within a publication, or if it is not tied to a particular publication. Last Name First Initial. Media title. Date Published. July 27, 2022.

OR 130

OR ED 130

EMDocs

JULY 25, 2024

Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Chuck Pilcher, MD, FACEP Editor, Medical Malpractice Insights Editor, Med Mal Insights The challenge of suicide evaluation in the ED “I’ve changed my mind. If you have a story to share click here.

ED 81

ED ALS Emergency Department OR 81

Dr. Smith's ECG Blog

OCTOBER 27, 2024

This was sent to me with no clinical information, and my initial impression viewing it on my phone was "It’s a tricky one. The cath lab was deactivated by cardiologist on arrival at ED because it was "not a STEMI". He presented to the ED for evaluation chest pain. He reported the crushing chest pain radiated down his left arm.

STEMI 119

STEMI ED Coronary EMS 119

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 130

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

ALiEM

OCTOBER 25, 2024

A 64-year-old male with a history of bipolar 1 disorder, PTSD, anxiety, depression, obsessive-compulsive disorder, GERD, and HTN presented to the ED with the chief complaint of foreign body and self-injury. He reported years of sticking sewing needles into his right arm, most recently yesterday. He denied homicidal ideation.

ED 177

ED OR 177

The Skeptics' Guide to EM

DECEMBER 16, 2023

Case: A 57-year-old Chinese woman presents to the emergency department (ED) with chest pain. Background: Patient experiences of care are associated with health outcomes and may impact perspectives of ED care and the patient recovery process.(1-5) 6-7) We looked at deaf and hard-of-hearing patients in the ED on SGEM#383.

Emergency Department 295

Emergency Department ED ALS OR 295

ALiEM

JUNE 10, 2024

A 10-year-old boy presents to the emergency department (ED) after a high-speed motor vehicle collision. The study enrolled 22,430 children, aged 0–17 years, presenting with blunt trauma across 18 PECARN-affiliated ED in the US. Case Scenario: What would you do? He complains of neck pain and is reluctant to move his head.

Emergency Department 317

Emergency Department ED OR 317

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 98

ED ICU Emergency Department Overdose 98

EMS 12-Lead

MAY 15, 2024

We will be using redacted information from different cases where paramedics attempted TCP in the field. Crew notifies the received ED of an incoming post-arrest patient and notes a sinus bradycardia on their monitor, as seen in Figure 2. Pacing was continued in the ED, with identical settings. Several learning points here.

Epinephrine 331

Epinephrine Paramedic CPR ED 331

REBEL EM

JUNE 5, 2023

Background Information: Opioid overdose deaths have been increasing in the past twenty years. These statistics make the ED a crucial treatment initiation point to prevent further morbidity and mortality from opioid overdoses. The national number of overdose deaths from any opioid has increased 62.5% PMID 33392580.

Naloxone 98

Naloxone ED Overdose Emergency Department 98

REBEL EM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. 2 Despite these recommendations there are no randomized clinical trials to help guide practice until now.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

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

The Skeptics' Guide to EM

NOVEMBER 9, 2024

In addition to finding ways to use technology in emergency department (ED) care, she is interested in how health systems work and how patients move through the healthcare system. Previously, she has been an ED medical director, quality chair, and regional hospital director.

Emergency Department 140

Emergency Department ED ALS OR 140

ALiEM

OCTOBER 28, 2024

A 2-year, 11-month-old female with a history of constipation was brought to the ED by her mother for abdominal pain. The patient had two episodes of unprovoked, non-bloody, non-bilious vomiting the morning prior to the ED visit. Author information Harshit Terala, DO Resident Physician St. HEENT : Normocephalic and atraumatic.

ED 161

ED OR 161

Core EM

OCTOBER 16, 2024

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% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1

Allergic Reaction 145

Allergic Reaction Plasma ED Epinephrine 145

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. No peritoneal signs. Non-tender rectal exam.

Emergency Department 152

Emergency Department ED OR 152

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. This is a case of perichondritis of the auricle, or a bacterial infection of the ear’s cartilage.

ED 169

ED OR 169

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

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? Please go to the above link.

EMS 246

EMS Emergency Department ED OR 246

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. Short acting. mg/kg IV followed by 0.05 – 0.4

ICU 246

ICU Emergency Department Critical Care ALS 246

ALiEM

NOVEMBER 18, 2024

In: Mattu A and Swadron S, ed. Author information Veda Ravishankar, MD Resident Physician Cook County Health | The post SAEM Clinical Images Series: A Rash with Cranial Nerve Deficits appeared first on ALiEM. He also endorsed left-sided facial weakness and diplopia for the last eight days. References Anderson Erik, Do-Nguyen Amy.

Emergency Department 161

Emergency Department ALS OR ED 161

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. Abdominal : Soft. No distention or tenderness.

ACS 161

ACS Emergency Department ED OR 161

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. Neuro : Alert.

ED 152

ED OR 152

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

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

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. He had no other complaints and denied any other trauma or loss of consciousness during the event.

Emergency Department 161

Emergency Department OR ED 161

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

Dr. Smith's ECG Blog

JUNE 17, 2023

EMS recorded this ECG during active symptoms and transmitted it to the ED: I had no information when I was shown the ECG. Written by Pendell Meyers A middle aged man called EMS for acute chest pain. I said "Not OMI. Some probably thought the inferior leads showed findings of OMI, but that's a fake."

OR 52

OR STEMI ALS EMS 52

The Skeptics' Guide to EM

JUNE 24, 2023

Case: A 27-year-old right hand dominant patient presents to the emergency department (ED) with a 2.5 EDs are an important touch point for individuals with opioid use disorder (OUD), given the number of encounters for overdose and complications associated with drug use. cm left forearm abscess. Reference: Reed et al.

Overdose 187

Overdose Emergency Department ALS ED 187

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. She reports occasional central chest pain exacerbated by coughing. 0 C, and has no jaundice. of PJP patients with sensitivity of 86.5%

E-9-1-1 87

E-9-1-1 ED ALS OR 87

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

ALiEM

NOVEMBER 1, 2024

A 67-year-old male with a past medical history of CHF, MI, hypertension, and diabetes presented to the ED with complaints of headache, chest pain, and dyspnea for the past four days. He stated that he has been without his medications for the past few months due to cost. He denied any past surgical history. Eur Respir J. Epub 2016 Oct 6.

ED 161

ED OR 161

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. The patient is reluctant to abduct the right arm secondary to pain.

Emergency Department 246

Emergency Department OR EMS ED 246