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 322

Emergency Department ED ALS OR 322

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth. Case: It is a steady Saturday afternoon in your rural emergency department (ED). Reference: Snelling et al. He is also a fully-fledged ultrasonographer.

Critical Care 347

Critical Care ALS ED Emergency Department 347

REBEL EM

JULY 1, 2024

The AVAPS mode is as effective and safe as BPAP S/T in treating patients with hypercapnic respiratory failure in the ED.” Clinical Take Home Point: I n patients presenting to the ED with hypercapnic respiratory failure, AVAPS did lead to a faster improvement in pH and PaCO2 levels compared to BPAP S/T. AVAPS: 0.07 AVAPS: 10.20

ED 132

ED Emergency Department ALS OR 132

Dr. Smith's ECG Blog

OCTOBER 15, 2024

He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon. He arrived to the ED by ambulance at 1529, only a half hour after the start of his chest pain around 1500 while eating. Patient 2 , EKG 1: What do you think? The patient had none of these conditions.

OR 116

OR STEMI ED Coronary 116

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

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

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

The Skeptics' Guide to EM

OCTOBER 21, 2023

Case: You are in your group meeting and have heard about a case at a nearby emergency department (ED) where the […] The post SGEM#418: I Ain’t Missing You – Spinal Epidural Abscess first appeared on The Skeptics Guide to Emergency Medicine. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals.

Emergency Department 338

Emergency Department ALS ED OR 338

The Skeptics' Guide to EM

JULY 6, 2024

The emergency department (ED) evaluation reveals an unremarkable chemistry panel with normal renal function and a white blood cell count of 10,000. Background: We have discussed agitation in the ED on the SGEM several times. They are afebrile and tolerate oral intake. These conflicts can ultimately lead to moral injury [1,2,3].

ED 242

ED ALS Emergency Department OR 242

Dr. Smith's ECG Blog

MARCH 28, 2024

Here is the prehospital ECG: First ED ECG What do you think? Here is the prehospital ECG: First ED ECG What do you think? He states that he maybe missed a dose or two during recent illness. On EMS arrival, patient's oxygen saturation was in the high 80s and improved on 4L O2 via nasal cannula. SVT with aberrancy?

OR 128

OR Emergency Department EMS Ambulance 128

EMDocs

SEPTEMBER 30, 2024

Today’s video evaluates inhaled corticosteroids (ICS) for asthma in the ED setting. EBM Updates: Inhaled Corticosteroids for Asthma in the ED Background : Asthma is a common ED issue, with patient presentations ranging from needing a medication refill to severe exacerbation in respiratory failure.

ED 106

ED Emergency Department OR 106

The Skeptics' Guide to EM

MARCH 25, 2023

Casey […] The post SGEM#398: Another Ab Gets BUSED – POCUS in the ED for Biliary Disease first appeared on The Skeptics Guide to Emergency Medicine. Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth.

ED 130

ED Critical Care Emergency Department ALS 130

Emergency Medicine Cases

JULY 18, 2023

You are working the ambulatory section of your ED and evaluating a 6-year boy with a possible distal radius injury. He lives with autism spectrum disorder and is uncomfortable in X-ray rooms, and you wonder if there is a role for PoCUS to help exclude a fracture.

OR 130

OR ED EMS 130

EMS 12-Lead

APRIL 9, 2024

At the time of ED arrival he was alert, oriented, and verbalizing only a headache with a normalized BP. The ED activated trauma services, and a 12 Lead ECG was captured. This was deemed “non-specific” by the ED physicians. Thus, the ED admission ECG changes cannot be blamed on LVH. The fall was not a mechanical etiology.

Coronary 290

Coronary ACS CAD ED 290

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-9-1-1 130

E-9-1-1 OR Coronary ACS 130

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. However, the ICU is full and the patient will likely be boarding in your ED for a bit before coming upstairs.

ICU 276

ICU ED Critical Care ALS 276

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

ACEP Now

JANUARY 5, 2025

A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. On exam, you see bright red blood trickling down her left tonsillar fossa.

Operating Room 98

Operating Room Epinephrine ALS ED 98

The Skeptics' Guide to EM

JANUARY 6, 2024

Case: After your shift in the emergency department (ED) one day, the medical director pulls you aside. July 2023 * Population: ED leadership across the United States. million annual pediatric ED visits. * Excluded: EDs that are not open 24 hours a day or 7 days a week. JAMA Netw Open.

Emergency Department 343

Emergency Department Emergency Medical Services ALS ED 343

St. Emlyn's

JUNE 1, 2024

FOAMed @stemlyns The post JC: Is nebulised ketamine an option in the ED? St.Emlyn's - Emergency Medicine #FOAMed Journal club review of an RCT on the use of nebulised ketamine use in the emergency department. Yet another route for ketamine? Or maybe not?? appeared first on St.Emlyn's.

ED 103

ED Emergency Department OR 103

Broome Docs

JANUARY 27, 2025

European Journal of Internal Medicine , [link] You can listen to my 27-minute rant on Youtube here: [link] This multinational trial looked at a three-pronged diagnostic protocol in the ED for adults with suspected acute aortic syndromes. The protocol used the ADD score, a POCUS echo protocol and D-dimer to try and exclude AAS in the ED.

ED 101

ED OR ACS Critical Care 101

Emergency Medicine Cases

DECEMBER 19, 2023

In this part 1 or our 2-part podcast series on wrist injuries Dr. Arun Sayal and Dr. Matt DiStefano answer such questions as:when should we suspect a DRUJ injury, why is it important to pick up DRUJ injuries in the ED, and how does it change our management? and many more.

ED 276

ED OR EMS 276

Core EM

JANUARY 25, 2024

A quick primer on hypocalcemia in the ED. Pfenning CL, Slovis CM: Electrolyte Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. Diagnosis and management of hypocalcaemia. BMJ 2008; 336:1298. Desai TK, Carlson RW, Geheb MA. Louis, Mosby, Inc.,

Critical Care 246

Critical Care ED ALS OR 246

Medic Mindset

NOVEMBER 13, 2024

As an EM physician, he shares how he decides to care for his own patients in the ED who present with rapid atrial fibrillation. Casey Patrick is the EMS medical director of Montgomery County Hospital District (Texas). He shares with listeners how he came to the decision to remove Diltiazem from his service.

Paramedic 98

Paramedic Emergency Department EMS ED 98

St. Emlyn's

DECEMBER 26, 2023

St.Emlyn's - Emergency Medicine #FOAMed Air France Flight 447 takes off at 1930hrs on the final day of May in 2009, from Rio de Janeiro en route to Paris, carrying 228 passengers. In charge is … AI & Medicine: Saviour or Snake Oil? Read More » The post AI & Medicine: Saviour or Snake Oil? appeared first on St.Emlyn's.

OR 113

OR ED 113

The Skeptics' Guide to EM

APRIL 13, 2024

When she arrives in your ED, her family tells you she was last seen normal about 12 hours ago. Initial evaluation by medics revealed right hemiplegia, a right facial droop, left gaze deviation, and aphasia. A code stroke is activated, and the initial CT head shows no signs of hemorrhage or early ischemic changes.

ALS 345

ALS Emergency Department OR EMS 345

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

Core EM

JANUARY 25, 2024

The SQuID Protocol (Subcutaneous Insulin in Diabetic Ketoacidosis): Impacts on ED Operational Metrics. Fidelity was examined by the frequency of required q2h glucose checks, safety by seeing how many patients required rescue dextrose for hypoglycemia, and operational impacts including ED LOS and ICU admission. Image from cited article.

EMS 246

EMS ICU ED OR 246

Pediatric EM Morsels

AUGUST 23, 2024

Concussion – Presentation [ Silverberg, 2023 ] There is no definitive test to diagnose concussion in the ED. It does NOT have structural brain damage visible on standard neuroimaging. In the research setting, abnormalities can be found via functional, blood flow, or metabolic imaging.

Emergency Department 281

Emergency Department OR ED EMS 281

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

While in the ED, patient developed acute dyspnea while at rest, initially not associated with chest pain. The patient had no chest symptoms until he had been in the ED for many hours and had been undergoing management of his DKA. The patient was under the care of another ED physician. Another ECG was recorded: What do you think?

ED 118

ED Coronary CAD STEMI 118

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

Core EM

JANUARY 25, 2024

We go over the essential and complex topic of vasopressors in the ED.

Epinephrine 246

Epinephrine Critical Care ED Emergency Department 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

Pediatric EM Morsels

APRIL 19, 2024

Trauma season is at hand and like all other pediatric emergency departments in the country, we find our ED breaking ( pun intended ) at the seams with orthopedic injuries. We see all different flavors of upper extremity injuries. The minority of parents would have wanted clinic follow up (6%) and reimaging (14%).

ALS 290

ALS ACS Emergency Department ED 290

The Skeptics' Guide to EM

OCTOBER 28, 2023

Case: A 37-year-old man without a significant past medical history presents to the emergency department (ED) with a chief complaint of lower back pain that started three days prior to the ED visit after unloading a truck with furniture. His twitter handle is @PainFreeED.

ALS 268

ALS Emergency Department ED OR 268

Pediatric EM Morsels

JULY 26, 2024

It is commonly missed during the first few ED visits. Keep a high index of suspicion for anti-NMDAr encephalitis in children and adolescents who have had multiple ED visits for new and worsening psych/behavioral concerns, seizures, and/or movement disorders over several months. Often initially misdiagnosed as a psychiatric illness.

Plasma 271

Plasma OR ED Critical Care 271