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. Conflicts in the ED often stem from clinical decision-making and actions, leading to potential adverse patient events and exacerbating access block issues.

ED 242

ED ALS Emergency Department OR 242

The Skeptics' Guide to EM

NOVEMBER 19, 2022

Intimate partner violence (IPV) in the Emergency Department (ED). 2022 Nov Guest Skeptics: Dr. Nour Khatib is an emergency physician in Toronto working in community sites Markham Stouffville Hospital and Lakeridge health. Intimate partner violence (IPV) in the Emergency Department (ED).

Emergency Department 102

Emergency Department ED OR 102

Pediatric EM Morsels

JULY 19, 2024

If bleeding has completely stopped, most of these children still come into the hospital for observation so access will likely be necessary and helpful should patient have rebleed event. If bleeding, the only lab that is needed in the Emergency Department is a type and cross. Set up suction x2 in the room! Get IV access!

E-9-1-1 290

E-9-1-1 Epinephrine Emergency Department OR 290

Don't Forget the Bubbles

MAY 10, 2023

You’re in the paediatric emergency department, typing some notes for the child you’ve just discharged. They lead to increased team cohesion and are often best led by people involved in the event. They are a judgement-free session focussing on events that occurred. You’re just about aware of the tannoy in the background.

Emergency Department 91

Emergency Department ED CPR OR 91

Core EM

JANUARY 25, 2024

Consider these medications if there are signs of end-organ dysfunction, there is a considerable delta in baseline BP, systolic is less than 90 and/or MAP is less than 65 Norepinephrine is a good pressor for a lot of the situations that we encounter in the emergency department, such as septic shock, undifferentiated shock and hypovolemic shock.

Epinephrine 246

Epinephrine Critical Care Emergency Department ED 246

CanadiEM

MARCH 12, 2024

In this issue, we collaborated with the CJEM team to present “Hypotension and respiratory events related to electrical cardioversion for atrial fibrillation or atrial flutter in the emergency department” in a visual abstract format​1​.

Emergency Department 52

Emergency Department OR ED 52

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. An emergent ophthalmology consult is needed to plan for operative repair.

Emergency Department 161

Emergency Department OR ED 161

The Skeptics' Guide to EM

MAY 19, 2018

Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events
 Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. Case: A 47-year-old woman presents to the emergency department with a 24-hour history of chest pain and shortness of breath. JAMA February 2018.

Emergency Department 130

Emergency Department ALS Coronary OR 130

FOAMfrat

DECEMBER 26, 2024

IF YOU OR A LOVED ONE NEEDS HELP, CALL 988 OR SEEK CARE AT A LOCAL EMERGENCY DEPARTMENT. TRIGGER WARNING: TOPICS OF SUICIDE MAY BE HARD FOR SOME PEOPLE TO READ ABOUT. THIS ARTICLE IS COVERING THE MEDICAL ASPECTS OF CHEMICAL SUICIDES. REMEMBER, IF YOU ARE TREATING A SUICIDE ATTEMPT SURVIVOR, DO NOT PASS JUDGMENT.

Epinephrine 116

Epinephrine First Responder OR Emergency Management 116

EMDocs

DECEMBER 23, 2024

Major adverse cardiac events 40 minutes after giving the antiarrhythmic. Major adverse cardiac events 40 minutes after giving the antiarrhythmic. The following table shows their results, take a look: Note that procainamide leads with less adverse cardiac events. This was based on 11, thats not a typo, ELEVEN patients.

ALS 75

ALS OR STEMI EMS 75

The Skeptics' Guide to EM

JANUARY 14, 2018

Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergency department. Urology 2012 Guest Skeptics: Dr. Tony Seupaul is the Chairman of the Department of Emergency Medicine at the University of Arkansas. Of course we were skeptical and wanted to review the evidence.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

OCTOBER 10, 2020

Sergey Motov is an Emergency Physician in the Department of Emergency Medicine, Maimonides Medical Center in New York City. He is also one of the world’s leading researchers on pain management in the emergency department, specifically the use of ketamine. His twitter handle is @PainFreeED.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

APRIL 2, 2022

Take-Pause: Efficacy of mindfulness-based virtual reality as an intervention in the pediatric emergency department. AEM March 2022 Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. Reference: Butt et al.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

SEPTEMBER 26, 2020

Case: A 34-year-old male presents to the emergency department with burning epigastric pain after eating two hours ago. Background: Patients presenting to emergency departments (EDs) with epigastric pain are typically treated with an antacid, either alone or combined with other medications. AEM Sept 2020. AEM Sept 2020.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

OCTOBER 14, 2019

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. first appeared on The Skeptics Guide to Emergency Medicine. Date: October 14th, 2019 Reference: CRASH-3 Trial Collaborators.

Emergency Department 130

Emergency Department EMS ALS OR 130

The Skeptics' Guide to EM

APRIL 10, 2021

He is a GP by training but works in Emergency Department, Anaesthesia, Internal Medicine and Paediatrics. He has a wonderful #FOAMed blog and podcast called Broomedocs and also work […] The post SGEM#326: The SALSA Study: Hypertonic Saline to Treat Hyponatremia first appeared on The Skeptics Guide to Emergency Medicine.

Emergency Department 130

Emergency Department Coronary ED OR 130

The Skeptics' Guide to EM

JANUARY 20, 2018

Background: Patients present commonly to their primary care providers (PCPs) and to the emergency department (ED) with complaints of a sore throat. The ibuprofen did not help and he is requesting antibiotics so he can get back to work sooner. In the US, adults accounted for 6.6 million visits annually to PCPs and EDs for sore throat.

Emergency Department 130

Emergency Department ALS EMS ED 130

Pediatric EM Morsels

NOVEMBER 17, 2023

Cuffed Endotracheal Tubes show no difference in immediate post-extubation adverse events (i.e Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Acad Emerg Med. In a systematic review of 10 RCTs comparing cuffed vs. uncuffed ETTs. 1.70) and 0.78 (0.46–1.35),

E-9-1-1 187

E-9-1-1 Operating Room Emergency Department ALS 187

ACEP Now

APRIL 5, 2024

A 68-year-old man presents to the emergency department (ED) with altered mental status and fever. Vital signs on arrival are: Temperature: 38.8 degrees Celsius Heart rate:128 Blood pressure: 74 over 48 Respiratory rate: 10 Oxygen saturation: 77 percent Physical examination was notable for lethargy and confusion.

OR 73

OR ALS Emergency Department Critical Care 73

Don't Forget the Bubbles

AUGUST 30, 2023

The parents of 9-month-old Josie bring her into the Emergency Department with coryzal symptoms and difficulty breathing. A secondary analysis of a nationwide study of Emergency Department attendance in America from 2006 to 2008 found that CXRs increase the average length of stay by 27 minutes.

E-9-1-1 131

E-9-1-1 Emergency Department ALS OR 131

NAEMSP

OCTOBER 9, 2024

In the emergency department, a lack of awareness about Addison’s disease led to delayed steroid administration. In the emergency department, the patient was evaluated and safely discharged. These cases highlight the impact of adrenal insufficiency on patients, especially during encounters with emergency care systems.

EMS 122

EMS Crisis Prevention Emergency Department BLS 122

The Skeptics' Guide to EM

OCTOBER 3, 2020

Date: October 2nd, 2020 Guest Skeptic: Dr.Barbra Backus is an emergency physician at the Emergency Department of the Erasmus University Medical Center in Rotterdam, the Netherlands. She is the creator of the HEART Score and an enthusiastic researcher. Reference: Claiborne Johnston S et al. Reference: Claiborne Johnston S et al.

Emergency Department 100

Emergency Department ALS OR 100

REBEL EM

NOVEMBER 20, 2023

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial [published online ahead of print, 2023 Oct 12]. Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. 2023;e2320850.

OR 91

OR Emergency Medical Technician CPR Emergency Medical Services 91

International Journal of Paramedicine

JULY 8, 2024

However, ketamine may be associated with adverse clinical events including a higher intubation rate. The primary endpoint was incidence of endotracheal intubation occurring during transportation and within one hour after arrival to the emergency department (ED). versus 2.9%, respectively; p = 0.383).

Emergency Department 98

Emergency Department Ambulance ED OR 98

ACEP Now

NOVEMBER 13, 2023

Physicians, nurses, and staff in emergency departments (EDs) across the country have encountered workplace violence for years. 1,2 In a 2018 study by ACEP, nearly half of emergency physicians polled reported a physical assault while at work. Click to enlarge.) are caused by a behavioral crisis. Click to enlarge.)

Emergency Department 52

Emergency Department Emergency Response ED ALS 52

EMDocs

OCTOBER 25, 2024

1: Hypertensive Crisis Averted…New AHA Statement on Asymptomatic Hypertension Spoon Feed This article emphasizes the difference between hypertensive emergency and asymptomatic elevated blood pressure (BP); while hypertensive emergency requires prompt treatment to lower BP, treatment of asymptomatic elevated BP in acute care settings may be harmful.

Defibrillator 95

Defibrillator Emergency Department ALS OR 95

The Skeptics' Guide to EM

NOVEMBER 1, 2022

AEM October 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: A 19-year-old man presents to the emergency […] The post SGEM#381: Put Your Hand on My Shoulder and Reduce It first appeared on The Skeptics Guide to Emergency Medicine.

ALS 123

ALS Emergency Department OR ED 123

The Skeptics' Guide to EM

JULY 2, 2022

Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia.

Coronary 100

Coronary Heart Attack ACS CAD 100

Don't Forget the Bubbles

AUGUST 23, 2023

In most Emergency Departments, staff are allotted little of that scarce resource, time, to begin processing what has just occurred. The Pause Jonathon Bartels worked as an Emergency Nurse in America in 2009. After the death of a young person in the Emergency Department, he initiated ‘ The Pause.’ & Liska, H.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

ALiEM

OCTOBER 26, 2023

The Learners The target learners were EM residents and physicians practicing in the emergency department. In order to avoid connectivity issues with Wifi, the event administrators broadcasted from an ethernet-connected computer. Internet connection: A stable internet connection is a must. Read more publications from the series.

EMS 161

EMS Emergency Department ALS ED 161

The Skeptics' Guide to EM

NOVEMBER 24, 2018

[display_podcast] Date: November 24th, 2018 As you may know, I was invited to give a keynote address on burnout at the Australasia College of Emergency Medicine 2018 Annual Scientific Meeting (#ACEM18) in Perth, Australia. This turned out to be a very meta event. This turned out to be a very meta event. got seriously ill.

EMR 130

EMR ALS Emergency Department OR 130

ACEP Now

MARCH 9, 2025

As hospital boarding, increased emergency department (ED) volumes, and complexity of patients have increased, so have wait times. Some physicians now coin themselves waiting room medicine specialists as departments schedule a physician in triage or attempt to evaluate patients in whatever spaces might be available.

Emergency Department 95

Emergency Department ED ALS OR 95

REBEL EM

JUNE 8, 2023

Epinephrine – 10ug/mL, 10mL syringe Phenylephrine – 100ug/mL, 10mL syringe Phenylephrine bolus doses from 100-200ug and epinephrine 10-20ug administered every 2-5 minutes pursuant to provider order Inclusion Criteria: Adults age >18 years old Received at least one bolus dose of phenylephrine or epinephrine pre-filled syringes Exclusion (..)

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

The Skeptics' Guide to EM

SEPTEMBER 1, 2018

Case: You are working in the emergency department (ED) and have just been involved in a difficult case in the resuscitation room. During the resuscitation, a relative of the patient you have been treating named Rudy makes a derogatory/rude comment about Emergency Medicine (EM) staff.

ALS 130

ALS Emergency Department OR EMS 130

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Audrey’s academic interests include trauma and resuscitation. Outside of medicine, Audrey likes to play rugby and run.

Epinephrine 130

Epinephrine Emergency Department EMS ALS 130

Dr. Smith's ECG Blog

FEBRUARY 14, 2024

A 41-year-old male who presents to the emergency department with chest pain. I do not think it is possible for a 2nd trop to remain undetectable in a patient then goes on to rule in for acute MI, unless there is a 2nd event. I know of no data on unstable angina/30-day adverse events/acute MI after 2 serial undetectable trops.

ACS 111

ACS Emergency Department OR 111

Pediatric EM Morsels

JULY 21, 2023

Interrater reliability of Glasgow Coma Scale scores in the emergency department. Ann Emerg Med. We use the GCS score in both trauma and medical patients, but where did this score come from? When is it useful and what does it tell us? Let’s wrap our heads around the Glasgow Coma Scale in children. May have shouts or exclamations.

Critical Care 246

Critical Care ALS Life Support OR 246