The Skeptics' Guide to EM

JANUARY 20, 2024

Case: A 4-year-old girl comes to the emergency department complaining of pain with urination. UTIs are one of the most common bacterial infections in childhood that we see in the emergency department [1]. Her research interests include improving the diagnosis of urinary tract infections in children.

Emergency Department 179

Emergency Department ALS ICU OR 179

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.

ICU 189

ICU Defibrillator CPR Paramedic 189

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)? The Journal of Emergency Medicine. Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives. Open Access Emerg Med. 2012.07.056.

Emergency Department 246

Emergency Department ICU ED OR 246

Core EM

OCTOBER 23, 2024

The Case A 24-year-old man with no past medical or surgical history presented to the emergency department with 5 days of progressively worsening bilateral leg cramping, paresthesias, and multiple falls. and tends to occur in men of Asian descent. and tends to occur in men of Asian descent.

Emergency Department 130

Emergency Department Critical Care ICU Ambulance 130

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.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

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.

ICU 130

ICU Emergency Department ALS ED 130

EMDocs

JULY 20, 2024

Spoon Feed An international, multi-center RCT found that administering pantoprazole to intubated ICU patients lowered the rate of upper GI bleeding compared to placebo. Acad Emerg Med. Ann Emerg Med. PMID: 38441515 The post Journal Feed Weekly Wrap-Up appeared first on emDOCs.net - Emergency Medicine Education.

Emergency Department 75

Emergency Department ICU OR 75

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. It’s unbalanced.

Critical Care 133

Critical Care ICU ALS Emergency Department 133

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.

CPR 130

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%. . #3:

ICU 75

ICU Emergency Department ED OR 75

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.’ 23 (2), pp.

Emergency Department 98

Emergency Department ICU ALS Critical Care 98

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Case: A 45-year-old female in the emergency department is being admitted to the intensive care unit (ICU) for septic shock secondary to urinary tract infection (UTI). You are ready to call the ICU and get her admitted. But you remember seeing in the news there was a study claiming vitamin C could cure sepsis.

ICU 130

ICU Critical Care ALS Emergency Department 130

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. In our emergency department, the RTs do not spend a lot of time going around measuring cuff pressures and usually save that until the patient reaches the ICU.

E-9-1-1 245

E-9-1-1 Emergency Department ICU OR 245

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

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. Continue reading "Episode 19: Emergency medicine with Seth Trueger" A few rapid-fire cases from the emergency department, with Dr. .

ICU 100

ICU Life Support Emergency Department ED 100

Broome Docs

SEPTEMBER 3, 2024

Do you still suggest emergency medicine to your students? … Adams C, Walsan R, McDonnell R, Schembri A. As loud as a construction site: Noise levels in the emergency department. Australas Emerg Care. PMID: 37532590 Bottom line: Emergency departments are noisy, although not ridiculously so.

E-9-1-1 109

E-9-1-1 Emergency Department ICU ALS 109

ACEP Now

JULY 7, 2024

Should emergency physicians rely on standard textbooks for diagnostic and treatment regimens? 1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). 1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED).

Emergency Department 52

Emergency Department Critical Care ALS ICU 52

REBEL EM

MARCH 23, 2023

The 30-day emergency department readmission rate and all-cause 30-day readmission were significantly lower only when adjusted for propensity scores. Treatment options for alcohol withdrawal include benzodiazepines such as lorazepam, diazepam, or chlordiazepoxide, gabapentin, and phenobarbital (Buell et al.).

ICU 52

ICU Emergency Department ALS OR 52

The Skeptics' Guide to EM

JANUARY 15, 2022

Intensive Care Med 2021 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a professor of Emergency Medical Services at Tacoma Community College’s paramedic program. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Reference: Matchett, G.

Emergency Medical Services 107

Emergency Medical Services Firefighter Critical Care Paramedic 107

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. Guest Skeptic: Dr. Jess Monas is a Consultant in the Department of Emergency Medicine at the Mayo Clinic Hospital, Phoenix, Arizona. Date: September 20th, 2021 Reference: Litell et al. mg/dl or 107 umol/L).

EMR 100

EMR Emergency Department ICU ALS 100

REBEL EM

OCTOBER 5, 2023

ClinicalTrials.gov: NCT02517489 7 Clinical Question: In adult patients with severe community-acquired pneumonia admitted to the ICU, does early hydrocortisone treatment, compared to standard therapy, reduce mortality at 28 days? Admitted to participating ICUs with severe community-acquired pneumonia.

Critical Care 94

Critical Care ICU E-9-1-1 ALS 94

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. glargine 0.3

ICU 104

ICU ALS ED Emergency Department 104

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. RSI inherently carries with it risks of complications such as post-intubation hypotension and cardiac arrest in the most extreme cases. Range 5 to 9) Diff -0.2;

ED 98

ED ICU Emergency Department Overdose 98

The Skeptics' Guide to EM

MARCH 18, 2023

Case: A 5-year-old child presents to the emergency department in the midst of flu season with three days of fever, upper respiratory symptoms, and malaise. Marisu Rueda-Altez is a pediatric infectious disease fellow at Children’s National Hospital in Washington, DC.

ICU 101

ICU Emergency Department OR 101

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. The patient was upgraded to the ICU for closer monitoring. What do you think? ng/mL, BNP 2790, and lactate 3.7.

E-9-1-1 136

E-9-1-1 ACS Emergency Department Coronary 136

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. J Trauma Acute Care Surg. She is otherwise well, and her vitals are stable, but she is in some pain. J Trauma Acute Care Surg.

ICU 100

ICU ALS Emergency Department ED 100

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

EMDocs

SEPTEMBER 19, 2023

Propofol utilized for sedation; patient admitted to ICU for EEG monitoring. American College of Cardiology released a new consensus statement, “ Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee “.

STEMI 72

STEMI Coronary Emergency Department ICU 72

ACEP Now

MAY 9, 2024

It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergency department (ED). After developing encephalopathy and hypoxemic respiratory failure, the patient was transferred to the ICU. Comparative Effectiveness Review, No.

Emergency Department 52

Emergency Department ICU ALS ACS 52

EMDocs

JUNE 27, 2024

Left lower lung field end demonstrates expiratory wheezing on auscultation. Other lung fields unremarkable. smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 mg/kg, max 0.4 C or 100.4

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

Broome Docs

OCTOBER 31, 2022

Ketamine vs etomidate in ICU intubation ? Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial.

E-9-1-1 52

E-9-1-1 Defibrillator ICU Critical Care 52

EMDocs

MAY 25, 2023

Design: Multi-centered, double-blinded, randomized trial PICO: Population: Inclusion Criteria: Age 2 years and older Must have been treated with a specified minimum dose of certain benzodiazepines for generalized convulsive seizures: Intravenous or rectal diazepam 0.3 mg/kg or 10 mg Intravenous lorazepam 0.1 mg/kg or 4 mg Intravenous midazolam 0.2

Emergency Department 64

Emergency Department ICU OR ALS 64

Broome Docs

MARCH 28, 2024

Until we see more science, it seems very reasonable to provide honey, jam, or sucralfate (which wasn’t studied here), every 10 minutes while arranging for that emergent scope. Although I miss performing the procedure, these days I almost always leave the central line until the patient is stabilized and settled into their ICU bed.

E-9-1-1 107

E-9-1-1 ICU Emergency Department ALS 107

Emergency Medicine Ireland

MARCH 4, 2021

GBS is a clinically important diagnosis for both the emergency department and the ICU. GBS is a clinically important diagnosis for both the emergency department and the ICU. In the ICU the diagnosis is usually fairly easy as they come with a label of possible GBS in the referral.

Critical Care 40

Critical Care ICU Plasma Emergency Department 40

EMDocs

JUNE 7, 2023

Disposition is often admission to an intensive care unit (ICU) setting. She is speaking one word at a time and constantly coughing. She complains of dizziness, nausea, and abdominal cramps. On exam, you notice there is a garlic-like odor filling the room. Questions: What is the most likely causative xenobiotic that led to these findings?

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

The Skeptics' Guide to EM

NOVEMBER 16, 2019

Laura Melville ( @lmelville535 ) is an emergency physician in Brooklyn, New York, is a part of the New York ACEP Research Committee, ALL NYC EM, and is the NYP-Brooklyn Methodist Resident Research Director. Case: A 59-year-old woman comes is brought into your emergency department (ED) by EMS in cardiac arrest. What do you say?

ALS 100

ALS CPR ICU EMS 100

The Skeptics' Guide to EM

DECEMBER 16, 2017

Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. He is also a Faculty member of the Emergency Medicine and Acute Care Series 1986 to present. Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure. Reference: Legriel et al.

ALS 100

ALS ICU Emergency Department Paramedic 100