The Skeptics' Guide to EM

DECEMBER 8, 2017

A Prospective Randomized, Double-Dummy Trial Comparing Intravenous Push Dose of Low Dose Ketamine to Short Infusion of Low Dose Ketamine for Treatment of Moderate to Severe Pain in the Emergency Department. Guest Skeptic: Dr. Salim Rezaie is a faculty physician at Greater San Antonio Emergency Physicians (GSEP) in San Antonio, Texas.

Emergency Department 52

Emergency Department Fractures EMS 52

Pediatric EM Morsels

JULY 21, 2023

In emergency medicine, we often use illness scripts and protocols to help drive our decision-making. We had just received a young child from EMS who was post-ictal with decreased mentation. Interrater reliability of Glasgow Coma Scale scores in the emergency department. Ann Emerg Med. Less than 8, intubate!

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

RebelEM

FEBRUARY 21, 2024

A 2007 review of the literature concluded that there was no difference in analgesia between IM ketorolac and PO ibuprofen ( Arora 2007 ). Read More REBEL EM: The Ketorolac Analgesic Ceiling References Irizarry E et al. Can J Emerg Med 2007; 9(1): 30-2. Ann Emerg Med 1995;26:117-20.

Administration 63

Administration Emergency Department EMS Research 63

ACEP Now

AUGUST 1, 2023

How does that apply to the role of the board certified emergency physician? Fundamentally, I believe every patient coming to an emergency department is best served by care delivered by board certified emergency physicians. When those same fundamentals done right achieve great success, they aren’t little at all.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? An implementation science approach improves language access in the emergency department. Association of limited English proficiency and increased emergency department waiting room lengths of stay. Annals of Emergency Medicine.

Documentation/Coding 104

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 104

The Skeptics' Guide to EM

MAY 21, 2017

He is also the host of EMToxCast and gave a talk at the Association of Academic Chairs of Emergency Medicine Annual Retreat called: Can Social Media Save Emergency Medicine ? Case: A 45-year-old male arrives via emergency medical services (EMS) complaining that he wants to be discharged. Reference: Willman et al.

Emergency Department 52

Emergency Department Administration Academics EMS 52

RebelEM

AUGUST 28, 2023

A 2007 review of the literature concluded that there was no difference in analgesia between IM ketorolac and PO ibuprofen ( Arora 2007 ). Read More REBEL EM: The Ketorolac Analgesic Ceiling References Irizarry E et al. Can J Emerg Med 2007; 9(1): 30-2. Ann Emerg Med 1995;26:117-20.

Administration 52

Administration Emergency Department EMS Research 52

EMDocs

SEPTEMBER 25, 2023

Personal take: While discussing this approach with many EM physicians whom we respect, one recurring critique was “We fought so hard to get the right to use paralytics in the ED, why would you want to go backwards.” actors Associated with the Occurrence of Cardiac Arrest after Emergency Tracheal Intubation in the Emergency Department.

Emergency Department 92

Emergency Department Soft Tissue Injuries Airway Management Operations 92

EMDocs

MAY 26, 2023

Emerg Med Clin North Am. Structured team approach to the agitated patient in the emergency department. Emerg Med Australas. Use and avoidance of seclusion and restraint: consensus statement of the american association for emergency psychiatry project Beta seclusion and restraint workgroup. West J Emerg Med.

Pediatrics 98

Pediatrics Psychiatric Emergency Department Documentation/Coding 98

RebelEM

MARCH 9, 2023

However, evaluating and managing patients with acute alcohol intoxication in the emergency department can be challenging. Unsuspected Critical Illness Among Emergency Department Patients Presenting for Acute Alcohol Intoxication. Annals of Emergency Medicine. J Emerg Med. Ann Emerg Med. Lancet Neurol.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

EMDocs

JANUARY 29, 2024

Authors: Sameer Desai, MD (EM Attending Physician, University of Kentucky); Omar Abbas Ahmed Malik, MBBS (Patients’ Aid Foundation, Jinnah Postgraduate Medical Center) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine in St. 2007 Jul 18;2007(3):CD000277. 1998 Apr;50(4):876-83.

Stroke 99

Stroke Outcomes EMS Seizures 99

EMDocs

JANUARY 4, 2024

Case Follow-up: The patient required a dose of lorazepam in the emergency department. Ann Emerg Med. Epub 2007 Sep 4. Symptoms, including any vital sign abnormalities (especially tachycardia,) must be completely resolved before discharge/medical clearance. 2008 Apr;51(4):412-5, 415.e1. doi: 10.1016/j.annemergmed.2007.06.004.

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

Don't Forget the Bubbles

MAY 29, 2023

Workplace Incivility Among Nationally Certified EMS Professionals and Associations with Workforce-Reducing Factors and Organizational Culture, Prehospital Emergency Care. Bad manners in the Emergency Department: Incivility among doctors. Internet] 2007; 505:1181–1197. Journal of Interpersonal Violence [Internet].

Leadership 98

Leadership Patient Safety Academics Research 98

EMDocs

JUNE 16, 2023

And now we’re here at our destination, the place we know and love, the emergency room to talk about what we should be doing for the growing volume of children with mental health problems boarding in the emergency department. McEnany, Olutosin Ojugbele, Julie R. Doherty, Jennifer L. McLaren, JoAnna K. 10.1542/peds.2020-1174

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 52

Taming the SRU

MARCH 14, 2023

Case 1 Fussy 1 month old A 1-month-old (ex-34 week premature) infant comes to your emergency department for fussiness. Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity. More on this below as we work through a few cases…. J Neurosurg.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

RebelEM

JANUARY 23, 2023

Noninferiority trials, covered here on REBEL EM , are helpful when the experimental treatment offers a distinct advantage over the standard treatment. 2007 Jul-Aug;28(4):418-26. Multicenter study of emergency department visits for insect sting allergies. Patients were randomized in a 1:1 ratio. Allergy Asthma Proc.

Allergic Reactions 52

Allergic Reactions Anaphylaxis Emergency Department Urgent Care 52

ALiEM

MARCH 7, 2024

Facts and Literature Review Bladder volume estimation Measuring bladder volume via POCUS in pediatric patients has been studied, demonstrating a benefit on Emergency Department workflow and length of stay (Table 1). Point-of-care ultrasound for the detection of hydronephrosis in emergency department patients with suspected renal colic.

Ultrasounds 70

Ultrasounds Pediatrics Radiology Radiology 70

RebelEM

DECEMBER 1, 2022

Background: Pneumothorax management is a common clinical condition in the emergency department (ED) occurring in patients of varying ages and caused by multiple etiologies, including spontaneous, traumatic, and iatrogenic pneumothorax. Regardless of the cause, a thoracostomy is often required for treatment (Currie 2007 ).

Outcomes 52

Outcomes Hospitals Research Critical Access 52

Northwestern EM Blog

SEPTEMBER 12, 2022

In most events, hospitals have communication with EMS personnel that are on scene allowing them to have some sort of estimation of the scale of the event and type of disaster encountered. This can be gauged by the type of disaster encountered and with assistance from EMS personnel at the scene. EMS Mass Casualty Management.”

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Hazardous Materials 52

Northwestern EM Blog

JANUARY 24, 2022

And for most forms, EM physicians are not typically shocked by shock. Emergency Medicine Clinics of North America. 2007; 25: 309-331. Revised National Estimates of Emergency Department Visits for Sepsis in the United States. However, what happens when the trusted treatment paradigm fails? Arch Surgery. 5) Kerns W.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

EMDocs

FEBRUARY 12, 2024

Authors: Rachel Kelly, MD ( EM Resident Physician, Stony Brook University Hospital); Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Int J Emerg Med. Eur J Emerg Med. Emerg Med J. 140.11.1122.

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

EB Medicine

JUNE 6, 2019

Jeff: Abdominal pain is the one of most frequent complaint in US emergency departments, representing 8% of all adult ED visits, with admission rates for all patients with abdominal pain ranging between 18-42% and reaching as high as 60% for the elderly. Emerg Med Clin North Am. The max score is therefore 10. Abdom Imaging.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EMDocs

DECEMBER 16, 2023

We’ll keep it short, while you keep that EM brain sharp. A 34-year-old male is brought via EMS after collapsing during an outdoor adventure race. EMS reports the patient was conscious but altered, with slurred speech and confusion. An 18-month-old boy presents to the emergency department with loss of consciousness.

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

Dr. Smith's ECG Blog

APRIL 8, 2015

in 2010 EM Clinics of North America (full text link) For an Exhaustive Review of Syncope and its full management outside the ED environment, go to the 2009 European Society of Cardiology Guidelines (full text pdf). 2) Boston syncope rule: J Emerg Med. 2007 Oct; 33(3): 233–239.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

JULY 17, 2023

2007 Jan 21;13(3):432-7. He describes the pain as a gradually worsening pressure-like discomfort distributed across his entire abdomen. He reports distension and the sensation of fullness. These symptoms progressed to significant nausea and several bouts of vomiting shortly before arrival. World J Gastroenterol. doi: 10.3748/wjg.v13.i3.432.

Operations 98

Operations EMS Fluid Resuscitation Resuscitation 98

EMDocs

MAY 29, 2023

Authors: Rachel Kelly, MD (EM Resident Physician, Stony Brook University Hospital) and Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. 2007 Aug;12(4):353-7. J Emerg Med. Am J Clin Pathol. Hematology.

Infectious Diseases 58

Infectious Diseases Emergency Department EMS Hospitals 58

Don't Forget the Bubbles

SEPTEMBER 18, 2023

This blog post aims to help familiarise you with some of the most common reasons for prescribing antibiotics in the paediatric emergency department. Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review. Emerg Med J. 2007 Feb 1;24(2):128–9. Karageorgos, S.; Hibberd, O.;

Emergency Department 143

Emergency Department Infectious Diseases Pediatrics Sepsis 143

EB Medicine

DECEMBER 1, 2018

Jeff: Of note, EMS providers should use face masks themselves and place them on patients as well. Jeff: Alright, so now that the EMS crew, wearing proper PPE of course, has delivered the patient, who is also wearing a mask, to the ED, we can begin our ED H&P. In 2007-2008, an oseltamivir-resistant H1N1 strain emerged globally.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

RebelEM

FEBRUARY 3, 2025

Training Set= 15641 Internal Validation Set=1738 Test Set N=1318 Clinical Validation Set ECGs from patients with chest pain who visited the emergency department of Severance Hospital in 2020, regardless of percutaneous coronary intervention. (N=2699) 5991 ECGs with Normal annotation and 79 STEMI ECGs.

EKG/ECG 87

EKG/ECG Emergency Department Outcomes Hospitals 87

EMDocs

JANUARY 20, 2025

Further #FOAMed: POCUS for Assessing Volume Responsiveness – Core Ultrasound Volume Assessment Using POCUS in the Emergency Department References McGee S, Abernathy WB 3rd, Simel DL. Does this dyspneic patient in the emergency department have congestive heart failure? Ann Emerg Med. Emerg Med J.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75