The Skeptics' Guide to EM

MARCH 6, 2021

Background: Epistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% ( Gifford 2008 , Pallin 2005 ). You administer phenylephrine topically, reapply pressure and, consider the use of tranexamic acid (TXA).

EMS 52

EMS Emergency Department Outcomes 52

Dr. Smith's ECG Blog

APRIL 17, 2023

Full case details and outcomes are below. The remainder of his Emergency Department stay was uneventful. Here is the clinical informaton on ECG 2: A man in his 50s presented to the Emergency Department with acute chest pain that started within the past few hours. Case 1: Case 2: Case 1: What do you think?

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Psychiatric 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…. Lancet Neurol.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

ACEP Now

MAY 3, 2023

is a bit like emergency medicine, she says: “Every day is different with a different set of circumstances and range of problems to be solved.” When she took the role in 2008, it was a newly created job tasked with expanding AARP’s approach to making health products and services available to its members from third party companies.

EMS 52

EMS Outcomes Emergency Department Hospitals 52

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Case: 64-year-old male presents to your emergency department with worsening abdominal pain, nausea, vomiting and anorexia for the past week. Over the course of his emergency department stay he has escalating vasopressor requirements. He writes an excellent blog called EM Nerd , which he describes as nihilistic ramblings.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

Northwestern EM Blog

JANUARY 2, 2023

While this may be surprising, there is literature that shows that catastrophic events can be associated with increased social support and reduce suicidal outcomes [4]. A pediatric emergency department in Texas looked at the resulted of their routine suicide risk screenings for patients aged 11-21. 2008 Dec;23(12):1231-8.

Emergency Department 52

Emergency Department Research CDC Pediatrics 52

Sensible Medicine

SEPTEMBER 29, 2023

For example, a model that assesses patients presenting to an emergency department with suspected acute coronary syndrome (ACS) was designed so that patients with ACS wrongly labelled as “low risk” and sent home would be just 1% (false negatives) [8]. 2008 Feb;117(6):743-53. Circulation. Resuscitation.

Research 55

Research Hospitals Academics Emergency Department 55

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Details cannot be shared here, but suffice it to say that inability to recognize acute occlusive myocardial infarction in the presence of ventricular paced rhythm contributed to a poor outcome. The Smith-Modified Sgarbossa Criteria Accurately Diagnose Acute Coronary Occlusion in Emergency Department Patients With Ventricular Paced Rhythm.

EKG/ECG 52

EKG/ECG Emergency Department Research Outcomes 52

Sensible Medicine

SEPTEMBER 29, 2023

For example, a model that assesses patients presenting to an emergency department with suspected acute coronary syndrome (ACS) was designed so that patients with ACS wrongly labelled as “low risk” and sent home would be just 1% (false negatives) [8]. 2008 Feb;117(6):743-53. Circulation. Resuscitation.

Research 40

Research Hospitals Academics Emergency Department 40

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. Ann Emerg Med. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

EMDocs

OCTOBER 30, 2023

Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. Increased Computed Tomography Utilization in the Emergency Department and Its Association with Hospital Admission.

Radiology 84

Radiology Radiology Emergency Department Hospitals 84

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. 7-9 The PE model then aims to sell acquired businesses for a profit within three to six years.

Hospitals 113

Hospitals Radiology Radiology Administration 113

EB Medicine

MAY 3, 2019

This month, we’re moving into uncharted territories for the podcast… we’re talking psychiatry Nachi: Specifically, we’ll be discussing Depressed and Suicidal Patients in the emergency department. The strongest predictor for suicide-related outcomes is history of prior suicidal ideation or suicide attempt. Pretty big numbers.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

Taming the SRU

JANUARY 29, 2024

She was concerned that this was not improving and decided to come to the emergency department (ED). Hospital Course The patient was initiated on a therapeutic heparin drip in the emergency department with vascular surgery consultation. 2008 Aug;6(8):1262-6. Epub 2008 May 15. Vasc Endovascular Surg.

Emergency Department 93

Emergency Department Fractures Hospitals Operations 93

EMDocs

JANUARY 29, 2024

Introduction: Neurologic emergencies are common in the Emergency Department (ED), and blood pressure management is critical to immediate management. Poor blood pressure management can worsen the outcome of hemorrhagic stroke by increasing the risk of hematoma expansion, cerebral edema, and ischemia [8-14]. PMID: 11988609.

Stroke 83

Stroke Outcomes EMS Seizures 83

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. Stuckey, T., Zimetbaum, P.

EKG/ECG 134

EKG/ECG Documentation/Coding Wellness Emergency Department 134

Pediatric Emergency Playbook

AUGUST 1, 2017

One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain. Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. J Med Genet 2008; 45:1.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

EMDocs

MAY 11, 2024

Available from: [link] American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Use of Intravenous tPA for Ischemic Stroke:; Brown MD, Burton JH, Nazarian DJ, Promes SB. Ann Emerg Med. Erratum in: Ann Emerg Med. 2015 Sep;66(3):322-333.e31. doi: 10.1016/j.annemergmed.2015.06.031. 2015.06.031.

Stroke 101

Stroke EMS EKG/ECG Radiology 101

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. From the 80’s to 2008, the worldwide prevalence of obesity nearly doubled! I hope everybody enjoyed a fantastic conference. million adults!!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

JANUARY 4, 2024

Whole bowel irrigation: 3 Not routinely performed and limited evidence to support improved outcome in general. Case Follow-up: The patient required a dose of lorazepam in the emergency department. Ann Emerg Med. 2008 Apr;51(4):412-5, 415.e1. World J Emerg Med. doi: 10.1016/j.annemergmed.2007.06.004.

Seizures 77

Seizures EKG/ECG Poisoning Shock 77

ACEP Now

AUGUST 1, 2023

In November 2022, the American College of Emergency Physicians sent a letter to President Biden on behalf of 34 organizations, asking to convene stakeholders to identify solutions to address the emergency department (ED) boarding crisis.1 ED crowding and boarding are causing patient experiences and outcomes to worsen.

Military 98

Military Hospitals Emergency Department Leadership 98

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. Notably, up to 40% of patients with native vertebral osteomyelitis had a normal WBC [33-34]. ng/mL, 0.25-0.5

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

PHEM Cast

MARCH 3, 2019

Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial. Emergency Medicine Journal. Emerg Med J. Ketamine for paediatric sedation/analgesia in the emergency department. Emerg Med J.

Emergency Department 52

Emergency Department Head Injuries Pediatrics Hospitals 52

The Skeptics' Guide to EM

APRIL 3, 2021

Stroke 2021 Case: A 74-year-old man presents to the emergency department after waking up with left sided weakness. Of the 13, eleven failed to show benefit for their primary outcome and four were stopped early due to harm or futility. Only two RCTs claimed benefit for their primary outcome. MRI-guided thrombolysis (0.6

Stroke 52

Stroke Research Outcomes Hospitals 52

EB Medicine

FEBRUARY 1, 2019

This month, we’re tackling an incredibly important topic - evaluation and management of life threatening headaches in the Emergency Department. Nachi: Unfortunately, the 2008 ACEP guideline and 2012 AHA guidelines still recommend a lumbar puncture in those being worked up for SAH. Tylenol should be offered for pain management.

Emergency Department 40

Emergency Department Stroke Outcomes Ultrasounds 40

RebelEM

MAY 15, 2024

Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department.

Infectious Diseases 86

Infectious Diseases Administration Sepsis Anaphylaxis 86

EMDocs

JANUARY 20, 2024

Takotsubo syndrome is often exceedingly difficult to distinguish from acute myocardial infarction in the emergency department, as there is significant overlap in many clinical and diagnostic features. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. 2008 Mar;155(3):408-17. Vital signs show T of 99.0°F

EMS 85

EMS Fluid Resuscitation Shock EKG/ECG 85

EMDocs

NOVEMBER 4, 2024

A comprehensive, patient-centered approach to pain management ensures effective treatment across these diverse pain syndromes, ultimately improving patient outcomes. Am J Emerg Med. The Treatment of Acute Pain in the Emergency Department: A White Paper Position Statement Prepared for the American Academy of Emergency Medicine.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

EMDocs

JANUARY 20, 2025

13 While there is good data that early antibiotics for patients in septic shock reduce mortality 18-19 the role of early and aggressive volume resuscitation and its impacts on patient-centered outcomes remain unclear. Volume status Assessing volume status, especially in critically ill patients, can be challenging. Inwald et al.

Dehydration 69

Dehydration Fluid Resuscitation Sepsis Resuscitation 69