The Skeptics' Guide to EM

JULY 8, 2023

Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at Staten Island University Hospital. Managing editor of EM:RAP and Associate Editor at REBEL EM. first appeared on The Skeptics Guide to Emergency Medicine. Managing editor of EM:RAP and Associate Editor at REBEL EM.

CDC 108

CDC Hospitals EMS Emergency Department 108

RebelEM

MARCH 27, 2023

Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients. Paper: Owyang CG, et al. J Crit Care. Crit Care Explor. Crit Care Med. Am J Respir Crit Care Med.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

EMDocs

SEPTEMBER 7, 2023

2 Laboratory assays for DEG are not widely available and have long turn-around-times, thus have limited utility in diagnosis in the emergency department. Fatal Poisoning Among Young Children from Diethylene Glycol-Contaminated Acetaminophen — Nigeria, 2008—2009”. 6, 8 July 2009, pp. References: Abubukar et al.

Poisoning 92

Poisoning CDC Administration Emergency Department 92

Taming the SRU

APRIL 14, 2024

This revealed that ultrasound can improve the ability to reduce an incarcerated inguinal hernia and may decrease the rate of emergency surgery. (1) 1) Table 1 - Study Protocol Table 2 - Results Conclusion Hernias are often encountered in the emergency department as an acute or non-acute finding. 4, 1 July 2009, p.

Ultrasounds 93

Ultrasounds Emergency Department Pediatrics Radiology 93

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. N Engl J Med.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

RebelEM

APRIL 29, 2024

World J Emerg Surg 2023 PMID: 36918947 3. Intraosseous vascular access in adults using the EZ-IO in an emergency department. Int J Emerg Med 2009 PMID: 20157465 4. Am J Emerg Med PMID: 19041528 5. Intraosseous versus central venous catheter utilization and performance during inpatient medical emergencies.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

RebelEM

AUGUST 30, 2023

Imaging Gadolinium enhanced MRI – modality of choice, highly sensitive and specific ( Mylona 2009 ). Evaluation and Treatment of Acute Back Pain in the Emergency Department. Orthopedic Emergencies 2015 May; 33(2) 311-26. 2009 Aug; 39(1):10-7. Simon’s Emergency Orthopedics. PMID: 25892724 Gouliouris T, et al.

Infectious Diseases 100

Infectious Diseases Fractures Radiology Radiology 100

ACEP Now

SEPTEMBER 5, 2024

Our state chapter members and leaders are uniquely positioned to follow EMRA’s lead in partnering with local EM residency programs to improve communication of ACEP’s value to EM-bound medical students and EM residents by hosting residency visits or local events relevant to our shared mission.

Leadership 98

Leadership PPE EMS Wellness 98

EMDocs

MAY 26, 2023

Emerg Med Clin North Am. 2009 Nov;27(4):655-67, ix. Emerg Med Clin North Am. 2009 Nov;27(4):655-67, ix. Structured team approach to the agitated patient in the emergency department. Emerg Med Australas. 2009 Jun;21(3):196-202. Deaths due to physical restraint. Dtsch Arztebl Int. PMC3272587.

Pediatrics 98

Pediatrics Psychiatric Emergency Department Documentation/Coding 98

RebelEM

JUNE 5, 2023

One study from a county in Massachusetts found that of all nonfatal opioid doses seen in the emergency department from 2011-2015, 1 in 20 patients subsequently died within one year of initial visit with 66% of these deaths being directly related to an opioid overdose (4). Drug Alcohol Depend 2009; 104:73. PMID 33392580.

Emergency Department 97

Emergency Department Hospitals Outcomes EMS 97

RebelEM

MARCH 8, 2023

Emergency Department Management: Emergency ophthalmology consultation. Emergency surgical management indicated if concomitant retinal tear, vitreous hemorrhage, or retinal detachment. Symptom characteristics ( Hollands 2009 ) Any flashers/floaters: (+) LR 1.2 and (–) LR 0.9. >10 floaters, (+) LR 8.1-36

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

EMDocs

JULY 9, 2024

The emergency department takes care of some of the highest risk patients with the worst access to health care and social services Over the past 20 years, many researchers have created and validated social needs screeners Some examples: iHELP, WE CARE, SEEK, USDA 2-item food insecurity questionnaire Does screening make a difference?

Pediatrics 74

Pediatrics Emergency Department Research Burns 74

RebelEM

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. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

RebelEM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Recruitment from only emergency departments may not represent the broader clinical context.

Outcomes 104

Outcomes Hospitals Research Emergency Department 104

RebelEM

FEBRUARY 22, 2023

difficult to see due to corneal edema) Emergency Department Management All patients should get emergency ophthalmologic consultation Start with eye drops (see table below) and add systemic medications if severe or refractory symptoms/IOP. Decreased visual acuity, Cup to disc ratio >0.6 Cup to disc ratio >0.6

Emergency Department 52

Emergency Department EMS Wellness 52

The Skeptics' Guide to EM

JULY 9, 2022

Great emergency care takes a team from the prehospital setting, emergency department, inpatient and outpatient all working together. They published their findings in Annals of EM 2009. While this is true, we are part of the team that diagnose and treat acute stroke patients. Any brief comments on this reanalysis?

Stroke 52

Stroke Emergency Department EMS Outcomes 52

EM Curious

JULY 24, 2015

EMS appears with a patient who just wiped out big time on the ice. A Comparison of Ultrasound-guided Three-in-one Femoral Nerve Block Versus Parenteral Opioids Alone for Analgesia in Emergency Department Patients With Hip Fractures: A Randomized Controlled Trial. Academic Emergency Medicine, 20(6), 584–591. doi:10.1111/j.1742-6723.2009.01163.xdoi:10.1097/PEC.0000000000000101

Fractures 52

Fractures Ultrasounds Emergency Department Dislocations 52

ACEP Now

FEBRUARY 11, 2024

A 95-year-old female with a history of stage III chronic kidney disease (CKD), heart failure with reduced ejection fraction (HFrEF), and dementia with baseline orientation only to person and place, presented to the emergency department (ED) for upper extremity myoclonic jerking for one day. References Tyring S, Douglas J, Corey L.

Emergency Department 52

Emergency Department CDC Hospitals EMS 52

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. Academy of Management Learning & Education [Internet] 2009: 8:2:301–303. Emergency Medical Journal [Internet] 2022;39;52-56. PLoS ONE [Internet].

Leadership 98

Leadership Patient Safety Academics Research 98

ALiEM

MAY 13, 2024

Case Introduction: Child with abdominal pain Wendy is a 7-year-old girl who comes into the emergency department with redness, swelling, and pain on her left calf. Point-of-Care Ultrasound on Management of Cellulitis Versus Local Angioedema in the Pediatric Emergency Department. Pediatr Emerg Care. J Emerg Med.

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

ACEP Now

MAY 6, 2023

Case A 35-year-old male is brought to the emergency department (ED) following a single-motor-vehicle collision in which two people were ejected and pronounced dead at the scene. EMS reports starring and significant damage to the windshield and show you a picture (Figure 1). Sudbury, Massachusetts: Jones and Bartlett; 2009.

Forensics 52

Forensics Documentation/Coding Head Injuries Fractures 52

Dr. Smith's ECG Blog

JULY 7, 2013

He had walked into the ED (did not use EMS). Apr 28, 2009. Emergency department two-dimensional echocardiography in the diagnosis of nontraumatic cardiac rupture. Ann Emerg Med 1994;23(6):1333-42. A man in his 60's presented after 4 days of chest pain, with some increase of pain on the day of presentation.

Ultrasounds 52

Ultrasounds EKG/ECG Emergency Department Shock 52

The Skeptics' Guide to EM

DECEMBER 5, 2020

John’s Riverside Hospital Emergency Medicine Residency in Yonkers, New York. She is the New York ACEP liaison for the Research and Education Committee and is a past ALL NYC EM Resident Education Fellow. She has nystagmus but no other physical exam findings. But what is the HINTS exam?

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

Dr. Smith's ECG Blog

JULY 18, 2014

He had walked into the ED (did not use EMS). Apr 28, 2009. Emergency department two-dimensional echocardiography in the diagnosis of nontraumatic cardiac rupture. Ann Emerg Med 1994; 23(6):1333-42. A man in his 60's presented after 4 days of chest pain, with some increase of pain on the day of presentation.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

ACEP Now

APRIL 5, 2024

2 TTP often presents abruptly, and most patients that develop it first visit the emergency department (ED) as their symptoms worsen. It is thus imperative that emergency physicians be able to recognize and properly treat this disease, especially in the absence of its classical presentation. Am J Emerg Med. J Emerg Med.

Domestic Violence 40

Domestic Violence Emergency Department Outcomes EKG/ECG 40

EM Guide Wire

MAY 19, 2019

2009; 125 (1): 60-66. Teeuw AH, Hoytema van Konijnenburg EM, Sieswerda-Hoogendoorn T, et al. Parents’ Opinions About a Routine Head-to-Toe Examination of Children as a Screening Instrument for Child Abuse and Neglect in Children Visiting the Emergency Department. Journal of Emergency Nursing. PEDIATRICS.

Pediatrics 40

Pediatrics Soft Tissue Injuries Fractures Emergency Nursing 40

RebelEM

NOVEMBER 3, 2022

Albert 2011, Jabre 2009) However, the existing literature comparing etomidate and ketamine is conflicting. Inclusion: Articles compared the safety and efficacy of etomidate compared to k etamine, in patients of all age groups, as induction agents for RSI in the Emergency Department (ED) and prehospital settings.

Emergency Department 52

Emergency Department Outcomes Sepsis Operations 52

Taming the SRU

OCTOBER 7, 2024

epidemiology of venous thromboembolism in pregnancy VTE is not only important to understand because it is the number one cause of mortality for pregnant patients, but also because it is common and will show up in your Emergency Department likely frequently throughout your career. original drawing by dr zinter. references Mulhotra, A.

Ultrasounds 64

Ultrasounds CDC Research Stroke 64

EMDocs

OCTOBER 7, 2023

We’ll keep it short, while you keep that EM brain sharp. A 17-year-old girl, in moderate distress, is brought in by EMS after a motor vehicle collision. EMS reports that she was “pinned” underneath the dashboard, and it took several hours to extricate her. Published June 2009. He has no medical problems. Critical Care.

EMS 97

EMS Fluid Resuscitation Fractures Resuscitation 97

EMDocs

JANUARY 20, 2024

We’ll keep it short, while you keep that EM brain sharp. 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. Vital signs show T of 99.0°F 2010;55(22):2514-2516. J Neurosurg.

EMS 101

EMS Fluid Resuscitation Shock EKG/ECG 101

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). Yield of Diagnostic Tests in Evaluating Syncopal Episodes in Older Patients Arch Intern Med 2009 Jul 27; 169:1299-1305.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

DECEMBER 18, 2023

Today, she would not get out of bed, prompting the facility to call EMS. 1 The rationale for the shift away from normal saline in 2021 derived from multiple trials, including the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) and Saline Against Lactated Ringer’s or Plasma-Lyte in the Emergency Department (SALT ED).

Sepsis 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

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. Epub 2011 Apr 22 Coyne CJ, Le V, Brennan JJ, Castillo EM, Shatsky RA, Ferran K, Brodine S, Vilke GM. Ann Emerg Med. Support Care Cancer.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

Dr. Smith's ECG Blog

JUNE 8, 2023

Written by Jesse McLaren A 75 year old with a history of CABG called EMS after 24 hours of chest pain. STEMI negative : the EMS automated interpretation read, “STEMI negative. Cardiology documented “late presentation STEMI but likely aborted given resolution of ST changes from EMS to hospital.” Eur Heart J 2009 4 Lemkes et al.

EKG/ECG 86

EKG/ECG Documentation/Coding EMS Emergency Department 86

EMDocs

JUNE 3, 2023

What is the EM physician’s role in the stabilization of unstable pelvic injuries? If a pelvic binder was placed by EMS, inquire whether this was placed empirically or if mechanical pelvic instability was already elicited. Her initial vital signs are blood pressure 76/54 mmHg, heart rate 128 bpm, temperature 37.0˚ J Clin Orthop Trauma.

Fractures 64

Fractures Resuscitation Operations EMS 64

ACEP Now

APRIL 5, 2024

In 2009, the Excited Delirium Task Force convened by an ACEP Council resolution authored a white paper that endorsed the existence of excited delirium syndrome and made recommendations for identifying and managing it clinically. 8,9 According to Dr. In a comprehensive review of the history of this term, Bhatia, et al. No,” Dr.

Forensics 49

Forensics Psychiatric Burns Hospitals 49