The Skeptics' Guide to EM

APRIL 16, 2022

Case: A 55-year-old man comes into the emergency department (ED) for increasing knee pain and decrease in function. Background: Musculoskeletal complaints are one of the most common presentations to emergency departments. JAMA Feb 2009 looked at the ACC/AHA guidelines from 1984 to 2008. Tricoci et al.

Military 40

Military Operations Emergency Department Pediatrics 40

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

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 Hospitals Pediatrics 52

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Published 2009 Jun 10. Ann Emerg Med. 2009;338:b2085.

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation CPR EMS 84

Taming the SRU

NOVEMBER 14, 2023

Chief complaints involving the ear are a common occurrence in Emergency Departments across the US and include presenting symptoms such as ear pain or fullness, hearing loss, redness, trauma, vertigo, and foreign bodies. A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011 identified 8.6

Emergency Department 91

Emergency Department Pediatrics Wellness Documentation/Coding 91

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Primary outcome There was no significant difference in the primary outcome, death before discharge home by 90 days between groups (14.0%

Sepsis 52

Sepsis Shock Administration Resuscitation 52

The Skeptics' Guide to EM

FEBRUARY 10, 2018

Tessa Davis is a Pediatrician specialising in Pediatric Emergency Medicine and currently practicing in a central London hospital. Case: Tom is a 4-year-old boy who comes into the emergency department with a wheeze following a viral illness. Meredith is also the director of a tertiary hospital paediatric emergency department.

Emergency Department 40

Emergency Department Pediatrics Sepsis Hospitals 40

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Basilar artery occlusion remains a challenging diagnosis to make, and the delays in reaching the diagnosis can have considerable impact on health outcomes. NIHSS does have limitations when applied to posterior circulation (PC) strokes.

EMS 74

EMS Stroke Outcomes Hospitals 74

The Skeptics' Guide to EM

DECEMBER 5, 2020

Case: A 50-year-old female presents to your community emergency department in the middle of the night with new-onset constant but mild vertigo and nausea. As an alternative diagnostic method, the HINTS exam was first established in 2009 to better differentiate central from peripheral causes of AVS [4].

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

Taming the SRU

OCTOBER 23, 2023

THE CASE A female in her early 20s, G4P2012, presents to the emergency department (ED) with a 5 day history of left lower quadrant abdominal pain which has been worsening since onset. Discrimination between an IUP and an interstitial pregnancy is critical as interstitial pregnancies can have devastating outcomes. O'Brien, E.

Ultrasounds 96

Ultrasounds Operations Radiology Radiology 96

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. This is a critical error that leads to poorer outcomes for patients in need of critical care.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. Pediatric Endotracheal Intubations for Airway Management in the Emergency Department.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

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. Outcomes: Primary Outcome: Pulmonary expansion 24 hours after the procedure. Secondary Outcomes: Pulmonary expansion 7 days after the procedure.

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Outcomes Hospitals Research Emergency Department 100

Pediatric EM Morsels

MAY 24, 2024

In 2009, more than 9,000 children died from accidental injuries. Ann Emerg Med. PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study. Low Risk Inta-Adbominal Trauma: Pediatric Trauma is Dangerous!

Pediatrics 161

Pediatrics Blood Transfusions EMS Fractures 161

Dr. Smith's ECG Blog

JULY 18, 2014

such Q-waves are associated with larger MI and worse outcomes (2. Apr 28, 2009. Emergency department two-dimensional echocardiography in the diagnosis of nontraumatic cardiac rupture. Ann Emerg Med 1994; 23(6):1333-42. Very unlikely. Raitt et al.), Armstrong et al.), J Am Coll Cardiol 53(17):1503-9. Brunette D.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

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 122

Ultrasounds Outcomes COPD Hospitals 122

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

PEMBlog

MAY 11, 2023

There is inconclusive evidence that it’s better than placebo for IVs too – it may help… ( see Auerbach, 2009 ). Acad Emerg Med, 2017 This was a single-center (one academic Pediatric Emergency Department) randomized double-blind trial of J-Tip versus EMLA – topical anesthetic (TA) cream for pain relief in 66 infant LPs.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Outcomes 52

ACEP Now

OCTOBER 15, 2023

In 2009, a consensus statement from the American Diabetes Association (ADA) discussed using a low-dose infusion (0.1 1 Additionally, the consensus statement discussed the emerging use of subcutaneous insulin to treat DKA. However, as with many treatments, there has been substantial de-escalation in intensity of therapy over time.

Hospitals 104

Hospitals Emergency Department Operations Research 104

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. A 2009 randomized control trial conducted in French ICUs supported the use of ketamine in this patient population [5].

Sepsis 42

Sepsis Shock Emergency Department Outcomes 42

EMDocs

DECEMBER 16, 2023

An 18-month-old boy presents to the emergency department with loss of consciousness. Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. The American Journal of Emergency Medicine., Emerg Med Pract.

Hyperthermia / Hypothermia 68

Hyperthermia / Hypothermia EMS Stroke Seizures 68

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.

Outcomes 52

Outcomes Emergency Department Sepsis Hospitals 52

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. 2009; 197:211-215.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

EMDocs

JUNE 3, 2023

Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality. Management and outcomes of open pelvic fractures: An update. link] Published November 11, 2009. Her initial vital signs are blood pressure 76/54 mmHg, heart rate 128 bpm, temperature 37.0˚

Fractures 54

Fractures Resuscitation Operations EMS 54

Pediatric Emergency Playbook

APRIL 1, 2016

used BNP in the emergency department to differentiate heart failure from respiratory causes in infants and children with heart failure and those with no past medical history. We could use it to track treatment , and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

The Skeptics' Guide to EM

SEPTEMBER 15, 2018

Intervention: Malpractice claims involving trainees (residents) in an emergency department setting over a three-year period from 2009-2012. Outcomes: Coded information covering a number of domains. Comparison: Malpractice claims not involving trainees in the same time period.

Documentation/Coding 40

Documentation/Coding Teamwork Hospitals Emergency Department 40

Dr. Smith's ECG Blog

APRIL 8, 2015

Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. These premonitory symptoms were negative predictors of adverse outcomes in EGSYS. 2) Boston syncope rule: J Emerg Med. Arch Intern Med 2009 Jul 27; 169:1262. Arch Intern Med 2009 Jul 27; 169:1305.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. 2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al.

Stroke 87

Stroke Radiology Radiology Emergency Department 87

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 96

Infectious Diseases Administration Sepsis Anaphylaxis 96

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. Vital signs show T of 99.0°F J Neurosurg. doi:10.3171/jns.2006.105.2.264

EMS 74

EMS Fluid Resuscitation Shock EKG/ECG 74

EMDocs

DECEMBER 18, 2023

8 Based on multiple randomized controlled trials (RCTs), SSC 2021 guidelines suggest against using procalcitonin as a screening method to guide initiation of antibiotic therapy, as no difference in clinical outcomes was appreciated. 36 However, the literature has failed to prove that the double coverage has any effect on clinical outcomes.

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Sepsis Fluid Resuscitation Shock Resuscitation 65