The Skeptics' Guide to EM

JULY 29, 2023

Another core element of emergency department (ED) and pre-hospital care is the assessment for potential spinal injuries [1,2]. This has evolved due to recognition of some of the adverse effects of immobilization as well as limitations to its benefits. We have also covered concussions ( SGEM#112 , SGEM#331 , and SGEM#362 ).

Head Injuries 81

Head Injuries EMS Research Emergency Department 81

The Skeptics' Guide to EM

JULY 8, 2023

Case: A 57-year-old woman with hypertension, hyperlipidemia and type-2 diabetes mellitus presents to the emergency department (ED) with fever, cough, myalgias, headache and congestion. Managing editor of EM:RAP and Associate Editor at REBEL EM. It’s flu season and you’ve already seen 15 people with the same symptoms.

CDC 97

CDC Hospitals EMS Emergency Department 97

EMDocs

SEPTEMBER 7, 2023

DGA concentrates in the kidney tissue and causes nephrotoxicity, as well as neurotoxicity. Elimination half-life data is not well established but increases in larger overdoses and as renal injury begins to occur. Fatal Poisoning Among Young Children from Diethylene Glycol-Contaminated Acetaminophen — Nigeria, 2008—2009”.

Poisoning 66

Poisoning CDC Administration Emergency Department 66

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. They may be well-circumscribed or may have irregular borders. Well-circumscribed abscess with heterogeneous debris C. Adams et al., Sivitz et al.,

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

PEMBlog

OCTOBER 18, 2023

The night prior to presentation, mom noticed he was not feeding as well and seemed fussy. Initially in the emergency department he was generally well-appearing with normal vital signs. Infants with NTED generally remain well-appearing and do not meet toxic shock syndrome (TSS) criteria. No medication exposures.

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

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

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. World J Emerg Surg 2023 PMID: 36918947 3. Int J Emerg Med 2009 PMID: 20157465 4.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

ACEP Now

SEPTEMBER 5, 2024

Creation of an accurate database of emergency physicians living and working within a state, as well as a network of each states’ EM groups and ED medical directors would help chapter leaders disseminate relevant information, strengthen advocacy efforts, and plan regional solutions summits to focus on unique challenges.

Leadership 52

Leadership PPE EMS Wellness 52

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

The Skeptics' Guide to EM

MARCH 7, 2020

Patey’s Disclaimer: I am not an expert on PPE (Personal Protective Equipment), Influenza/HINI/Coronavirus, Journal Reviews or Emergency Department management of pandemics. Patey and I) are experts on asking questions on the frontline of a Rural Emergency Department to ensure quality, and most importantly, effective patient care.

Emergency Nursing 40

Emergency Nursing PPE Emergency Department Administration 40

The Skeptics' Guide to EM

OCTOBER 7, 2017

Steve is currently an Assistant Professor in the Department of Family Medicine at Western University working at the Fowler Clinic and the Roth McFarlane Hand and Upper Limb Centre. Case: A 43-year-old male presents to your local rural emergency department Monday morning after rolling his ankle during his usual weekend pickup basketball game.

Urgent Care 40

Urgent Care Emergency Department Fractures Wellness 40

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

The Skeptics' Guide to EM

MAY 12, 2018

Case: A 24-year-old male is brought into the emergency department by police. He is brought to the emergency department extremely agitated and despite being held down by two police and three security guards he is still trying to bite the staff.

Psychiatric 52

Psychiatric Emergency Department Hospitals Wellness 52

Dr. Smith's ECG Blog

JUNE 8, 2023

There were trends toward larger infarct size with delayed angiography, both by cMR and integral high-sensitivity troponin concentration, as well as toward higher rate of major adverse cardiovascular events (MACE) (8.5 Eur Heart J 2009 4 Lemkes et al. vs. 2.9%; P  = 0.28) in the delayed group. Kontos et al. Welsh et al. Busk et al.

EKG/ECG 62

EKG/ECG Documentation/Coding EMS Emergency Department 62

Taming the SRU

JANUARY 1, 2024

For laboratory testing, it is important to be aware that not all values obtained via an intraosseous line correlate well with peripheral venous samples (11). Additional Resources Please see a previous Taming the SRU post for extra tips and trouble-shooting tricks, as well as a video demonstration for IO access. Ann Emerg Med.

Emergency Department 90

Emergency Department Ultrasounds Administration Burns 90

EM Curious

JULY 24, 2015

Identify the triangle shaped femoral nerve, lateral to the femoral artery, as well as the iliopsoas muscle and the fascia illiaca running over its surface. Get your tip as close as possible to the nerve, and under the fascia illiaca, then inject (well, after aspirating first, of course). Academic Emergency Medicine, 20(6), 584–591.

Fractures 52

Fractures Ultrasounds Emergency Department Dislocations 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2022

Written by Bobby Nicholson MD, with edits by Meyers A woman in her 50s with past medical history of heart failure, prior stroke, atrial fibrillation on Eliquis, lung cancer in remission, and CKD, presented to the emergency department for evaluation of cough and shortness of breath. Epub 2009 Sep 29. What do you think?

EKG/ECG 52

EKG/ECG Stroke Emergency Department Wellness 52

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. There were similar baseline characteristics and the groups were well-matched. N Engl J Med. 2023;388(6):499-510. 2021, Jarczak, Kluge et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

All went well. Holbrook MD September 01, 2013 Umbilical Cord Prolapse and Other Cord Emergencies Marybeth Lore, MD Complications of Labor and Delivery by Jeanie Ward Pulmonary Embolism: Evaluation in the pregnant patient. 2014) Emergency Care Institute, New South Wales. Postpartum Emergencies. Stafford, I.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Don't Forget the Bubbles

MARCH 19, 2024

Becasue paediatric emergency departments are accessible out-of-hours they become the de facto place of safety with access to immediate support. Just 20% of a person’s health and general well-being is related to access to care and the quality of services. More ACEs can lead to increased rates of common childhood illnesses.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

Pediatric Emergency Playbook

JANUARY 1, 2017

Further, children participate in and absorb their family’s culture and specific personality from a very young age ( Finley 2009 ). Tachycardia, tachypnea, and a change in behavior can be indicators not only to the presence of pain, but possibly to its etiology as well. Knowing the context of the episode may help.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

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 Documentation/Coding Academics 52

Dr. Smith's ECG Blog

JULY 18, 2014

the presence of such well developed, wide, anterior Q-wave suggests completed transmural STEMI. 2) premature, gradual reversal of inverted T waves to positive (upright) deflections by 48 to 72 hours after MI onset in the presence of well formed Q-waves. Apr 28, 2009. Ann Emerg Med 1994; 23(6):1333-42. Raitt et al.),

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

Taming the SRU

DECEMBER 11, 2023

1,2] Patients at risk for suicide often interact with emergency medical care. Suicide-related behavior (SRB) accounts for 1% of all Emergency Department (ED) visits; additionally, greater than 8% of patients visiting emergency departments are likely experiencing suicidal ideation at the time of the encounter.[3-5]

Psychiatric 95

Psychiatric EMS Emergency Department Poisoning 95

Don't Forget the Bubbles

JULY 22, 2024

The most recent meta-analysis , published in 2016 (comparing eleven studies from 1986 to 2009), struggled to reach a consensus because the trials were too heterogeneous to make robust conclusions. Annals of Emergency Medicine. 2009 Jan 22;360(4):329–38. So, an up-to-date, high-quality meta-analysis iss much needed. N Engl J Med.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

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

EB Medicine

DECEMBER 1, 2018

Jeff: In fact, a meta-analysis on vaccine effectiveness from 2004-2015 found that the pooled effectiveness against influenza B was 54%, against the H1N1 pandemic in 2009 was 61%, and against the H3N2 virus was 33%. Jeff: Of note, EMS providers should use face masks themselves and place them on patients as well. Nachi: Amazing.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

PEMBlog

MAY 11, 2023

Injectable lidocaine, when done well, is reliable – but it can take years to master the ideal technique that doesn’t create a giant mound of subcutaneous lidocaine that can impact needle entry and landmarks. Acad Emerg Med. 2009 May;16(5):388-93. Epub 2009 Apr 15. doi: 10.1111/j.1553-2712.2009.00401.x.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Outcomes 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

The Skeptics' Guide to EM

MARCH 18, 2018

Alfred Sacchetti is a full time practicing Emergency Physician, who is also the Chief of Emergency Medicine at Our Lady of Lourdes Medical Center in Camden, New Jersey, USA, an Assistant Clinical Professor of Emergency Medicine, an Active Researcher and faculty member for the Emergency Medicine and Acute Care course.

Emergency Department 40

Emergency Department Wellness Research 40

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. Manual of Forensic Emergency Medicine: A Guide for Clinicians. Sudbury, Massachusetts: Jones and Bartlett; 2009. In: Ralph Riviello, ed.

Forensics 52

Forensics Documentation/Coding Fractures Head Injuries 52

EMDocs

JUNE 17, 2023

Acute Periorbital Infections: Who Needs Emergent Imaging? 2009-1709 The post EM@3AM: Periorbital Cellulitis appeared first on emDOCs.net - Emergency Medicine Education. insect bite, scratch, etc.) or nearby infection (e.g., URI, dacryocystitis, blepharitis, impetigo, hordeolum, etc.) swelling, chemosis, fever, etc.),

EMS 72

EMS Infectious Diseases Pediatrics Emergency Department 72

EMDocs

JUNE 3, 2023

23 Pelvic binding remains a critical resuscitation step well within the purview of the ED physician, and can be reviewed here: [link]. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality. link] Published November 11, 2009. J Clin Orthop Trauma.

Fractures 54

Fractures Resuscitation Operations EMS 54

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

Dr. Smith's ECG Blog

APRIL 8, 2015

True Syncope: If, on the other hand, the patient is well, had no other serious symptoms , has a normal sinus rhythm, and normal physical exam , then you need to be certain the syncope was not due to a dangerous brady- or tachydysrhythmia that could recur. 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

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. 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.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Pediatric Emergency Playbook

APRIL 1, 2017

Look for a small tip diameter (to fit in the ear canal as well as the nose) and a strong “hold” (at least a 3-lb hold). Nonfatal Choking on Food Among Children 14 Years or Younger in the United States, 2001–2009. Am J Emerg Med. Emergency department management of foreign bodies of the external ear canal in children.

Pediatrics 52

Pediatrics CPR Operations Resuscitation 52