ALiEM

NOVEMBER 17, 2023

kg General : Well-appearing 4-year-old female acting appropriately with grandmother and mother at the bedside. 2009 May;73(5):1008-11. Epub 2009 Mar 13. Of note, the patient’s father took her to a trampoline park with her younger sister two days ago. C; Wt 18.2 Abdomen : Soft, nontender, nondistended. 2008.10.063.

Pediatrics 100

Pediatrics Emergency Department Academics OB/GYN 100

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Background: Sepsis remains one of the leading causes of morbidity and mortality. to 0.97; p = 0.02 Length of ICU Stay 906 patients Prehospital Abx: 300 pts No Prehospital Abx: 606 pts Pooled Mean Difference 0.11; 95% CI -1.85

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

The Skeptics' Guide to EM

JULY 8, 2023

She looks well enough to go home but asks if she should be prescribed oseltamivir (Tamiflu) because some of her friends have been given it recently by their doctors. Safety issues popped up soon after widespread use of the drug including neuropsychiatric effects as well as the more common adverse effects of nausea and vomiting.

CDC 108

CDC Hospitals EMS Emergency Department 108

The Skeptics' Guide to EM

JUNE 3, 2023

One aspect that has not been well covered on the SGEM is the choice of induction agent when intubating patients. This goes back to at least 2009 the Ketased study. This got some feedback from our friend Scott Weingart over at EMcrit. There was an episode 10 years ago looking at the use of etomidate in septic patients ( SGEM#44 ).

Outcomes 111

Outcomes Wellness 111

The Skeptics' Guide to EM

JULY 29, 2023

This has evolved due to recognition of some of the adverse effects of immobilization as well as limitations to its benefits. Some of this research has observed substantial under-treatment among patients who met criteria for precautions, as well as some patients with confirmed injuries who received no treatment from EMS [15-16].

Head Injuries 98

Head Injuries EMS Research Emergency Department 98

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 92

Poisoning CDC Administration Emergency Department 92

ALiEM

OCTOBER 11, 2024

On the day of presentation, she developed a painful, intermittently bleeding “blood blister” to the left lower cheek that had increased in size, as well as new red spots on her arms and legs. Initial diagnostics include a CBC which will show isolated thrombocytopenia, as well as hemolysis labs to exclude alternative etiologies.

Academics 60

Academics Wellness 60

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. Sagoschen, I.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

EMDocs

FEBRUARY 7, 2024

healthcare workers previously remained low and relatively stagnant between 2009 and 2021. Unionization of healthcare providers can create opportunities to improve staff’s financial and general well-being, but may also facilitate future strikes. Trends in labor unionization among US health care workers, 2009-2021.

Hospitals 98

Hospitals Research Patient Safety Wellness 98

ALiEM

FEBRUARY 26, 2024

Otherwise, he was well-appearing, acting normally, and eating/voiding/stooling normally. Additional Images Physical Exam General : Well appearing, acting appropriately for age HEENT : Scalp normal. 2009 Jul-Aug;26(4):373-80. The patient presented with a vesicular rash on his face including around his eyes. Pediatr Dermatol.

Academics 78

Academics Pediatrics Wellness 78

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 98

Leadership PPE EMS Wellness 98

Taming the SRU

APRIL 14, 2024

You may place cold packs or ice packs to the hernia site to help reduce inflammation and swelling, as well as to assist in local analgesia. Symptoms include persistent tenderness in the area, as well as symptoms of obstruction including nausea, vomiting, and pain, despite reduction. (2) 4, 1 July 2009, p. 6, June 2005, pp.

Ultrasounds 93

Ultrasounds Emergency Department Pediatrics Radiology 93

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. Romero (2009). A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in. Triage vital signs (VS) include BP 88/45, HR 121, T 97.1,

EMS 111

EMS Resuscitation Blood Transfusions Seizures 111

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. 2009 Sep 11;2(3):155–60.

Emergency Department 92

Emergency Department Ultrasounds Administration Burns 92

Pediatric EM Morsels

AUGUST 18, 2023

From 2001 to 2009, in a pediatric hospital gram negative culture showed a drop in sensitivity to ciprofloxacin from 96% to 93%. (Jackson 2016) It can also be used in UTIs , but is typically reserved for special cases where the infectious bacteria is found to be multidrug resistant or in complicated UTIs.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. The Pause Jonathon Bartels worked as an Emergency Nurse in America in 2009. Psychological harm occurs. To limit the psychological harm, perhaps we should implement THE PAUSE.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

Dr. Smith's ECG Blog

OCTOBER 8, 2024

2009;Available from: [link] 4. In support of my impression that the ST-T wave changes in the chest leads are acute until proven otherwise — is the ST segment flattening and depression in lead II — as well as the J-point ST depression in lead I ( BLUE arrows in these leads ). Heart [Internet]. Dressler W, Roesler H. 1947;34:627–645.

EKG/ECG 123

EKG/ECG Documentation/Coding Resuscitation Shock 123

ALiEM

SEPTEMBER 29, 2023

Additional Images Physical Exam General : Well-appearing male in no distress Neck : Hemostatic wound to his left neck. 2009 Nov;67(5):1046-1050. He now presents requesting “Neosporin.” ” His tetanus status is out of date. No significant pain, no hematoma, no bruits. The Journal of Trauma. DOI: 10.1097/ta.0b013e3181b83b63.

Radiology 70

Radiology Radiology Academics Ultrasounds 70

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

This retrospective observational cohort study considered consecutive STEMI patients from May 02, 2009 to December 31, 2018. But this is not what we see in the chest leads with BLUE arrows that instead suggest slight-but-real ST depression that may well indicate associated posterior OMI.

EKG/ECG 119

EKG/ECG Hospitals Outcomes Wellness 119

RebelEM

JANUARY 25, 2024

CHF, in particular, lends itself well to diagnosis and treatment with PoCUS, as it readily reveals the presence of B lines. 2009 Oct;114(7):1053-64. Epub 2009 Aug 20. Furthermore, the serial US group included more patients with conditions detectable with US. vs. 18.3%). vs. 74%), consolidation (37.3% Radiol Med. PMID: 19697100.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

ALiEM

JANUARY 22, 2024

The patient also complained of shortness of breath for one week associated with a dry cough, as well as an altered sensorium for one day. 2009 Jan;11(1):66-72. Fever was documented to be 102°F and was not associated with any chills or rigors. He was then extubated and discharged after 27 days. Infect Dis Clin North Am. 2007.08.002.

Academics 64

Academics Documentation/Coding Emergency Department Hospitals 64

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. Int J Emerg Med 2009 PMID: 20157465 4. World J Emerg Surg 2023 PMID: 36918947 3.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

EMDocs

JUNE 25, 2024

Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. National Burn Repository 2019 Update, Report of data from 2009–2018. Location: evaluate the neurovascular status in an extremity with circumferential or near circumferential burn injury.

Burns 97

Burns Fluid Resuscitation Resuscitation Poisoning 97

Cook County EM Blog

MAY 1, 2023

Findings suggestive of septic bursitis include complex fluid in the bursa with septations (as seen in this case), as well as hyperemia on color flow doppler or gas. 2009 Jun 25. 2009 Oct;37(3):269-272. Ultrasound is often a more useful imaging modality and is readily available at the bedside. emDocs.net. Skeletal Radiol.

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Outcomes 52

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. Overnight, she had to wake him to feed.

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

ALiEM

MAY 13, 2024

They may be well-circumscribed or may have irregular borders. Well-circumscribed abscess with heterogeneous debris C. Larger abscess with well-circumscribed borders D. Superficial abscess with well-circumscribed borders Table 1. Epub 2009 Aug 8. The rim may be echogenic or blend in with surrounding tissue.

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

EMDocs

FEBRUARY 7, 2024

Multiple well-designed, multicenter, multinational studies suggest GLP-1 agonists are associated with improved glucose control in diabetes type 2 and approximately a 15% reduction in weight over 1-2 years (around 2/3s of patients regain weight if treatment is stopped). 2009 Jun;160(6):909-17. Obesity affects over 40% of U.S.

Allergic Reactions 97

Allergic Reactions Anaphylaxis Dehydration Wellness 97

EMDocs

JULY 9, 2024

Addressing social determinants of health at well child care visits: a cluster RCT. 2009 Mar;123(3):858-64. JAMA Pediatr. 2016 Nov 7;170(11):e162521. doi: 10.1001/jamapediatrics.2016.2521. Epub 2016 Nov 7. PMID: 27599265. Garg A, Toy S, Tripodis Y, Silverstein M, Freeman E. Pediatrics. 2015 Feb;135(2):e296-304. doi: 10.1542/peds.2014-2888.

Pediatrics 74

Pediatrics Emergency Department Research Burns 74

RebelEM

FEBRUARY 22, 2023

Giant Cell Arteritis (arteritic anterior ischemic neuropathy) ( Bagheri 2015 , Hayreh 2009 ) Pathophysiology Giant cell arteritis(GCA) affects that medium-sized and large arteries. T-cell-dependent disease. Predilection to involve the posterior ciliary artery.

Emergency Department 52

Emergency Department EMS Wellness 52

Dr. Smith's ECG Blog

MAY 28, 2013

However, there is an uncertain history of sudden death as well as inducible Brugada pattern. Drug-Induced Brugada Syndrome Suffice it to say that this is a very complex topic and I know little more about it than can be read in this 2009 article from Europace, the most recent article I could find on the topic. It is free full text.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

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. 2009 May;16(5):388-93. Epub 2009 Apr 15. Should we be using it for LPs instead of injecting? Acad Emerg Med.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Academics 52

Taming the SRU

NOVEMBER 14, 2023

A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011 identified 8.6 B) on right: hand drawn images of layers of ear demonstrating auricular hematoma The epidemiology and incidence of ED presentation for auricular hematomas has not been well-studied because it is a relatively uncommon condition.

Emergency Department 94

Emergency Department Pediatrics Wellness Fractures 94

The Skeptics' Guide to EM

JUNE 4, 2017

Huber-Wagner et al ( Lancet 2009 ) showed a mortality reduction in a retrospective database study of patients who have had a pan scan. The NNT varied from 17 to 32 according to the injury severity.

Radiology 52

Radiology Radiology CPR Hospitals 52

Taming the SRU

DECEMBER 11, 2023

8] While there is no standardized screening tool for SRB, there are well established trends that emergency medical providers may use to identify patients at risk.[9] Suicides - United States, 2005-2009. 9] Adolescents and patients in their early twenties are at increased risk.[10] BMC Psychiatry. 2018;18(1):112. MMWR Suppl.

EMS 97

EMS Psychiatric Emergency Department Poisoning 97

The Skeptics' Guide to EM

OCTOBER 22, 2017

A systematic review by Wijesinge et al from 2009 found only two randomized control trials looking at supplemental oxygen. The Cochrane authors said that a well-designed RCT is needed due to the uncertainty of routinely using supplemental oxygen in patients with acute myocardial infarctions.

Hospitals 52

Hospitals EKG/ECG Wellness 52

The Skeptics' Guide to EM

MAY 12, 2018

Bell distinguished these cases of extreme agitation from delirium tremens, diseases of the meninges and advanced typhoid based on a list of clinical criteria, as well as autopsy results from the brains and intestines of the patients.

Psychiatric 52

Psychiatric Emergency Department Hospitals Wellness 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52