The Skeptics' Guide to EM

JULY 2, 2023

His Glasgow Coma Scale (GCS) score is 13 with obvious head trauma as well. There is also the CRASH-2 trial from 2010 which was reviewed with our good friend Dr. Anand Swaminathan ( SGEM#80 ). That classic practice changing paper showed a 1.5% absolute decrease in death in trauma patients receiving TXA vs placebo (NNT = 66).

EMS 145

EMS Outcomes Hospitals Research 145

RebelEM

FEBRUARY 24, 2025

Well, the established cutoff for the distensibility index is 18%. Jul 2010; PMID: 20620859. Sep 2010; PMID: 20502865 Teboul JL, et al. Distensibility index (DI) Distensibility IVC = ( (IVC max – IVC min) / IVC Max ) * 100 The IVC distensibility index is used for IVC assessment in mechanically ventilated patients.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

RebelEM

MAY 29, 2024

VS abnormalities can drive this as well Strongly consider reversal of AC (this will typically come after control) Stopping the Bleeding PPE: these things bleed like stink. Laryngoscope 2010; 120: 2325-2330. Laryngoscope 1971; 81(8): 1261-6. PMID: 5569677 Zeyyan E et al. PMID: 20938948 Loftus BC et al.

PPE 104

PPE EMS Hospitals Wellness 104

Ken Grauer, MD

MAY 28, 2024

12:15 — Regarding my experience from the 1980s until ~2010: How I went from hating computer interpretations to loving them ( after I finally understood what the computer can and can not do ). 11:35 — My views on: Will the computer ever be able to interpret complex arrhythmias?

EKG/ECG 333

EKG/ECG Wellness 333

Emergency Live

JULY 11, 2023

Time Fighters: Renault and the Fire Brigade united for Road Safety For more than a decade, a unique partnership has revolutionised the way road accidents are dealt with: that between Renault, the well-known car manufacturer, and the firefighters.

Wellness 75

Wellness 75

Northwestern EM Blog

MARCH 27, 2025

Attach a flush to ensure the vein and catheter is functioning well. For the clinician really looking to take their difficult IV access POCUS skills from good to great, I always recommend pre-scanning in both the short axis as well as the long axis to fully understand the anatomy and identify the best site for insertion.

Ultrasounds 52

Ultrasounds Dehydration Academics Hospitals 52

Pediatric EM Morsels

JULY 5, 2024

We collected data directly from the bedside clinician which enabled us to gather pertinent patient symptoms and physical examination findings that may not be well documented in the medical record, but more accurately identify the child’s injuries.” 2010; doi:10.1016/j.annemergmed.2010.08.038. Lancet Child Adolesc Health. Ann Emerg Med.

Pediatrics 164

Pediatrics Head Injuries Dislocations Research 164

EMDocs

JUNE 8, 2023

and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. Of note, the authors declared that their groups were well balanced, but they do not report on the baseline mRS of each group. Intervention: Alteplase 0.9

Stroke 98

Stroke Administration Documentation/Coding Outcomes 98

Pediatric EM Morsels

AUGUST 18, 2023

Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. (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

ACEP Now

OCTOBER 26, 2023

2010 : The ACA extends the PLP to individual and small-group health plans, as well as self-funded employer plans under ERISA. Early 1990s: The PLP emerged in the insurance environment and gained recognition in the healthcare industry after first appearing in consumer protection law.

Documentation/Coding 124

Documentation/Coding Hospitals Emergency Department Administration 124

Don't Forget the Bubbles

SEPTEMBER 20, 2023

Although there are guidelines from leading organisations, and the potentially harmful effects of unnecessary radiation exposure are well known, AXRs are widely used in practice. Clinical guideline [CG99] Published: 26 May 2010 Last updated: 13 July 2017. What is the evidence for avoiding abdominal X-rays? 2022;251:127-133.

Pediatrics 133

Pediatrics Emergency Department Radiology Radiology 133

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. 2010; 376(9734):23-32. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] Lancet (London, England).

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

JUNE 19, 2023

Demographics were well balanced in the two groups. Lancet 2010; 376(9734): 23-32. Randomization and blinding were appropriately conducted. All trial personnel were unaware of trial-group assignments. Broad inclusion (and limited exclusion) criteria increasing external validity. PMID: 20554319 Post Peer Reviewed By: Salim R.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

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

ALiEM

OCTOBER 7, 2024

F; O2 saturation 96% on room air General : No acute distress, well-appearing Neurologic : AOx3; Following commands. 2010 Dec;14(6):502-5. She denied trauma, headache, neck pain, dizziness, dysphagia, numbness, tingling, weakness, or gait instability. Additional Images Physical Exam Vitals : BP 181/119; HR 76; RR 18; T 98.4°F;

Academics 64

Academics Emergency Department Pediatrics Wellness 64

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. 2010 Oct;39(4):468–75.

Emergency Department 92

Emergency Department Ultrasounds Administration Burns 92

PulmCCM

OCTOBER 8, 2024

The 21st Century Cures Act disrupted the health data ecosystem (and Epic’s business) Under the Affordable Care Act passed in 2010, EHR vendors were mandated to (someday) produce interoperability standards ensuring data portability. Epic and Cerner) remained largely proprietary.

Wellness 98

Wellness 98

The Skeptics' Guide to EM

MAY 30, 2020

This study published in 2010 showed an absolute mortality reduction of 1.5% Lancet 2010 ) CRASH-3 was a well-designed, large, multi-centred randomized placebo controlled trial published in October 2019 ( The Lancet ). Anand Swaminathan and I covered the classic CRASH-2 Trial ( SGEM#80 ).

Head Injuries 52

Head Injuries Academics EMS Stroke 52

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. 1, 2010, pp. Metabolism of DEG adapted from Bessenhofer, et al. Accessed August 2022. Besenhofer, Lauren M.,

Poisoning 92

Poisoning CDC Administration Emergency Department 92

Don't Forget the Bubbles

JUNE 26, 2023

Too much pulmonary blood flow and we will see well-oxygenated blood ( SpO2 >85% ) but insufficient systemic blood flow (pallor/mottling, cool peripheries, delayed capillary refill time, weak pulses, hypotension, narrow pulse pressure) and hypoxia (lactic acidosis). This is the most nuanced aspect.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

The Skeptics' Guide to EM

MARCH 20, 2021

She is low risk by Wells Criteria but PERC Rule positive because of an appendectomy last month. A study from 2010 showed that half of PE patient from one centre in Ontario were safely being treated as outpatients ( Kovacs ). Outpatient Management of Patients Following Diagnosis of Acute Pulmonary Embolism.

Academics 52

Academics Hospitals Wellness 52

SheMD

MAY 11, 2023

Transcripts were coded to sort data into “leadership occurrences” or “unrelated to leadership” as well as critical treatment decisions. There was a significant increase in female contribution to leadership statements after behavioral intervention (53% vs 69%, p=0.011) as well as in critical treatment decisions (57% vs 73%, 0.029).

Leadership 52

Leadership Documentation/Coding CPR Teamwork 52

Don't Forget the Bubbles

FEBRUARY 19, 2024

The Role of Gaming in Emotional Well-being Stress Relief: Gaming can be a form of relaxation and stress relief, providing an escape from the pressures of daily life. There is a complex interplay between gaming, psychological needs, and adolescent well-being. It can offer a safe environment to unwind and engage in enjoyable activities.

Academics 59

Academics Leadership Research Teamwork 59

Don't Forget the Bubbles

AUGUST 2, 2023

As well as nonpharmacological treatments included physiotherapy and psychological therapy, 79% were also prescribed medication, most commonly gabapentin. More recently, Mesaroli et al. carried out a retrospective chart review of children with CRPS presenting to a paediatric Chronic Pain Clinic in Canada over a 5-year period (2012 to 2016).

Psychiatric 98

Psychiatric Pediatrics Outcomes Academics 98

EMDocs

AUGUST 7, 2023

Physician gestalt and clinical decision-making tools such as the Wells’ ( [link] or Geneva ( [link] scores are helpful when assessing a patient’s pre-test probability, which is categorized as low, moderate, or high risk. Published 2010 Mar 30. D-dimer testing is most useful in low- to moderate-risk patients. 2010;340:c1475.

EMS 95

EMS Wellness Emergency Department 95

Taming the SRU

FEBRUARY 5, 2024

The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). As may be seen in the table below, there are several themes as well a range of stringency. WHO - Who Needs an LP in the ED? Patients with concern for infection (i.e.,

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

PHEM Cast

MARCH 17, 2016

2010; Grant S, Khan F, Keijzers G, Shirran M, Marneros L. video cast from Emergency Medicine colleagues in the States discussing and demonstrating techniques for optimal bag-valve-mask ventilation. Annals of Emergency Medicine. 2014; 65(4): 349-355. Weingart SD. The Journal of Emergency Medicine.

Airway Management 52

Airway Management Burns Emergency Department Resuscitation 52

Taming the SRU

NOVEMBER 14, 2023

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. 2010 Dec;26(6):451-5. Courtesy of wiki commons under CC Attribution 3.0 Laryngoscope. 2015;125(8):1926-1933.

Emergency Department 94

Emergency Department Pediatrics Wellness Fractures 94

EMDocs

APRIL 13, 2024

If the hematoma is not drained it can cause disruption of blood supply to the cartilage and subsequent necrosis, as well as an increase in risk of infection. Am J Otolaryngol 2010; 31:21. I&D should then be considered.[4] 1] Disposition: A 7-10 day course of prophylactic antibiotics is recommended due to limited vascular supply.[7]

EMS 104

EMS Emergency Department Pediatrics Wellness 104

Pediatric Emergency Playbook

AUGUST 1, 2017

2010; 26:769-781. 2010; 149(3):386-391. 2010; 45:1182-1186. 2010; 28(11):544-548. 2010 Oct;40(4):613-20. . J Emerg Med. 2012; 43(1):49-51. Martin V, Shaw-Smith C. Review of genetic factors in intestinal malrotation. Pediatr Surg Int. Nehra D, Goldstein AM. Am J Emerg Med. 2012; 30:426-431. Whitehouse et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

ACEP Now

AUGUST 8, 2023

Arch Dis Child Educ Pract Ed 2010; 95: 83-87. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. Circulation 2010; 121: 1544-1579. Clinical decision rules: how to build them. Hiratzka LF, Bakris GL, Beckman JA, et al.

Shock 52

Shock Hospitals Wellness 52

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010. J Emerg Med. 2021;61(5):517-528. doi:10.1016/j.jemermed.2021.07.006

Fractures 96

Fractures COPD Hospitals Emergency Department 96

The Skeptics' Guide to EM

OCTOBER 10, 2020

He denies weakness or numbness of the legs as well as bowel or bladder dysfunctions. million visits each year in the USA ( Friedman et al Spine 2010 ). Pain gets worse with movement and minimal bending. The pain is limiting his usual activities included his ability to go to work. Low back pain (LBP) is responsible for 2.3%

Emergency Department 52

Emergency Department Research Wellness 52

Dr. Smith's ECG Blog

SEPTEMBER 20, 2011

You can see that the part of the heart closest to the transducer (top) is the anterior wall and is moving and contracting well. It seems to have disappeared off the internet, but here is the interpretation: This is a parasternal short axis view (a transverse cut through the heart; you see the left ventricle). The Q-wave in lead III persists.

EKG/ECG 52

EKG/ECG Ultrasounds Resuscitation Wellness 52

Broome Docs

APRIL 6, 2023

PMID: 35780790 [ open access here ] Stiell IG, Clement CM, Grimshaw JM, Brison RJ, Rowe BH, Lee JS, Shah A, Brehaut J, Holroyd BR, Schull MJ, McKnight RD, Eisenhauer MA, Dreyer J, Letovsky E, Rutledge T, Macphail I, Ross S, Perry JJ, Ip U, Lesiuk H, Bennett C, Wells GA. 2010 Oct 5;182(14):1527-32. Epub 2010 Aug 23.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

Taming the SRU

OCTOBER 30, 2024

Case #2: Facial Swelling CT imaging has seen a significant increase in the last 20 years. ​ Although there has been an increase in imaging, diagnostic yield has remained relatively stable​ Factors the impact imaging decision includes reliability of the physical exam as well as extrinsic factors such as consultants and admitting services.​

Hospitals 52

Hospitals Emergency Department EKG/ECG Documentation/Coding 52

Dr. Smith's ECG Blog

JULY 26, 2023

But the well-formed Q-wave and the presence of a normal T-wave in inferior leads led me to believe this was Old Inferior MI with persistent ST Elevation, otherwise known as inferior LV aneurysm. At this point — I learned a bit more about today's patient: The patient is a man who had an inferior STEMI in 2010.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52