The Skeptics' Guide to EM

OCTOBER 14, 2023

Case: A 5-year-old boy presents to the emergency department (ED) with his parents for fever and fatigue. That episode reviewed the 2011 Fleming et al systematic review for the normal ranges of HR and RR in children from birth to 18 years of age. He has had three days of high fevers at home. Does he have sepsis?”

Pediatrics 88

Pediatrics Sepsis Urgent Care Emergency Department 88

RebelEM

FEBRUARY 12, 2024

There are greater than 2 million annual emergency department visits for suspected renal colic in the US, and Ct scanning is performed for more than 90% of patients who receive a diagnosis of kidney stone. 2011; 18(7):699-707. CT in Detecting Urinary Tract Calculi: Influence on Patient Imaging and Clinical Outcomes Radiology.

Radiology 85

Radiology Radiology Emergency Department Ultrasounds 85

PulmCCM

JUNE 12, 2023

TTM2 found no improvement in survival or neurologic outcome among patients randomized to cooling to a target of 33 °C, as compared to controls receiving fever prevention (e.g. with acetaminophen) until temperatures reached 37.8 °C who then received external cooling to maintain a target temperature of 37.5 °C.

Hyperthermia / Hypothermia 102

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 102

Taming the SRU

SEPTEMBER 25, 2023

Musculoskeletal injuries are a common occurrence, representing a substantial number of Emergency Department visits on an annual basis. 1) Oftentimes, Emergency Physicians are the first provider patients encounter after an injury. 2011 Jan-Feb;50(1):62-7. Figure 1 highlights the mechanism of injury and range of severity.

Fractures 101

Fractures Operations Emergency Department EMS 101

ACEP Now

OCTOBER 9, 2024

In the emergency department (ED), physicians face the challenge of making rapid decisions that can significantly impact patient outcomes. This mindset shift is crucial for improving outcomes and fostering a more inclusive and equitable health care system. Dr. Harrell is a PGY-1 emergency physician at Houston Health.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Ultrasounds Outcomes 52

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). PMID 33392580. mg tablet) 1 Buprenorphine 0.5

Emergency Department 98

Emergency Department Hospitals Outcomes EMS 98

RebelEM

MARCH 23, 2023

The primary outcome, hospital length of stay, was significantly shorter both before and after propensity score adjustment for the phenobarbital group. The 30-day emergency department readmission rate and all-cause 30-day readmission were significantly lower only when adjusted for propensity scores.

Emergency Department 52

Emergency Department Outcomes Burns Hospitals 52

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. The primary outcome was the successful intubation on the second attempt. Secondary outcomes included tracheal intubation adverse events (TIAEs) or severe desaturation.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

EMDocs

JANUARY 29, 2024

Introduction: Neurologic emergencies are common in the Emergency Department (ED), and blood pressure management is critical to immediate management. Poor blood pressure management can worsen the outcome of hemorrhagic stroke by increasing the risk of hematoma expansion, cerebral edema, and ischemia [8-14]. PMID: 11988609.

Stroke 73

Stroke Outcomes EMS Seizures 73

Don't Forget the Bubbles

JUNE 17, 2024

Introduction: Civility Matters Healthcare environments, particularly emergency departments, are characterised by high levels of Volatility, Uncertainty, Complexity, and Ambiguity ( VUCA ). High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. 2011 Apr 1;78(2):202-9.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Don't Forget the Bubbles

AUGUST 7, 2023

The controversy around what is ‘normal’ in infants’ and children’s vitals was demonstrated in a 2011 systematic review by Fleming et al. The study also did not assess outcomes for each patient, and as such, the impact on deviation from the normal range was not explored. Yes Was the outcome accurately measured to minimize bias?

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

Don't Forget the Bubbles

SEPTEMBER 5, 2024

Am J Emerg Med. In this study, the Broselow tape had the best overall accuracy, with 50.7% (vs 30.88% for APLS 2011) of estimates occurring within 10% of measured weight and 80.0% (vs 55% for APLS 2011) estimates within 20% of measured weight. Obesity is considered a contributing factor for some musculoskeletal outcomes.

Ultrasounds 52

Ultrasounds Research Emergency Department Outcomes 52

PHEM Cast

DECEMBER 12, 2016

Emergency thoracotomy in thoracic trauma: a review. Emergency Department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World Journal of Emergency Surgery; 2006: 1:4. Survival after Emergency Department thoracotomy: review of published data for last 25 years.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 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 93

Emergency Department Pediatrics Wellness Documentation/Coding 93

The Skeptics' Guide to EM

APRIL 28, 2018

Case: A 72-year-old gentleman presents to your emergency department. He has been generally unwell for around one week, with a worsening cough, shortness of breath […] The post SGEM#216: Pump It Up – Corticosteroids for Patients with Pneumonia Admitted to Hospital first appeared on The Skeptics Guide to Emergency Medicine.

Hospitals 40

Hospitals Emergency Department Outcomes Shock 40

PHEM Cast

APRIL 21, 2021

The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury. Emergency tracheal intubation: complications associated with repeated laryngoscope attempts. 2011 Dec;82(12):1519-24. Epub 2011 Jul 2. J Trauma 2003; 54:444-453 Mort TC. Anesth Analg. Resuscitation. 2011.06.028.

Airway Management 52

Airway Management Resuscitation EMS Hospitals 52

The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services at Tacoma Community College. Case: During a busy emergency department (ED) shift the paramedic phone rings.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

EMDocs

FEBRUARY 12, 2024

There is well-documented evidence that low systolic blood pressure, a low Glasgow Coma Score (GCS), and a high Injury Severity Score (ISS) are known predictors of poor outcomes, and in combination with serum lactate provide adequate prognostic value. Int J Emerg Med. Eur J Emerg Med. Emerg Med J. Open Access Emerg Med.

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

EMDocs

SEPTEMBER 9, 2023

2021.0052 Emergency Department Management of Extensor Tendon Lacerations – Page 3 of 4. Ann Emerg Med. Emergency Medicine Residents’ Association; 2022:10-11. Extensor tendon repair in the emergency department. J Emerg Med. Emergency Orthopedics. Medicine (Baltimore). 2019;98(44):e17823.

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

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 Operations 52

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. They recommend synovial joint aspiration and analysis for bacteria (and leukocytes) to diagnose SANJO [28].

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

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. 2011, 10:1002-1014. hour IV thrombolytic window. hour IV thrombolytic window.

EMS 74

EMS Stroke Outcomes Hospitals 74

Taming the SRU

JANUARY 29, 2024

She was concerned that this was not improving and decided to come to the emergency department (ED). Hospital Course The patient was initiated on a therapeutic heparin drip in the emergency department with vascular surgery consultation. 2011 Dec;77(12):1606-12. She had not had any blood clots previously.

Emergency Department 93

Emergency Department Fractures Hospitals Operations 93

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 95

Sepsis Documentation/Coding Administration Fractures 95

PEMBlog

JANUARY 17, 2024

2011 Mar;127(3):e573-80. Epub 2011 Feb 21. Clin Infect Dis 2011; 52:e18. Now, some facilities have a short stay unit, like in their emergency department. Randomized controlled trial of cephalexin versus clindamycin for uncomplicated pediatric skin infections. Pediatrics. doi: 10.1542/peds.2010-2053.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

EMDocs

APRIL 27, 2024

A 67-year-old man with a history of hypertension and diabetes presents to the emergency department with right ear pain for 2 weeks. However, the bioavailability of antipseudomonal antibiotics has improved outcomes, limiting surgery as a confirmatory diagnostic procedure and as needed for granulation tissue removal.

EMS 83

EMS Infectious Diseases Radiology Radiology 83

Don't Forget the Bubbles

JANUARY 17, 2024

Curious Ken is brought into your emergency department. Forrester reported data from the Texas Poison Centers surrounding 110 cases of superabsorbent polymer bead ingestions between 2011 and 2016. There have been reports of the Orbeez Challenge leading to serious outcomes. What are the risks of water beads?

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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. 2011; 364(3):255-264.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

ACEP Now

JUNE 7, 2023

Clinical Question What is the Emergency Severity Index (ESI), triage pain score, emergency department (ED) length of stay (LOS), and acute ED revisit rate in deaf and hard-of-hearing (DHH) American Sign Language speakers and DHH English speakers who utilize the ED? Acad Emerg Med. 1,6 Reference: James TG, et al.

Emergency Department 52

Emergency Department Outcomes Research Academics 52

PHEM Cast

APRIL 10, 2016

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. The impact of emergency medical services on the ED care of severe sepsis. Am J Emerg Med. Academic Emergency Medicine. 2011 Aug 30;18(9):934–40.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Dr. Smith's ECG Blog

AUGUST 23, 2017

Ventricular slowing l50 Joules, Ibutilide/Amiodarone lDiltiazem slows at AV node Procainamide before Diltiazem is dangerous it will slow the atrial rate and allow for 1:1 conduction results in a FASTER ventricular rate See this case: Wide complex tachycardia at a rate of 270 Relevant literature Emergency Department Management and 1-Year Outcomes of (..)

Stroke 52

Stroke Sepsis Emergency Department EMS 52

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S.,

Psychiatric 88

Psychiatric Seizures Emergency Department Pediatrics 88

ALiEM

OCTOBER 4, 2024

A 31-year-old female G3P2 presented to the emergency department with vaginal spotting for one week and worsening lower abdominal cramping. 2011 Jul;118(1):184-196. Pregnancy outcome in women with an intrauterine contraceptive device. Crit Ultrasound J 3, 91–92 (2011). She had not yet seen an OB for this pregnancy.

Ultrasounds 64

Ultrasounds Academics Emergency Department Hospitals 64

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. 2011 Jun;153(6):773-9. Epub 2011 Apr 22 Coyne CJ, Le V, Brennan JJ, Castillo EM, Shatsky RA, Ferran K, Brodine S, Vilke GM. Ann Emerg Med.

Infectious Diseases 105

Infectious Diseases Administration Sepsis Anaphylaxis 105

ALiEM

OCTOBER 30, 2024

Bupe Allergy Buprenorphine induction has been the mainstay of emergency department treatment of opioid use disorder for more than a decade [11, 12]. 2011 Dec;6:1-4. Emergency department-initiated buprenorphine for opioid dependence with continuation in primary care: outcomes during and after intervention.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

ACEP Now

AUGUST 1, 2023

How does that apply to the role of the board certified emergency physician? Fundamentally, I believe every patient coming to an emergency department is best served by care delivered by board certified emergency physicians. When those same fundamentals done right achieve great success, they aren’t little at all.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

RebelEM

SEPTEMBER 11, 2023

1 It is a quickly deployable and easily interpreted study that can be done in real time to guide decisions in the Emergency Department. Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Acad Emerg Med. 2011 Mar;18(3):227-35. PMID: 21401784.

Ultrasounds 69

Ultrasounds Radiology Radiology Emergency Department 69