The Skeptics' Guide to EM

APRIL 8, 2023

John Brown PhD is a Professor of Health Services Research in Ireland who has been studying rural healthcare issues since 2012. There have been many “temporary” rural emergency department closures during the past last year. It was a stepped-wedge reconfiguration of the entire Danish emergency healthcare system.

Stroke 55

Stroke Emergency Department Academics COPD 55

RebelEM

MARCH 8, 2023

Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. Emergency Department Management: Emergency ophthalmology consultation. Emergency surgical management indicated if concomitant retinal tear, vitreous hemorrhage, or retinal detachment. >10 floaters, (+) LR 8.1-36

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

Cook County EM Blog

APRIL 27, 2022

Effectiveness and safety of droperidol in a United States emergency department. Am J Emerg Med. 2019.09.007 What : Retrospective cohort study of all droperidol administrations between January 2012 and April 2018 at an academic and pediatric emergency department in the US with 77,000 annual visits.

Administration 52

Administration EKG/ECG Emergency Department EMS 52

RebelEM

APRIL 29, 2024

Given AHA guidelines recommend early epinephrine administration in cardiac arrest, obtaining access is imperative for resuscitative efforts ( 9) When evaluating over 300,000 out-of-hospital cardiac arrests, a meta-analysis found no significant change in primary outcomes when IV and IO access were compared ( 10 ). 2012 PMID: 21893125.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

The Skeptics' Guide to EM

MARCH 4, 2023

Case: Jim is a 50-year-old male who presents to the emergency department with anterior epistaxis. The episode included the Dundee protocol for adult epistaxis management from 2012. Lastly, the primary outcome was different than the previous two RCTs claiming efficacy. He denies nose picking. Trauma (CRASH-2): 1.5%

Outcomes 40

Outcomes EMS Emergency Department Hospitals 40

Northwestern EM Blog

SEPTEMBER 26, 2022

Written by: Diana Halloran (NUEM ‘24) & Andrew Long (NUEM ‘25) Edited by: Nick Wleklinski (NUEM ‘22) Expert Commentary by : John Bailitz, MD Introduction The Emergency Department is a challenging work environment for a variety of reasons. Promoting hot debriefing in an emergency department. Www.Heart.Org.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 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. Ann Emerg Med. 2012 Jun 1;59(6):504–12.e1–2. Ann Emerg Med. 2012 Jan 11. Emerg Med J.

Emergency Department 52

Emergency Department Head Injuries Hospitals Pediatrics 52

EB Medicine

MARCH 1, 2019

This month, after a few months of primarily medical topics, we’re talking trauma, specifically Blunt Cardiac Injury: Emergency Department Diagnosis and Management. Early defibrillation is linked to better outcomes. Ann Emerg Med. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta. of those patients. topics.php?paction=showTopic&topic_id=597)

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. Guest Skeptic: Dr. Jess Monas is a Consultant in the Department of Emergency Medicine at the Mayo Clinic Hospital, Phoenix, Arizona. Background: We have covered sepsis many times on the SGEM since 2012.

Sepsis 40

Sepsis Emergency Department COPD Hospitals 40

The Skeptics' Guide to EM

JUNE 5, 2021

Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke: The SKIP Randomized Clinical Trial. JAMA 2021 Case: A 74-year-old woman presents to your emergency department with 1.5 References: * Suzuki et al. JAMA 2021 * Zi et al.

Stroke 52

Stroke Urgent Care Critical Access Outcomes 52

Don't Forget the Bubbles

JANUARY 17, 2024

Curious Ken is brought into your emergency department. Mirza and Sheikh reported perhaps the first unfortunate case in 2012. There have been reports of the Orbeez Challenge leading to serious outcomes. In 2012, one brand of SAP beads – Water Balz – was recalled by the U.S. 2012 Jan;3(1):6.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Taming the SRU

JUNE 12, 2023

Although not every person seeks health care for these injuries, the majority of those that do end up in the emergency department. In 2008, this led to greater than 316,000 emergency department (ED) visits and about 9,500 hospitalizations [1]. Annals of Emergency Medicine. Annals of Emergency Medicine.

Infectious Diseases 101

Infectious Diseases Emergency Department Administration Academics 101

The Skeptics' Guide to EM

JANUARY 7, 2018

Chris Carpenter is from Washington University, Deputy Editor of Academic Emergency Medicine and faculty member of Emergency Medicine and Critical Care course. Case: A 35-year-old female presents to your emergency department three-hours after the onset of a severe frontal headache.

Emergency Department 40

Emergency Department Academics Outcomes 40

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. 2020 Sep 29;95(13):e1819-e1829.

Seizures 85

Seizures Stroke Outcomes EMS 85

Taming the SRU

MARCH 14, 2023

Case 1 Fussy 1 month old A 1-month-old (ex-34 week premature) infant comes to your emergency department for fussiness. Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity. More on this below as we work through a few cases…. Lancet Neurol.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

EMDocs

MAY 11, 2024

Available from: [link] American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Use of Intravenous tPA for Ischemic Stroke:; Brown MD, Burton JH, Nazarian DJ, Promes SB. Ann Emerg Med. Erratum in: Ann Emerg Med. 2012) 43:2904–9. 2015 Sep;66(3):322-333.e31. doi: 10.1016/j.annemergmed.2015.06.031.

Stroke 89

Stroke EMS EKG/ECG Radiology 89

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. Annals of Emergency Medicine 2012; Volume 60, Issue 6, Pages 749–754.e2 J Trauma 2003; 54:444-453 Mort TC. Anesth Analg.

Airway Management 52

Airway Management Resuscitation Hospitals EMS 52

EM Guide Wire

NOVEMBER 2, 2020

Nebulized Mg sulfate treatment shows no significant effect on respiratory function or hospital admission High-Dose Magnesium Sulfate Infusion for Severe Asthma in the Emergency Department Efficacy Study All patients of 6–16 years old who failed to improve after 2 hours of standard therapy for asthma. final FEV1 was 51.1%

Pediatrics 52

Pediatrics Anaphylaxis Hospitals Administration 52

EMDocs

SEPTEMBER 9, 2023

Answer : Extensor tendon laceration Epidemiology: Hand extensor injuries make up >25% of orthopedic soft tissue injuries 2, 3 Common in young men in manual labor Dominant hand more likely to be injured 4 2012 study on 86 patients reported 83% men with a mean age of 34.2 Ann Emerg Med. J Emerg Med. Emergency Orthopedics.

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

Sensible Medicine

SEPTEMBER 29, 2023

For example, a model that assesses patients presenting to an emergency department with suspected acute coronary syndrome (ACS) was designed so that patients with ACS wrongly labelled as “low risk” and sent home would be just 1% (false negatives) [8]. 2012 05;9(5):1-13. [5] Resuscitation. 2014;85(5):587-94. [3]

Research 59

Research Hospitals Academics Emergency Department 59

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. Most frequent reasons for emergency department visits, 2018. 2012 Nov; 470(11):3270-3274. Injuries discussed are shown in Image 1. 9(1):31-36. PMID: 31851021.

Fractures 75

Fractures Dislocations Operations Radiology 75

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

Sensible Medicine

SEPTEMBER 29, 2023

For example, a model that assesses patients presenting to an emergency department with suspected acute coronary syndrome (ACS) was designed so that patients with ACS wrongly labelled as “low risk” and sent home would be just 1% (false negatives) [8]. 2012 05;9(5):1-13. [5] Resuscitation. 2014;85(5):587-94. [3]

Research 40

Research Hospitals Academics Emergency Department 40

Pediatric Emergency Playbook

JANUARY 1, 2016

Accuracy of a screening instrument to identify potential child abuse in emergency departments. J Emerg Med. 2012; 43(1): e49–e51. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. Child Abuse & Neglect. 2014; (38): 1275–1281.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

ACEP Now

AUGUST 25, 2023

Case A critically ill patient presents to the emergency department (ED) requiring an emergent, definitive airway. However, a 2012 systematic review and meta-analysis (SRMA) reported that etomidate was associated with adrenal insufficiency and increased mortality in septic patients. to 1.21]).

Outcomes 52

Outcomes Emergency Department Sepsis Hospitals 52

The Skeptics' Guide to EM

AUGUST 5, 2023

Computerized tomography (CT) is commonly used in the emergency department in the diagnosis of TBI. Annals of Emergency Medicine 2014. Population: Children less than 18 years of age presenting with head injury to a level 2 pediatric trauma center in the United States between 2012-2013.

Head Injuries 40

Head Injuries Pediatrics Outcomes Fractures 40

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. In 7 studies with 4164 patients, PCT with a cut-off > 0.1 ng/mL (strongly recommended against antibiotics), 0.1-0.25

Infectious Diseases 86

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 86

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? 1 Low-dose non-contrast abdominal CT has become the gold standard for diagnosis as it has become readily available in emergency departments nationwide, with some studies touting sensitivity and specificity of 97% and 95%, respectively.2

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

EB Medicine

FEBRUARY 1, 2019

This month, we’re tackling an incredibly important topic - evaluation and management of life threatening headaches in the Emergency Department. Nachi: Unfortunately, the 2008 ACEP guideline and 2012 AHA guidelines still recommend a lumbar puncture in those being worked up for SAH. Tylenol should be offered for pain management.

Emergency Department 40

Emergency Department Stroke Outcomes Wellness 40

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. J Emerg Med. Lee HC et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 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. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine; 2012 Jun 27;20(1):1–1. Am J Emerg Med. 2012 Jan;30(1):51–6.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

PEMBlog

MAY 11, 2023

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. Pediatr Emerg Care. 2012 Jul;28(7):687-90. Acad Emerg Med. doi: 10.1097/PEC.0b013e31825d210b.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Outcomes 52

The Skeptics' Guide to EM

MARCH 6, 2021

Background: Epistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% ( Gifford 2008 , Pallin 2005 ). The episode included the Dundee protocol for adult epistaxis management from 2012. You apply direct pressure for 10 minutes, but the bleeding continues.

EMS 52

EMS Emergency Department Outcomes 52

Don't Forget the Bubbles

JULY 26, 2023

Prioritise listening to the first 30 minutes which given a good overview of aetiology and treatment (53 mins) Basics of cardiac rhythm problems in the ED Palpitations are a common reason for children to present to the emergency department, the majority of these will be benign from a cardiac perspective and instead related to stress or anxiety.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. Stuckey, T., Zimetbaum, P.

EKG/ECG 119

EKG/ECG Documentation/Coding Wellness Emergency Department 119

The Skeptics' Guide to EM

DECEMBER 12, 2020

She is Chair of the Royal College of Emergency Medicine Women in Emergency Medicine group and involved with the RCEM Public Health and Informatics groups. Case: A 52-year-old previously healthy woman presents to your emergency department (ED) with an abscess on her left forearm.

Operations 52

Operations Outcomes Research Academics 52