Don't Forget the Bubbles

AUGUST 2, 2023

in 2012 of 19 children with CRPS treated with CBT and physical therapy showed that 89% eventually had full symptom resolution. 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). A small, retrospective review by Brooke et al.

Psychiatric 98

Psychiatric Pediatrics Outcomes Academics 98

RebelEM

FEBRUARY 24, 2025

Well, the established cutoff for the distensibility index is 18%. Oct 2012; PMID: 23043910 Kumar A, 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. Why does it matter?

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

EMDocs

AUGUST 22, 2024

Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter. 15 Ensuring bilingual providers are tested and credentialed. Lion KC, et al. Pediatrics.

Documentation/Coding 104

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 104

PEMBlog

APRIL 24, 2024

Retrospective use has been shown to be valid and reliable in one cross-sectional study ( Beslow 2012 ).This

Stroke 59

Stroke Pediatrics Blood Transfusions Radiology 59

ALiEM

OCTOBER 16, 2023

Additional Images Physical Exam Vitals : BP 115/80; HR 120; T 101°F; RR 16; O2 sat 97% General : Well appearing in no acute distress HEENT : Poor dentition, mild trismus. Treatment should include both an extended course of antibiotic therapy as well as surgical source control of abscesses. 2012 Oct;12(10):808-15.

Academics 60

Academics Wellness Emergency Department Hospitals 60

EMDocs

JULY 13, 2024

2012 May;27(5):1368-74. Epub 2012 Mar 14. Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. Hum Reprod. doi: 10.1093/humrep/des076. PMID: 22419745. Morens, David. 2024, [link] Accessed 7 February 2024.

OB/GYN 88

OB/GYN EMS Sepsis Fluid Resuscitation 88

ALiEM

JANUARY 29, 2024

It requires immediate consultation with ophthalmology as well as neurology as it is considered a stroke equivalent. 2012 Dec;33(7):E263-E267. Epub 2012 Sep 21. The retrobulbar “spot sign” as a discriminator between vasculitic and thrombo-embolic affections of the retinal blood supply. Ultraschall Med. PMID: 23023446.

Stroke 64

Stroke Ultrasounds Academics Outcomes 64

Downeast Emergency Medicine

JUNE 7, 2021

Use a tourniquet when you LOOK for the vein as well as when you place the IV otherwise the pressure from the probe will compress the veins and you won’t find anything. 2012 Sep;30(7):1134-40 References Fields JM et al. 2012 Sep;30(7):1134-40. Consider the use of lidocaine if a patient has has repeated attempts at IV placement.

Ultrasounds 52

Ultrasounds Wellness 52

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. 2012 Feb;33(1):46-54. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood right in front of you. EM:RAP HD Videos.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

ALiEM

SEPTEMBER 27, 2023

What well-known adverse reaction results from ingestion of the pictured mushroom? Disulfiram-like reaction with ethanol consumption Coprinus atramentarius or Ink Cap mushroom is well known to cause a disulfiram-like reaction when it is consumed prior to ethanol. 2012 Jul;64(3):520-39. Koppaka V, Thompson DC, Chen Y, et al.

Seizures 67

Seizures Academics Wellness 67

ALiEM

SEPTEMBER 13, 2024

On arrival to our emergency department, the patient expressed continued eye pain with bloody discharge as well as blurry vision from his right eye. 2012 Feb;26(2):212-7. At the outside hospital, he was given analgesia, antiemetics, and a tetanus booster, and transferred to our hospital for ophthalmologic evaluation. 2023, March 23).

Emergency Department 64

Emergency Department Academics Fractures Hospitals 64

PHEM Cast

MARCH 17, 2016

Taken from Weingart & Levitan 2012. 2012; 59(3): 165-175. Annals of Emergency Medicine. 2015; 65(4): 371-376. Weingart SD, Levitan RM. Preoxygenation and Prevention of Desaturation During Emergency Airway Management. Annals of Emergency Medicine. Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS.

Airway Management 52

Airway Management Burns Emergency Department Resuscitation 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. 2012 PMID: 21893125. Resuscitation. 9 Zhang W et al. Medicine (Baltimore).

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

The Skeptics' Guide to EM

JUNE 2, 2021

We have discussed Choosing Wisely before on SGEM Episodes: * SGEM#15: Choosing Wisely * SGEM Xtra: CAEP Choosing Wisely * SGEM Xtra: Right, You’re Bloody Well Right, You’ve got the Bloody Right to Care Choosing Wisely Canada ( CWC ): It is the national voice for reducing unnecessary tests and treatments in health care.

Documentation/Coding 52

Documentation/Coding Hospitals Wellness 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2012; 43(1):49-51. BMJ 2012; 345:e5521. 2012; 3:247-250. 2012; 92:527-39. 2012; 30:426-431. 2012; 29:231-236 Blakely ML et al. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. J Am Coll Surg. 2004; 199(4):628-635. Lee HC et al. Intestinal Malrotation and Catastrophic Volvulus in Infancy.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

ALiEM

OCTOBER 20, 2023

Raised reddish-brown well-demarcated plaques with waxy centers were also noted on the dorsal forearms and hands. 2012 Jul;16(4):614-20. Additional Images Physical Exam Vitals : T 37.2°C; Laboratory Data Glucose : 539 (with a normal anion gap) Hemoglobin A1C : 10.9 Available from: [link] PMID:29083569. Indian J Endocrinol Metab.

Academics 64

Academics Emergency Department Wellness Research 64

Dr. Smith's ECG Blog

MAY 23, 2014

Since this is a contrast study, well-perfused areas are bright with contrast, whereas poorly perfused areas remain dark. T he subendocardial layer is most susceptible to ischemia because it is closest to the high pressure LV chamber; that higher pressure inhibits perfusion while the subepicardial (outer) layer may still be well perfused.

EKG/ECG 52

EKG/ECG Wellness 52

The Skeptics' Guide to EM

AUGUST 17, 2019

Attempting to decrease a patient’s pain to zero is certainly well-intentioned but you have to ask yourself how many patients are being harmed by such a goal? Pain 2012). ACEP has a clinical policy regarding prescribing of opioids for adult ED patients that was published in 2012 ( Cantrill et al ). Volkow et al. JAMA 2011).

Emergency Department 52

Emergency Department Academics Fractures Outcomes 52

Advanced Medical Reviews

SEPTEMBER 15, 2017

Especially since millennial satisfaction with the healthcare system is lower – only 32 percent report being treated well , according to an Accenture survey – than it is for preceding generations. Access to personalized recommendations, as well as public reviews, is a defining feature of the current media landscape.

Operations 56

Operations Research Wellness Hospitals 56

Dr. Smith's ECG Blog

JUNE 1, 2012

This demonstrates that the precordial T-wave inversion is new as well. This case was written in 2012, before we changed the paradigm to OMI/NOMI and years before the Queen of Hearts was in use. However, then a previous ECG was located: Previous ECG has LVH in aVL, but no "secondary" ST-T abnormalities.

EKG/ECG 52

EKG/ECG EMS Wellness 52

Don't Forget the Bubbles

NOVEMBER 8, 2023

Tilly is normally fit and well, with no significant past medical history. The Shera Score Children with a low Shera score (less than 3) who are otherwise systemically well may be suitable for discharge home with safety netting advice , whereas patients with high scores (8 or more) warrant immediate surgical referral. Pediatrics, 2012.

Emergency Department 105

Emergency Department Ultrasounds Pediatrics Best Practices 105

EMDocs

DECEMBER 11, 2023

There are multiple criteria systems for diagnostic an acute myocardial infarction in this population, as well as patients with ventricular-paced rhythms. 2012 Dec;60(6):766-76. However, it still serves as evidence of a patient’s elevated risk for underlying coronary artery disease or cardiomyopathy. Ann Emerg Med. N Engl J Med.

EKG/ECG 120

EKG/ECG Emergency Department Academics Operations 120

ALiEM

AUGUST 14, 2023

Treatment is appropriate antibiotics and improved foley hygiene, foley exchange as well as improved bowel regimen to increase stool transit time. 2012 Dec;13(6):499-500. It is predominantly found in women, chronically catheterized, institutionalized, and constipated patients. References Meekins Pauline, Ramsay Amy, Ramsay Michael.

Academics 52

Academics Wellness Infectious Diseases 52

Pediatric Emergency Playbook

OCTOBER 1, 2016

Well appearing? Consider allergic proctocolitis if the child is well. Think -- pink stain, without clot: Infants and Young Children Well appearing? Pitfalls in the infant and young child Epistaxis; food-related misadventures Older Child and Adolescent Well appearing? Neonates Well appearing? 2012 Nov 9;2(1):46.

Pediatrics 52

Pediatrics Wellness Shock Resuscitation 52

Maria Yang, MD

DECEMBER 14, 2024

Internet platforms profit from obtaining information from children without parents knowledge or consentand social medias effect on the well-being of American children is well-documented. Around 2012, American teens experienced a dramatic decline in wellness.

Documentation/Coding 40

Documentation/Coding Wellness 40

Advanced Emergency Nursing from AENJ

OCTOBER 18, 2014

An example would be the recent ACLS graduate who tells the airway manager, who is ventilating the patient well without a leak, that he/she is holding the mask “upside-down”. This deliberate choice is known to the expert, but not well-published in basic literature. —David Dunning ” (as cited in Wikipedia article, below).

Airway Management 40

Airway Management Emergency Nursing Pediatrics Wellness 40

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. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients. Pediatr Cardiol.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

Well, don't we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)? 109 (20):361-368, 2012 — CLICK HERE ). But it is very distinct from hyperkalemia (and anything else, including VT), and such confusion can only be due to lack of familiarity, because, if you look closely, its morpholgoy is very different from anything else.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

The Skeptics' Guide to EM

DECEMBER 12, 2020

She is systemically well and there is no sign of tracking, so you decide to perform incision and drainage in the ED. Way back in 2012 we looked at packing after incision and drainage (I&D) on SGEM#13 and concluded routine packing might not be necessary. Kirsty is also the creator of the wonderful infographics called #PaperinaPic.

Operations 52

Operations Academics Outcomes Research 52

RebelEM

JULY 20, 2023

This can be plotted as a Forgetting Curve (Figure 2), the slope of which depends on many things – the quality of the teacher, if stress is included in the training, if you’re well fed, have good sleep, etc. This is the idea of learning something so well you bring yourself well above the line of competence.

EMS 75

EMS Burns Airway Management Wellness 75

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Brief aside: "Early repolarization" is a frequently proclaimed and poorly understood electrocardiographic phenomenon which mostly serves to reassure clinicians that not all ST elevations are ischemic (something readers of this blog know well). linking the finding with long term risk of idiopathic ventricular fibrillation. Tikkanen, J.

EKG/ECG 129

EKG/ECG Documentation/Coding Wellness Emergency Department 129

ACEP Now

FEBRUARY 13, 2024

See below: Fascia iliaca Serratus anterior Erector spinae The risks of opioid medications, especially in the elderly, has been well described. Trends in opioid prescriptions among part D medicare recipients from 2007 to 2012. J Gen Intern Med. 2016 May;31(5):478-85. Goodwin J. American Journal of Medicine. 2016;129(2):221.e21–221.e30.

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Wellness 52

RebelEM

JANUARY 25, 2023

J Trauma Acute Care Surg 2012; 73(5): S362-9. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Pediatric Emergency Playbook

MAY 1, 2017

Home care The neonate who is safe to go home is well appearing, and not dehydrated. Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

This definition includes clinically apparent seizures as well as those seen only on EEG.) Or… is it something else as well? 2012; DOI 10.1007/s12028-012-9695-z Capovilla G et al. 2012; 79:2355-2358. During a seizure, GABA receptors in the neuron’s membrane are internalized and destroyed. In other words – time is brain.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Exceptions to the above general rule of course exist ( ie, Children may have sinus tach well over 200/minute — and an occasional adult with enhanced sympathetic tone may also have surprisingly fast sinus tachycardia ) — but I find it helpful to be aware of these general rate limits.

EKG/ECG 63

EKG/ECG Wellness Hospitals 63

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

Emlyn’s blog and podcast since 2012. However, if the child is looks well, but the clinician determines that the febrile infant is not in the low risk group for a UTI, the AAP recommends two options. She’s been there for the last 18 months working in prehospital and retrieval medicine and then in Emergency Medicine.

Pediatrics 52

Pediatrics Emergency Department Sepsis Wellness 52