Sensible Medicine

JUNE 9, 2024

I trained at Northwestern Medical Center in Chicago between 2009 and 2012 in internal medicine. “Fake” sick is something that admittedly we have no public data on, but programs know well. If I ever called out “fake” sick, my program director would give me a “real” ass-kicking.

Wellness 140

Wellness 140

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Admission allows for close monitoring, given the risks of perforation, ischemic bowel, and ulceration, as well as appropriate management of the condition and patient symptoms. 2012 May-Jun;13(3):283-289. Korean J Radiol. link] Sacerdote, M., Limback, J., & Zhu, J.

EMS 94

EMS Sepsis Shock Fluid Resuscitation 94

The Trauma Pro

MARCH 8, 2024

We instituted a trauma team EMS timeout process in 2012, which persists to this day. They decrease handoff errors and reduce preventable adverse events as well. The EMS to trauma team handoff is well-received and is subjectively valuable. Please take a look at my post here. Unfortunately, there is little real data to prove this.

EMS 113

EMS Wellness 113

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

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. 2012) “Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue”. 2012) “Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting”. Newell, J. &

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

Don't Forget the Bubbles

AUGUST 9, 2023

There is no pain or discharge, no lymphadenopathy, and she is otherwise well. 2012 Aug;97(8):2732-40. Epub 2012 Jun 20. Her parents first noticed it when she was two years old, and since then, it has gradually been increasing in size. It is soft, cystic, and not tender. It moves on swallowing, and when she sticks out her tongue.

Ultrasounds 98

Ultrasounds Pediatrics Wellness 98

Ken Grauer, MD

MARCH 12, 2023

PEARL # 1: An additional ( less well known ) feature of QRS morphology in today’s initial tracing that favors aberrant conduction — is the finding of the mirror -image opposite morphology for the QRS in lead I and/or lead V6 — compared to the rSR’ complex just described for lead V1.

EKG/ECG 195

EKG/ECG Administration Wellness 195

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

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 100

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 100

Don't Forget the Bubbles

JANUARY 17, 2024

Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. Mirza and Sheikh reported perhaps the first unfortunate case in 2012. 2012 Jan;3(1):6. From Mullens et al., Krisch et al. Mirza B, Sheikh A.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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

PulmCCM

JUNE 26, 2023

Cervical and pancreatic cancer patients often do as well with less invasive surgery, and some patients with rectal cancer or Hodgkin lymphoma can safely get less radiation. An expert panel broadened the definition of acute respiratory distress syndrome (ARDS). They announced this at the American Thoracic Society meeting in May 2023.

Outcomes 98

Outcomes Ultrasounds Hospitals Wellness 98

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. Shock 2012. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

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

EMDocs

NOVEMBER 7, 2023

Antibiotics are recommended for those with complicated diverticulitis, as well as surgical specialist consult if necessary (e.g., 2012 Apr;99(4):532-9. 2012 Apr;99(4):532-9. perforation). Randomized Controlled Trials: The AVOD trial: Chabok A, Påhlman L, Hjern F, Haapaniemi S, Smedh K; AVOD Study Group. Randomized  Br J Surg.

Sepsis 108

Sepsis Best Practices Hospitals Outcomes 108

EMDocs

FEBRUARY 7, 2024

Unionization of healthcare providers can create opportunities to improve staff’s financial and general well-being, but may also facilitate future strikes. Trainees and attending providers should be informed about both the opportunities that come with unionization, as well as the challenges that come with managing strikes.

Hospitals 95

Hospitals Research Patient Safety Wellness 95

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

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 81

OB/GYN EMS Sepsis Fluid Resuscitation 81

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

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

EMDocs

JULY 25, 2024

Do them well and document the process, preferably at the bedside. Oct 04, 2012. Assure and document the patient’s resources and safety net if discharged. If PA-C’s are allowed to care for suicidal patients, their privileges should so specify. Handoffs are a high-risk exchange. Applebaum PS. N Eng J Med 2007;357:1834-40 3.

Documentation/Coding 100

Documentation/Coding Hospitals Patient Safety Emergency Department 100

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

OCTOBER 8, 2023

There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. There again are well for med R-waves. The STE vector produces ST depression in lead s aVR and V1, and thus this ST depression must be viewed as mirroring/reflectin g (reciprocal to) the widespread nonischemic S TE. There are also J-waves.

Hyperthermia / Hypothermia 124

Hyperthermia / Hypothermia EKG/ECG Shock Wellness 124

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

PHEM Cast

FEBRUARY 25, 2021

In the UK sea water is very unlikely to be icy or cold enough – however, small areas of water may well be, particularly in the winter months. References Szpilman D, Bierens JJ, Handley AJ, Orlowski JP (2012) Drowning. Water temperature is a key determinant: icy versus not. New Engl J Med. 366: 2102–10. Tipton & Golden (2011).

Resuscitation 52

Resuscitation Hospitals Outcomes 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

Dr. Smith's ECG Blog

MARCH 13, 2013

There is reciprocal ST depression in I, II, aVL and V4-V6, as well as some very subtle STD in posterior leads V8 and V9 (which also have very low QRS voltage) Here is his initial ECG, which the tech recorded as a 15-lead ECG (the doctors were not sure why): Thus, there is a rightward, anterior, and slightly superior ST axis. Wong, 2012)" 1.

EKG/ECG 52

EKG/ECG Hospitals Outcomes Wellness 52

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 119

EKG/ECG Emergency Department Academics Operations 119

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

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