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

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 122

Wellness 122

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 Hospitals Fractures 64

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

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

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

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 81

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 81

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

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

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

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

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

Ken Grauer, MD

JULY 29, 2023

This young woman did well for a year — but unfortunately suffered another cardiac arrest, from which she could not be resuscitated. Insight into this question is provided by 2 Hoffmayer et al manuscripts ( JACC 58(8):831-838, 2011 — and — Front Physiol 3:23, 2012 ). MRI confirmed ARVC. About A RVC/ A RVD.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

Taming the SRU

MARCH 30, 2023

10.1186/s13613-020-00658-8 P: A total of 761 patients from two separate cohorts found to have septic shock I: Diastolic shock index C: Comparison to a variety of well adopted markers of morbidity and mortality, including systolic shock index, SOFA score, APACHE II score, lactate, etc. Ann Intensive Care 2020;10(1):41. Opal, Jonathan E.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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 64

OB/GYN EMS Sepsis Fluid Resuscitation 64

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

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 77

Hospitals Research Patient Safety Wellness 77

Mind The Bleep

OCTOBER 22, 2024

Cardiology applications typically open around November, and since 2012, there has been no Round 2 for Cardiology. Late applications are not accepted, so checking the dates for the application year and applying well in advance is essential. All applications to Cardiology are made nationally via the Oriel Application System.

Evidence-Based Practice 52

Evidence-Based Practice Academics Operations Hospitals 52

Sensible Medicine

JULY 31, 2024

They slept well and thrived. The campaign was rebranded “Safe to Sleep” in 2012, to reflect the emphasis on more than just sleep position. I vividly remember whisper-sobbing: please don’t die. When our first grandchild arrived, her parents and I dutifully put her on her back.

Research 95

Research Pediatrics Outcomes Wellness 95

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 64

EKG/ECG Wellness Hospitals 64

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

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

Taming the SRU

JULY 21, 2023

Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. Corneal ulcers are most frequently caused by Pseudomonas (especially if they wear contact lens), as well as S. They report blurred vision as well as photophobia and redness / watery discharge of the eye. October 2012 revision.

Emergency Department 87

Emergency Department EMS Burns Wellness 87

Northwestern EM Blog

SEPTEMBER 26, 2022

It is well-documented that ED physicians have historically high rates of burnout compared to other specialties as well as a high incidence of post-traumatic stress disorder (PTSD) compared to the general population. PTSD is 2 times more prevalent in physicians (14.8%), with EM resident physicians falling in the range from 11.9%-21.5%.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

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 26, 2023

Kit Carney and Dr. Kristen Humphrey discuss gun violence, its impact on our patients and their families, as well as practical tips on advocating for safe storage of firearms, and how we can support victims of violence. Pediatrics November 2012; 130 (5): e1416–e1423. 2012-2481 Haasz, M., Melzer-Lange, Joseph O’Neil, Wendy J.

Pediatrics 52

Pediatrics Wellness Poisoning Burns 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

Pediatric Education

MAY 19, 2024

Patient Presentation A 5-day-old male came to clinic for his well-examination. He was breastfeeding, stooling, and urinating well, and had no concerns for jaundice. doi:10.1136/bjophthalmol-2012-302539 Callaway NF, Ludwig CA, Blumenkranz MS, Jones JM, Fredrick DR, Moshfeghi DM. Li LH, Li N, Zhao JY, et al. Br J Ophthalmol.

Pediatrics 40

Pediatrics Wellness Hospitals 40

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

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

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 88

Sepsis Best Practices Hospitals Outcomes 88

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 81

Documentation/Coding Hospitals Patient Safety Emergency Department 81

ACEP Now

JULY 7, 2023

The article also will not address severe agitation, which is already well covered elsewhere and is the topic of an ACEP clinical policy currently in development. 2012 Feb;13(1):17-25. 2012 Feb;13(1):26-34. This article focuses on calming medication in patients with mild to moderate agitation. West J Emerg Med. J Emerg Med.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 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

Taming the SRU

FEBRUARY 5, 2024

Several definitions have been set forth for this common injury, with perhaps the most well accepted definition being introduced by the Centers for Disease Control and World Health Organization. The history should focus on both the events surrounding the traumatic event, as well as current symptomatology. 2012 Jan 15;85(2):123-32.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

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