The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Case: It is a steady Saturday afternoon in your rural emergency department (ED). This includes SGEM#19 way back in 2013 reporting a bandage wrap is a safe alternative to traditional casting for children with greenstick fractures. He has been a guest skeptic on the SGEM multiple times. Reference: Snelling et al.

Fractures 126

Fractures Ultrasounds Pediatrics Outcomes 126

ACEP Now

JULY 7, 2024

1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). 2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus). Ann Emerg Med.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

The Skeptics' Guide to EM

JULY 8, 2023

Case: A 57-year-old woman with hypertension, hyperlipidemia and type-2 diabetes mellitus presents to the emergency department (ED) with fever, cough, myalgias, headache and congestion. Managing editor of EM:RAP and Associate Editor at REBEL EM. It’s flu season and you’ve already seen 15 people with the same symptoms.

CDC 96

CDC Hospitals EMS Emergency Department 96

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 Hospitals Burns 52

The Skeptics' Guide to EM

AUGUST 28, 2021

Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial. Case: A forty-year-old woman presents to the emergency department […] The post SGEM#342: Should We Get Physical, Therapy for Minor Musculoskeletal Disorders in the ED?

Emergency Department 52

Emergency Department Research Outcomes 52

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

Northwestern EM Blog

APRIL 15, 2024

Tracheostomy: Epidemiology, Indications, Timing, Technique, and Outcomes.” Tracheotomy outcomes and complications: a national perspective. While most of the immediate complications of tracheostomy will occur in the ICU, these patients still frequent our emergency department with and without tracheostomy related emergencies.

Emergency Department 98

Emergency Department Resuscitation Pediatrics Outcomes 98

The Skeptics' Guide to EM

OCTOBER 20, 2018

Ann Emerg Med 2018 (CRD42017056195) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. Ann Emerg Med 2018 ( CRD42017056195 ) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. mg/dL within 3 days.

Outcomes 69

Outcomes Emergency Department Pediatrics 69

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

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. with generally good clinical outcomes including improved quality of life and reducing or staving off comorbidities. Obesity (Silver Spring).

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

JUNE 27, 2024

Critical Care Medicine 41(12):p A191, December 2013. 2013 Jan-Mar;16(1):91-5. Epub 2013 Aug 7. Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. Roy A, Allareddy V, Lee M, Nalliah R, Rampa S, Allareddy V, Rotta A. Br J Haematol.

Pediatrics 76

Pediatrics EMS Dehydration Hospitals 76

Don't Forget the Bubbles

AUGUST 7, 2023

This prospective cohort study included patients between 0-16 years old, who presented to one of four NHS hospital sites in Greater Manchester (a large metropolitan area in the North of England), consisting of an Urgent Care Centre and three Emergency Departments. Yes Was the outcome accurately measured to minimize bias?

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

EMDocs

JUNE 7, 2023

Parenteral organophosphorus poisoning in a rural emergency department: a case report. 2013; 6:524. Published 2013 Dec 9. Indira M, Andrews MA, Rakesh TP: Incidence, predictors, and outcome of intermediate syndrome in cholinergic insecticide poisoning: a prospective observational cohort study. BMC Res Notes.

Poisoning 84

Poisoning Airway Management Seizures PPE 84

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). 2013 Jan 24;368(4):394]. Ann Emerg Med. N Engl J Med.

Hyperthermia / Hypothermia 85

Hyperthermia / Hypothermia Resuscitation CPR EMS 85

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. Emerg Med J. Ketamine for paediatric sedation/analgesia in the emergency department. Emerg Med J.

Emergency Department 52

Emergency Department Head Injuries Hospitals Pediatrics 52

The Skeptics' Guide to EM

DECEMBER 15, 2018

He specialises in Paediatric Emergency Medicine and is a passionate believer that education exists to be shared (#foamed). The primary outcome was the FART (Found and Retrieved Time) score. The seizure lasted no more than a minute and now having been in the department for a couple of hours the infant is back to their normal selves.

Seizures 52

Seizures Pediatrics Emergency Department Outcomes 52

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

This was the third time coming to McGill University Department of Emergency Medicine to give Grand Rounds. The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest. TXA also seems to improve patient-oriented outcomes in epistaxis ( SGEM#53 and SGEM#210 ).

Academics 52

Academics Resuscitation EMS Research 52

EB Medicine

AUGUST 6, 2019

In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. Nachi: Though you can, in theory, test for plasma DOAC concentrations, such tests are not routinely indicated as levels don’t correspond to bleeding outcomes. of patients per year. Nachi: Next we have apixaban, tradename Eliquis.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Don't Forget the Bubbles

OCTOBER 19, 2023

Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. This is what they found: Length of hospital stay (time from randomisation to the time of hospital discharge or death), the primary outcome, was significantly longer in the high-flow group at 1.77

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

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

Don't Forget the Bubbles

JANUARY 10, 2024

Let’s take the humble blood transfusion – used in emergency departments across the globe and playing a key role in critical care. Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. Outcomes Primary outcome Mortality at 28 days after randomisation. Was blinding achieved?

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. 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. doi: 10.1053/j.sult.2013.01.004.

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. Int J Emerg Med 6, 38 (2013). J Trauma 2003; 54:444-453 Mort TC. Anesth Analg. 2004 Aug;99(2):607-13, Hasegawa K et al.

Airway Management 52

Airway Management Resuscitation EMS Hospitals 52

The Skeptics' Guide to EM

MARCH 13, 2021

Lancet 2021 Case: You’re working a busy evening shift in your community emergency department (ED) when a 58 year old female presents with a rapid onset terrible intensity headache. Jeff was actually on the SGEM as the guest skeptic discussing this clinical decision instrument way back in 2013 ( SGEM#48 ).

Stroke 40

Stroke Emergency Department EMS Outcomes 40

Taming the SRU

SEPTEMBER 15, 2023

Limited availability of radiology-performed US services in certain hospitals, especially overnight Can avoid unnecessary anticoagulation in patients Reduce time in ED to disposition In terms of workflow, when there is suspicion for a DVT, you need to first calculate a Wells’ Score for a DVT If low/moderate risk, can start with a D-dimer prior to committing (..)

CPR 89

CPR Burns Airway Management Wellness 89

RebelEM

MAY 11, 2023

Background: The emergency department is frequently visited by patients suffering from symptomatic alcohol withdrawal, and the traditional management has been dominated by repeated doses of benzodiazepines. Return Encounters in Emergency Department Patients Treated with Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal.

Emergency Department 98

Emergency Department Administration Hospitals Academics 98

PEMBlog

JANUARY 17, 2024

Camargo, Clinical Trial: Comparative Effectiveness of Cephalexin Plus Trimethoprim-Sulfamethoxazole Versus Cephalexin Alone for Treatment of Uncomplicated Cellulitis: A Randomized Controlled Trial, Clinical Infectious Diseases, Volume 56, Issue 12, 15 June 2013, Pages 1754–1762, [link] Liu C, Bayer A, Cosgrove SE, et al.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

ACEP Now

MARCH 14, 2024

A 24-year-old male with history of quadriplegia and traumatic brain injury presents to the emergency department with hemorrhage in his oral cavity and blood from his tracheostomy tube. 2013:1960-62. He has had a tracheostomy for approximately 15 months since his injury. Blood is spurting from the orifice of the tube. 169:334-48.

Operations 52

Operations Pediatrics Radiology Radiology 52

Pediatric EM Morsels

MAY 24, 2024

Low Risk Intra-Abdominal (IAI) Trauma – Derivation of the Rule The PECARN Group first released their derivation of a pediatric prediction rule for intra-abdominal injury in 2013. 2013 Aug 1;167(8):700-707. Lancet Child Adolesc Health. 2024;8:339-344. Miglioretti DL, Johnson E, Williams A, et al. JAMA Pediatr. 2013.311.

Pediatrics 161

Pediatrics Blood Transfusions EMS Fractures 161

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

Dr. Smith's ECG Blog

MAY 23, 2023

Am J Emerg Med. This " imbalance of precordial T waves" is not seen very often — and in the “right” clinical setting, has been associated with acute OMI ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM ). 2022 Jan;51:384-387. doi: 10.1016/j.ajem.2021.11.023. 2021.11.023. Epub 2021 Nov 17.

EKG/ECG 82

EKG/ECG Wellness Emergency Department EMS 82

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department. As a result — cardiac cath was not performed — since results of a cath would not have altered the unfortunate outcome. Am J Med 2019, 132(5):622-630. Miranda DF, Lobo AS, Walsh B, et al.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Taming the SRU

MARCH 11, 2024

of all orthopedic injuries and may be difficult to recognize if the dislocation spontaneously reduces prior to care in the Emergency Department, which may occur in upwards of 50% of cases (3). 4) This classification system is more specific but may be impractical to use in an Emergency Department setting. No open wound.

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

Dr. Smith's ECG Blog

FEBRUARY 10, 2022

1] The patient did not have a good outcome because their ECG was labeled ‘normal’ but in spite of it. Significance of atypical symptoms for the diagnosis and management of myocardial infarction in elderly patients admitted to emergency departments. Arch Cardiovasc Dis 2013 Khan AR et al. JAHA 2022 Grosmaitre P et al.

EKG/ECG 40

EKG/ECG Emergency Department Outcomes 40

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

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 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

Emergency Medicine Journal

JULY 22, 2024

The main outcome variable was the diagnosis of acute appendicitis. For those patients who had formal ultrasound, direct and indirect findings of ultrasound were abstracted from the ultrasound report.

Ultrasounds 52

Ultrasounds Radiology Radiology Emergency Department 52