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. The bottom line was this was interesting, but VSE protocol was not ready for routine use.

Academics 52

Academics Resuscitation EMS Stroke 52

EB Medicine

MAY 3, 2019

This month, we’re moving into uncharted territories for the podcast… we’re talking psychiatry Nachi: Specifically, we’ll be discussing Depressed and Suicidal Patients in the emergency department. Routine serum testing and urine toxicology testing are not recommended for psychiatric patients presenting to the emergency department.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

EMDocs

JANUARY 11, 2025

A 75-year-old woman who is bedridden after a stroke presents to the ED from a nursing facility with abdominal pain and constipation. Stercoral colitis in the emergency department: a review of the literature. International journal of emergency medicine, 17(1), 3. Annals of emergency medicine, 82(1), 3746.

EMS 72

EMS Sepsis Shock Fluid Resuscitation 72

Taming the SRU

FEBRUARY 5, 2024

The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). WHO - Who Needs an LP in the ED? Patients with concern for infection (i.e., Clin Infect Dis. 2018;66(3):321-328. doi:10.1093/cid/cix806 5. Glimåker, M., Johansson, B., Ericsson, M., Bläckberg, J.,

Infectious Diseases 96

Infectious Diseases Seizures Ultrasounds Sepsis 96

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

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

The Skeptics' Guide to EM

AUGUST 19, 2023

I responded by posting the 2013 SGEM episode on INTERACT-2 ( SGEM#73 ) which showed no statistical difference between intensive (<140 mmHg) and guideline directed (<180 mmHg). Case: A 67-year-old male presents to the emergency department obtunded with left hemiplegia. Symptoms began just prior to presentation.

EMS 50

EMS Stroke Emergency Department 50

EMDocs

OCTOBER 30, 2023

Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013. West J Emerg Med.

Radiology 73

Radiology Radiology Emergency Department Hospitals 73

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

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. 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. Cardiology in the Young; 2013. 2013; 29:715-719.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Pediatric Emergency Playbook

JANUARY 1, 2017

The FPS-R uses more neutral and realistic faces and, unlike the Wong Baker scale, does not use smiling or crying faces to anchor the extremes of pain ( Tsze 2013 ). Use soothing sensory measures: speak softly, offer a pacifier, and stroke the skin softly. PAIN PHYSIOLOGY Pain includes two major components: generation and perception.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Taming the SRU

OCTOBER 7, 2024

epidemiology of venous thromboembolism in pregnancy VTE is not only important to understand because it is the number one cause of mortality for pregnant patients, but also because it is common and will show up in your Emergency Department likely frequently throughout your career. 2013 Apr;98(4):545-8. Haematologica. 2012.072009.

Ultrasounds 63

Ultrasounds CDC Research Stroke 63

Pediatric Emergency Playbook

JUNE 1, 2016

Conversely, is the heart rate too slow – even if the stroke volume is sufficient, if there is severe bradycardia, then cardiac output -- which is in liters/min – is decreased. Pulmonary embolism in the pediatric emergency department. 2013 Oct;132(4):663-7. 2013; 41:580-637. 2013; 17:R246. mg/kg up to 0.5

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

Northwestern EM Blog

MAY 16, 2022

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 He endorses nausea without vomiting and denies fever. References Fwu, C. Eggers, P. Kimmel, P.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

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. Tracheo-innominate artery fistula after stroke. He has had a tracheostomy for approximately 15 months since his injury.

Operations 52

Operations Pediatrics Radiology Radiology 52

ACEP Now

OCTOBER 10, 2023

A 76-year-old female presents to the emergency department obtunded with left hemiplegia. The CT scan reveals a hemorrhage in the right internal capsule, suggestive of acute hypertensive hemorrhagic stroke. External Validity: It is unclear if this data applies to patient you see in your emergency department.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

Don't Forget the Bubbles

FEBRUARY 7, 2024

My first real encounter with the healthcare system took place when I was about seven years old and had to go into hospital for an orchidopexy, so I can empathize with all the young people who come through our emergency department with acute testicular pain. The cremaster muscle contracts, elevating the testicle on that side.

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

The Skeptics' Guide to EM

JULY 4, 2020

He is Head of the Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research; Professor of Emergency Medicine, University of Western Australia; and Director of Research for Royal Perth Hospital. hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances.

Stroke 52

Stroke Research Hospitals Emergency Department 52

PEMBlog

MAY 9, 2024

Transcript Note: This transcript was partially completed with the use of the Descript AI Welcome to PEMCurrents, the Pediatric Emergency Medicine Podcast. This episode is all about febrile seizures, one of the most common neurological problems that you will see in the emergency department in children. And you know what?

Seizures 59

Seizures Pediatrics Wellness Emergency Department 59

EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. 2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al.

Stroke 87

Stroke Radiology Radiology Emergency Department 87

EM Literature of Note

OCTOBER 14, 2024

link] “Empathy and clarity in GPT-4-Generated Emergency Department Discharge Letters” The cold, unfeeling computer generates better feels than emergency clinicians. Bland treacle, no doubt, but generic bland treacle will beat the terse output of a distracted human any day.

Stroke 89

Stroke Emergency Department Resuscitation Best Practices 89