The Skeptics' Guide to EM

NOVEMBER 11, 2023

Case: A 24-year-old manual labourer presents to the emergency department (ED) after drinking a few too many beers, having a disagreement with another beer drinker and gets knocked down. DISCLAIMER: THE VIEWS AND OPINIONS OF THIS BLOG AND PODCAST DO NOT REPRESENT THE UNITED STATES GOVERNMENT OR THE US MILITARY.

Fractures 130

Fractures Military Radiology Radiology 130

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 108

CDC Hospitals EMS Emergency Department 108

ACEP Now

AUGUST 14, 2024

This recommendation is a departure from the 2014 guideline iteration that only recommended against CCBs in patients with decompensated heart failure. grams of IV magnesium to placebo, doses considerably higher than the two grams of magnesium often administered in the emergency department (ED). J Emerg Med. Circulation.

Emergency Department 105

Emergency Department Outcomes Research Wellness 105

RebelEM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

The Skeptics' Guide to EM

OCTOBER 14, 2023

Case: A 5-year-old boy presents to the emergency department (ED) with his parents for fever and fatigue. Background: We have looked at pediatric vital signs on the SGEM back in 2014 with PedEM superhero Dr. Anthony Crocco ( SGEM#98 ). He has had three days of high fevers at home. It seems awfully high. Does he have sepsis?”

Pediatrics 105

Pediatrics Sepsis Urgent Care Emergency Department 105

The Skeptics' Guide to EM

JUNE 17, 2023

Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Date: June 15, 2023 Reference: Rees CA et al. Date: June 15, 2023 Reference: Rees CA et al. Opioids are the primary therapy.

Emergency Department 74

Emergency Department Pediatrics Head Injuries Administration 74

ACEP Now

OCTOBER 10, 2023

A 76-year-old female presents to the emergency department obtunded with left hemiplegia. Both INTERACT-2 and ATACH-2 showed no statistical difference in their primary outcome between intensively lowering the BP and a less-intensive strategy. Symptoms began just prior to presentation. Her blood pressure (BP) is 195/104 mmHg.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

RebelEM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Outcomes: Primary Outcome: Pulmonary expansion 24 hours after the procedure. Secondary Outcomes: Pulmonary expansion 7 days after the procedure.

Outcomes 104

Outcomes Hospitals Research Emergency Department 104

Northwestern EM Blog

APRIL 15, 2024

“Tracheostomy: Epidemiology, Indications, Timing, Technique, and Outcomes.” Respiratory Care 59 (2014): 895 - 919. Tracheotomy outcomes and complications: a national perspective. As emergency physicians, we need to be familiar with the nuances of these devices so we can safely manage the airway just as we would any sick patient.

Emergency Department 98

Emergency Department Resuscitation Pediatrics Outcomes 98

ACEP Now

JULY 7, 2023

CASE A 30-year-old woman presents to the emergency department with left arm pain from a chronic wound. Prior to medical school, she received her MBA in Healthcare Management and currently works on health policy and outcomes-based research. Dr. Marco is professor of emergency medicine at Penn State Health Milton S.

Forensics 98

Forensics Airway Management Emergency Department Administration 98

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 99

Stroke Outcomes EMS Seizures 99

EMDocs

SEPTEMBER 27, 2023

Additionally, a 2022 study in JAMA found no association between MIPS measures and any meaningful clinical outcomes and moreover physicians who cared for the most medically and socially vulnerable were more likely to receive worse scores (8). Burleson (2014). References American Medical Association. ” from [link] Seidenwurm, D.

Emergency Department 88

Emergency Department Research Outcomes Hospitals 88

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. b) Emergency thoracotomy Let’s be clear: YOU will not be doing any of this. c) Or, do both?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Pediatric Emergency Playbook

NOVEMBER 1, 2017

Ann Emerg Med. 2014; 63(6):657-665. To scan or not to scan: pediatric minor head trauma in your office, clinic or emergency department. 2014; 168(9):837-843. Acad Emerg Med. Children with Arachnoid Cysts who Sustain Blunt Head Trauma: Injury Mechanisms and Outcomes. Acad Emerg Med. Pediatrics.

Pediatrics 52

Pediatrics Emergency Department Outcomes 52

Don't Forget the Bubbles

JUNE 17, 2024

Introduction: Civility Matters Healthcare environments, particularly emergency departments, are characterised by high levels of Volatility, Uncertainty, Complexity, and Ambiguity ( VUCA ). High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. 2014 Jun 26;23(12):653-9.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

EMDocs

SEPTEMBER 25, 2023

Still, there are those that believe that FPS is more of a physician-centered endpoint that does not fully reflect important patient-centric outcomes (16). actors Associated with the Occurrence of Cardiac Arrest after Emergency Tracheal Intubation in the Emergency Department. PLoS One 2014; 9(11): e112779.

Emergency Department 92

Emergency Department Soft Tissue Injuries Airway Management Operations 92

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Basilar artery occlusion remains a challenging diagnosis to make, and the delays in reaching the diagnosis can have considerable impact on health outcomes. link] Published January 2014. Epub 2014 Dec 4. Arch Neurol. 114.007036.

EMS 97

EMS Stroke Outcomes Hospitals 97

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 Burns Outcomes Hospitals 52

EMDocs

SEPTEMBER 7, 2023

2 Laboratory assays for DEG are not widely available and have long turn-around-times, thus have limited utility in diagnosis in the emergency department. Long-Term Renal and Neurologic Outcomes among Survivors of Diethylene Glycol Poisoning.” 6, 1 June 2014, pp. Sulfanilamide Disaster.” Conklin, Laura, et al.

Poisoning 92

Poisoning CDC Administration Emergency Department 92

EM Curious

JULY 11, 2015

Up to 25% of these injuries can be missed on initial presentation and if left untreated or missed, the function outcome will not be good. Orthopedic consultation should be obtained from the emergency department as most of these injuries will require surgical repair of the disrupted ligaments. Emergency Orthopedics 7th Ed.

Dislocations 52

Dislocations Emergency Department Fractures Outcomes 52

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

She is interested in social determinants of health in the emergency department and health policy. Dr. Ian Holley is also a PGY-3 resident in Emergency Medicine at Washington University School of Medicine in St. He is interested in ultrasound and international emergency medicine.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

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. Jeff: A 2014 study even showed an up to 80% reduction in the likelihood of developing DM2 postoperatively at the 7-year mark. Am J Emerg Med.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

PHEM Cast

APRIL 10, 2016

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. The impact of emergency medical services on the ED care of severe sepsis. Am J Emerg Med. 2014 Oct 28;:1–9. UK Sepsis Trust; 2014 Nov pp.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

The Injectable Orange

APRIL 4, 2017

There is a wealth of information relating to best practice in preventing falls and harm from falls, however there is little to guide the accurate prediction of future falls for geriatric patients presenting to the Emergency Department. Predicting Geriatric Falls Following an Episode of Emergency Department Care: A Systematic Review.

Emergency Department 52

Emergency Department Evidence-Based Practice Academics Documentation/Coding 52

The Skeptics' Guide to EM

AUGUST 5, 2023

Annals of Emergency Medicine 2014. Date: July 10, 2023 Guest Skeptic: Dr. Joe Mullally is a paediatric trainee in the Welsh paediatric training program and interested in Paediatric Emergency Medicine. Annals of Emergency Medicine 2014. Annals of Emergency Medicine 2014. Reference: Easter JS et al.

Head Injuries 40

Head Injuries Pediatrics Fractures Outcomes 40

The Skeptics' Guide to EM

DECEMBER 28, 2019

Despite a significant increase in CT use for diagnosis during the last two decades, patient-centered outcomes such as admission and intervention do not appear to have been affected. There was a trial published in 2014 comparing radiology department ultrasound, POCUS and CT for suspected nephrolithiasis (Smith-Bindman et al.

Radiology 40

Radiology Radiology Ultrasounds Emergency Department 40

The Skeptics' Guide to EM

DECEMBER 17, 2022

Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: A 71-year-old man is brought to your emergency department (ED) by emergency medical serviced (EMS) having fallen two steps at home.

Blood Transfusions 52

Blood Transfusions Fractures EMS Emergency Department 52

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. 2014, Hjortrup, Haase et al. Safety outcomes Serious adverse event occurrences were similar in both groups. N Engl J Med. versus 14.9%

Sepsis 52

Sepsis Shock Administration Resuscitation 52

The Skeptics' Guide to EM

NOVEMBER 20, 2021

You wonder if any emergency department (ED)-based interventions would help her and people like her be safe. In 2014 the SGEM looked at a systematic review by Dr. There are three other GEAR 1.0 Moving the Needle on Fall Prevention: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement.

Geriatric Emergencies 52

Geriatric Emergencies Elder Abuse Research Academics 52

The Skeptics' Guide to EM

JANUARY 12, 2019

He is also one of the world’s leading researchers on pain management in the emergency department and specifically the use of ketamine. We haver reviewed papers on pain management in the emergency department for many years on the SGEM. However, these were not patients recruited from the emergency department.

Emergency Department 40

Emergency Department Research Outcomes Hospitals 40

Taming the SRU

OCTOBER 23, 2023

THE CASE A female in her early 20s, G4P2012, presents to the emergency department (ED) with a 5 day history of left lower quadrant abdominal pain which has been worsening since onset. Discrimination between an IUP and an interstitial pregnancy is critical as interstitial pregnancies can have devastating outcomes. Shaukat, N.M.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. Guest Skeptic: Dr. Jess Monas is a Consultant in the Department of Emergency Medicine at the Mayo Clinic Hospital, Phoenix, Arizona. Date: September 20th, 2021 Reference: Litell et al.

Sepsis 40

Sepsis Emergency Department COPD Hospitals 40

EMDocs

JANUARY 3, 2024

Case Conclusion Your patient is given an IV dose of furosemide and improves after diuresis over the next few hours in the emergency department. Remote Monitoring With Appropriate Reaction to Alerts Was Associated With Improved Outcomes in Chronic Heart Failure: Results From the OptiLink HF Study. Published May 2014.

Allergic Reactions 113

Allergic Reactions Hospitals EMS Emergency Department 113

ACEP Now

MAY 10, 2024

A 59-year-old man presents to your community emergency department (ED) with chest pain that is radiating to his back. Emerg Med Australas. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult.

Ultrasounds 52

Ultrasounds Outcomes Academics Documentation/Coding 52

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? 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

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Emergency Medicine Journal

JUNE 22, 2023

Introduction The History, Electrocardiogram (ECG), Age, Risk Factors and Troponin (HEART) score is commonly used to risk stratify patients with possible myocardial infarction as low risk or high risk in the Emergency Department (ED).

EKG/ECG 40

EKG/ECG Emergency Department Outcomes 40

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 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89