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 94

Pediatrics Sepsis Urgent Care Emergency Department 94

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 104

Fractures Military Radiology Radiology 104

Taming the SRU

JUNE 12, 2023

Although not every person seeks health care for these injuries, the majority of those that do end up in the emergency department. In 2008, this led to greater than 316,000 emergency department (ED) visits and about 9,500 hospitalizations [1]. Annals of Emergency Medicine. Annals of Emergency Medicine.

Infectious Diseases 102

Infectious Diseases Emergency Department Administration Academics 102

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 Administration Emergency Department 98

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 95

Outcomes Hospitals Research Emergency Department 95

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

EMDocs

JANUARY 11, 2025

Stercoral colitis in the emergency department: a review of the literature. International journal of emergency medicine, 17(1), 3. Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Annals of emergency medicine, 82(1), 3746. In StatPearls.

EMS 88

EMS Sepsis Shock Fluid Resuscitation 88

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

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 72

Emergency Department Research Outcomes Hospitals 72

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

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 Documentation/Coding Academics 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 Outcomes Fractures 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

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 76

Poisoning CDC Administration Emergency Department 76

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

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

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

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

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).

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EKG/ECG Emergency Department Outcomes 40

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. 3,950 children were recruited between September 2014 to May 2017. What were the research questions?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

RebelEM

DECEMBER 1, 2022

Background: Pneumothorax management is a common clinical condition in the emergency department (ED) occurring in patients of varying ages and caused by multiple etiologies, including spontaneous, traumatic, and iatrogenic pneumothorax. Regardless of the cause, a thoracostomy is often required for treatment (Currie 2007 ).

Outcomes 52

Outcomes Hospitals Research Critical Access 52

Northwestern EM Blog

JANUARY 2, 2023

While this may be surprising, there is literature that shows that catastrophic events can be associated with increased social support and reduce suicidal outcomes [4]. A pediatric emergency department in Texas looked at the resulted of their routine suicide risk screenings for patients aged 11-21. JAMA Netw Open. 2020.34261 5.

Emergency Department 52

Emergency Department Research CDC Pediatrics 52

The Skeptics' Guide to EM

DECEMBER 16, 2017

Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. He is also a Faculty member of the Emergency Medicine and Acute Care Series 1986 to present. Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure. Reference: Legriel et al.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

Dr. Smith's ECG Blog

JUNE 18, 2013

These patients have worse outcomes: higher mortality, more CHF, higher biomarkers, and worse ejection fractions than the NonSTEMI patients with open arteries. Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chest pain. Ann Emerg Med 1998;31(1):3-11.

EKG/ECG 52

EKG/ECG Outcomes Emergency Department Hospitals 52

Taming the SRU

MAY 23, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. Foot injuries in the emergency department. 2014 May;4(3):432-5. 2014 May;4(3):432-5. Injuries discussed are shown in Image 1. 2015 Apr 28].

Fractures 57

Fractures Dislocations Operations EMS 57

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. Most frequent reasons for emergency department visits, 2018. 2014 May;4(3):432-5. Injuries discussed are shown in Image 1. Foot & Ankle Specialist.

Fractures 77

Fractures Dislocations Operations Radiology 77

Pediatric Emergency Playbook

JANUARY 1, 2016

Accuracy of a screening instrument to identify potential child abuse in emergency departments. 2014; (38): 1275–1281. J Emerg Med. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. ISPAD Clinical Practice Consensus Guidelines 2014. 2012; 43(1): e49–e51.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

Pediatric Emergency Playbook

APRIL 1, 2016

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. We could use it to track treatment , and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

PEMBlog

JANUARY 17, 2024

Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:e10. Now, some facilities have a short stay unit, like in their emergency department. Clin Infect Dis 2011; 52:e18.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

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. Methods STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. 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

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. Ann Emerg Med. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

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

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.

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Emergency Department Outcomes Research Wellness 105