The Skeptics' Guide to EM

FEBRUARY 22, 2020

Maia Dorsett is an Emergency and EMS Physician at the University of Rochester Medical Center. Date: January 27th, 2020 Guest Skeptics: Dr. Bringing value, balance and humanity to the emergency department: The Right Care Top 10 for emergency medicine. ” Where does emergency medicine fit into the RCA initiative?

Wellness 52

Wellness Emergency Department EMS 52

ALiEM

APRIL 12, 2023

The thin alcohol layer serves to eliminate any air bubbles under the adhesive cover as well as minimizes residual adhesive material sticking to the probe when removing the cover. emDOCs.net – Emergency Medicine Education. The adhesive cover itself serves as a sterile barrier and a slick surface to improve probe maneuverability.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

RebelEM

APRIL 29, 2024

In these situations, the American Heart Association (AHA) and the European Resuscitation Council (ERC) of 2015 recommend the intraosseous (IO) route after the peripheral route and before the central venous route ( 1). World J Emerg Surg 2023 PMID: 36918947 3. Int J Emerg Med 2009 PMID: 20157465 4. Ong MEH, Chan YH, Oh JJ, et al.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Don't Forget the Bubbles

JULY 19, 2023

Olivia, a previously well 13-year-old girl, is referred to the paediatric ED from the Ophthalmology ED. Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation. 2015 Aug 1;19(4):344–8. Clin Ophthalmol.

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

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. In our emergency department, the RTs do not spend a lot of time going around measuring cuff pressures and usually save that until the patient reaches the ICU.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

EMDocs

JUNE 8, 2024

Post septal (retrobulbar) is higher risk to vision and requires CT imaging to diagnose as well as thorough exam to check for proptosis, afferent pupillary defect, increased intraocular pressure [7]. A 32-year-old man presents to the emergency department with eye pain. Overview of Eye Injuries in the Emergency Department.”

EMS 92

EMS Allergic Reactions Poisoning Emergency Department 92

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 122

Ultrasounds Outcomes COPD Hospitals 122

EB Medicine

DECEMBER 1, 2018

Jeff: In fact, a meta-analysis on vaccine effectiveness from 2004-2015 found that the pooled effectiveness against influenza B was 54%, against the H1N1 pandemic in 2009 was 61%, and against the H3N2 virus was 33%. Jeff: Of note, EMS providers should use face masks themselves and place them on patients as well. Nachi: Amazing.

Emergency Department 40

Emergency Department CDC Infectious Diseases EMS 40

EB Medicine

SEPTEMBER 1, 2018

Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

The Skeptics' Guide to EM

OCTOBER 10, 2020

Sergey Motov is an Emergency Physician in the Department of Emergency Medicine, Maimonides Medical Center in New York City. He is also one of the world’s leading researchers on pain management in the emergency department, specifically the use of ketamine. His twitter handle is @PainFreeED.

Emergency Department 52

Emergency Department Research Wellness 52

ALiEM

AUGUST 9, 2023

Child with Cough and Fever: Case Introduction A 6-year-old boy presents to the emergency department complaining of cough for 3 days and fever for the last day. F Heart Rate 138 bpm Blood Pressure 102/61 Respiratory Rate 32 Oxygen Saturation (room air) 100% He is well appearing but has increased work of breathing. Balk et al.,

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

Guest Skeptic: Dr. Natalie May trained as an emergency physician with subspecialty paediatric emergency medicine in the UK and worked in Manchester and Oxford before moving to Australia in 2015 to work for Sydney […] The post SGEM#190: Wee are the Champions of Pediatric Urine Samples first appeared on The Skeptics Guide to Emergency Medicine.

Pediatrics 52

Pediatrics Emergency Department Sepsis Wellness 52

EMDocs

MAY 25, 2023

Study included children, as well as adults. population at large Enrollment was terminated at an interim analysis due to predefined futility criteria that suggested that there was a 1% chance that carrying the trial to completion would demonstrate a most effect or least effective treatment. This increases applicability or ED care.

Seizures 73

Seizures Administration Anaphylaxis Outcomes 73

Taming the SRU

JULY 24, 2023

THE CASE A male in his 60s presented to the emergency department for right upper quadrant abdominal pain. Risk factors associated with increased risk of acute perforated cholecystitis include age greater than 65 years old, as well as diabetes mellitus, atherosclerosis, or organ failure (1, 2). 2015 Oct;16(5):509-12.

Ultrasounds 78

Ultrasounds Sepsis Radiology Radiology 78

ALiEM

MAY 13, 2024

Case Introduction: Child with abdominal pain Wendy is a 7-year-old girl who comes into the emergency department with redness, swelling, and pain on her left calf. They may be well-circumscribed or may have irregular borders. Well-circumscribed abscess with heterogeneous debris C. Lam et al., 94.7%) 80% (70.0-87.4%)

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

The Skeptics' Guide to EM

SEPTEMBER 16, 2017

Though they are relatively safe, upper airway angioedema is one of the life-threatening adverse effects that we see frequently in the Emergency Department. A 2015 phase 2 study published in the NEJM (Bas et al) touted the role for icatibant in the treatment of these patients.

Anaphylaxis 52

Anaphylaxis Administration EMS Emergency Department 52

Northwestern EM Blog

MAY 9, 2022

There is no gold standard with respect to its definition, and it requires a medication history (which we typically don't do very well in the emergency department). 12 March 2015. Goldfrank's Toxicologic Emergencies, 11e. NMS is hard to diagnose because it's rare. References 1. Accessed February 11, 2022.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Administration 52

The Skeptics' Guide to EM

SEPTEMBER 12, 2020

I have discussed burnout and wellness a number […] The post SGEM Xtra: The Water is Wide first appeared on The Skeptics Guide to Emergency Medicine. Mayo Clin Proc 2015 * Shanafelt et al. I was invited by the College of Physicians and Surgeons of Ontario (CPSO) to give a talk at their council meeting on burnout. Shanafelt et al.

Emergency Department 52

Emergency Department Wellness 52

ACEP Now

OCTOBER 15, 2023

1 The emergency department remains an important frontier for work in judicious prescribing, but opiate analgesia remains a valuable tool for the initial treatment of a variety of presentations. The treatment response for any six-week program is of limited relevance to the acute treatment provided in the emergency department.

Emergency Department 52

Emergency Department Outcomes CDC Research 52

Mind The Bleep

JANUARY 28, 2025

per 1000 emergency department attendances in the UK (1). Epidemiology Pretibial lacerations may occur following minor trauma to the shin area, particularly in elderly individuals with fragile skin. The prevalence of these injuries is estimated at 5.2 fall, bump against an object). References: Cahill, K. Gilleard, O., link] Gohil, K.,

Documentation/Coding 52

Documentation/Coding Head Injuries Fractures Emergency Department 52

RebelEM

FEBRUARY 22, 2023

Bagheri 2015 ). difficult to see due to corneal edema) Emergency Department Management All patients should get emergency ophthalmologic consultation Start with eye drops (see table below) and add systemic medications if severe or refractory symptoms/IOP. Persistent vision loss defined as loss of vision >24 hours.

Emergency Department 52

Emergency Department EMS Wellness 52

Mind The Bleep

APRIL 26, 2024

For all patients who come into the emergency department with a swelling, it is helpful to know if they have seen their GP or dentist recently and if they have had any treatment or recent courses of antibiotics. 2015) ‘Emergency Department’, in On-call in Oral and Maxillofacial Surgery.

Emergency Department 52

Emergency Department Fluid Resuscitation Dehydration Resuscitation 52

EM Curious

JULY 1, 2015

More FOAMed HARDWARE MALFUNCTION PACEMAKER AND AICD MANAGEMENT IN THE ED [BLOG]: EM Docs brings us some well needed cardiac hardware meducation on the patient with AICD/pacemaker issues presenting to the ED. LITERATURE THAT MAY INTEREST YOU [JOURNALS]: Should we be looking for and treating isolated calf vein thrombosis?

EMS 52

EMS Ultrasounds EKG/ECG Fractures 52

Taming the SRU

MAY 22, 2023

Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area. Most frequent reasons for emergency department visits, 2018.

Fractures 77

Fractures Dislocations Operations Radiology 77

Taming the SRU

MAY 23, 2023

BACKGROUND Foot injuries are common and can have significant implications for a patient’s well-being, functional capacity, and finances. Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. Foot injuries in the emergency department. 2015 Apr 28].

Fractures 57

Fractures Dislocations Operations EMS 57

The Skeptics' Guide to EM

OCTOBER 28, 2017

Anthony Crocco is a Pediatric Emergency Physician and is the Medical Director & Division Head of the Division of Pediatric Emergency at McMaster’s Children’s Hospital. Case: A 12-day old girl presents with fever and is otherwise well. Anthony is also the creator of SketchyEBM.

Pediatrics 52

Pediatrics Documentation/Coding Emergency Department Hospitals 52

The Skeptics' Guide to EM

FEBRUARY 19, 2022

. * SGEM Xtra: The Water is Wide * SGEM#289 : I Want a Dog to Relieve My Stress in the Emergency Department * SGEM Xtra : CAEP Wellness Week 2019 * SGEM Xtra: On the Edge of Burnout * SGEM Xtra: Don’t Give Up – The Power of Kindness * SGEM#178 : Mindfulness – It’s not Better to Burnout than it is to Rust * SGEM Xtra: Five Tips to Avoid Emergency Medicine (..)

Emergency Department 52

Emergency Department Wellness 52

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). As may be seen in the table below, there are several themes as well a range of stringency. WHO - Who Needs an LP in the ED? Patients with concern for infection (i.e., REFERENCES 1.

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

EMDocs

JUNE 16, 2023

And now we’re here at our destination, the place we know and love, the emergency room to talk about what we should be doing for the growing volume of children with mental health problems boarding in the emergency department. It’s stressful for the ED clinical staff as well. This has a downstream effect.

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 52

Mind The Bleep

AUGUST 18, 2024

Facial trauma commonly presents in Emergency Departments and in primary care. They commonly present with a ‘flattened cheekbone’ and can involve orbital rim as well. More advanced facial trauma will be redirected to major trauma centres. History If the patient is stable, it is important to start with a thorough history.

Fractures 91

Fractures Soft Tissue Injuries Burns Emergency Department 91

The Skeptics' Guide to EM

MARCH 12, 2022

She is an emergency physician at Mount Sinai Hospital and a Clinician Scientist and the Deputy Director of the Schwartz-Reisman Emergency Medicine Institute. Case: An 18-year-old female presents to the emergency department (ED) after falling off a moving snowmobile and hitting her head on the ground.

Emergency Department 40

Emergency Department Head Injuries Pediatrics Research 40

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Case: You’re working a shift in a rural emergency department when a 68-year-old man presents with a two-day course of worsening cough, shortness of breath, and fever. This study expands upon that investigation to patients with other conditions as well. This is Bob’s ninth visit to the SGEM.

Poisoning 52

Poisoning Administration Hospitals Outcomes 52

Taming the SRU

MARCH 14, 2023

Case 1 Fussy 1 month old A 1-month-old (ex-34 week premature) infant comes to your emergency department for fussiness. He appears well and is triaged to an ESI 4. Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

Don't Forget the Bubbles

MAY 6, 2024

For a deep dive into intubation, see Intubation of the critically unwell Child in the emergency department – Don’t Forget the Bubbles (dontforgetthebubbles.com) For all things neonatal (lines and tubes), see Neonatal lines and tubes – Don’t Forget the Bubbles (dontforgetthebubbles.com) Why does it matter?

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

ALiEM

JULY 17, 2023

as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4]. In fact, the average number of applicants between 2015-2020 and 2022-2023 were relatively similar, with the latter demonstrating 122 more applicants (2,801 vs 2,923).

EMS 52

EMS Burns Emergency Department Shock 52

Don't Forget the Bubbles

MARCH 19, 2024

Becasue paediatric emergency departments are accessible out-of-hours they become the de facto place of safety with access to immediate support. Just 20% of a person’s health and general well-being is related to access to care and the quality of services. Canadian Journal of General Internal Medicine (2015) 10(4).

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

Taming the SRU

SEPTEMBER 1, 2023

2015) reported a sensitivity of 98.9% for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al.,

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95