The Skeptics' Guide to EM

JULY 30, 2022

Point-of-Care Ultrasound-First for the Evaluation of Small Bowel Obstruction: National Cost Savings, Length of Stay Reduction, and Preventable Radiation Exposure. AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. specificity with ultrasound [1].

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

The Trauma Pro

OCTOBER 4, 2024

years from 2013 to 2016. Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. ” This means they probably did not.

Pediatrics 113

Pediatrics Operations Emergency Department Outcomes 113

RebelEM

APRIL 29, 2024

The current standard of practice has moved away from landmark-based central line placement given the efficacy and safety of ultrasound-based techniques. World J Emerg Surg 2023 PMID: 36918947 3. Intraosseous vascular access in adults using the EZ-IO in an emergency department. Int J Emerg Med 2009 PMID: 20157465 4.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The children’s Emergency department sees approximately 50,000 presentations per year. Emerg Med J. Paediatr Int Child Health. 2024 Jan 11:1-7.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

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). It is most helpful to do the ultrasound immediately before needle insertion, as movement of the patient may shift cutaneous landmarks from underlying bony structures. WHY - Why Not? REFERENCES 1.

Infectious Diseases 98

Infectious Diseases Seizures Ultrasounds Sepsis 98

EMDocs

AUGUST 8, 2023

2016 validation study 0 points for low risk, 1-5 for intermediate risk and 6-7 for high risk. 2016 validation study 0 points for low risk, 1-5 for intermediate risk and 6-7 for high risk. Keys: Order the ultrasound in a patient with testicular pain, especially with any TWIST score >0. Horizontally lying testicle.

Ultrasounds 93

Ultrasounds Documentation/Coding Outcomes Emergency Department 93

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. Additional trick: If the x-ray is delayed, you can pre-check with ultrasound [7]. PulmCrit Wee: Ultrasound-guided blakemore tube placement. Published May 4, 2016.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

ACEP Now

FEBRUARY 13, 2024

A 77-year-old man presented to the emergency department (ED) with hip pain following a fall. In the January issue of Annals of Emergency Medicine , Merz-Herrara, et al., published a study, “Safety and Pain Reduction in Emergency Practitioner Ultrasound-Guided Nerve Blocks: A One-Year Retrospective Study.”

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Wellness 52

Taming the SRU

JANUARY 10, 2024

89% agree that violence in the emergency department has harmed patient care. None of the physicians in the study believe that the rate of violence has decreased at all. It usually takes 4-6 weeks for a coronary artery to heal from dissection.

EKG/ECG 94

EKG/ECG Shock Fractures Dislocations 94

Don't Forget the Bubbles

JANUARY 31, 2024

Article 1: What predicts parental anxiety in the Paediatric Emergency Department? Predictors of parental anxiety in a paediatric emergency department. Emergency Medicine Journal. The authors compared 100 POCUS (Point-Of-Care-UltraSound ) images captured by trained physicians (in FUSIC/CACTUS). Martin, S.R.,

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

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. While it was < 15% in 1990, by 2016 it reached 40%. Jeff: Next up is ultrasound. I hope everybody enjoyed a fantastic conference.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

RebelEM

MARCH 8, 2023

Signs Shafer’s sign (tobacco dust) May see a Weiss ring when the posterior vitreous (PV) detaches from the optic disc margin Visualization with ultrasound. Emergency Department Management: Emergency ophthalmology consultation. Ophthalmology, in Marx J et al (eds): Rosens Emergency Medicine: Concepts and Practice, ed 9.

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

Cook County EM Blog

APRIL 22, 2022

The Case: A 68-year-old male with a history of CHF, COPD, CAD s/p stenting, HTN, and DM presents to the emergency department with worsening dyspnea and bilateral lower extremity edema for one week with associated orthopnea, and increased home oxygen requirement. Point of Care Ultrasound is shown below: Clip 1. VS: T 36.6,

Ultrasounds 40

Ultrasounds COPD Emergency Department 40

The Skeptics' Guide to EM

NOVEMBER 1, 2022

AEM October 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: A 19-year-old man presents to the emergency department (ED) with his first time anterior should dislocation after trying to recreate one of his favourite scenes in the movie Lethal Weapon.

Dislocations 49

Dislocations Ultrasounds Emergency Department 49

Pediatric Emergency Playbook

AUGUST 1, 2017

One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain. Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. 2016; 13:590-600.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Pediatric Emergency Playbook

DECEMBER 1, 2016

Ultrasound Not ready for prime time. 2016 May 14. 2016 Apr;35(4):363-8. 2016 Aug 20. Discharged on supplemental oxygen from an emergency department in patients with bronchiolitis. Management of bronchiolitis in the emergency department: impact of evidence-based guidelines? 2016 May;172:202-204.e1.

Pediatrics 40

Pediatrics Emergency Department Hospitals Wellness 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. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. ng/mL, 0.25-0.5

Infectious Diseases 90

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 90

The Skeptics' Guide to EM

MAY 28, 2017

Case: It is 7pm on a quiet evening in the emergency department and Bobby comes in. His blood work shows an elevated WBC count and the ultrasound is consistent with acute uncomplicated appendicitis (AUA). Background: Appendicitis is the most common paediatric surgical emergency. In girls I would probably use a laparoscope.

Pediatrics 40

Pediatrics Operations Emergency Department Ultrasounds 40

The Skeptics' Guide to EM

JULY 2, 2017

Case: A 22-year-old patient presents to the emergency department with sudden onset shortness of breath. Then in episode #163 we shuffled off to Buffalo and discussed ultrasound-facilitated, catheter directed, low-dose fibrinolysis for acute massive or submassive PEs.

Fractures 40

Fractures Emergency Department Ultrasounds Outcomes 40

Pediatric Emergency Playbook

DECEMBER 1, 2015

Ultrasound can be used to troubleshoot when needed. Emergency department evaluation after conducted energy weapon use: review of the literature for the clinician. Taser dispo: People who have been tased do remarkably well and complications are rare. In a review of tasers used by law enforcement, Vilke et al. Phiadelphia.

Burns 40

Burns Emergency Department EKG/ECG Shock 40

Don't Forget the Bubbles

NOVEMBER 1, 2023

This month, Bubble Wrap has teamed up with Sheffield Children’s Hospital Emergency Department to have a look at what’s new in paediatric literature. Lactate as a screening tool for critical illness in a pediatric emergency department. Pediatric Emergency Care. 2023 Oct 1;39(10):735-8. What’s it about?

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

EMDocs

NOVEMBER 4, 2023

An ultrasound of the testes reveals the following: What is the diagnosis? aureus infections among patients in the emergency department. Skin and Soft Tissue Infections in the Emergency Department. Emerg Med Clin North Am. December 27, 2016. Managing a Cutaneous Abscess in the Emergency Department.

EMS 93

EMS Ultrasounds Emergency Department Infectious Diseases 93

Don't Forget the Bubbles

JANUARY 17, 2024

Curious Ken is brought into your emergency department. Forrester reported data from the Texas Poison Centers surrounding 110 cases of superabsorbent polymer bead ingestions between 2011 and 2016. Abdominal ultrasound, used in 34 cases, was able to visualize a rounded intraluminal image corresponding to a bead in 28 patients.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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. 2016 Mar-Apr;27(2):89-94. Cardiovasc J Afr.

Ultrasounds 64

Ultrasounds CDC Research Stroke 64

Taming the SRU

OCTOBER 1, 2023

This post aims to broadly cover the types of PTX, the diagnostic modalities available, and the ideal management by PTX type in the Emergency Department. Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax, 1968-2016. The "lung point": an ultrasound sign specific to pneumothorax.

Fractures 97

Fractures COPD Hospitals Emergency Department 97

EMDocs

DECEMBER 18, 2023

1 The rationale for the shift away from normal saline in 2021 derived from multiple trials, including the Isotonic Solutions and Major Adverse Renal Events Trial (SMART) and Saline Against Lactated Ringer’s or Plasma-Lyte in the Emergency Department (SALT ED). Procalcitonin and sepsis in the Emergency Department: an update.

Sepsis 90

Sepsis Fluid Resuscitation Resuscitation Shock 90

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. 2016, Andrews, Semler et al. N Engl J Med. 2023;388(6):499-510. 2021, Jarczak, Kluge et al. 2014, Hjortrup, Haase et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: For more information on HIV and its management, check out the February 2016 issue of Emergency Medicine Practice , which covered this and more in depth. Sounds familiar.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EMDocs

NOVEMBER 4, 2024

The Treatment of Acute Pain in the Emergency Department: A White Paper Position Statement Prepared for the American Academy of Emergency Medicine. J Emerg Med. Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial. Acad Emerg Med.

Emergency Department 106

Emergency Department Fractures Burns EMS 106

EB Medicine

FEBRUARY 1, 2019

This month, we’re tackling an incredibly important topic - evaluation and management of life threatening headaches in the Emergency Department. In addition, one 2016 study demonstrated a LR of 0.01 Anyway, the last test to discuss is our good friend the ultrasound, specifically the ocular ultrasound.

Emergency Department 40

Emergency Department Stroke Outcomes Ultrasounds 40

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). The ROSE (Risk Stratification of syncope in the emergency department) Study. orthostatic vitals b.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

Pediatric Emergency Playbook

JANUARY 1, 2017

NON-PHARMACOLOGIC TREATMENT The first line of treatment in all pain management is non-pharmacopeia ( Horeczko 2016 ). mg/kg IV, up to 10 mg) may be substituted for ibuprofen ( Paniyot 2016 ). Intranasal ketamine for analgesia in the emergency department: a prospective observational series. Acad Emerg Med.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

EMDocs

JANUARY 6, 2024

A bedside cardiac ultrasound is performed which shows biventricular failure with a dilated inferior vena cava. Answer : Cardiac Transplant Complications Epidemiology: There were over 3,000 heart transplants in North America in 2016. A 63-year-old man presents to the emergency department for dyspnea on exertion.

EMS 87

EMS Infectious Diseases Shock Emergency Department 87

ACEP Now

APRIL 4, 2024

3 The majority of those who arrive to the emergency department (ED) live for 2 hours or more, leaving a small window for surgical intervention. The diagnosis is confirmed with bedside ultrasound (US) or CT. Eur J Emerg Med. 2016; 23:386-90. About 35 percent of individuals with rAAA will die at home. J Vasc Surg.

Operations 40

Operations Ultrasounds Emergency Department 40

EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. in 2016, is a more succinct evaluation for LVO that has been shown to be as sensitive and more specific than the NIHSS. Computed Tomography Angiography in Head and Neck Emergencies.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Dr. Smith's ECG Blog

DECEMBER 16, 2024

And almost all of them could be detected by bedside ultrasound. Conclusion: you may take a few moments to look for dissection with your bedside ultrasound, but when it is a clear STEMI, do NOT waste time with a CT scan. It is not a waste of time to use bedside ultrasound to look for dissection 3. Ultrasound Med.

Ultrasounds 104

Ultrasounds EKG/ECG Operations Emergency Department 104

Don't Forget the Bubbles

FEBRUARY 17, 2025

1] Fred is a 3-year-old boy who presents to the emergency department. Before considering a further fluid bolus, you do a point-of-care ultrasound (POCUS). Taken together, the adult critical care community has shifted towards assessing for venous congestion at the organ level with Doppler ultrasound. References 1.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78