The Skeptics' Guide to EM

NOVEMBER 18, 2017

[display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Critical Care Medicine 2017. display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

AslangerE A 65-year-old gentleman presented to the emergency department after experiencing two recent ICD shocks in the preceding hours. The subsequent ECG, taken 5-10 minutes post-shock, depicted a soothing of ST deviation. This was contributed by Co-editor Emre Aslanger, an interventional cardiologist in Turkey.

EKG/ECG 112

EKG/ECG Shock Emergency Department Administration 112

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. International Consensus Criteria for Pediatric Sepsis and Septic Shock.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

EMDocs

MARCH 30, 2024

Answer : Thoracic and Lumbar Spine Trauma Epidemiology: Approximately half of the vertebral injuries that are seen in the emergency department are thoracic and lumbar injuries. Intervertebral disks lie between vertebrae and act as shock absorbers. September 30, 2017. The spinal canal houses the spinal cord.

EMS 105

EMS Fractures Emergency Department Dislocations 105

EB Medicine

MARCH 4, 2020

No 1996 AAP guidelines, 2016 ACG guidelines, and 2017 IDSA guidelines all note diarrhea illness but may be vomiting predominant. IV hydration for patients with severe dehydration, hypovolemic shock, septic shock, or failed oral rehydration. Hemoglobin and platelets are helpful if HUS is suspected.

Emergency Department 40

Emergency Department Dehydration Poisoning Allergic Reactions 40

EMDocs

JANUARY 4, 2024

Cardiogenic shock and hypotension can occur (systolic heart failure with reduced ejection fraction.) 10,12 Refractory shock or malignant arrhythmias occur in < 5% of patients. Case Follow-up: The patient required a dose of lorazepam in the emergency department. Eds (2017). Clin Toxicol (Phila). J Med Toxicol.

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

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

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. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

The Skeptics' Guide to EM

APRIL 28, 2018

December 2017. Case: A 72-year-old gentleman presents to your emergency department. December 2017. Case: A 72-year-old gentleman presents to your emergency department. December 2017. [display_podcast] Date: April 25th, 2018 Reference: Stern A et al, Corticosteroids for pneumonia (Review).

Hospitals 40

Hospitals Emergency Department Outcomes Shock 40

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. In 2017, these were performed 60%, 18%, and 3% of the time. I hope everybody enjoyed a fantastic conference.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Critical Care Now

APRIL 7, 2022

Notable is the patient’s feeling that their “heart stopped” or the sensation of an “electric shock”. The large benefit with using diltiazem is that there is no association with the “electric shock” or “heart stop” feeling that is synonymous with adenosine. Published 2017 Oct 12. What is the Alternative? 2017;10(10):CD005154.

Administration 52

Administration Resuscitation Shock Emergency Department 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. Jeff: a 2017 ACEP clinical policy also recommends against routine lab testing in those with acute psychiatric complaints.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding 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. 2017 Dec 14;9(6):7204-7218. In 7 studies with 4164 patients, PCT with a cut-off > 0.1 ng/mL, 0.25-0.5

Infectious Diseases 89

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

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. b) Emergency thoracotomy Let’s be clear: YOU will not be doing any of this. 2017 Dec;83(6):1136-1141. c) Or, do both? Trials 23, 384 (2022).

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EB Medicine

AUGUST 6, 2019

Nachi: Next we have Betrixaban, the latest Factor Xa inhibitor to be approved, back in 2017. Because it’s utility is limited to venous thromboembolism prophylaxis in mostly medically ill inpatients, it’s unlikely to be encountered by emergency physicians very frequently. Jeff: That is simply shocking!

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Don't Forget the Bubbles

JULY 26, 2023

Prioritise listening to the first 30 minutes which given a good overview of aetiology and treatment (53 mins) Basics of cardiac rhythm problems in the ED Palpitations are a common reason for children to present to the emergency department, the majority of these will be benign from a cardiac perspective and instead related to stress or anxiety.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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. doi:10.1155/2017/6014967 Light RW. Ann Emerg Med. J Emerg Trauma Shock. Ann Emerg Med. Clin Pract Cases Emerg Med. Am J Emerg Med.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

RebelEM

NOVEMBER 3, 2022

In 2017, a single-centered, retrospective study found a lower incidence of clinical hypotension with ketamine compared to etomidate following endotracheal intubation in septic patients. ( Van Berkel 2017) In 2020 the NEAR study reported peri-intubation hypotension rates of 18.3% in the ketamine cohort compared to 12.4%

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. RV pressures > LV pressures.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

The patient went into cardiogenic shock and ultimately died of this MI. Discussion There are many, cardiologists especially, who think that Emergency Physicians order too many troponins. Design Prospective study of three independent consecutive patient populations presenting to emergency departments. Sandoval Y et al.

EKG/ECG 52

EKG/ECG Emergency Department Wellness Shock 52

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. 3,950 children were recruited between September 2014 to May 2017. Transfusion Decisions in Severe Anaemia Reducing child mortality remains high on the global health agenda. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

EB Medicine

JUNE 6, 2019

Jeff: Abdominal pain is the one of most frequent complaint in US emergency departments, representing 8% of all adult ED visits, with admission rates for all patients with abdominal pain ranging between 18-42% and reaching as high as 60% for the elderly. You can also use the shock index, which as a reminder is simply the HR/SBP.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EMDocs

FEBRUARY 12, 2024

First, there can be a poor correlation between venous and arterial gases in states of shock, hemodynamic instability, or extremes of acid-base disturbances, due to poor cardiac output/circulatory failure impairing venous and arterial flow, with associated poor gas exchange as well as hypercapnia and acidemia at the tissue level (8).

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Written by Destiny Folk MD, with edits by Meyers, peer reviewed by Smith and Grauer A woman in her late 20s with a past medical history of cervical cancer status post chemotherapy and radiation therapy presented to the emergency department for shortness of breath, chest tightness, and two episodes of syncope. 2017 Nov;35(4):525-537.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

RebelEM

MAY 15, 2024

Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents. Epub 2017 Nov 22. Ann Emerg Med. 2017 Jun;69(6):755-764. Give appropriate fluids, vasopressors, and antibiotics. Support Care Cancer.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

EMDocs

OCTOBER 5, 2024

A 62-year-old female patient with a history of recurrent urinary tract infections (UTIs) presents to the emergency department with fever, chills, and dysuria. 4 The incidence of ESBL-E identified in bacterial cultures in the United States increased by 53% from 2012 to 2017. 2017 Jun 28;12(6):e doi: 10.1371/journal.pone.0180121.

EMS 97

EMS Infectious Diseases Sepsis Hospitals 97

EMDocs

JULY 15, 2023

However, it must be considered in toxic-appearing patients, those with prosthetic heart valves, artificial joints, or immunocompromised states Clinicians must keep a broad differential and consider other conditions such as necrotizing fasciitis, clostridial myonecrosis, compartment syndrome, toxic shock syndrome, etc. Published April 3, 2017.

EMS 92

EMS Infectious Diseases Shock Ultrasounds 92

EMDocs

DECEMBER 16, 2023

An 18-month-old boy presents to the emergency department with loss of consciousness. Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. The American Journal of Emergency Medicine., link] Chava, R.,

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

EMDocs

JULY 17, 2023

Bowel perforation demonstrated by CT, hard signs of peritonitis, or an overall toxic appearance warrant emergent surgical consultation. Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients. World J Emerg Surg.

Operations 98

Operations EMS Fluid Resuscitation Resuscitation 98

EMDocs

JUNE 3, 2023

For a broader overview of pelvic trauma, please review Dr. Lupez’s 2017 article here: [link]. 4 Patients with pelvic fractures are considered unstable when systolic blood pressure < 90mmHg and heart rate >120bpm, or in those with dyspnea, altered mental status, or skin findings of shock. World J Emerg Surg.

Fractures 64

Fractures Resuscitation Operations EMS 64

Downeast Emergency Medicine

OCTOBER 21, 2021

Background Suicide is disturbingly prevalent among patients we care for in the Emergency Department. We chose this topic for Journal Club with the goals to raise awareness around these shocking statistics, discuss etiologies behind these high rates of suicide, and to normalize the discussion around physician mental health.

Documentation/Coding 52

Documentation/Coding Emergency Department Shock Research 52

Pediatric Emergency Playbook

JANUARY 1, 2017

Unexplained tachycardia may be the early signs of shock. Intranasal ketamine for analgesia in the emergency department: a prospective observational series. Acad Emerg Med. Is there a role for intravenous acetaminophen in pediatric emergency departments? Pediatr Emerg Care. Emerg Med Australas.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

RebelEM

NOVEMBER 11, 2024

compared cefepime to piperacillin-tazobactam in a cohort of 250 patients with septic shock and found a signal toward higher mortality in those receiving cefepime. What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018.

Sepsis 113

Sepsis Outcomes Administration Shock 113

EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. However, IgE-mediated or not, anaphylactic shock is possible in either case. Computed Tomography Angiography in Head and Neck Emergencies. Semin Ultrasound CT MR 2017, 38 (4), 345-356.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

EMDocs

JUNE 27, 2024

2017 Dec 1;30(4):191-201. Am J Emerg Med. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. 2024 Mar 12;14(1):5978. PMID: 38472301; PMCID: PMC10933399. 2022 Aug;58:235244.

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97