Sensible Medicine

MAY 28, 2024

The adoption of depression screening is, of course, well-intentioned. In a 2017 Lancet trial , 10,190 personnel from the UK military were randomized to post-deployment depression screening or no screening. The benefit of screening is just too small to be detected by well-designed trials. fold (NNH=14, p= 0.01 ).

Military 139

Military Outcomes Psychiatric Wellness 139

RebelEM

DECEMBER 23, 2024

Background: Sickle cell disease (SCD) affects an estimated 300,000 infants born worldwide each year and has a total estimated prevalence of 100,000 in the United States alone ( Piel 2017 ). VOE is often complicated by hypovolemia, making fluid administration a common intervention ( Lovett 2017 ). Lactated Ringer (LR) and 0.9%

Fluid Resuscitation 121

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 121

RebelEM

DECEMBER 17, 2024

You order antibiotics, an initial fluid bolus as well as blood cultures. A large observational study of > 2000 patients found an association with fever at presentation and ICU survival for patients with severe sepsis or septic shock ( Sunden-Culberg 2017 ). Crit Care Med 2017; 45(4): 591-9. Sat 93% on RA.

Sepsis 68

Sepsis Shock EMS Emergency Department 68

The Skeptics' Guide to EM

JULY 8, 2023

She looks well enough to go home but asks if she should be prescribed oseltamivir (Tamiflu) because some of her friends have been given it recently by their doctors. Safety issues popped up soon after widespread use of the drug including neuropsychiatric effects as well as the more common adverse effects of nausea and vomiting.

CDC 96

CDC Hospitals EMS Emergency Department 96

Northwestern EM Blog

FEBRUARY 4, 2025

Treating Kratom toxicity varies based upon the clinical presentation as well as severity of symptoms. Over 1100 cases of Kratom only exposure were reported to the National Poison Control Center from 2011-2017. 2017 Jul 1;176:63-70. Epub 2017 May 10. Just over half of these cases required medical intervention. Grundmann O.

Seizures 72

Seizures Poisoning Forensics Emergency Department 72

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. The adhesive cover itself serves as a sterile barrier and a slick surface to improve probe maneuverability. Alerhand S, Singh M, editors.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

Sensible Medicine

NOVEMBER 14, 2023

Criticism of these programs is both well-deserved and unfair. As of 2017, just 15% of patients admitted to residential programs with opioid use disorder received any of the medications approved by the US Food and Drug Administration for treatment opioid use disorder – this despite the fact that those medicines save lives.

Research 129

Research Psychiatric CDC Best Practices 129

Dr. Smith's ECG Blog

OCTOBER 12, 2024

The providers documented concern for ST elevation in the precordial and lateral leads as well as a concern for hyperkalemic T waves in the setting of succinylcholine administration. 2017 Sep-Oct;50(5):561-569. Epub 2017 Apr 19. Potassium resulted as 4.9, initial troponin I 0.05 J Electrocardiol. doi: 10.1016/j.jelectrocard.2017.04.005.

EKG/ECG 118

EKG/ECG Documentation/Coding Emergency Department COPD 118

Pediatric EM Morsels

APRIL 7, 2023

Observation, interaction with patient, as well as parent information is key to bring the whole picture together! 2017 Jan;26(1):108-115. J Stroke Cerebrovasc Dis. doi: 10.1016/j.jstrokecerebrovasdis.2016.08.038. 2016.08.038. Epub 2016 Oct 17. PMID: 27765556.

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

Sensible Medicine

JUNE 21, 2024

.” I, then a 50-year-old associate professor of medicine, said those words over the phone to a friend late one night in 2017. “Well,” my friend advised, “if you’re feeling nervous right now, that is because the thing you are about to do might upset people, and that takes courage.”

Academics 81

Academics Research Burns Outcomes 81

Don't Forget the Bubbles

SEPTEMBER 11, 2023

Willow is normally fit and well. pii: bcr-2017-220473. You take a careful history from Willow’s mum and establish that she has been aware of Willow scratching her bottom for a few days. Willow mentioned seeing “wiggly white things” in her poo the other day. She has no past medical history. BMJ Case Rep.

Wellness 116

Wellness 116

EMDocs

DECEMBER 23, 2024

The most recent and well-known trial is the PROCAMIO trial (1). It was published in European Heart Journal in 2017. Well, the trial was a multicenter prospective open label trial. Well, lets look at some other trials. 2017 May 1;38(17):1329-1335. 2017 Apr;52(4):484-492. Great question. Eur Heart J.

EKG/ECG 72

EKG/ECG Wellness Shock EMS 72

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. Lancet Haematol 2017. Some clinicians have advocated for early administration of 4-factor prothrombin complex concentrate (4F-PCC) based on limited observational data. High-quality studies are needed to determine the utility of this intervention. to 3.33; P = 0.72

Administration 135

Administration Outcomes Resuscitation Radiology 135

The Skeptics' Guide to EM

SEPTEMBER 16, 2017

[display_podcast] Date: September 12th, 2017 Reference: Sinert et al. J Allergy Clin Immunol Pract 2017. display_podcast] Date: September 12th, 2017 Reference: Sinert et al. J Allergy Clin Immunol Pract 2017. J Allergy Clin Immunol Pract 2017. Reference: Sinert et al.

Anaphylaxis 52

Anaphylaxis Administration EMS Emergency Department 52

The Skeptics' Guide to EM

OCTOBER 28, 2017

[display_podcast] Date: October 24th, 2017 Reference: Harrison et al. Pediatrics 2017 Guest Skeptic: Dr. 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. Anthony is also the creator of SketchyEBM.

Pediatrics 52

Pediatrics Documentation/Coding Emergency Department Hospitals 52

Dr. Smith's ECG Blog

OCTOBER 23, 2023

2017 Oct 1;177(10):1520-1522. This 1910 description by Lewis serves well to this day to remind us of the 2 principal clinical situations in which electrical alternans is most often encountered: i ) Supraventricular reentry tachycardias; and , ii ) Pericaradial tamponade. J Am Coll Cardiol. 2006 Jan 17;47(2):269-81. doi: 10.1016/j.jacc.2005.08.066.

EKG/ECG 134

EKG/ECG Documentation/Coding Psychiatric EMS 134

The Skeptics' Guide to EM

SEPTEMBER 3, 2017

[display_podcast] Date: September 2nd, 2017 Reference: Caputo et al. display_podcast] Date: September 2nd, 2017 Reference: Caputo et al. EmergeNcy Department use of Apneic Oxygenation versus usual care during rapid sequence intubation: A randomized controlled trial (The ENDAO Trial).

Emergency Department 52

Emergency Department Resuscitation Operations EMS 52

The Skeptics' Guide to EM

NOVEMBER 18, 2017

[display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Critical Care Medicine 2017. display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Critical Care Medicine 2017.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

Don't Forget the Bubbles

NOVEMBER 27, 2023

And lastly, it’s actually quite hard to see how well the cardiovascular system is working, and this is one of its measurable features. This works well for a while, but eventually, the heart beats too fast to fill adequately. It’s only a piece of the puzzle, though. The next element of stroke volume is the emptying. link] Roland D.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Total Medical ComplianceHIPAA

NOVEMBER 7, 2022

Website owners are required to tell visitors what kind of cookies they use, as well as how they use and disclose the visitor’s information collected by their website. Cookies are like flags that allow a website to recognize and remember your device if you return to that site in the future.

Documentation/Coding 72

Documentation/Coding Wellness 72

ACEP Now

JULY 11, 2024

The United States Preventive Services Task Force (USPSTF) recommends screening for problem drinking in the primary setting, but we know that patients who present to the ED are twice as likely to engage in dangerous drinking, so arguably the ED is an important venue for screening as well. Anton RF, O’Malley SS, Ciraulo DA, et al.

Emergency Department 98

Emergency Department Psychiatric Outcomes Wellness 98

RebelEM

MAY 25, 2023

Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8% Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8% NEJM 1994. [2] Shock 2012.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

The Skeptics' Guide to EM

OCTOBER 22, 2017

[display_podcast] Date: October 19th, 2017 Reference: Hofmann et al. NEJM Sept 2017. display_podcast] Date: October 19th, 2017 Reference: Hofmann et al. NEJM Sept 2017. Oxygen Therapy in Suspected Acute Myocardial Infarction. Guest Skeptic: Marcus Prescott is a nurse in Norway. He is also now a first-year medical student.

Hospitals 52

Hospitals EKG/ECG Wellness 52

The Skeptics' Guide to EM

JANUARY 20, 2018

BMJ 2017 Guest Skeptic: Meghan Groth is an Emergency Medicine Pharmacist at the UMass Memorial Medical Center in Worcester, Massachusetts. BMJ 2017 Guest Skeptic: Meghan Groth is an Emergency Medicine Pharmacist at the UMass Memorial Medical Center in Worcester, Massachusetts. Reference: Sadeghirad B, et al.

Academics 52

Academics Emergency Department EMS Administration 52

The Skeptics' Guide to EM

MAY 14, 2022

He denies numbness or paresthesia in both lower extremities, as well as bowel or bladder dysfunctions. These include: acetaminophen ( Williams et al Lancet 2014), steroids ( Balakrishnamoorthy et al Emerg Med J 2014) and benzodiazepines ( Friedman et al Ann Emerg Med 2017).

Emergency Department 52

Emergency Department Research Wellness 52

Emergency Medicine Ireland

OCTOBER 14, 2024

Similarly loculations can be very easily seen with ultrasound, better than CT it seems but again don’t necessarily correlate that well with empyema. Well, adding extra or bigger drains is all very reasonable and it would seem wise to involve a thoracic surgeon at some point. 153, e129–e146 (2017). What are your options?

Wellness 52

Wellness Ultrasounds 52

PulmCCM

FEBRUARY 12, 2024

The Society of Critical Care Medicine (SCCM) expanded its prior 2017 guidance, now recommending strongly that corticosteroids be given for severe community-acquired pneumonia, and also suggesting steroids for patients with acute respiratory distress syndrome (ARDS) and septic shock of any severity.

Shock 52

Shock Administration Sepsis Fractures 52

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Heart disease and stroke statistics-2017 update: A report from the American Heart Association.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

EMDocs

JANUARY 25, 2025

Well keep it short, while you keep that EM brain sharp. A previously healthy 23-year-old male with no medical or surgical history presents to the ED with generalized malaise and no energy, progressively getting worse over the last six weeks. 10^9/L) Moderate (0.50.9 10^9/L) Severe (< 0.5 10^9/L) Generalized leukopenia (i.e. Najivash, P.,

EMS 80

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 80

Sensible Medicine

JULY 28, 2023

Owing to a collaboration with the Wuhan University Medical School, I had visited Wuhan in 2008 and 2017. In 2017, I’d even spent a day knocking around one of the city’s wet markets. I made the mistake of feeling that I needed to do something new rather than apply what I do well to a novel situation.

Hospitals 97

Hospitals PPE Urgent Care Academics 97

ALiEM

DECEMBER 16, 2024

CT demonstrates osteomyelitis of the frontal bone with osseous destruction with a 5 cm bifrontal complex loculated anterior epidural abscess as well as a 3 cm midline frontal subgaleal extracranial scalp abscess. 2017 Apr;30(2):179-181. Laboratory Data WBC : 14.35 ESR : 23 mm/h CRP : 0.74 Pott puffy tumor. Proc (Bayl Univ Med Cent).

Pediatrics 52

Pediatrics Academics Wellness Infectious Diseases 52

The Skeptics' Guide to EM

NOVEMBER 25, 2017

[display_podcast] Date: November 24th, 2017 Reference: Roldan et al. AEM November 2017 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. display_podcast] Date: November 24th, 2017 Reference: Roldan et al. AEM November 2017.

Psychiatric 40

Psychiatric Emergency Department Operations Administration 40

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

There is some upwards concave ST segment elevation in the inferior leads with what seems to be well formed J-waves. maybe not seen well on these echo-loops) The CW doppler at the tricuspid valve showed a maximum TR velocity of 2,55m/s with a TRP gradient of 26mmHg. 21, 2017 ). Not much difference from 1st ECG. The RV > LV.

EKG/ECG 119

EKG/ECG COPD Shock Wellness 119

EMDocs

NOVEMBER 7, 2023

Antibiotics are recommended for those with complicated diverticulitis, as well as surgical specialist consult if necessary (e.g., 2017 Jan;104(1):52-61. 2017 Jan;104(1):52-61. Recent evidence suggests antibiotics may not be necessary for all patients with uncomplicated diverticulitis. perforation).  Br J Surg.  Br J Surg.

Sepsis 100

Sepsis Best Practices Hospitals Outcomes 100

ALiEM

DECEMBER 18, 2023

2017 Jun 9;18(6):1243. Of note, she reported that her dose of lamotrigine has been slowly uptitrated, most recently two days prior changing from 50 mg BID to 75 mg BID. Additional Images Physical Exam Vitals : T 39.6°C; Corticosteroids are the mainstay of treatment with gradual tapering over multiple months. Int J Mol Sci.

Academics 70

Academics Emergency Department Wellness 70

The Skeptics' Guide to EM

JUNE 4, 2017

[display_podcast] Date: June 3rd, 2017 Reference: Sierink et al. display_podcast] Date: June 3rd, 2017 Reference: Sierink et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet August 2016. Reference: Sierink et al.

Radiology 52

Radiology Radiology CPR Hospitals 52

Cook County EM Blog

MAY 1, 2023

Findings suggestive of septic bursitis include complex fluid in the bursa with septations (as seen in this case), as well as hyperemia on color flow doppler or gas. 2017 Oct;53(4):475-484. 2017 Dec;45(6):781-786. Ultrasound is often a more useful imaging modality and is readily available at the bedside. J Emerg Med. emDocs.net.

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Outcomes 52