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

NIOSH Science Blog

AUGUST 29, 2022

Most research on the mental health and well-being of healthcare workers has focused on physicians and nurses, with less attention paid to other healthcare occupations. 1] Assessing Mental Health and Wellbeing Researchers evaluated data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2017 to 2019.

Wellness 49

Wellness Research 49

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 96

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 96

The Trauma Pro

JUNE 14, 2024

The authors called out the usual culprits: Fluid between loops of bowel Active bleeding in the mesentery Bowel wall perfusion defects But they also noted that traumatic abdominal wall hernias were highly associated with seat belt sign as well. With newer scanners, radiologists are better able to detect subtle areas of hypoperfusion as well.

Operations 147

Operations Radiology Radiology Hospitals 147

Ken Grauer, MD

JULY 29, 2023

This young woman did well for a year — but unfortunately suffered another cardiac arrest, from which she could not be resuscitated. Epsilon waves are best seen in leads V1 , V2 — and a bit less well seen in V3,V4. MRI confirmed ARVC. About A RVC/ A RVD. ARVD is a genetic disorder of the myocardium.

EKG/ECG 370

EKG/ECG Resuscitation Documentation/Coding Hospitals 370

Ken Grauer, MD

DECEMBER 23, 2023

This is perhaps best seen in lead V1 ( but also well seen in leads V3,V4,V6 ). Clinically: Initial treatment of AFlutter is the same, regardless of whether the rotation direction is CW or CCW — so this distinction is not important to the emergency provider ( Cosio — Arrhythmia & EP Review 6(2):55-62, 2017 ).

EKG/ECG 441

EKG/ECG Wellness 441

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 144

Military Outcomes Psychiatric Wellness 144

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 108

CDC Hospitals EMS Emergency Department 108

Pediatric EM Morsels

JULY 21, 2023

PECARN compared the pediatric GCS (pGCS) in preverbal children (<2yo) to the standard GCS in verbal children (>2yo) in over 42,000 patients [Borgialli 2016] Looked at how well each scale predicted traumatic brain injury (TBI) findings on head CTAlso looked at how well each scale predicted clinically important TBI pGCS was slightly less sensitive (..)

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

AED Leader

NOVEMBER 25, 2024

Effective January 1, 2017, the state’s Health and Safety Code 19300 mandates that certain high-occupancy buildings must install Automated External Defibrillators (AEDs). Staff members should be equipped with the skills to use AEDs effectively, as well as perform CPR when necessary. Training is another crucial component.

CPR 52

CPR Documentation/Coding Shock Hospitals 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. 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 132

Research Psychiatric CDC Best Practices 132

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 86

Academics Research Burns Outcomes 86

Don't Forget the Bubbles

JANUARY 24, 2024

The first human trials for children with SRSE were conducted in 2014 where 2 patients responded well to the treatment and there have been encouraging results in open label adult trials more recently. 2017 May 25;376(21):2011-2020. 2017 Sep;82(3):342-352. Epub 2017 Sep 11. N Engl J Med. doi: 10.1056/NEJMoa1611618.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

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

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 143

Administration Outcomes Resuscitation Radiology 143

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 116

EKG/ECG Documentation/Coding Emergency Department COPD 116

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

Northwestern EM Blog

MARCH 1, 2025

In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Position arms in a comfortable position, avoiding any position that could cause a brachial plexus injury, and ensure they are well-supported to avoid pressure ulcers.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

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

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

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 131

EKG/ECG Documentation/Coding Psychiatric EMS 131

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

SEPTEMBER 20, 2023

Although there are guidelines from leading organisations, and the potentially harmful effects of unnecessary radiation exposure are well known, AXRs are widely used in practice. Clinical guideline [CG99] Published: 26 May 2010 Last updated: 13 July 2017. What is the evidence for avoiding abdominal X-rays? 2022;251:127-133.

Pediatrics 133

Pediatrics Emergency Department Radiology Radiology 133

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

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 114

Sepsis Best Practices Hospitals Outcomes 114

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

Dr. Smith's ECG Blog

JULY 22, 2023

The patient did well and was ultimately discharged home. For now, the 2017 AHA/ACC/HRS guidelines for asymptomatic patients that have inducible types of Brugada syndrome recommend observation without any specific therapies or interventions [8]. Is there fever again? There were no dysrhythmias on cardiac monitor during observation.

EKG/ECG 92

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 92