The Skeptics' Guide to EM

FEBRUARY 24, 2018

[display_podcast] Date: February 14th, 2018 Reference: Venkatesh S et al. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018. He writes an […] The post SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock first appeared on The Skeptics Guide to Emergency Medicine.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

Taming the SRU

JANUARY 10, 2024

89% agree that violence in the emergency department has harmed patient care. Additionally, ED boarding is a now a larger factor than in 2018. None of the physicians in the study believe that the rate of violence has decreased at all.

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

EMDocs

OCTOBER 9, 2023

Yoo, MD (Assistant Professor/Core Faculty, San Antonio, TX) // Reviewed by Brit Long, MD (@long_brit) Case An 18-year-old man with a history of asthma and medication noncompliance presents to the emergency department (ED) with acute onset shortness of breath. October 19, 2018. Which one do you select? 2015;116(6):960-975.

Basic Life Support 101

Basic Life Support CPR Fractures Emergency Department 101

EB Medicine

NOVEMBER 1, 2018

But this month’s episode is special in its own way - we’ll be tackling Electrical Injuries in the emergency department - from low and high voltage injuries to the more extreme and rare lightning related injuries. In total, they pulled references from 1966 until 2018. Jeff: Let’s move on to evaluation in the emergency department.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

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. J Emerg Med. Published 2018 Jan 25. Diagnosis includes imaging.

EMS 104

EMS Fractures Emergency Department Dislocations 104

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

AUGUST 14, 2021

Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Circulation 2020 Guest Skeptic: Missy Carter is a PA practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

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. 2018, Kuttab, Lykins et al. 2018, Kuttab, Lykins et al. N Engl J Med. 2023;388(6):499-510. 2021, Jarczak, Kluge et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

The Skeptics' Guide to EM

SEPTEMBER 21, 2019

Chris Bond is an emergency medicine physician and clinical lecturer in Calgary. Case: A 55-year-old male presents to the emergency department with sudden onset of palpitations and pre-syncope starting one hour ago. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM.

Emergency Department 52

Emergency Department Stroke Academics Shock 52

The Skeptics' Guide to EM

FEBRUARY 10, 2018

[display_podcast] Date: February 6th, 2018 Reference: Foster SJ et al. Lancet January 2018 Guest Skeptic: Dr. Tessa Davis is a Pediatrician specialising in Pediatric Emergency Medicine and currently practicing in a central London hospital. display_podcast] Date: February 6th, 2018 Reference: Foster SJ et al.

Emergency Department 40

Emergency Department Pediatrics Sepsis Hospitals 40

The Skeptics' Guide to EM

JUNE 18, 2022

Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. first appeared on The Skeptics Guide to Emergency Medicine. Should we give our shocked patient saline or plasma / red cells en route to the ED?”

Shock 40

Shock Resuscitation Administration Emergency Department 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

The Skeptics' Guide to EM

APRIL 28, 2018

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

Hospitals 40

Hospitals Emergency Department Outcomes Shock 40

RebelEM

JANUARY 25, 2024

A 2018 systematic review and meta-analysis of 25 studies focusing on the accuracy of emergency lung ultrasound showed sensitivity of 85-95% and specificity of 75-90% for pneumonia, sensitivity of 78% and specificity of 94% for COPD/asthma, and sensitivity of 75-90% and specificity of 80-90% for acute heart failure [4]. Epub 2014 Jul 3.

Ultrasounds 125

Ultrasounds Outcomes COPD Hospitals 125

The Skeptics' Guide to EM

MARCH 10, 2018

[display_podcast] Date: March 6th, 2018 Reference: Zahed et al. AEM March 2018. Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. display_podcast] Date: March 6th, 2018 Reference: Zahed et al. AEM March 2018.

Blood Transfusions 40

Blood Transfusions Emergency Department Shock Hospitals 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. 2018 Aug 1;10(8):a028456. Evaluation of fever in the emergency department. ng/mL, 0.25-0.5

Infectious Diseases 89

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

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Resuscitation 2018. Am J Emerg Med. N Engl J Med.

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation CPR EMS 104

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

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. c) Or, do both? Trauma Surg Acute Care Open.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Critical Care Now

APRIL 7, 2022

Notable is the patient’s feeling that their “heart stopped” or the sensation of an “electric shock”. In addition, a Cochrane systematic review of seven randomized control trials published in 2018, found similar rates of conversion to normal sinus rhythm between adenosine and non-dihydropyridine CCBs (90% vs 93%).

Administration 52

Administration Shock Resuscitation Emergency Department 52

EB Medicine

AUGUST 6, 2019

Jeff: That is simply shocking! Nachi: Next up is recombinant coagulation factor Xa (brand name Andexxa), which was approved in 2018 for the FXa inhibitors. Let’s also talk lab studies. Hemoglobin and platelet counts should be obtained as part of the standard trauma work up.

Emergency Department 40

Emergency Department Stroke Wellness Administration 40

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

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

This finding does not alter the need to pursue emergent reperfusion, although it might suggest a poorer prognosis.”[3] New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

RebelEM

NOVEMBER 20, 2023

Military practice guidelines recommend REBOA for profound shock (SBP <90mmHg) 1 and ACEP along with the American College of surgeons recommend REBOA for traumatic life-threatening hemorrhage below the diaphragm in patients with hemorrhagic shock who are unresponsive or transiently responsive to resuscitation. J Spec Oper Med.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

Dr. Smith's ECG Blog

JANUARY 15, 2024

Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. A patient in their 40s with type 1 diabetes mellitus and hyperlipidemia presented to the emergency department with 5 days of “flu-like” illness. Edits by Willy Frick.

EKG/ECG 65

EKG/ECG Point-of-Care Testing Wellness Shock 65

Dr. Smith's ECG Blog

MAY 19, 2020

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). In this case, profound shock for 1 hour would result in the same degree of infarction. The Type 2 MI would then have been a result of the prolonged severe shock while in arrest.

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

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

PEMBlog

JUNE 5, 2024

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

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

EMDocs

JANUARY 6, 2024

10 Dysrhythmias (more commonly ventricular), chest pain, dyspnea, acute CHF and shock are all possible. 3 Heart transplant patients with ACS have higher risks for cardiogenic shock and in-hospital mortality compared with the general population. A 63-year-old man presents to the emergency department for dyspnea on exertion.

EMS 80

EMS Infectious Diseases Shock Emergency Department 80

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 95

Operations EMS Fluid Resuscitation Resuscitation 95

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. 2018 May;26(5):1465-1470. Ann Emerg Med. Give appropriate fluids, vasopressors, and antibiotics. Support Care Cancer. Epub 2017 Nov 22.

Infectious Diseases 90

Infectious Diseases Administration Sepsis Anaphylaxis 90

The Skeptics' Guide to EM

JUNE 15, 2018

[display_podcast] Date: June 12th, 2018 Reference: DeMeester S et al. Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation. display_podcast] Date: June 12th, 2018 Reference: DeMeester S et al.

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 52

RebelEM

DECEMBER 19, 2022

This procedure involves applying another set of pads attached to a second defibrillator to a patient and shocking them in hopes of terminating the rhythm. The fragility index of these findings found to be 1 for VC and 9 for DED Obtaining a second defibrillator in the emergency department or intensive care unit can be very easy to do.

EMS 52

EMS CPR Shock Resuscitation 52

ACEP Now

JANUARY 13, 2024

While these discriminatory and brutal acts were shocking, they were not surprising to Black people. percent of physicians being Black (as of 2018). Dr. Kendall is the chief of clinician engagement at US Acute Care Solutions and has 15 years of emergency department leadership experience. Racism lives among us.

Leadership 52

Leadership Academics Emergency Department Shock 52

EMDocs

JUNE 3, 2023

In fact, the World Society of Emergency Surgery (WSES) classification assigns grades I-III depending on their Young-Burgess classification, but any patient hemodynamically unstable from their pelvic fracture is automatically WSES grade IV regardless of their fracture pattern. Published October 9, 2018. Int J Environ Res Public Health.

Fractures 60

Fractures Resuscitation Operations EMS 60

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 101

Sepsis Outcomes Administration Shock 101