The Skeptics' Guide to EM

FEBRUARY 15, 2020

Case: A 32-year-old woman with no previous medical history calls you while a passenger on a […] The post SGEM#284: Might as Well Jump, but We would Recommend a Parachute first appeared on The Skeptics Guide to Emergency Medicine. Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial.

Wellness 52

Wellness Outcomes Emergency Department Research 52

PulmCCM

NOVEMBER 18, 2024

Most will do well with anticoagulation alone, but it’s believed that more severely ill intermediate-risk patients can benefit from catheter-directed thrombolysis (CDT), widely performed at tertiary centers using the EKOS™ system or its competitors. systolic dysfunction) on echocardiogram or CT.

Shock 52

Shock Wellness 52

Pediatric EM Morsels

JUNE 7, 2024

For children at least 4 years of age who are not well controlled on ICS alone. 2018 Jun 19;6:170. Lucky for us, in 2020 there were some updates made to the NIH Asthma Management Guidelines and we’re going to discuss which ones can help us in the Emergency Department! Front Pediatr. doi: 10.3389/fped.2018.00170. 2018.00170. 2.3.155.

Pediatrics 268

Pediatrics Emergency Department Wellness EMS 268

Pediatric EM Morsels

JUNE 21, 2024

Palmieri 2002, Choi 2018, Raymond 2018] A systematic review with moderate quality evidence found no difference in the rate of wound healing or epithelialization with silver sulfadiazine compared to silver impregnated foam dressing. Irie 2018] Moral of the Morsel Burns are Bad! Get the Goop!

Burns 169

Burns Pediatrics Hospitals Wellness 169

Emergency Medicine Journal

SEPTEMBER 25, 2024

Being a trauma team leader, emergency physician in charge or clinical lead all look very different and require a range of skills, but are all certainly forms of leadership that have a significant impact on the running of an emergency department, patient outcomes and, as is increasingly being recognised, staff well-being.

Leadership 52

Leadership Emergency Department Outcomes Wellness 52

EM Literature of Note

SEPTEMBER 11, 2023

Well, PRISMS demonstrated unfavorable results. The population included for analysis is the Austrian Stroke Unit Registry from 2018 until 2019, an original cohort of 53,899 patients. The remaining ~4,000 were analyzed both in their unadjusted cohorts, as well as propensity scored cohorts comprised of roughly 20% of the original.

Stroke 112

Stroke Outcomes Wellness 112

Pediatric EM Morsels

SEPTEMBER 22, 2023

” Children compensate for blood and volume loss very well… until they don’t. 2018 Oct;14(2):47-54. Epub 2018 Oct 31. As our fearless leader likes to say: “children are not aliens, but they are a special population with unique anatomy and physiology.” Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

Pediatric EM Morsels

AUGUST 4, 2023

Ganss, 2018) There are additional associations with scoliosis, burn injuries, and spinal cord injuries. (Oka, Positional changes after intake can also be helpful including the lateral decubitus position as well as knee to chest. Ganss, 2018) At least one case of abdominal compartment syndrome noted in the literature.

Pediatrics 246

Pediatrics Burns Operations Ultrasounds 246

The Trauma Pro

AUGUST 22, 2023

The patient is doing well but has an unexplained pressure dip. They found that they both worked well with the following results: Shock index > 1 – 68% sensitive 81% specific ABC > 2 – 47% sensitive, 90% specific The study suggests that shock index is more sensitive, and takes less technical skill to calculate. It happens again.

Shock 100

Shock Wellness EMS 100

Pediatric EM Morsels

APRIL 5, 2024

Globally, ticks are the second most common vector to transmit illnesses after mosquitos (Parola 2018). Menoza 2024) Diagnosis depends on high clinical suspicion as well as testing of both serum and CSF. 2018 Mar; 3(1): 8. Travel Medicine and Infectious Disease, 2018, 26, pp.1-2. John H, Jian J, RIchards AL.

CDC 161

CDC Infectious Diseases Pediatrics Wellness 161

Pediatric EM Morsels

OCTOBER 27, 2023

Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Broselow does not.

Pediatrics 269

Pediatrics Resuscitation Documentation/Coding Wellness 269

Pediatric EM Morsels

AUGUST 18, 2023

Wirth 2018) One study including 4.4 Meesters 2018) Resistance is growing (likely from inappropriate / overuse)! (Jackson 2016) It can also be used in UTIs , but is typically reserved for special cases where the infectious bacteria is found to be multidrug resistant or in complicated UTIs. 451 pediatric patients were included.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

EM Literature of Note

SEPTEMBER 13, 2024

These authors compare the burden of lower respiratory tract infections and bronchiolitis admissions at 15 pediatric emergency departments across 2018 to 2024, with 2023-24 being the first season where nirsevimab was in wide usage. The two “COVID seasons” of 2020-21 and 2021-22 were excluded from their comparisons.

Emergency Department 85

Emergency Department Pediatrics Administration Wellness 85

Pediatric EM Morsels

JULY 7, 2023

Cunningham, 2018 ] Account for less than 1% of all knee injuries. Seen in sports that involved aggressive twisting of the knee (ex, snowboarding, soccer, horse-riding) as well as direct trauma. Epub 2018 Apr 19. The PTF joint is inherently stable with good ligamentous support, especially when the knee is in extension.

Dislocations 141

Dislocations Fractures Pediatrics EMS 141

Pediatric EM Morsels

JULY 21, 2023

cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! 2018 Jun;128(6):1612-1620. 2018): 192–200. Fun fact for animal lovers!- Brennan PM, Murray GD, Teasdale GM. Simplifying the use of prognostic information in traumatic brain injury. J Neurosurg.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Greater Sydney Area HEMS

FEBRUARY 20, 2024

The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i]. Its use in the prehospital environment is not well known or studied and may be an interesting area for future research. [i] Anesthesiology 2018; 128 : 38–43. [v] Medicine 2018; 97 : e13661. Green et al.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

The Skeptics' Guide to EM

OCTOBER 12, 2024

June 2024 Population: Children aged 7-17 years and their caregivers who presented to ten Canadian pediatric EDs between 2018 and 2020 Excluded: Children who remained medically unstable during their ED stay, had altered levels of consciousness, were suspected of being abused, or had a caregiver who was not their legal guardian​.

Emergency Department 91

Emergency Department Pediatrics Outcomes EMS 91

ALiEM

SEPTEMBER 9, 2024

Past surgical history was significant for laparoscopic ventral hernia repair with mesh and lysis of adhesions (three years ago), as well as prior appendectomy, cholecystectomy, c-section, and right nephrectomy. C); BP 110/56; HR 64; RR 16; SpO2 100% General : No acute distress, well appearing. Interdisciplinary Neurosurgery, 13, 66-70.

Sepsis 60

Sepsis Academics Operations Wellness 60

Ken Grauer, MD

APRIL 18, 2023

This blog post reviews the basics for predicting the " C ulprit" A rtery ( as well as reviewing why the term "STEMI" — should replaced by " OMI" = O cclusion-based MI ). For review — Check Out My Comment — at the bottom of the page in the following posts on Dr. Smith's ECG Blog: The June 4, 2018 post ( LA-LL reversal ).

EKG/ECG 195

EKG/ECG Wellness 195

Ken Grauer, MD

APRIL 26, 2024

An example of a case in which the diagnosis of acute OMI was made purely by assessment of ST-T wave morphology in a PVC can be found HERE ( See My Comment at the bottom of this page in the October 8, 2018 post in Dr. Smith's ECG Blog ). = A cknowledgment : My appreciation for this case that is anonymously contributed. =

EKG/ECG 395

EKG/ECG Resuscitation EMS Wellness 395

Sensible Medicine

JUNE 17, 2024

Europeans do PFA ablation in well under an hour. Proponents wrote back in 2018 that longer-term safety studies are needed that specifically assess…”cerebral microemboli assessed by magnetic resonance imaging.” Fortunately, we now know about the complication, and have active avoidance measures.

Shock 125

Shock Stroke Operations Ultrasounds 125

Ken Grauer, MD

JUNE 6, 2023

That said — lack of a well defined P wave in lead II makes assessment of the PR interval difficult — and — the QRS looks a little wide in lead V3, albeit QRS duration does not appear to exceed 0.10 This explains the marked increased in QRS amplitude in the lateral chest leads — as well as some of the ST-T wave depression in these leads.

EKG/ECG 195

EKG/ECG Hospitals Wellness Resuscitation 195

Dr. Smith's ECG Blog

JUNE 14, 2024

But artifact is "alive and well" — and learning to recognize it will amaze many of your colleagues ( and may serve to avoid an unnecessary defibrillation or two ). KEY Point: As per Dr. Frick: i ) Artifact is "alive and well" in 2024. The January 30, 2018 post — for PTA. The August 26, 2019 post — baseline artifact.

EKG/ECG 77

EKG/ECG Wellness Hospitals 77

Mount Sinai EM

OCTOBER 11, 2024

2018 , compared a random sampling of patients from 12 Southern California Kaiser centers which adopted a PTA algorithm of medical management and ENT follow up the next day, with subsequent I+D if needed vs patients from seven centers in the same system that opted for initial surgical drainage. in the medical cohort and 6.2%

Ultrasounds 100

Ultrasounds Wellness Outcomes Hospitals 100

ALiEM

MAY 13, 2024

They may be well-circumscribed or may have irregular borders. Well-circumscribed abscess with heterogeneous debris C. Larger abscess with well-circumscribed borders D. Superficial abscess with well-circumscribed borders Table 1. 2018 Jan;54(1):96-101. The rim may be echogenic or blend in with surrounding tissue.

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Background: Sepsis remains one of the leading causes of morbidity and mortality.

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

Dr. Smith's ECG Blog

JULY 26, 2023

But the well-formed Q-wave and the presence of a normal T-wave in inferior leads led me to believe this was Old Inferior MI with persistent ST Elevation, otherwise known as inferior LV aneurysm. To facilitate comparison in Figure-1 — I put this 2018 prior tracing ( = ECG #3 ) — together with ECG #1.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

EMDocs

JULY 9, 2024

Epub 2018 Nov 22. Addressing social determinants of health at well child care visits: a cluster RCT. 2018 Jul;84(1):10-21. Epub 2018 May 23. Community Resource Needs Assessment Among Families Presenting to a Pediatric Emergency Department. Acad Pediatr. 2019 May-Jun;19(4):378-385. doi: 10.1016/j.acap.2018.11.009.

Pediatrics 71

Pediatrics Emergency Department Research Burns 71

The Trauma Pro

SEPTEMBER 14, 2023

” This guideline was implemented in 2018-2019, and patients presenting before implementation were compared to those arriving after. The Medical College of Wisconsin trauma group performed a retrospective review of 391 patient charts to test a new 300cc rule defining when a hemothorax is “too big.”

Resuscitation 162

Resuscitation Hospitals Wellness 162

ALiEM

DECEMBER 8, 2023

Major risk factors for their development include prior abdominal surgeries that weaken the musculature as well as cardiovascular co-morbidities. 2018 Apr;22(2):353-361. Epub 2018 Jan 27. Case Discussion Take-Home Points Abdominal wall hernias are classified by their location: ventral, groin, pelvic, and flank. PMID: 32310432.

Academics 60

Academics Emergency Department Outcomes Wellness 60

Taming the SRU

MAY 13, 2024

The patient is a well-appearing male who is awake, alert, and oriented. There is also a well-appearing, healed surgical scar. There is also a well-appearing, healed surgical scar. The skin is warm and well perfused with brisk capillary refill. World J Emerg Surg 13, 22 (2018). Notable diagnostics CBC : WBC 19.2,

Ultrasounds 97

Ultrasounds Emergency Department Wellness Operations 97

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. 2018) “Benefits of using the pause after death in emergency departments: a Delphi study”. 2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. Psychological harm occurs. & Liska, H. Journal of Trauma Nursing.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

ALiEM

MARCH 7, 2024

It is usually large, nodular, well-defined, homogeneous, and slightly hypoechoic (Figure 13) [6]. Acad Emerg Med , 2018 [11] Systematic review & Meta-analysis, Multicenter, 2005 Through April 2016 N=1,773, Adults POCUS has modest diagnostic accuracy in adults for nephrolithiasis. Wong et al.,

Ultrasounds 70

Ultrasounds Pediatrics Radiology Radiology 70

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Exceptions to the above general rule of course exist ( ie, Children may have sinus tach well over 200/minute — and an occasional adult with enhanced sympathetic tone may also have surprisingly fast sinus tachycardia ) — but I find it helpful to be aware of these general rate limits.

EKG/ECG 64

EKG/ECG Wellness Hospitals 64

PEMBlog

SEPTEMBER 24, 2024

Further evaluation with computed tomography (CT) chest was obtained with representative cuts shown and a 3D reconstruction shown as well. 2018 Jul;48(3):247-250. Epub 2018 Apr 6. His chest x-ray revealed persistent opacity in the left lower lobe, shown below. What’s the Diagnosis? Aspirated foreign body B. Lymphoma D.

Pediatrics 52

Pediatrics Ultrasounds Hospitals Wellness 52

Dr. Smith's ECG Blog

AUGUST 18, 2024

He did well. We've periodically reviewed cases regarding Pacemaker Troubleshooting ( See the February 18, 2024 post — the January 13, 2024 post — the October 19, 2022 post — the August 3, 2022 post — the May 21, 2023 post — the June 19, 2024 post — and the November 9, 2018 post , to name a number of them ).

EKG/ECG 90

EKG/ECG Fractures Burns Wellness 90

Dr. Smith's ECG Blog

NOVEMBER 14, 2024

History of diabetes type II and stent placement in 2018. Since this patient has known coronary disease as well as diabetes — we can speculate that these changes in this anterior lead distribution may be the result of some compromise in collateral flow to the anterior wall. What do you think? I responded: "Definite inferior OMI.

Academics 116

Academics EKG/ECG Wellness 116