The Skeptics' Guide to EM

OCTOBER 5, 2019

Date: September 25th, 2019 Reference: Bath PM et al. Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomized, sham-controlled, blinded, phase 3 trial. The Lancet March 2019. Date: September 25th, 2019 Reference: Bath PM et al.

Stroke 52

Stroke Hospitals EMS Administration 52

The Skeptics' Guide to EM

FEBRUARY 26, 2019

Date: February 4th, 2019 Guest Skeptic: Dr. Jerome Hoffman is a Professor Emeritus of Medicine and Emergency Medicine, University of California, Los Angeles. Date: February 4th, 2019 Guest Skeptic: Dr. Jerome Hoffman is a Professor Emeritus of Medicine and Emergency Medicine, University of California, Los Angeles.

Stroke 52

Stroke EMS Research Outcomes 52

Emergency Medicine Journal

MARCH 21, 2024

Background In 2019, the emergency medical services (EMS) covering the western Norway Regional Health Authority area implemented its version of the prehospital clinical criteria G-FAST (Gaze deviation, Facial palsy, Arm weakness, Visual loss, Speech disturbance) to detect acute ischaemic stroke (AIS) with large vessel occlusion (LVO).

Stroke 52

Stroke Documentation/Coding EMS Hospitals 52

The Skeptics' Guide to EM

APRIL 4, 2020

Date: April 4th, 2020 It has been just over a year since Dr. Salim Razaie (REBEL EM) and I stepped into the ring for a boxing matched theme debate in Sydney, Australia. It was the EBM rumble down under for SMACC 2019. It was the EBM rumble down under for SMACC 2019. You can see the original SGEM Xtra post from March 2019.

CPR 52

CPR EMS Stroke Hospitals 52

The Skeptics' Guide to EM

APRIL 25, 2020

Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. He has been practicing in Emergency Medicine for over 40 years and involved in EMS services for over 30 years.

Stroke 40

Stroke Emergency Department Outcomes Administration 40

RebelEM

FEBRUARY 8, 2024

PMID: 32109843 For More Thoughts on This Topic Checkout: REBEL EM: Is ATLS Wrong About Palpable Blood Pressure Estimates? appeared first on REBEL EM - Emergency Medicine Blog. to 1.12; p = 0.03 for every change in 5ug/min Lower MAP Value: aOR 0.98; 95% CI 0.98 to 0.99; p <0.01 to 1.09; p = 0.01 to 1.37; p <0.01 to 2.47; p – 0.04

Resuscitation 125

Resuscitation Outcomes EMS Sepsis 125

RebelEM

FEBRUARY 24, 2025

Of course, there are other methods of assessing fluid tolerance : Capillary refill evaluation, passive leg raise, central venous pressure measurement, pulmonary artery wedge pressures, stroke volume variation, pulse pressure variation, etc. Jan 2019; PMID: 30138573. Intensive care medicine. Sep 2010; PMID: 20502865 Teboul JL, et al.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

The Skeptics' Guide to EM

FEBRUARY 8, 2020

Stroke 2019 Guest Skeptic: Dr. Rory Spiegel is an EM/CC doctor who splits his time in the Emergency Department and Critical Care department. He also has this amazing #FOAMed blog called EM Nerd. He also has this amazing #FOAMed blog called EM Nerd. Reference: Perry et al.

Emergency Department 52

Emergency Department Stroke EMS Academics 52

The Skeptics' Guide to EM

OCTOBER 14, 2019

Date: October 14th, 2019 Reference: CRASH-3 Trial Collaborators. The Lancet October 2019 Guest Skeptic: Dr. Salim Rezaie currently works as a community emergency physician at Greater San Antonio Emergency Physicians […] The post SGEM#270: CRASH-3 TXA for Traumatic Head Bleeds? first appeared on The Skeptics Guide to Emergency Medicine.

Stroke 52

Stroke EMS Emergency Department Outcomes 52

RebelEM

JUNE 26, 2023

J Trauma Acute Care Surg 2019. appeared first on REBEL EM - Emergency Medicine Blog. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03 Four-Factor Prothrombin Complex Concentrate is Associated with Improved Survival in Trauma-Related Hemorrhage: A Nationwide Propensity-Matched Analysis.

Administration 145

Administration Outcomes Resuscitation Radiology 145

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Here is that last post: A 90-something with acute stroke. For examples of such exceptions — See My Comment in the January 9, 2019 — August 22, 2020 — and June 30, 2023 posts in Dr. Smith's ECG Blog ). EMS arrived — and recorded 2 ECGs. 14 minutes later — ECG #2 was recorded by EMS. She has no chest symptoms.

EKG/ECG 116

EKG/ECG EMS Stroke Outcomes 116

RebelEM

MAY 18, 2023

These patients can have a vasodilated vascular bed and the initial use of fluids is hypothesized to serve two purposes: Augmenting the macrovascular system (stroke volume and cardiac output) and augmenting the microvascular perfusion (capillary blood flow). Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104

RebelEM

FEBRUARY 29, 2024

3, 6 Among patients with stroke or traumatic brain injury (TBI), the risk may be as high as 28%-76% and 23%-60%, respectively. Post-stroke infection: a systematic review and meta-analysis. N Engl J Med 2019 , 381 (19), 1831-1842. 4, 8 Paper: Dahyot-Fizelier, C., Infect Control Hosp Epidemiol 2014 , 35 (8), 915-936. Dequin, P.

CDC 122

CDC Radiology Radiology Head Injuries 122

The Skeptics' Guide to EM

APRIL 6, 2019

Date: April 5th, 2019 Reference: Connolly et al. NEJM 2019 Guest Skeptic: Dr. Ryan Radecki is an Emergency Physician at Kaiser Permanente NW, co-host of the Annals of Emergency Medicine podcast and Journal Club section editor. Date: April 5th, 2019 Reference: Connolly et al. You order a non-contrast CT to rule out hemorrhage.

Stroke 52

Stroke Administration EMS Wellness 52

Dr. Smith's ECG Blog

OCTOBER 12, 2024

With EMS, patient had a GCS of 3 and was saturating 60% on room air. He improved to 100% with the addition of non-rebreather, however remained altered and was intubated by EMS with ketamine and succinylcholine. Vital signs were within normal limits on arrival to the Emergency Department. Blood glucose was not low at 162 mg/dL.

EKG/ECG 116

EKG/ECG Documentation/Coding Emergency Department COPD 116

EMDocs

OCTOBER 30, 2023

Pillai, MBBS (@sspillai01, EM Resident Physician, University of Kentucky) and Christopher N. 2 In response to the constrained availability of contrast media, emergency medicine (EM) and radiology departments were compelled to enact modifications in their imaging techniques. Authors: Saran S. 11 Table 1.

Radiology 99

Radiology Radiology Emergency Department Hospitals 99

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Her husband called EMS when the patient experienced new onset seizures accompanied by micturition. The ECG below was recorded by EMS. Written by Magnus Nossen — with edits by Grauer. The patient in today’s case is a 30-something female. She has no known previous medical history. What is your assessment?

Seizures 113

Seizures EKG/ECG EMS Stroke 113

Taming the SRU

NOVEMBER 3, 2023

Broad strokes In this prospective, non-randomized study published by Kring et al in January 2022 out of Maine Medical Center, researchers compared mean pain scores at rest and during incentive spirometry before, at 15 minutes after, and then 60 minutes after treatment with a serratus anterior plane block. Ultrasound Med. 41, 2695–2701 (2022).

Fractures 98

Fractures Ultrasounds Research Outcomes 98

The Skeptics' Guide to EM

MAY 30, 2020

Case: A 44-year-old male presents to your level 1 trauma center by EMS after a motor vehicle collision. REBEL EM has looked at using TXA for those conditions plus a few others (we will include a table in the show notes). Corey Heitz is an emergency physician in Roanoke, Virginia. He is hypotensive and tachycardic. TXA vs. 19.8%

Head Injuries 52

Head Injuries Academics EMS Stroke 52

RebelEM

JUNE 8, 2023

They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine. Epub 2019 Jul 3. However, peripherally dosed push dose pressors, (PDPs), are beginning to be administered more frequently for management of acute hypotension.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

ACEP Now

NOVEMBER 7, 2023

EMS physicians report he was found in ventricular fibrillation. 8-12 A recent scoping review published in The American Journal of Emergency Medicine reviewed articles between 2016 and 2019, and found 18 observational studies, which failed to demonstrate sufficient evidence for widespread implementation of DSED. Simon EM, Tanaka K.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

The Skeptics' Guide to EM

MARCH 13, 2021

Dr. Perry did publish a prospective implementation of the Ottawa SAH Rule ( Stroke 2019 ). This article was covered on the SGEM with EM Nerd Dr. Rory Spiegel. The results demonstrated that the Ottawa SAH Rule is highly sensitive (100%) but has very poor specificity (13%).

Stroke 40

Stroke Emergency Department EMS Outcomes 40

Taming the SRU

OCTOBER 7, 2024

The contraindications are the same as for the non-pregnant patient including: prior ICH, known brain lesion/malignancy, ischemic stroke in the past three months, suspected aortic dissection, active bleeding, and closed head trauma in the past three months. She is a graduate from the UC EM residency, class of 2018. MD, Weinberger, S.

Ultrasounds 64

Ultrasounds CDC Research Stroke 64

Dr. Smith's ECG Blog

OCTOBER 7, 2019

This is by one of our outstanding 3rd year residents , Aaron Robinson, with some edits and comments by Smith EMS responded to a reported seizure in a 42 year old male. One of our EMS Fellows along with a Senior EM Resident were on duty that evening, and arrived on the scene with the Fire Department.

Seizures 40

Seizures EKG/ECG Shock EMS 40

Dr. Smith's ECG Blog

MARCH 15, 2023

IF the Patient is Younger and Athletic: The mechanism of AFib in younger, athletic individuals is often heavily influenced by increased vagal tone ( Rao and Shipon — ACC, 2019 — and — Calvo et al — Br J Sports Med, 2012 ). Ballatore et al — Medicina (Kaunas) 55(8): 497, 2019 — and — Page et al — Circulation 107:1141-1145, 2003 ).

EKG/ECG 52

EKG/ECG Dehydration Stroke Shock 52

Northwestern EM Blog

MAY 16, 2022

Finally, a burden on us as EM clinicians is training in and awareness of clinical practice guidelines and recommendations from specialties outside of EM. J Urol 2019. He endorses nausea without vomiting and denies fever. Please ensure that you document and discuss with the patient accordingly. Thanks again toDr.’s

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Dr. Smith's ECG Blog

MARCH 6, 2019

I believe this is by far the most common outcome for this patient around the world in 2019. Current practice ranges widely, but based on my short experience and reports from other institutions, most of these patients are not being taken emergently to the cath lab in 2019. European Heart Journal 2019. vs. 6.6%, p=0.37).

EKG/ECG 52

EKG/ECG Outcomes Hospitals Wellness 52

Taming the SRU

MARCH 31, 2023

of emergency medicine residents report 1 or more dimensions of burnout (Lin Annals Emerg Med 2019) Moral Injury with COVID “We pushed aside our fear and frustration to focus on saving the patients in front of us; we kept our eyes open, and our feelings closed.

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

EB Medicine

AUGUST 1, 2018

Nachi: Sometimes… Jeff: This month’s issue was authored by Mollie Williams, who is the EM residency program director at the Brooklyn Hospital Center. First up is the link between cannabis use and stroke or TIA. times higher risk of stroke or TIA. times higher risk of stroke or TIA. Effects can be seen within 3 minutes.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

DECEMBER 16, 2023

We’ll keep it short, while you keep that EM brain sharp. A 34-year-old male is brought via EMS after collapsing during an outdoor adventure race. EMS reports the patient was conscious but altered, with slurred speech and confusion. Both can result in heat exhaustion and heat stroke and have many overlapping symptoms.

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

EMDocs

JULY 3, 2023

Authors: Mikalah Ward, MD (EM Resident Physician, University of Kentucky); Susan Owens, MD (EM Attending Physician, University of Kentucky) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. 2019 Mar;123:184-187. 2019 Sep;17(5):378-384. 2019 Mar;20(2):203-211.

Seizures 98

Seizures Stroke Outcomes EMS 98

EMDocs

NOVEMBER 13, 2023

Authors: Mary Hamblen, DO (EM Resident Physician, TX); Justin Hacnik, MD (EM Resident Physician, TX); Katherine Spencer, MD (EM Resident Physician, TX); J.D. Stroke Authors’ Recommendation: CTA head/neck should be acquired in patients with stroke symptoms presenting within 24 hours of symptom onset.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Taming the SRU

NOVEMBER 18, 2024

Other causes include gastritis, gastric malignancy, pancreatitis, hiatal hernia, SBO, large meal, spicy foods, and carbonated drinks Neurologic Stroke, space occupying lesion, epilepsy, CNS infection, demyelinating and neurodegenerative disorders such as multiple sclerosis and Parkinson’s disease are causes of intractable hiccups.

Stroke 86

Stroke Administration COPD Dehydration 86

EMDocs

FEBRUARY 3, 2025

Collins, MD (EM Resident Physician, San Antonio, Texas); Michael J. However, the European Alliance of Associations for Rheumatology(EULAR) and American College of Rheumatology (ACR) created a classification criterion in 2019 with a 96.1% Authors: William J. Currently there is no formal diagnostic criteria for SLE. sensitivity and 93.4%

Stroke 70

Stroke EMS Seizures Outcomes 70

EMDocs

NOVEMBER 2, 2024

We’ll keep it short, while you keep that EM brain sharp. cognitive and behavioral impairment) – 33% Ataxia – 28% Stroke – 23% Ophthalmic symptoms (e.g., The early manifestations of neurosyphilis occur during the secondary stage and include headache , meningitis , stroke , hearing loss , and ocular findings. In: StatPearls.

EMS 115

EMS Infectious Diseases CDC Research 115

ACEP Now

DECEMBER 7, 2024

The use of thrombolytics for acute ischemic stroke may be one of the most controversial topics in emergency medicine during the last several decades. 1 The reason is understandablethrombolytics in stroke is a high-risk, higher-reward treatment. This debate recurs in multiple forums including many previous pieces in ACEP Now.

Stroke 98

Stroke Research Hospitals Outcomes 98

EMDocs

JANUARY 6, 2025

These patients suffer from untreated physical injuries, including gunshot wounds, shrapnel, accidents, envenomations, sequelae of physical or sexual assault, and heat exhaustion/heat stroke. 8,88 Careful inquiry and a head-to-toe evaluation are necessary to exclude traumatic injuries. Can J Surg J Can Chir. 2006;49(1):51-57. link] UNHCR.

Infectious Diseases 75

Infectious Diseases CDC PPE Rapid Diagnostic Testing 75