Emergency Medicine Journal

MARCH 21, 2024

This month’s journal covers a wide variety of topics, from COVID-19 and fever in the Emergency Department (ED) to prehospital care. Reflecting backwards to early 2020, it thus far remains one of the most challenging times in my career. One of the notable outcomes was the disparities among different ethnic groups.

Emergency Department 52

Emergency Department Outcomes 52

Emergency Medicine Journal

MAY 23, 2023

Background To identify the impact of enrolment onto a national pulse oximetry remote monitoring programme for COVID-19 (COVID-19 Oximetry @home; CO@h) on health service use and mortality in patients attending Emergency Departments (EDs).

Emergency Department 52

Emergency Department Outcomes Hospitals 52

Don't Forget the Bubbles

MAY 31, 2023

Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. During the COVID-19 pandemic , we noticed a change in the type of patients presenting to the Emergency Department. Arch Dis Child.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Emergency Medicine Journal

NOVEMBER 28, 2023

Methods This multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands. The primary outcome was the proportion of patients requiring more than one reduction attempt.

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? Certified interpreter use can improve communication and patient outcomes. An implementation science approach improves language access in the emergency department. One cohort study in a public ED found that 84.5% 45:446-458. Taira B, et al.

Documentation/Coding 82

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 82

Taming the SRU

MARCH 27, 2024

The parent trial was conducted from October 2020 to July 2022 in the capital region of Denmark. The primary outcome was cumulative norepinephrine use during the first 48 hours of admission. That said, outcomes for these patients are generally poor and the use of steroids as a one-time dose likely has little risk. Hill, J.

Resuscitation 96

Resuscitation Outcomes CPR Hospitals 96

Taming the SRU

SEPTEMBER 25, 2023

Musculoskeletal injuries are a common occurrence, representing a substantial number of Emergency Department visits on an annual basis. 1) Oftentimes, Emergency Physicians are the first provider patients encounter after an injury. 2020 Feb 12;4(2):e20.00005. 2020 Dec;12(6):1644-1651. Epub 2020 Sep 7.

Fractures 99

Fractures Emergency Department Operations EMS 99

PulmCCM

NOVEMBER 6, 2023

The therapy was approved for emergency use in 2020 by FDA after an observational study of 10 patients showed likely benefit (yes, 10, which should remind us of our collective desperation). patients infected with the Wuhan/Delta variants in 2020-2021). Thromboelastometry (e.g., The balloon generally required 30 minutes to insert.

Blood Transfusions 98

Blood Transfusions Operations Resuscitation Infectious Diseases 98

The Skeptics' Guide to EM

NOVEMBER 21, 2020

Date: November 19th, 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. The impact of advanced practice provider staffing on emergency department care: productivity, flow, safety, and experience. AEM November 2020.

Emergency Department 52

Emergency Department Telemedicine Academics Outcomes 52

ACEP Now

OCTOBER 15, 2023

prescriptions annually per 100 persons in 2020. 1 The emergency department remains an important frontier for work in judicious prescribing, but opiate analgesia remains a valuable tool for the initial treatment of a variety of presentations. In this respect, the conclusion is absolutely true.

Emergency Department 52

Emergency Department Outcomes CDC Research 52

The Skeptics' Guide to EM

OCTOBER 14, 2023

Case: A 5-year-old boy presents to the emergency department (ED) with his parents for fever and fatigue. Time to change the reference ranges of children’s physiological observations in emergency care? He has had three days of high fevers at home. A prospective study. J Paediatr Child Health.

Pediatrics 91

Pediatrics Sepsis Urgent Care Emergency Department 91

The Skeptics' Guide to EM

AUGUST 22, 2020

Date: August 18th, 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Diagnosing COVID-19 in the Emergency Department: A Scoping Review of Clinical Exam, Labs, Imaging Accuracy and Biases. Reference: Carpenter et al.

Emergency Department 52

Emergency Department Academics Research Administration 52

Northwestern EM Blog

JANUARY 2, 2023

In a survey from June 2020, 11% of adults reported thoughts of suicide in the past 30 days [1]. They found that suicide rates in 2020 were increased in October and November for men and in July through November for women when compared to 2016-2019. Deaths, isolation, loss of work, and countless other hardships abound.

Emergency Department 52

Emergency Department Research CDC Pediatrics 52

The Skeptics' Guide to EM

MARCH 18, 2023

Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020.

Pediatrics 40

Pediatrics Infectious Diseases Administration Outcomes 40

Northwestern EM Blog

SEPTEMBER 26, 2022

Written by: Diana Halloran (NUEM ‘24) & Andrew Long (NUEM ‘25) Edited by: Nick Wleklinski (NUEM ‘22) Expert Commentary by : John Bailitz, MD Introduction The Emergency Department is a challenging work environment for a variety of reasons. Any team member of the resuscitation may lead the hot debrief.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

PulmCCM

JUNE 12, 2023

TTM2 found no improvement in survival or neurologic outcome among patients randomized to cooling to a target of 33 °C, as compared to controls receiving fever prevention (e.g. with acetaminophen) until temperatures reached 37.8 °C who then received external cooling to maintain a target temperature of 37.5 °C.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 105

Don't Forget the Bubbles

JANUARY 8, 2024

Dr Bourke’s work is not only about deepening academic understanding but also about forging practical approaches to help healthcare professionals navigate the nuanced and often uncertain waters of adolescent care in emergency settings. Mulraney, M., Coghill, D., Sciberras, E., and Sawyer, M., Mulraney, M., Coghill, D., Sciberras, E.,

Research 105

Research Emergency Department Psychiatric Outcomes 105

RebelEM

JUNE 5, 2023

One study from a county in Massachusetts found that of all nonfatal opioid doses seen in the emergency department from 2011-2015, 1 in 20 patients subsequently died within one year of initial visit with 66% of these deaths being directly related to an opioid overdose (4). PMID 33392580. mg tablet) 1 Buprenorphine 0.5

Emergency Department 95

Emergency Department Hospitals Outcomes EMS 95

ACEP Now

JULY 7, 2023

CASE A 30-year-old woman presents to the emergency department with left arm pain from a chronic wound. Since 2020 to 2021, the Drug Enforcement Administration has reported a sharp rise in xylazine use across the U.S., percent of all overdose deaths in 2020. US Department of Justice, Drug Enforcement Administration.

Forensics 98

Forensics Airway Management Administration Emergency Department 98

The Skeptics' Guide to EM

APRIL 25, 2020

Date: April 21st, 2020 Reference: Juergens et al. Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. Date: April 21st, 2020 Reference: Juergens et al. Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke.

Stroke 40

Stroke Emergency Department Outcomes Hospitals 40

The Skeptics' Guide to EM

AUGUST 28, 2021

Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial. Case: A forty-year-old woman presents to the emergency department […] The post SGEM#342: Should We Get Physical, Therapy for Minor Musculoskeletal Disorders in the ED?

Emergency Department 52

Emergency Department Research Outcomes 52

The Skeptics' Guide to EM

JULY 8, 2023

Case: A 57-year-old woman with hypertension, hyperlipidemia and type-2 diabetes mellitus presents to the emergency department (ED) with fever, cough, myalgias, headache and congestion. There was a large unblinded RCT of over 3,000 patients published in the Lancet in 2020.

CDC 97

CDC Hospitals EMS Emergency Department 97

The Skeptics' Guide to EM

JANUARY 18, 2020

Date: January 16th, 2020 Reference: Troponin Testing and Coronary Syndrome in Geriatric Patients With Nonspecific Complaints: Are We Overtesting? AEM January 2020 Guest Skeptics: Dr. James VandenBerg: James has a master’s degree in clinical investigation from Washington University in St. Reference: Wang et al.

Emergency Department 52

Emergency Department Hospitals Outcomes 52

The Skeptics' Guide to EM

AUGUST 14, 2021

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. The key result was that significantly fewer patients had a favorable neurologic outcome in the IO group compared to the IV group.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

RebelEM

APRIL 29, 2024

Given AHA guidelines recommend early epinephrine administration in cardiac arrest, obtaining access is imperative for resuscitative efforts ( 9) When evaluating over 300,000 out-of-hospital cardiac arrests, a meta-analysis found no significant change in primary outcomes when IV and IO access were compared ( 10 ). Resuscitation.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

The Skeptics' Guide to EM

JUNE 6, 2020

Date: June 2nd, 2020 Reference: Permpikul et al. Guest Skeptic: Dr. Max Hockstein trained as an Emergency Medicine physician at University of Texas Southwestern and is finishing his Intensive Care fellowship at Emory. Date: June 2nd, 2020 Reference: Permpikul et al. Case: It’s another day in your emergency department (ED).

Sepsis 52

Sepsis Shock Resuscitation Outcomes 52

The Skeptics' Guide to EM

APRIL 3, 2021

Stroke 2021 Case: A 74-year-old man presents to the emergency department after waking up with left sided weakness. Background: We have talked about stroke management a number of times recently including SGEM#297 on the reanalysis of ECASS-3 by Alper et al 2020. Only two RCTs claimed benefit for their primary outcome.

Stroke 52

Stroke Research Outcomes Hospitals 52

The Skeptics' Guide to EM

NOVEMBER 13, 2021

Neil Dasgupta is an emergency physician and ED intensivist from Long Island, NY, and currently an assistant clinical professor and Director of Emergency Critical Care at Nassau University Medical Center. Case: A code blue is called for a 71-year-old male in-patient that is boarding in the emergency department (ED).

Advances Cardiac Life Support (ACLS) 40

Advances Cardiac Life Support (ACLS) Hospitals Emergency Department Resuscitation 40

The Skeptics' Guide to EM

JULY 30, 2022

Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: A 63-year-old woman presents to your emergency department (ED) with two-day history of nausea, vomiting and constipation. Charles Brower is a second-year resident training in Emergency Medicine at the University of Cincinnati.

Ultrasounds 52

Ultrasounds Operations Outcomes Documentation/Coding 52

RebelEM

JANUARY 30, 2023

PSA, also referred to as intravenous sedation in this paper, requires considerable resources, including 1:1 nursing observation, and burdens the emergency department (ED). In addition, many hospitals are still reeling from the COVID-19 pandemic and face crippling staff shortages, and sparing a nurse for PSA will be difficult.

Dislocations 55

Dislocations Outcomes Emergency Department Research 55

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Date: September 16th, 2020 Guest Skeptics: Dr. Robert Goulden and Dr. Audrey Marcotte are Chief Residents from the Royal College of Emergency Medicine Program at McGill University. Outside of medicine, Audrey likes […] The post SGEM#301: You Can’t Stop GI Bleeds with TXA first appeared on The Skeptics Guide to Emergency Medicine.

Academics 52

Academics Resuscitation EMS Research 52

EMDocs

MAY 11, 2024

Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department. Ann Emerg Med. Erratum in: Ann Emerg Med. Salim Rezaie, “Thrombolysis in Acute Ischemic Stroke: Now We Have No Positive RCTs”, REBEL EM blog, July 27, 2020.

Stroke 89

Stroke EMS EKG/ECG Radiology 89

The Skeptics' Guide to EM

JULY 18, 2020

Date: July 13th, 2020 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the excellent #FOAMed project called First10EM.com. first appeared on The Skeptics Guide to Emergency Medicine. Reference: Ebell et […] The post SGEM#298: What’s the Signs and the Symptoms of Pneumonia?

Radiology 52

Radiology Radiology Emergency Department Outcomes 52

The Skeptics' Guide to EM

DECEMBER 25, 2021

The patient is transported to the emergency department with vital signs absent (VSA). Intraosseous access is quickly obtained, and a dose of epinephrine is provided. CPR is continued while a supraglottic airway is placed successfully. Background: We have covered adult OHCA multiple times on the SGEM.

CPR 52

CPR Administration Outcomes Hospitals 52

Don't Forget the Bubbles

AUGUST 7, 2023

This prospective cohort study included patients between 0-16 years old, who presented to one of four NHS hospital sites in Greater Manchester (a large metropolitan area in the North of England), consisting of an Urgent Care Centre and three Emergency Departments. Yes Was the outcome accurately measured to minimize bias?

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

The Skeptics' Guide to EM

MARCH 27, 2021

Spirometry not pain level predicts outcomes in geriatric patients with isolated rib fractures. 2020 Case: A 74-year-old woman who suffered a fall earlier today presents to the emergency department (ED) and is found to have five rib fractures to her right thorax, but no other injury. Reference: Schuster et al.

Fractures 40

Fractures Outcomes Hospitals Emergency Department 40

Don't Forget the Bubbles

JANUARY 17, 2024

After Meshram et al, 2020 When Orbeez are exposed to water, the water molecules diffuse into the polymer network through osmosis. Curious Ken is brought into your emergency department. There have been reports of the Orbeez Challenge leading to serious outcomes. Clinical and Experimental Emergency Medicine , 7 (4), p.330.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111