The Skeptics' Guide to EM

JULY 23, 2022

Date: July 22nd, 2022 Reference: Perry et al. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Date: July 22nd, 2022 Reference: Perry et al. Case: Jack is nine years old, and he presents to emergency department (ED) with an arm injury.

Fractures 52

Fractures Pediatrics Emergency Department Outcomes 52

ALiEM

OCTOBER 30, 2024

A trans-esophageal echocardiogram showed a normal ejection fracture, normal right ventricular function, and no vegetations. Bupe Allergy Buprenorphine induction has been the mainstay of emergency department treatment of opioid use disorder for more than a decade [11, 12]. Drug Checking Quarterly Report (Q3 2022).

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

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. 3,4 Risk factors include engaging in high energy activities, consumption of large amounts of alcohol, osteoporosis, and previous thoracic or lumbar fractures.

EMS 105

EMS Fractures Emergency Department Dislocations 105

The Skeptics' Guide to EM

DECEMBER 10, 2022

Date: November 30th, 2022 Reference: Johnson et al. One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture: A meta-analysis of randomized controlled trials. Date: November 30th, 2022 Reference: Johnson et al.

Operations 52

Operations Fractures Military Emergency Department 52

Mind The Bleep

AUGUST 18, 2024

Facial trauma commonly presents in Emergency Departments and in primary care. Patients with orbital fractures will present with swelling and periorbital bruising. Subconjunctival haematoma Pupils and reaction to light Sometimes the fat or inferior rectus muscle can get trapped in a fracture and cause restriction in upward gaze.

Fractures 91

Fractures Soft Tissue Injuries Burns Emergency Department 91

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. Treasure Island (FL): StatPearls Publishing; July 26, 2022.

Basic Life Support 109

Basic Life Support CPR Fractures Emergency Department 109

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The children’s Emergency department sees approximately 50,000 presentations per year. Emerg Med J. doi: 10.1136/emermed-2022-212931. PMID: 38212934.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. The value of ultrasound for detecting hand fractures: A meta-analysis. Examination reveals the following: What is the diagnosis? 2012;16(4):338-349.

EMS 96

EMS Fractures Operations Ultrasounds 96

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Rib fractures account for over 15% of all trauma attendances in the Emergency Department. Among patients with multiple rib fractures, the mortality rate can reach a staggering 33%, and this risk doubles for individuals above the age of 65. ED Physicians are already well-versed in the use of ultrasound.

Fractures 40

Fractures Anaphylaxis Emergency Department Ultrasounds 40

RebelEM

APRIL 29, 2024

2022 PMID: 35206981 2. World J Emerg Surg 2023 PMID: 36918947 3. Intraosseous vascular access in adults using the EZ-IO in an emergency department. Int J Emerg Med 2009 PMID: 20157465 4. Intraosseous versus central venous catheter utilization and performance during inpatient medical emergencies. Healthcare.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Taming the SRU

JANUARY 10, 2024

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

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

Taming the SRU

OCTOBER 20, 2023

Higher sensitivity with the lever sign test for diagnosis of anterior cruciate ligament rupture in the emergency department. 142, 1979–1983 (2022). Guiraud, K. Trauma Surg. Clinical Question: Does the lever sign provide improved sensitivity to the diagnosis of acute ACL tear in the ED?

Fractures 95

Fractures Dislocations Emergency Department 95

Taming the SRU

NOVEMBER 27, 2023

These patients may be discharged with close outpatient follow-up, and should be instructed to return to the Emergency Department if they develop worsening and/or spreading pain and swelling, as this may be indicative of an infectious process. Treasure Island (FL): StatPearls Publishing; June 29, 2022. [5] Paronychia Drainage.

Soft Tissue Injuries 95

Soft Tissue Injuries Emergency Department EMS Fractures 95

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Written by Pendell Meyers A teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. Trauma CTs showed a "mildly displaced sternal fracture and a small retrosternal hematoma." Retrieved July 2, 2022, from [link] Moyé, D. Zangouri, V.,

EKG/ECG 115

EKG/ECG Wellness Fractures Emergency Department 115

Mind The Bleep

NOVEMBER 6, 2023

In this injury, there is a fracture of the orbital floor and the inferior orbital rim remains intact. The “teardrop sign” is a radiological sign of inferior orbital wall fractures in which intraorbital fat +/- inferior rectus muscle herniates through the fracture. Teardrop sign (inferior orbital wall fracture).

Fractures 52

Fractures Radiology Radiology Emergency Department 52

Don't Forget the Bubbles

OCTOBER 19, 2023

Over 1,500 children in EDs, aged 1 to 4 with acute hypoxemic respiratory failure needing hospital admission, across 14 emergency departments in Australia and New Zealand were randomly allocated 1:1 to high-flow oxygen therapy OR standard oxygen therapy (approximately 750 children in each group). An x-ray confirms a toddler’s fracture.

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

The Skeptics' Guide to EM

DECEMBER 17, 2022

Date: December 16th, 2022 Reference: Hohle et al. AEM December 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: December 16th, 2022 Reference: Hohle et al. Massive Blood Transfusion Following Older Adult Trauma: the Effect of Blood Ratios on Mortality.

Blood Transfusions 52

Blood Transfusions Fractures EMS Emergency Department 52

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. Clin Cardiol 2022 4. But does this matter? Int J Cardiol 2024 3. Lupu et al. Herman, Meyers, Smith et al.

EKG/ECG 121

EKG/ECG Documentation/Coding Fractures Emergency Department 121

The Skeptics' Guide to EM

MARCH 25, 2023

Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Trauma Surg Acute Care Open 2022 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care.

Ultrasounds 52

Ultrasounds Emergency Department Dislocations Radiology 52

Don't Forget the Bubbles

MAY 17, 2023

2023 Apr 20:fetalneonatal-2022-324835. Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study. 2023 Apr 4:archdischild-2022-325281. Distribution and pattern of hand fractures in children and adolescents. Kuypers KLAM, et al.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

The Skeptics' Guide to EM

APRIL 8, 2023

There have been many “temporary” rural emergency department closures during the past last year. In Ontario alone there have been approximately 160 emergency departments (ED) temporarily closed since the beginning of 2022. It was a stepped-wedge reconfiguration of the entire Danish emergency healthcare system.

Stroke 56

Stroke Emergency Department COPD Academics 56

ACEP Now

MAY 4, 2023

Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. Discussion FIGURE 5: Chest X-ray OF post open reduction and interior fixation of rib fractures.

EMS 52

EMS Fractures Operations Radiology 52

Taming the SRU

OCTOBER 1, 2023

This post aims to broadly cover the types of PTX, the diagnostic modalities available, and the ideal management by PTX type in the Emergency Department. Blunt trauma can cause rib fracture or dislocation that may injure the visceral pleura. Treasure Island (FL): StatPearls Publishing; November 28, 2022. Ann Emerg Med.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Mind The Bleep

NOVEMBER 6, 2023

Importance: the medial wall is thin and most easily fractured. RAPD Figure 3 – Stanford Medicine 2022 RAPD is a sign where pupils react differently when light is shone into one eye at a time using the swinging flashlight test. Accessed 11.10.22 < [link] > Gardiner (2022) Overview of eye injuries in the emergency department.

Emergency Department 52

Emergency Department Dislocations Burns Fractures 52

RebelEM

MARCH 9, 2023

However, evaluating and managing patients with acute alcohol intoxication in the emergency department can be challenging. Assess for blood in the nares or signs of basal skull fracture, including battle signs, raccoon eyes, or hemotympanum. Annals of Emergency Medicine. Remove all clothing and do a full skin exam.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

Broome Docs

APRIL 6, 2023

Emerg Med J. 2022 Dec 16:emermed-2021-211946. Am J Emerg Med. Epub 2022 Nov 21. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. 2022 Jul 2;400(10345):39-47. 2022 Oct;51(10):595-604. 2022 Dec 20;328(23):2296. 2022.11.027.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 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). Canadian Journal of Emergency medicine. October 2022. Paper: Sithamparapillai A, Grewal K, Thompson C, Walsh C, McLeod S. vs. 91.4%; RR 0.93; 95% CI 0.86–1.01,

Dislocations 58

Dislocations Emergency Department Outcomes Research 58

Taming the SRU

JANUARY 29, 2024

She was concerned that this was not improving and decided to come to the emergency department (ED). Notable Diagnostics CBC : unremarkable, BMP : unremarkable X-ray imaging of the left hand, wrist, and forearm: chronic degenerative changes without acute fracture or bony abnormality. 2022 Apr 26. Clin Exp Med.

Emergency Department 94

Emergency Department Fractures Hospitals Operations 94

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. 2022 Jul 11;11(14):2163. 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

Taming the SRU

MARCH 14, 2023

Case 1 Fussy 1 month old A 1-month-old (ex-34 week premature) infant comes to your emergency department for fussiness. Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity. More on this below as we work through a few cases….

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

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 in the emergency department: an evidence-based review. Emerg Med Pract. Am J Emerg Med.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Don't Forget the Bubbles

OCTOBER 2, 2024

A previously well 6-year-old boy is brought into the emergency department at a major trauma centre via HEMS following a road traffic accident, in which he was hit by a car while crossing the road. He is diagnosed with a traumatic brain injury and a fracture to his right tibia and fibula. 2022 Mar 10;5(3). 2019 Mar;20(3S).

Administration 49

Administration Pediatrics Outcomes Research 49

EMDocs

NOVEMBER 16, 2024

6 Periprosthetic fracture Occurs at an estimated rate of 3.5-4.1%. 5 CT if concern for occult fracture. Periprosthetic Fractures Pain prior to injury may point toward underlying pathology like infection, implant loosening, etc. Unified classification system used to describe periprosthetic hip fractures. 10% of patients.

EMS 98

EMS Dislocations Fractures Operations 98

Emergency Medicine Journal

OCTOBER 23, 2024

Background The aims of this study were to assess whether delayed admission from the ED influenced mortality risk, length of acute hospital stay, risk of developing delirium and return to domicile for patients presenting with a hip fracture. Delay was defined as spending >4 hours in the ED from arrival.

Fractures 98

Fractures Hospitals Emergency Department 98

Pediatric EM Morsels

SEPTEMBER 1, 2023

One such vital aspect of pediatric emergency medicine is the appreciation of how psychosocial history impacts a patient’s life and care. As previously mentioned by Dr. Richardson , adolescents use the Emergency Department as their Primary Care resource often. Pediatrics June 2022; 149 (6): e2021053458. Pediatrics.

Pediatrics 164

Pediatrics Emergency Department Fractures EMS 164

EMDocs

JUNE 3, 2023

How should pelvic fractures be identified in unstable trauma patients? Pelvic fractures can involve disruptions in any of the bony or ligamentous structures of the pelvic ring. Due to the round shape of the pelvic ring, multiple fractures typically occur concurrently. 2 Vertical shear fractures are also unstable.

Fractures 66

Fractures Resuscitation Operations EMS 66

Don't Forget the Bubbles

DECEMBER 2, 2024

This single-centre prospective study focused on a quality improvement (QI) project to reduce the overuse of chest X-rays (CXR) in paediatric patients with acute asthma exacerbations (AAE) arriving at the emergency department (ED ). Arch Acad Emerg Med. Pediatric Emergency Medical Journal 2023;10(4):109-117. 95% CI 1.01

Documentation/Coding 98

Documentation/Coding Pediatrics Emergency Department Fractures 98