The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Case: It is a steady Saturday afternoon in your rural emergency department (ED). Tessa Davis covered the FORCE trial on SGEM #372 which looked at buckle fractures and compared immobilization in a cast or splint vs. a soft bandage and they found no difference in pain scores or functional outcomes. Reference: Snelling et al.

Fractures 130

Fractures Ultrasounds Pediatrics Outcomes 130

RebelEM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). Amiodarone versus digoxin for acute rate control of atrial fibrillation in the emergency department. Am J Emerg Med. Am J Emerg Med. 2022 Sep 7.

Emergency Department 52

Emergency Department Administration EMS Dehydration 52

RebelEM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

RebelEM

DECEMBER 23, 2024

There has been ongoing study about the clinical significance of these effects, as well as whether and for whom LR might provide meaningfully better clinical outcomes ( Myburgh 2013 , Self 2018 , Semler 2018 , Self 2020 ). The enrollment was multicenter, large, and adequately powered for clinically meaningful changes in outcome.

Fluid Resuscitation 121

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 121

ACEP Now

JULY 11, 2024

2 Although the opiate epidemic is certainly worthy of attention, it accounts for only about half of the number of deaths annually and only around a quarter of the number of emergency department visits annually relative to alcohol use. This medication has limited outcomes data and multiple contraindications. West J Emerg Med.

Emergency Department 98

Emergency Department Psychiatric Outcomes Wellness 98

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 98

Resuscitation Outcomes CPR Hospitals 98

Taming the SRU

SEPTEMBER 22, 2023

Several single-center and moderately-sized studies have compared the outcomes of these two methods with varying results. Trial personnel reviewed the medical record to collect each patient's baseline characteristics, periprocedural care, and clinical outcomes. BMI was around 26.5 for both groups.

Operations 104

Operations Outcomes Emergency Department Academics 104

Broome Docs

OCTOBER 6, 2024

Can acutely ill patients predict their outcomes? Emerg Med J. doi: 10.1136/emermed-2022-213000. PMID: 39025092 Is early CT actually 100% sensitivity for SAH (Of course not) Roberts et al, Subarachnoid haemorrhage in the emergency department (SHED): a prospective, observational, multicentre cohort study.

Emergency Department 102

Emergency Department EMS Research Outcomes 102

RebelEM

NOVEMBER 25, 2024

2 Moreover, the American Society of Anesthesiologists’ 2022 Practice Guidelines for Management of the Difficult Airway recommend the use of adjuncts like bougies in anticipated difficult airways but stop short of endorsing their routine universal use. Randomized controlled trials or comparative non-randomized observational studies.

Outcomes 93

Outcomes Emergency Department Operations Hospitals 93

Dr. Smith's ECG Blog

OCTOBER 18, 2023

If you were working in a busy emergency department, would you like to be interrupted to interpret these ECGs or can these patients safely wait to be seen because of the normal computer interpretation? Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department.

EKG/ECG 122

EKG/ECG Documentation/Coding Emergency Department Outcomes 122

RebelEM

JUNE 8, 2023

Am J Emerg Med. 2022 Sep 5. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose. Paper: Singer S, et al. The safety and efficacy of push dose vasopressors in critically ill adults.

Administration 97

Administration Emergency Department Outcomes Documentation/Coding 97

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Research in the Emergency Department needs to be delivered in real time, within a specific clinical time-frame, and on a wide variety of conditions and states of emergency, on participants presenting in an unscheduled manner at any time.

Emergency Department 40

Emergency Department Research Outcomes Hospitals 40

The Skeptics' Guide to EM

DECEMBER 28, 2024

Emergency department staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder. She is anAssistant Professor and Director of Research in theDepartment of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. Date: December 26, 2024 Reference: Steinhauser S et al.

Emergency Department 82

Emergency Department Research Academics Outcomes 82

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 94

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 94

Emergency Medicine Journal

JUNE 20, 2024

Emergency departments (ED) represent a promising setting to address preventive health measures like CRC screening. We enrolled ED patients, 45–75 years old, in the Greater Rochester, NY region into a randomised controlled pilot from January to May 2022. The primary outcome was patient CRC screening or scheduling.

Emergency Department 40

Emergency Department Documentation/Coding Outcomes 40

The Skeptics' Guide to EM

AUGUST 10, 2024

He is an assistant professor in Emergency Medicine, Neurology, and Neurosurgery at the School of Medicine at the University of Washington. Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table.

Stroke 76

Stroke Airway Management Documentation/Coding Outcomes 76

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. 2022 May 16;10(14):4684-4690. screws for medial malleolus. References 1. World J Clin Cases.

Fractures 101

Fractures Operations Emergency Department EMS 101

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives In recent years there has been a large increase in demand for emergency care across the country, particularly during winter. This study utilised 12 months’ of routinely collected data from Emergency Departments (EDs) and acute Admitted Patient Care Episodes (APCs) to understand trends in demand for emergency care.

Emergency Department 40

Emergency Department Hospitals Outcomes Research 40

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 ). 2022 PMID: 35206981 2.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

EMDocs

SEPTEMBER 26, 2024

This story, while unlikely to reflect the standards of most readers, has a somewhat surprising outcome. References : System-Level Process Change Improves Communication and Follow-Up for Emergency Department Patients With Incidental Radiology Findings. 3 : September 2022. What role do discharge instructions play?

Radiology 87

Radiology Radiology EKG/ECG Documentation/Coding 87

RebelEM

NOVEMBER 6, 2024

2022 Aug 2. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998 Jan-Feb;6(1):15-23. doi: 10.5435/00124635-199801000-00002. PMID: 9692937 Decker N, Norse A. Anterior Elbow Dislocation. Shoulder Elbow.

Dislocations 103

Dislocations Fractures Soft Tissue Injuries Outcomes 103

The Skeptics' Guide to EM

APRIL 2, 2022

Date: March 31st, 2022 Reference: Butt et al. Take-Pause: Efficacy of mindfulness-based virtual reality as an intervention in the pediatric emergency department. Date: March 31st, 2022 Reference: Butt et al. Take-Pause: Efficacy of mindfulness-based virtual reality as an intervention in the pediatric emergency department.

Pediatrics 52

Pediatrics Emergency Department Outcomes Research 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Chest drains are commonly inserted in the Emergency Department (ED) with a complication rate of 30-40%. Training in chest drain insertion is essential in Emergency Medicine (EM) as approximately 25,000 patients undergo in England and Wales undergo this procedure annually.

Emergency Department 40

Emergency Department EMS Research Operations 40

Don't Forget the Bubbles

JULY 19, 2023

Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation. 2022 May 18;16:1525-1528. 2022 [cited 2023 May 14];16:1525–8. Outcome of pediatric patients referred for papilledema. Clin Ophthalmol.

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

The Skeptics' Guide to EM

FEBRUARY 22, 2025

Clinical Chemistry and Laboratory Medicine 2022; 60(5):786-792 Clin Chem Lab Med. 2022 Date: February 21, 2025 Guest Skeptic: Dr. Aaron Skolnik is an Assistant Professor of Emergency Medicine at the Mayo Clinic Alix School of Medicine and Vice Chair of Critical Care Medicine at Mayo Clinic Arizona.

Sepsis 52

Sepsis Infectious Diseases Emergency Department Pediatrics 52

The Skeptics' Guide to EM

SEPTEMBER 10, 2022

Date: August 25th, 2022 Reference: Martin et al. Single-dose dexamethasone is not inferior to 2 doses in mild to moderate pediatric asthma exacerbations in the emergency department. Pediatr Emerg Care. 2022 Guest Skeptic: Dr. Harrison Hayward is a Pediatric Emergency Medicine fellow at Children’s National Hospital.

Pediatrics 52

Pediatrics Emergency Department Urgent Care Hospitals 52

PulmCCM

JULY 3, 2023

emergency departments and ICUs were randomized to undergo either DL or VL for intubation. More than 90% of the intubations were performed by emergency medicine residents (~70%) or critical care fellows (~23%). At six months of followup, there was no difference in the rate of good neurologic outcome (43.5%

Airway Management 105

Airway Management Outcomes Hospitals Emergency Department 105

The Skeptics' Guide to EM

JANUARY 29, 2022

Date: January 25th, 2022 Reference: Beyde et al. Efficacy of empiric antibiotic management of septic olecranon bursitis without bursal aspiration in emergency department patients. AEM January 2022 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Reference: Beyde et al.

Emergency Department 52

Emergency Department Academics Hospitals Outcomes 52

PulmCCM

NOVEMBER 6, 2023

open label) at 17 sites in Belgium in 2020-2022, 35% of those receiving plasma died at 28 days, vs. 45% of the usual care patients — a number needed to treat of 10 to save one life. The intervention took place in the emergency department, with device placement by ED physicians. Thromboelastometry (e.g.,

Blood Transfusions 98

Blood Transfusions Operations Resuscitation Infectious Diseases 98

Taming the SRU

JANUARY 10, 2024

89% agree that violence in the emergency department has harmed patient care. Phenobarbital has been proven to be equivalent to benzodiazepines with regard to clinical, pharmacologic and utilization outcomes. 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

SEPTEMBER 27, 2023

Additionally, a 2022 study in JAMA found no association between MIPS measures and any meaningful clinical outcomes and moreover physicians who cared for the most medically and socially vulnerable were more likely to receive worse scores (8). link] Bond, A. ” JAMA 328 (21): 2136-2146.

Emergency Department 72

Emergency Department Research Outcomes Hospitals 72

ACEP Now

JULY 7, 2023

CASE A 30-year-old woman presents to the emergency department with left arm pain from a chronic wound. Prior to medical school, she received her MBA in Healthcare Management and currently works on health policy and outcomes-based research. Dr. Marco is professor of emergency medicine at Penn State Health Milton S.

Forensics 98

Forensics Airway Management Administration Emergency Department 98

Broome Docs

MARCH 28, 2024

Emerg Med J. PMID: 38050078 Bottom line: High dose nitroglycerin seems to result in better outcomes in SCAPE, at least according to this small, single center, unblinded trial. Am J Emerg Med. 2022 Feb;52:85-91. 2024 Jan 22;41(2):96-102. doi: 10.1136/emermed-2023-213285. Is our PPE evidence-based? doi: 10.1016/j.ajem.2021.11.030.

PPE 96

PPE Ultrasounds Resuscitation Administration 96

Taming the SRU

JUNE 12, 2023

Although not every person seeks health care for these injuries, the majority of those that do end up in the emergency department. In 2008, this led to greater than 316,000 emergency department (ED) visits and about 9,500 hospitalizations [1]. Annals of Emergency Medicine. Annals of Emergency Medicine.

Infectious Diseases 102

Infectious Diseases Emergency Department Administration Academics 102

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

Emergency Medicine Journal

AUGUST 23, 2023

Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, other relevant trial registries, journals, and conference proceedings up to September 2022. The primary outcome was change in severity of nausea, measured by a validated scale. A secondary outcome was vomiting during the ED stay.

Emergency Department 40

Emergency Department Outcomes 40