The Skeptics' Guide to EM

SEPTEMBER 9, 2023

New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. Case: It is a steady Saturday afternoon in your rural emergency department (ED). Reference: Snelling et al.

Fractures 122

Fractures Ultrasounds Pediatrics Outcomes 122

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. 2023 May 17:archdischild-2022-325280. What outcomes did they look at? Was the outcome accurately measured to minimise bias?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

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). References American Medical Association. ” from [link] Seidenwurm, D. Burleson (2014).

Emergency Department 63

Emergency Department Research Outcomes Hospitals 63

RebelEM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

Dislocations 109

Dislocations Fractures Soft Tissue Injuries Outcomes 109

The Skeptics' Guide to EM

OCTOBER 21, 2023

Date: October 20, 2023 Reference: Cai et al. AEM October 2023. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: October 20, 2023 Reference: Cai et al. AEM October 2023. AEM October 2023. Reference: Cai et al.

Emergency Department 104

Emergency Department Radiology Radiology Hospitals 104

AENJ: Current Issue

MAY 8, 2024

The article titled “Using Artificial Intelligence to Predict Adverse Outcomes in Emergency Department Patients With Hyperglycemic Crises in Real Time,” authored by C.

Emergency Department 40

Emergency Department Outcomes Sepsis Research 40

EM Ottawa

NOVEMBER 27, 2023

2023 Oct 12:e2320850. Methodology: 2/5 Usefulness: 2/5 Jansen JO, et al. Editorial: Contemporary Adjuncts to Hemorrhage Control.

Emergency Department 57

Emergency Department Resuscitation Outcomes 57

Don't Forget the Bubbles

JULY 17, 2023

2023 Jun;38(6):1733-1751. 2023 May 16;28(3):172-183. 2023 Jun 6;28(4):205-251. 2023 Jun 6;28(4):252-266. 2023 Jun 1;177(6):559-560. 2023 Jun;182(6):2785-2792. 2023 May 16;28(3):184-202. 2023 Jun 15. 2023 Jun 1;42(6):456-460. 2023 Jun;182(6):2567-2575. 2023 Jun 29.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. When seven South Florida gluteal AFT patients died tragically in one year alone, the Florida Board of Medicine issued an emergency regulation restricting fat injection to the subcutaneous space rather than injecting into muscle. units per patient.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Broome Docs

SEPTEMBER 3, 2024

As loud as a construction site: Noise levels in the emergency department. Australas Emerg Care. Epub 2023 Jul 31. PMID: 37532590 Bottom line: Emergency departments are noisy, although not ridiculously so. Epub 2023 Oct 26. … Adams C, Walsan R, McDonnell R, Schembri A. 2024 Mar;27(1):26-29.

Sepsis 109

Sepsis Emergency Department Outcomes Hospitals 109

ACEP Now

AUGUST 14, 2024

Rate Versus Rhythm in the ED The 2023 AHA/ACC guideline doesn’t give explicit recommendations or preference regarding initial rate or rhythm control strategy for new-onset AF patients who are hemodynamically stable. In fact, few studies compare the two classes. 2 Heart failure, however, is a different story.

Emergency Department 105

Emergency Department Outcomes Research Wellness 105

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 126

Ultrasounds Outcomes COPD Hospitals 126

Broome Docs

MARCH 28, 2024

Emerg Med J. doi: 10.1136/emermed-2023-213285. 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. 2023 Sep 21:ciad571. Ann Emerg Med. 2023 Sep 19:S0196-0644(23)00671-6. 2023 Dec;193:109991.

PPE 107

PPE Ultrasounds Resuscitation Administration 107

The Skeptics' Guide to EM

JUNE 17, 2023

Date: June 15, 2023 Reference: Rees CA et al. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Date: June 15, 2023 Reference: Rees CA et al. Reference: Rees CA et al.

Emergency Department 72

Emergency Department Pediatrics Head Injuries Administration 72

ACEP Now

AUGUST 13, 2024

Studies consistently show that having a diverse physician workforce leads to improved patient outcomes, lower mortality, reduced morbidity rates, and, ultimately, a more robust health care system. Dr. Kendall is the chief of clinician engagement at US Acute Care Solutions and has 15 years of emergency department leadership experience.

Leadership 111

Leadership Outcomes Academics Emergency Department 111

EMDocs

MAY 4, 2024

Consequently, emergency physicians must remain vigilant to identify signs of OMI regardless of the initial computer ECG interpretation. Source Emergency department Code STEMI patients with initial electrocardiogram labeled “normal” by computer interpretation: A 7-year retrospective review. Acad Emerg Med.

Documentation/Coding 78

Documentation/Coding Stroke Emergency Department Pediatrics 78

Broome Docs

JANUARY 30, 2023

Association of Chest Pain Protocol-Discordant Discharge With Outcomes Among Emergency Department Patients With Modest Elevations of High-Sensitivity Troponin. Does wound eversion improve cosmetic outcome?: Outcomes of patients discharged from the pediatric emergency department with abnormal vital signs.

Emergency Department 52

Emergency Department Outcomes Ultrasounds Pediatrics 52

Broome Docs

APRIL 6, 2023

2023 Jan 21. Am J Emerg Med. 2023 Feb;64:206.e1-206.e3. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. 2023 Jan 30. 2023 Jan 13;76(2):185-191. Acad Emerg Med. 2023 Feb;30(2):144-146.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

The Skeptics' Guide to EM

OCTOBER 14, 2023

Time to change the reference ranges of children’s physiological observations in emergency care? March 2023 Date: July 12th, 2023 Guest Skeptic: Dr. Vicki Currie is a paediatric emergency medicine registrar in the West Midlands in the United Kingdom. Reference: Brennan L et al. A prospective study. J Paediatr Child Health.

Pediatrics 87

Pediatrics Sepsis Urgent Care Emergency Department 87

Taming the SRU

SEPTEMBER 22, 2023

389, 418–429 (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. Prekker, M. Background More than 1.5

Operations 103

Operations Outcomes Emergency Department Academics 103

Taming the SRU

SEPTEMBER 21, 2023

2023) doi:10.1016/j.annemergmed.2023.05.014. Background Rapid sequence intubation (RSI) is frequently performed under emergent conditions in acutely ill patients. Exclusion criteria were pre-intubation hypotension, use of topical anesthesia, or missing data including primary outcome, patient weight, etomidate / ketamine dose.

Outcomes 91

Outcomes Emergency Department Shock 91

The Skeptics' Guide to EM

NOVEMBER 11, 2023

Date: November 2, 2023 Reference: Coventry et al. Emerg Med J. Aug 2023 Guest Skeptic: Dr. Matt Schmitz is an Orthopaedic Surgeon who sub-specializes in adolescent sports and hip preservation. first appeared on The Skeptics Guide to Emergency Medicine. Date: November 2, 2023 Reference: Coventry et al. Emerg Med J.

Fractures 96

Fractures Military Radiology Radiology 96

RebelEM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Outcomes: Primary Outcome: Pulmonary expansion 24 hours after the procedure. Secondary Outcomes: Pulmonary expansion 7 days after the procedure.

Outcomes 100

Outcomes Hospitals Research Emergency Department 100

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 118

EKG/ECG Documentation/Coding Emergency Department Outcomes 118

RebelEM

JULY 17, 2023

Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. RSI inherently carries with it risks of complications such as post-intubation hypotension and cardiac arrest in the most extreme cases.

Outcomes 95

Outcomes Administration Emergency Department Resuscitation 95

Don't Forget the Bubbles

OCTOBER 10, 2024

Reviewed by: Isabella Davenport Article 2: Does it improve outcomes if you replace the nail in nail bed repair? 2023 Mar 30;110(4):432-438. Children with nail bed injuries were randomly assigned to nail replacement or discarding , with the primary outcomes being secondary infection in 7 days and cosmetic outcome in four months.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

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 76

Emergency Department Research Academics Outcomes 76

The Skeptics' Guide to EM

JANUARY 20, 2024

Aug 2023 Date: October 30, 2023 Guest Skeptic: Dr. Ellie Hill is a pediatric emergency medicine physician at Children’s National Hospital in Washington, DC and Assistant Professor of Pediatrics and Emergency Medicine at George Washington University School of Medicine and Health Sciences. Reference: Zaoutis T, et al.

Pediatrics 71

Pediatrics Anaphylaxis Emergency Department Outcomes 71

ACEP Now

MARCH 6, 2024

The Sisyphean task remains to try to keep up—and, in that vein—here is a light round of the emergency medicine literature from 2023. 4 Repeated trials have not shown alteplase to have any signal of better outcomes, nor tenecteplase to have an association with increased adverse events. How Best to Stop the Bleeding in Trauma?

Research 52

Research Airway Management Stroke Outcomes 52

The Skeptics' Guide to EM

JULY 8, 2023

Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023. Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at Staten Island University Hospital. first appeared on The Skeptics Guide to Emergency Medicine. Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023.

CDC 94

CDC Hospitals EMS Emergency Department 94

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. 2023 and Kovarik et al., 2022 [cited 2023 May 14];16:1525–8. 2023 Jan 1 [cited 2023 May 14];245:8–13. 2020 Oct [cited 2023 May 14];10:966–7.

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

RebelEM

JULY 24, 2023

Ann Emerg Med 2023. Population: Patients > 14 years of age who underwent RSI with either etomidate or ketamine from the National Emergency Airway Registry (NEAR). Outcomes: Primary: Postintubation hypotension (SBP < 100 mm Hg) 15 minutes post-intubation. Emerg Med J. mg/kg 1.33 mg/kg 1.33 2022;206:449-458.

Resuscitation 98

Resuscitation Outcomes Emergency Department EMS 98

EMDocs

SEPTEMBER 30, 2024

Inhaled Corticosteroids Rarely Prescribed at Emergency Department Discharge Despite Low Rates of Follow-Up Care. J Emerg Med. 2023 May;64(5):555-563. Guidelines – Global Initiative for Asthma (GINA) 2023 The 2019 Global Initiative for Asthma (GINA) guidelines recommend that all patients with asthma be prescribed ICS.

Outcomes 83

Outcomes Documentation/Coding Academics Administration 83

Don't Forget the Bubbles

AUGUST 7, 2023

2023 Mar;59(3):480-486 Who were the patients? 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. Acad Emerg Med.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

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 Federal Emergency Management Agency Best Practices 82

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 90

Emergency Department Hospitals Outcomes EMS 90

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. Read in Nature Don’t forget to register for the Hospitalist and Resuscitationist 2023 conference Sepetmber 27-30 in Montreal.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 105