The Skeptics' Guide to EM

FEBRUARY 1, 2025

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. The learning didnt end because she then completed another fellowship in pediatric emergency medicine at Harbor UCLA. Lancet Child Adolesc Health.

Pediatrics 65

Pediatrics EMS Emergency Department Research 65

Pediatric EM Morsels

JUNE 7, 2024

Lucky for us, in 2020 there were some updates made to the NIH Asthma Management Guidelines and we’re going to discuss which ones can help us in the Emergency Department! For children at least 4 years of age who are not well controlled on ICS alone. No more SABA ! Isn’t this more relevant for the outpatient pediatricians?

Pediatrics 208

Pediatrics Emergency Department Wellness EMS 208

Pediatric EM Morsels

JULY 19, 2024

DON’T forget to put on your Personal Protective Equipment as well! If bleeding, the only lab that is needed in the Emergency Department is a type and cross. Have traditional, direct laryngoscopes available as well. This is worth a shot in a well appearing child that is old enough to gargle and spit.

Pediatrics 290

Pediatrics Airway Management Wellness Operations 290

EMDocs

JUNE 8, 2024

We’ll keep it short, while you keep that EM brain sharp. Post septal (retrobulbar) is higher risk to vision and requires CT imaging to diagnose as well as thorough exam to check for proptosis, afferent pupillary defect, increased intraocular pressure [7]. A 32-year-old man presents to the emergency department with eye pain.

EMS 96

EMS Allergic Reactions Poisoning Emergency Department 96

Pediatric EM Morsels

JUNE 2, 2023

Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! link] The post Food Protein Induced Enterocolitis Syndrome (FPIES) appeared first on Pediatric EM Morsels. Allergy Asthma Clin Immunol 18, 54 (2022).

Dehydration 193

Dehydration Shock Pediatrics Emergency Department 193

EMDocs

APRIL 13, 2024

We’ll keep it short, while you keep that EM brain sharp. If the hematoma is not drained it can cause disruption of blood supply to the cartilage and subsequent necrosis, as well as an increase in risk of infection. A 21-year-old man presents to the emergency department for pain and swelling in his ear beginning 3 days ago.

EMS 101

EMS Emergency Department Pediatrics Wellness 101

EMDocs

NOVEMBER 19, 2024

1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. Movement Disorder Emergencies. His roommate found an empty pill bottle on the floor next to him. 2022;15:3915-3929.

Poisoning 108

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 108

EMDocs

APRIL 27, 2024

We’ll keep it short, while you keep that EM brain sharp. A 67-year-old man with a history of hypertension and diabetes presents to the emergency department with right ear pain for 2 weeks. link] The post EM@3AM: Malignant/Necrotizing Otitis Externa appeared first on emDOCs.net - Emergency Medicine Education.

EMS 102

EMS Infectious Diseases Radiology Radiology 102

EMDocs

SEPTEMBER 23, 2023

We’ll keep it short, while you keep that EM brain sharp. Physical exam reveals a well-appearing female in no acute distress. A 23-year-old man with no significant medical history presents to the emergency department for evaluation of a syncopal episode. The patient states that this has never happened before. Heart Rhythm.

EMS 102

EMS EKG/ECG Documentation/Coding Emergency Department 102

EMDocs

AUGUST 12, 2023

We’ll keep it short, while you keep that EM brain sharp. 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. Emergency Medicine Residents’ Association; 2022:10-11. Roberts, James R.

EMS 89

EMS Fractures Operations Ultrasounds 89

Taming the SRU

DECEMBER 11, 2023

PATIENT PRESENTATION A young woman with a past medical history of major depressive disorder presented to the emergency room via EMS for a report of intentional ingestion of an unknown substance. EMS reported that she was vomiting profusely on their arrival to the scene but during transport became increasingly lethargic.

EMS 97

EMS Psychiatric Emergency Department Poisoning 97

EMDocs

JULY 29, 2023

We’ll keep it short, while you keep that EM brain sharp. A 75-year-old male with past history of HTN, CVA, DM II presents to the emergency department with right facial swelling since last night. Clin Pract Cases Emerg Med. Other bacterial causes include anaerobic oral flora, Strep viridans, E. Afr J Paediatr Surg.

EMS 90

EMS Dehydration Ultrasounds Emergency Department 90

EMDocs

JUNE 17, 2023

We’ll keep it short, while you keep that EM brain sharp. Acute Periorbital Infections: Who Needs Emergent Imaging? 2009-1709 The post EM@3AM: Periorbital Cellulitis appeared first on emDOCs.net - Emergency Medicine Education. Parents report the swelling has progressively worsened and is greater in the upper eyelid.

EMS 91

EMS Infectious Diseases Pediatrics Emergency Department 91

SheMD

OCTOBER 15, 2023

Yes, I am a woman, yes I am a feminist, yes I am a physician, yes I am in academic leadership for a well-known emergency department… The yes’s are many, but what do I have to say that is so meaningful or useful that people would want to publish it? So the answer to the million dollar question: how to be happy as a woman in EM?

Emergency Department 52

Emergency Department EMS Leadership Academics 52

EMDocs

DECEMBER 23, 2024

The most recent and well-known trial is the PROCAMIO trial (1). Well, the trial was a multicenter prospective open label trial. Well, lets look at some other trials. His initial EKG is the following: What do you think? It was published in European Heart Journal in 2017. Ok, so what did the PROCAMIO trial find?

EKG/ECG 75

EKG/ECG Shock Wellness EMS 75

ACEP Now

JULY 7, 2023

Last month’s article focused on ACEP’s efforts and resources to support EDs and patients with psychiatric emergencies. Emergency departments (EDs) focus on rapid initiation of medical treatment. Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

Emergency Medicine Journal

MARCH 21, 2024

Background Staff retention in Emergency Medicine (EM) is at crisis level and could be attributed in some part to adverse working conditions. This study aimed to better understand current concerns relating to working conditions and working practices in Emergency Departments (EDs).

Emergency Department 52

Emergency Department Leadership EMS Wellness 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Emergency Department (ED) crowding has dominated discourse around Emergency Medicine (EM) in recent years and is now well recognised as contributing towards patient harm. Less is known about the implications of crowded departments on staff. We identified three themes.

Emergency Department 40

Emergency Department Wellness EMS Patient Safety 40

RebelEM

MARCH 27, 2023

Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients. Paper: Owyang CG, et al. J Crit Care. N Engl J Med. 2000 May 4; PMID: 10793162 Harvey CE, et al.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

ACEP Now

MAY 9, 2024

Jon Krohmer, MD, FACEP, who says he has “the EMS blood type,” practically had a front row seat to the growth of EMS care starting as a volunteer EMT more than 50 years ago. The evolution of EMS really mirrors the evolution of emergency physicians.” Dr. Krohmer said. So physicians need to be involved.

EMS 52

EMS Emergency Department CPR Wellness 52

The Skeptics' Guide to EM

JUNE 1, 2024

His research focuses on the pre-hospital care of children by EMS. He is the principal investigator for EMSC State Partnership in Washington, DC and is also involved in various multi-center EMS studies with the Pediatric Emergency Care Applied Research Network (PECARN). EMS placed him in a C-collar and brought him to you.

Pediatrics 87

Pediatrics EMS Emergency Department Research 87

The Skeptics' Guide to EM

JULY 29, 2023

Emergency Medical Services (EMS) is called and on arrival the patient is walking but has obvious facial trauma and is complaining of some neck pain. As an EMS crew member, you are tasked with deciding what method of spinal motion restriction to use. He has midline neck tenderness but no limb numbness or paresthesia.

Head Injuries 95

Head Injuries EMS Research Emergency Department 95

The Skeptics' Guide to EM

FEBRUARY 22, 2020

Richelle Cooper is a Professor of Emergency Medicine at the UCLA Department of Emergency Medicine. Dr. Maia Dorsett is an Emergency and EMS Physician at the University of Rochester Medical Center. Richelle Cooper is a Professor of Emergency Medicine at the UCLA Department of Emergency Medicine.

Wellness 52

Wellness Emergency Department EMS 52

RebelEM

JULY 1, 2024

Comparison of BPAP S/T and Average Volume-Assured Pressure Support Modes for Hypercapnic Respiratory Failure in the Emergency Department: A Randomized Controlled Trial. AVAPS may be useful, but we still need a well conducted RCT to find out if it is (i.e Paper: Goren NZ et al. Balkan Med J 2021. References: Goren NZ et al.

COPD 129

COPD Emergency Department Outcomes EMS 129

The Skeptics' Guide to EM

JULY 8, 2023

Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at Staten Island University Hospital. Managing editor of EM:RAP and Associate Editor at REBEL EM. first appeared on The Skeptics Guide to Emergency Medicine. Managing editor of EM:RAP and Associate Editor at REBEL EM.

CDC 107

CDC Hospitals EMS Emergency Department 107

Pediatric EM Morsels

JULY 21, 2023

In emergency medicine, we often use illness scripts and protocols to help drive our decision-making. We had just received a young child from EMS who was post-ictal with decreased mentation. Interrater reliability of Glasgow Coma Scale scores in the emergency department. Ann Emerg Med. Less than 8, intubate!

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Emergency Medicine Cases

NOVEMBER 5, 2019

Gaibrie Stephen, we discover the evidence supporting a more rigorous and professional approach to language translation services as well as some practical available options. The post WTBS 19 Does Poor Access to Language Services Leave Emergency Departments Primed for Tragedy? appeared first on Emergency Medicine Cases.

Emergency Department 52

Emergency Department Wellness EMS 52

ACEP Now

AUGUST 22, 2023

Regardless of the domain, somewhere an expert panel has convened to issue a pronouncement informing all of the ideal care of patients under their specialty umbrella, indirectly extending to their care in the emergency department. Therefore, the authors of GRACE-3 call for wide training of the EM workforce in the use of HINTS.

Emergency Department 98

Emergency Department Academics Critical Access Research 98

EMDocs

DECEMBER 6, 2024

5 Severe metabolic acidosis persists Multi-system organ failure The endpoints of deferoxamine are less well defined but it can be weaned off as the patient is clinically improving, the anion gap resolves, and down-trending serum iron concentration. A partner at bedside reports recent depressed mood, abdominal pain, and vomiting yesterday.

Poisoning 94

Poisoning Fluid Resuscitation Seizures Resuscitation 94

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage.

EKG/ECG 140

EKG/ECG Emergency Department Shock Ultrasounds 140

Pediatric EM Morsels

JULY 5, 2024

We collected data directly from the bedside clinician which enabled us to gather pertinent patient symptoms and physical examination findings that may not be well documented in the medical record, but more accurately identify the child’s injuries.” Indian J Orthop. 2018;52(5):489-500. PMID: 30237606. Leonard JC, Harding M, Cook LJ, et al.

Pediatrics 164

Pediatrics Head Injuries Dislocations Research 164

RebelEM

FEBRUARY 24, 2025

RESUS SCENARIO Picture this: you just arrived at your shift at the local emergency department. Well, the established cutoff for the distensibility index is 18%. For more than just the correctness of terminology, the distensibility index should then be calculated. Why does it matter?

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC? first appeared on The Skeptics Guide to Emergency Medicine.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

EM Updates

JUNE 15, 2021

Maimonides Medical Center (MMC) is Brooklyn’s largest hospital, an academic quaternary care center with, in normal times, 711 total beds, 66 intensive care beds, and an Emergency Department that treats approximately 120,000 patients per year. On March 9, the first patient with a novel coronavirus infection was admitted to MMC.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

EMDocs

DECEMBER 4, 2023

Johnson, MD ( Community EM, Salina Regional Health Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (Cleveland Clinic Foundation, EM-CCM); Brit Long, MD (@long_brit) Case A 40-year-old woman presents to a rural emergency department (ED) with left leg pain and swelling for the past 5 days.

Ultrasounds 90

Ultrasounds Documentation/Coding Wellness EMS 90

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. link] Fesmire, F. Wharton, D.

EKG/ECG 108

EKG/ECG EMS Emergency Department Wellness 108

ACEP Now

SEPTEMBER 5, 2024

Our state chapter members and leaders are uniquely positioned to follow EMRA’s lead in partnering with local EM residency programs to improve communication of ACEP’s value to EM-bound medical students and EM residents by hosting residency visits or local events relevant to our shared mission.

Leadership 98

Leadership PPE EMS Wellness 98