The Skeptics' Guide to EM

AUGUST 24, 2024

Sean Baldwin is an Emergency Physician practising in Sydney, Australia in both a large tertiary emergency department and a small regional emergency department. Case: A 67-year-old male presents to your hospital emergency department (ED) after a fall from his bicycle. Reference: Partyka et al.

Fractures 51

Fractures Emergency Department Ultrasounds Radiology 51

Taming the SRU

OCTOBER 23, 2023

THE CASE A female in her early 20s, G4P2012, presents to the emergency department (ED) with a 5 day history of left lower quadrant abdominal pain which has been worsening since onset. Discrimination between an IUP and an interstitial pregnancy is critical as interstitial pregnancies can have devastating outcomes. PMID: 30948256.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

Emergency Medicine Journal

JULY 22, 2024

The main outcome variable was the diagnosis of acute appendicitis. In those who did not, appendicitis was considered not to be present if there was no evidence in their charts that they had undergone an appendectomy or conservative therapy for appendicitis during the episode.

Ultrasounds 52

Ultrasounds Radiology Radiology Emergency Department 52

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? 1 Low-dose non-contrast abdominal CT has become the gold standard for diagnosis as it has become readily available in emergency departments nationwide, with some studies touting sensitivity and specificity of 97% and 95%, respectively.2

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

RebelEM

NOVEMBER 20, 2023

Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. Outcome: Primary Outcome: All-cause mortality at 90 days. The primary outcome focused on patient-centered outcomes. Paper: Jansen JO, Hudson J, Cochran C, et al.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

The Skeptics' Guide to EM

DECEMBER 28, 2019

This is an SGEM Xtra and is a result of a paper that was published in three journals ( Annals of EM , Journal of Urology and Journal of the American College of Radiology ). There was a trial published in 2014 comparing radiology department ultrasound, POCUS and CT for suspected nephrolithiasis (Smith-Bindman et al. NEJM 2014 ).

Radiology 40

Radiology Radiology Ultrasounds Emergency Department 40

EMDocs

FEBRUARY 26, 2024

4 Early diagnosis is key to allow for early treatment to improve outcomes. 15 Diagnostic considerations Timely diagnosis of PJP is absolutely essential for effective management and improved disease outcomes. Pneumocystis pneumonia in patients with HIV infection: clinical manifestations, laboratory findings, and radiological features.

Radiology 100

Radiology Radiology Outcomes Ultrasounds 100

Pediatric Education

JUNE 9, 2024

Patient Presentation An 18-year-old female came to the emergency department with an 18 hour history of sudden onset of right lower quadrant pain. The radiologic evaluation of ultrasound showed an enlarged right ovary with a large follicular cyst and decreased blood flow in the pedicle. Overall outcomes are good.

Pediatrics 52

Pediatrics Ultrasounds Radiology Radiology 52

The Skeptics' Guide to EM

JULY 18, 2020

Background: Depending on the time of year, fever and cough can be one of the most common presentations seen in the emergency department. However, being an evidence-based medicine enthusiast, you wonder what aspects of the patient’s presentation are going to be truly helpful in making a diagnosis.

Radiology 52

Radiology Radiology Emergency Department Outcomes 52

EMDocs

DECEMBER 6, 2024

7 Workup other than serum iron concentration at 4 hours after ingestion not shown to accurately predict clinical outcomes or severity of toxicity. Pediatric Emergency Care, 27 (10), 978-985. Radiology in the management of acute iron poisoning. 6 Absence of visualized tablets on x-ray does not exclude iron ingestion. Hosking CS.

Poisoning 88

Poisoning Fluid Resuscitation Seizures Resuscitation 88

ACEP Now

DECEMBER 7, 2024

3,4 In addition, for patients with contraindications or those who have failed thrombolysis, catheter-directed thrombolysis and surgical thrombectomy are useful treatment modalities that are associated with low major complication rates and improved patient outcomes.

Ultrasounds 52

Ultrasounds Radiology Radiology EKG/ECG 52

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. Most frequent reasons for emergency department visits, 2018. This post will cover some of the most common and important injuries, but is not comprehensive.

Fractures 77

Fractures Dislocations Operations Radiology 77

ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. Dr. Helman is an emergency physician at North York General Hospital in Toronto. The emergency department evaluation and management of massive hemoptysis. Am J Emerg Med.

Radiology 52

Radiology Radiology Airway Management Emergency Department 52

PEMBlog

SEPTEMBER 13, 2023

The causes are many – it could be a force of habit, a medical liability concern for “missing something,” a desire to please the caregivers, a previous seizure patient of theirs who had a bad outcome, or numerous other causes.

Seizures 52

Seizures Pediatrics Point-of-Care Testing Wellness 52

EMDocs

OCTOBER 30, 2023

2 In response to the constrained availability of contrast media, emergency medicine (EM) and radiology departments were compelled to enact modifications in their imaging techniques. In most cases, the radiology team functioned as the main decision-maker playing a key role in drafting institutional protocols. 11 Table 1.

Radiology 84

Radiology Radiology Emergency Department Hospitals 84

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. Radiology Business. Heartland-Charleston of Hanahan SC LLC et al. Stempniak M.

Hospitals 113

Hospitals Radiology Radiology Administration 113

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.

Documentation/Coding 98

Documentation/Coding Pediatrics Emergency Department Fractures 98

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. As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11].

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Taming the SRU

SEPTEMBER 18, 2024

Development of a Clinical Risk Score to Risk Stratify for a Serious Cause of Vertigo in Patients Presenting to the Emergency Department. Ann Emerg Med 2024 Aims The authors cite a wide variation in practice, particularly in obtaining neuro-imaging in patients presenting with vertigo. Ohle R, Savage DW, Roy D, et al.

Stroke 86

Stroke Outcomes Emergency Department Radiology 86

RebelEM

SEPTEMBER 11, 2023

1 It is a quickly deployable and easily interpreted study that can be done in real time to guide decisions in the Emergency Department. Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Acad Emerg Med. and specificity of 88.0% 2022;7(1):e000944.

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68

EMDocs

MAY 11, 2024

Brainstem stroke: anatomy, clinical and radiological findings. Available from: [link] American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Use of Intravenous tPA for Ischemic Stroke:; Brown MD, Burton JH, Nazarian DJ, Promes SB. Ann Emerg Med. Erratum in: Ann Emerg Med.

Stroke 101

Stroke EMS EKG/ECG Radiology 101

RebelEM

OCTOBER 5, 2023

Pneumonia diagnosis supported by clinical and radiologic criteria. Secondary Outcome By day 90, mortality was 9.3% Strengths: The investigators framed a research question centered on patient outcomes, ensuring the study’s relevance and practicality. Population Inclusion Criteria: Adult patients (≥18 years old). to −0.8).

Research 94

Research Outcomes Administration Shock 94

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. with generally good clinical outcomes including improved quality of life and reducing or staving off comorbidities. J Gastrointest Surg.

Emergency Department 40

Emergency Department Sepsis Operations Ultrasounds 40

Don't Forget the Bubbles

OCTOBER 28, 2024

doi: 10.1136/archdischild-2024-327224 Six-year-old Rhaenyra is brought into the emergency department after being hit by a car. As this is being given and definitive treatment is planned (either surgery or interventional radiology), you consider what adjunctive treatments are needed. Published Online First: 24 June 2024.

Blood Transfusions 72

Blood Transfusions Hyperthermia / Hypothermia Shock Pediatrics 72

EMDocs

JULY 3, 2023

Louis); Alex Koyfman, MD (@EMHighAK); Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic Foundation) Case A 62-year-old male with past medical history of hypertension (HTN), hyperlipidemia (HLD), and prior cerebrovascular accident (CVA) presents to the emergency department (ED) via ambulance. 2020 Sep 29;95(13):e1819-e1829.

Seizures 95

Seizures Stroke Outcomes EMS 95

Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED?

CPR 89

CPR Burns Airway Management Wellness 89

ACEP Now

JULY 7, 2023

Case A 50-year-old woman presents to the emergency department (ED) complaining of epigastric pain and nausea for 36 hours. Will this be enough for the general surgeon, or will they want an US performed by the radiology department to make their surgical decision? Click to enlarge. Reference: Hilsden, et al.

Ultrasounds 52

Ultrasounds Radiology Radiology Emergency Department 52

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EMDocs

JUNE 3, 2023

This is a unique scenario where interventional radiology, orthopedic surgery, and trauma surgery all have potential roles, and it is most important for emergency physicians to know their own institutional policies on unstable pelvic trauma. Management and outcomes of open pelvic fractures: An update. Radiopaedia.org.

Fractures 57

Fractures Resuscitation Operations EMS 57

EMDocs

APRIL 27, 2024

A 67-year-old man with a history of hypertension and diabetes presents to the emergency department with right ear pain for 2 weeks. However, the bioavailability of antipseudomonal antibiotics has improved outcomes, limiting surgery as a confirmatory diagnostic procedure and as needed for granulation tissue removal. The Lancet.

EMS 96

EMS Infectious Diseases Radiology Radiology 96

ACEP Now

MARCH 14, 2024

A 24-year-old male with history of quadriplegia and traumatic brain injury presents to the emergency department with hemorrhage in his oral cavity and blood from his tracheostomy tube. 15,19 Endovascular intervention depends upon the patient’s hemodynamic stability and availability of interventional radiology.

Operations 52

Operations Pediatrics Radiology Radiology 52

Don't Forget the Bubbles

AUGUST 10, 2023

We will focus on the most important structures when assessing paediatric hands in the emergency department. Finger injuries caused by fingers being caught in closing doors are extremely common presentations to the paediatric emergency department. It additionally has an intricate blood and nerve supply.

Fractures 52

Fractures Soft Tissue Injuries Emergency Department Operations 52

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, million presentation to ED’s throughout the US Usually occur due to falls Also commonly occur due to sports, MVC’s, etc.

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

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. Paediatr Int Child Health. 2024 Jan 11:1-7.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

EB Medicine

FEBRUARY 1, 2019

This month, we’re tackling an incredibly important topic - evaluation and management of life threatening headaches in the Emergency Department. Let’s talk radiology. Nachi: In addition, nimodipine, 60 mg q4h, should be given to those with aneurysmal SAH to improve outcomes. Tylenol should be offered for pain management.

Emergency Department 40

Emergency Department Stroke Outcomes Ultrasounds 40

EMDocs

NOVEMBER 16, 2024

16 US or CT guided biopsy/joint aspiration (typically performed by Orthopedic surgery or Interventional Radiology). 13 Management: Dislocation As with all dislocation, early reduction improves outcomes. Epidemiology of total hip arthroplasty: demographics, comorbidities and outcomes. The American Journal of Emergency Medicine.

EMS 88

EMS Dislocations Fractures Operations 88

EMDocs

OCTOBER 17, 2023

World Society of Emergency Surgery guidelines (2020) “What is the best way to make a diagnosis of ALCD? In patients with suspected ALCD, we suggest a complete assessment of the patients using clinical history, signs, laboratorial inflammation markers, and radiological findings (weak recommendation based on very low-quality evidence, 2D).” “In

Radiology 79

Radiology Radiology Operations Best Practices 79