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 90

Stroke Airway Management Documentation/Coding Outcomes 90

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. Ann Emerg Med. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

EMDocs

JANUARY 29, 2024

Introduction: Neurologic emergencies are common in the Emergency Department (ED), and blood pressure management is critical to immediate management. This article will discuss blood pressure goals and preferred pharmacotherapy for non-traumatic ischemic and hemorrhagic strokes.

Stroke 101

Stroke Outcomes EMS Seizures 101

ACEP Now

MARCH 11, 2025

Many patients with PE can be discharged directly from the emergency department (ED). 1 Further, a Cochrane review found that LMWH is associated with improved outcomes compared with UFH including reduced incidence of major hemorrhage (odds ratio [OR]=0.69; 95 percent CI, 0.50-0.95) Ann Emerg Med. 2024;84(5):518-529.

Hospitals 52

Hospitals Administration Outcomes Stroke 52

ACEP Now

JANUARY 5, 2025

The PREOXI trial compared oxygen mask pre-oxygenation versus noninvasive positive-pressure ventilation (NIPPV) in patients requiring intubation in emergency departments (EDs) and intensive care units. 1 The primary outcome was the frequency of observed hypoxemia, defined as any pulse oximetry reading below 85 percent.

Sepsis 40

Sepsis Research Airway Management Stroke 40

ACEP Now

OCTOBER 10, 2023

A 76-year-old female presents to the emergency department obtunded with left hemiplegia. The CT scan reveals a hemorrhage in the right internal capsule, suggestive of acute hypertensive hemorrhagic stroke. Symptoms began just prior to presentation. Her blood pressure (BP) is 195/104 mmHg. Reference Ma LM, Hu X, Song L, et.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

EMDocs

OCTOBER 21, 2023

Answer : Basilar Artery Occlusion Epidemiology:  Basilar artery occlusion (BAO) is a subset of the posterior circulation strokes. Posterior circulation strokes are estimated to account for 20% of all strokes, with BAO accounting for ~1% of all strokes. Symptoms may range from days to months prior to stroke onset.

EMS 98

EMS Stroke Outcomes Hospitals 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. Plast Reconstr Surg.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

The Skeptics' Guide to EM

APRIL 25, 2020

Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. There is no previous history of stroke. We have covered acute ischemic stroke many times on the SGEM.

Stroke 40

Stroke Emergency Department Outcomes Administration 40

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

ACEP Now

AUGUST 25, 2023

Intranasal Fentanyl for Sickle Cell Vaso-Occlusive Pain Case A 15-year-old female with sickle cell disease (SCD) presents to your emergency department (ED) with a vaso-occlusive pain episode (VOE) of her legs and back. Primary Outcome: Discharged home from the ED Secondary Outcomes: There were several secondary outcomes.

Administration 97

Administration Pediatrics Emergency Department Outcomes 97

The Skeptics' Guide to EM

JUNE 17, 2023

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. Date: June 15, 2023 Reference: Rees CA et al. Reference: Rees CA et al.

Emergency Department 74

Emergency Department Pediatrics Head Injuries Administration 74

RebelEM

JUNE 8, 2023

They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

EMDocs

OCTOBER 30, 2023

Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. Increased Computed Tomography Utilization in the Emergency Department and Its Association with Hospital Admission.

Radiology 101

Radiology Radiology Emergency Department Hospitals 101

Taming the SRU

JANUARY 26, 2024

Wosiski-Kuhn and Stothers BP cuff sizing: Using a cuff too large results in lower SBP, using too small results in higher BP VTE risk with hormonal contraception and NSAIDS Isolated use + and contraception leads to IRR of 7.2 10 or greater days and high or moderate risk hormonal contraception amplifies risk to IRR of 44.8

Stroke 59

Stroke EKG/ECG Seizures Outcomes 59

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 57

Stroke Emergency Department COPD Academics 57

The Skeptics' Guide to EM

JUNE 5, 2021

Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke: The SKIP Randomized Clinical Trial. JAMA 2021 Case: A 74-year-old woman presents to your emergency department with 1.5 JAMA 2021 * Zi et al.

Stroke 52

Stroke Urgent Care Critical Access Outcomes 52

RebelEM

MARCH 8, 2023

Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. CRAO is a stroke of the eye; patients should be considered for a complete stroke work up. Emergency Department Management: Emergency ophthalmology consultation. et al, Emergency Medicine Clinical Essentials ed 2.

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

The Skeptics' Guide to EM

JULY 9, 2022

Ravi Garg is a Neurologist in the Department of Neurology, Division of Neurocritical Care at Loyola University Chicago. Risk of selection bias assessment in the NINDS rt-PA stroke study. Dr. Garg […] The post SGEM Xtra: Here Comes the NINDS Again first appeared on The Skeptics Guide to Emergency Medicine. BMC Med Res Methodol.

Stroke 52

Stroke Emergency Department EMS Outcomes 52

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EM Literature of Note

JANUARY 9, 2022

The Annals of Emergency Medicine Podcast continues apace, with free monthly updates from the original research published in the journal: iTunes Link SoundCloud Link Likewise, the Annals of Emergency Medicine Journal Club has published several monthly installments: Predicting Outcomes in Pediatric Pneumonia: Are We Omnipotent or Incompetent?

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 40

EB Medicine

SEPTEMBER 1, 2018

Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

ACEP Now

MARCH 6, 2024

The PATCH-Trauma trial took a critical look at TXA in major trauma in the advanced trauma systems of Australia and found a mixed result: a slightly greater number of patients were still alive six months following TXA administration, but there was no difference in survival with a good functional outcome. What’s New in Stroke Care?

Research 52

Research Airway Management Stroke Outcomes 52

The Skeptics' Guide to EM

OCTOBER 14, 2019

He arrives at the emergency department via EMS with a Glasgow Coma Scale (GCS) score of 10 and both pupils reactive. The evidence for TXA providing a patient-oriented outcome (POO) has been mixed. Case: A 42-year-old man falls off a backyard deck. He is hemodynamically stable and sent for a STAT head CT.

Stroke 52

Stroke EMS Emergency Department Outcomes 52

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Guest Skeptics: Dr. Erin Willard is a PGY-3 Emergency Medicine Resident, Department of Emergency Medicine, University of Arkansas for Medical Sciences. Critical Care Medicine.

Sepsis 52

Sepsis Shock Outcomes Stroke 52

EB Medicine

MAY 3, 2019

This month, we’re moving into uncharted territories for the podcast… we’re talking psychiatry Nachi: Specifically, we’ll be discussing Depressed and Suicidal Patients in the emergency department. The strongest predictor for suicide-related outcomes is history of prior suicidal ideation or suicide attempt.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

ACEP Now

JULY 7, 2024

1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). Although they may not appear as physically injurious as convulsive seizures, nonconvulsive seizures can significantly impact the neurological outcomes and overall prognosis of patients in critical care settings.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

RebelEM

MARCH 13, 2024

This was not a Code 3 respiratory distress, fentanyl overdose with minimal response to Narcan or even an unconscious stroke patient with the blood pressure of a giraffe. As doctors working in Emergency Medicine we often have to do the same thing and the wrong decision could potentially be fatal!

Documentation/Coding 59

Documentation/Coding Outcomes EMS Stroke 59

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

We were trying to answer the question: Do all patients presenting to the emergency department with chest pain need to be placed on cardiac monitoring or could some be safely removed? TXA also seems to improve patient-oriented outcomes in epistaxis ( SGEM#53 and SGEM#210 ). The CRASH-2 trial showed a 1.5%

Academics 52

Academics Resuscitation EMS Stroke 52

JournalFeed

MARCH 26, 2022

High-dose IN Fentanyl Spoon Feed: Higher doses of intranasal (IN) fentanyl for pain ranging from 2-5 μg/kg (with a maximum of 200 μg) were given in a pediatric emergency department, with no documented episodes of apnea, hypotension, or respiratory failure.

Stroke 40

Stroke Documentation/Coding Emergency Department Resuscitation 40

Dr. Smith's ECG Blog

DECEMBER 26, 2020

On arrival to the PCI center's Emergency Department, the receiving team recorded an ECG on arrival: Persistent atrial flutter, however this time the QRS occurs on a slightly different portion of the flutter wave. The patient was admitted for stroke management. Long-term outcome is unknown. Serial troponins were negative.

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

The Skeptics' Guide to EM

DECEMBER 5, 2020

Case: A 50-year-old female presents to your community emergency department in the middle of the night with new-onset constant but mild vertigo and nausea. You’re about to call in your MRI tech from home, but then you remember reading that the HINTS exam is more sensitive than early MRI for diagnosis of posterior stroke.

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

Dr. Smith's ECG Blog

AUGUST 23, 2017

Same stroke precautions as atrial fib

Stroke 52

Stroke Sepsis Emergency Department EMS 52

Taming the SRU

DECEMBER 6, 2023

artiga and stothers After concern for stroke is identified, pursue neuroimaging (non-contrast CT head and CT angio head/neck) within 25 minutes of patient arrival to the ED to differentiate between a hemorrhagic or ischemic process. With rare exception, patients with sICH should be admitted to a specialized stroke unit (NSICU).

Leadership 57

Leadership Stroke Airway Management EMS 57

ACEP Now

APRIL 5, 2024

2 TTP often presents abruptly, and most patients that develop it first visit the emergency department (ED) as their symptoms worsen. It is thus imperative that emergency physicians be able to recognize and properly treat this disease, especially in the absence of its classical presentation. Am J Emerg Med. J Emerg Med.

Domestic Violence 40

Domestic Violence Emergency Department Outcomes EKG/ECG 40

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

The Skeptics' Guide to EM

DECEMBER 16, 2017

Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. He is also a Faculty member of the Emergency Medicine and Acute Care Series 1986 to present. Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure. Reference: Legriel et al.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40