The Skeptics' Guide to EM

OCTOBER 21, 2023

Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. 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.

Emergency Department 102

Emergency Department Radiology Radiology Hospitals 102

Emergency Medicine Journal

FEBRUARY 20, 2024

Reference standard was radiological or operative confirmation of AAS. Anonymised, routinely collected patient data including components of CDTs, was abstracted. Clinicians treating prospectively identified patients were asked to record their perceived likelihood of AAS, prior to any confirmatory testing. 14 (0.3%; n=5353) had confirmed AAS.

Emergency Department 52

Emergency Department Operations Radiology Radiology 52

Don't Forget the Bubbles

SEPTEMBER 13, 2023

The parents of 18-month-old Susie brought her to the Emergency Department after she had a seizure at home. The American College of Radiology guidelines provide further detail on imaging recommendations based on different age and seizure type variants. She has had two days of coryzal symptoms and fever. Pediatrics. doi:10.1111/j.1528-1157.2000.tb00277.x

Seizures 131

Seizures Pediatrics Emergency Department Radiology 131

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 73

Radiology Radiology Emergency Department Hospitals 73

RebelEM

FEBRUARY 12, 2024

There are greater than 2 million annual emergency department visits for suspected renal colic in the US, and Ct scanning is performed for more than 90% of patients who receive a diagnosis of kidney stone. Radiological Imaging of Patients With Suspected Urinary Tract Stones: National Trends, Diagnoses, and Predictors.

Radiology 69

Radiology Radiology Emergency Department Ultrasounds 69

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives CT Head scans are commonly requested in the Emergency Department (ED), but the increasing demand has led to longer radiology report turnaround times, affecting ED flow. In the prospective phase, 4,815 CT Head interpretations with linked radiology reports were recorded, and data analysis is ongoing.

Emergency Department 40

Emergency Department Radiology Radiology Research 40

ALiEM

JUNE 10, 2024

A 10-year-old boy presents to the emergency department (ED) after a high-speed motor vehicle collision. However, until now, there has been a gap in guidance for clinicians managing pediatric patients at risk for cervical spine injuries. Case Scenario: What would you do? He complains of neck pain and is reluctant to move his head.

Pediatrics 126

Pediatrics Emergency Department Research Fractures 126

Don't Forget the Bubbles

NOVEMBER 8, 2023

7-year-old Tilly is brought to your emergency department at 11 p.m. Abdominal pain in children is common, accounting for over 1 in 20 attendances to paediatric emergency departments [1]. Clinical scoring tools have improved diagnostic performance in assessing suspected appendicitis in the emergency department.

Emergency Department 105

Emergency Department Ultrasounds Pediatrics Best Practices 105

The Skeptics' Guide to EM

NOVEMBER 11, 2023

Case: A 24-year-old manual labourer presents to the emergency department (ED) after drinking a few too many beers, having a disagreement with another beer drinker and gets knocked down. However, the x-rays read as “normal” by radiology. The mechanism was described as a classic FOOSH (fall on outstretched hand) injury.

Fractures 95

Fractures Military Radiology Radiology 95

ALiEM

MARCH 7, 2024

Renal cysts can be confused for hydronephrosis, and both warrant further imaging by Radiology. Facts and Literature Review Bladder volume estimation Measuring bladder volume via POCUS in pediatric patients has been studied, demonstrating a benefit on Emergency Department workflow and length of stay (Table 1). Dessie et al.,

Ultrasounds 70

Ultrasounds Pediatrics Radiology Radiology 70

The Skeptics' Guide to EM

FEBRUARY 3, 2024

Case: You’re working the morning shift in the emergency department (ED) when you encounter a 3-year-old boy and his family. Authors’ Conclusions: “Imaging with CTA yielded radiological abnormalities in a few instances. She is also the director of the Pediatric Otolaryngology Fellowship at Children’s National Hospital.

Pediatrics 65

Pediatrics Radiology Radiology Head Injuries 65

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 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. She states her pain is similar to pain that she felt during a prior ectopic pregnancy. Epub 2019 Mar 21. PMID: 30948256. J Ultrasound Med. 14607 14.

Ultrasounds 97

Ultrasounds Operations Radiology Radiology 97

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

APRIL 14, 2024

This revealed that ultrasound can improve the ability to reduce an incarcerated inguinal hernia and may decrease the rate of emergency surgery. (1) 1) Table 1 - Study Protocol Table 2 - Results Conclusion Hernias are often encountered in the emergency department as an acute or non-acute finding. Strange, Chad D, et al.

Ultrasounds 92

Ultrasounds Emergency Department Pediatrics Radiology 92

Broome Docs

NOVEMBER 17, 2024

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. J Emerg Med. Lancet Child Adolesc Health. 2024 Jul;8(7):482-490. doi: 10.1016/S2352-4642(24)00104-4. Epub 2024 Jun 4. 2020 Jan;58(1):162-166. 2019.10.034.

Administration 62

Administration Resuscitation Radiology Radiology 62

The Skeptics' Guide to EM

MARCH 25, 2023

Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Trauma Surg Acute Care Open 2022 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. Date: March 22, 2023 Reference: Hilsden et al.

Ultrasounds 52

Ultrasounds Emergency Department Dislocations Radiology 52

Cook County EM Blog

APRIL 11, 2023

Radiology is called to conduct bedside x-ray prior to reduction. So, you reach for your ultrasound… Why It Matters : Shoulder dislocations are a common presentation to the emergency department and account for approximately 200,000 visits annually [1]. You suspect a shoulder dislocation.

Dislocations 52

Dislocations Ultrasounds Emergency Department Radiology 52

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. Internal hernia after laparoscopic Roux-en-Y gastric bypass: a correlation between radiological and operative findings. J Gastrointest Surg.

Emergency Department 40

Emergency Department Sepsis Operations Ultrasounds 40

Emergency Medicine Journal

JULY 22, 2024

We determined whether the absence of indirect ultrasound signs can rule out appendicitis in children undergoing a radiology-performed ultrasound in which the appendix is not visualised Methods This was a single-centre retrospective observational study of patients aged 3–13 with a clinical suspicion of acute appendicitis evaluated in a Paediatric (..)

Ultrasounds 52

Ultrasounds Radiology Radiology Emergency Department 52

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

ACEP Now

SEPTEMBER 3, 2024

Still, this wave of private equity acquisitions in emergency medicine has come crashing down on the heads of many early-career physicians. As of 2022, 1 in 4 emergency departments in the United States were staffed by a private equity-owned physician group. Radiology Business. Heartland-Charleston of Hanahan SC LLC et al.

Hospitals 113

Hospitals Radiology Radiology Administration 113

EM SIM Cases

MAY 9, 2023

EHS arrived, provided oxygen supplementation, and brought them to your tertiary emergency department, with access to PICU. Radiologic, Neurologic and Cardiopulmonary Aspects of Submersion Injury. Pediatric Emergency Care,32 (9), 623-626. Pediatric Drowning Download Hon, K. , Cheung, H. & & Cheung, K.

Pediatrics 52

Pediatrics CPR Radiology Radiology 52

Emergency Medicine Journal

JULY 24, 2023

Clinical Introduction An 80-year-old man with a medical history of hypertension, dyslipidaemia, coronary artery disease, alcohol consumption and atrial fibrillation, not anticoagulated, presented to the emergency department with sudden onset of pleuritic chest pain, dyspnoea and fever. A CXR was performed ( figure 1 ).

Radiology 40

Radiology Radiology Emergency Department 40

SheMD

APRIL 24, 2023

I break bad news almost every shift in the emergency department. An email with a sad face to a woman jacked up hormones was not the best approach. I put on my scrubs (I was on the schedule… again) and drove myself to the Emergency Department (ED). I waited in radiology for my formal ultrasound. It was certain.

Ultrasounds 83

Ultrasounds Radiology Radiology Emergency Department 83

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. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. His vital signs are normal except for a temperature of 38.2°C The Lancet. The Lancet.

EMS 84

EMS Infectious Diseases Radiology Radiology 84

Don't Forget the Bubbles

MAY 22, 2023

You’ve just started working in the Children’s Emergency Department (CED). Robin’s emergency care plan/RESPECT form and ventilator settings should be reviewed and updated while he is in hospital too. The triage nurse comes to let you know about Robin.

Radiology 98

Radiology Radiology Hospitals Wellness 98

RebelEM

AUGUST 30, 2023

Diagnostic Radiology: Musculoskeletal and Breast Imaging. Evaluation and Treatment of Acute Back Pain in the Emergency Department. Orthopedic Emergencies 2015 May; 33(2) 311-26. J Spinal Disord Tech. 2015 Jul;28(6):E316-27 PMID: 26079841 Chowdhury V, Gupta A, Khandelwal N. PMID: 25892724 Gouliouris T, et al.

Infectious Diseases 90

Infectious Diseases Fractures Radiology Radiology 90

EM Ottawa

AUGUST 22, 2024

Assessing patients with pleural effusions in the emergency department (ED) can be challenging and nuanced. This is largely due to the lack of guidelines around pleural effusions in the ED. In part one we focused on imaging, diagnosis, and management of parapneumonic effusions.

Emergency Department 62

Emergency Department Infectious Diseases Radiology Radiology 62

EMDocs

MARCH 25, 2024

2, 3 Biliary POCUS can help decrease patient length of stay in the Emergency Department. 1 A biliary point-of-care ultrasound (POCUS) is the fastest and most accurate way to assess for biliary pathology, but it can be difficult to locate the gallbladder, as it is not a fixed organ. 4 Benefits of Biliary POCUS?

Ultrasounds 88

Ultrasounds Radiology Radiology Operations 88

ALiEM

APRIL 12, 2023

emDOCs.net – Emergency Medicine Education. Author information Ivan Ivanov, DO Resident Physician Emergency Department South Brooklyn Health | The post Trick of the Trade: Gel-free ultrasound-guided peripheral IV technique appeared first on ALiEM. US Probe: Ultrasound Water Bath for Distal Extremity Evaluation.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

ACEP Now

JANUARY 4, 2025

The photos that Dr. Clarke took from 19781980 provide a glimpse into working in an emergency department in the years the specialty was being established. for a few years working as an emergency physician. Dr. Clarke was then hired as assistant director in the emergency department (ED) at Pomona Valley Hospital, Pomona, Calif.

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

ALiEM

AUGUST 9, 2023

Child with Cough and Fever: Case Introduction A 6-year-old boy presents to the emergency department complaining of cough for 3 days and fever for the last day. His work of breathing increased during his emergency department visit, and he was started on high flow nasal cannula at 30 L/min with improvement in his respiratory status.

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

Northwestern EM Blog

MAY 16, 2022

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 The estimated incidence over the past two decades is up to 340 visits per 100,000 individuals.1

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 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

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. doi:10.1148/radiology.144.4.7111716 Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department.

Fractures 95

Fractures COPD Hospitals Emergency Department 95

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.

Pediatrics 52

Pediatrics Ultrasounds Radiology Radiology 52