The Skeptics' Guide to EM

SEPTEMBER 21, 2019

Chris Bond is an emergency medicine physician and clinical lecturer in Calgary. Case: A 55-year-old male presents to the emergency department with sudden onset of palpitations and pre-syncope starting one hour ago. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM.

Emergency Department 52

Emergency Department Stroke Academics Shock 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 Resuscitation 40

JournalFeed

MARCH 26, 2022

Epi vs. NorEpi Spoon feed: Continuous epinephrine infusion for post-resuscitation shock in out of hospital cardiac arrest (OHCA) was associated with both higher all-cause and cardiovascular specific mortality when compared to norepinephrine. Check out journalfeed.org for details.

Stroke 40

Stroke Documentation/Coding Emergency Department Resuscitation 40

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. Slow VT below the detection rate of the ICD lead to worsening heart failure and low stroke volume. She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. The ECG below was recorded.

EKG/ECG 118

EKG/ECG Stroke Hospitals Documentation/Coding 118

ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. Double sequential external defibrillation (DSED) is a technique in which rapid sequential shocks are placed from two defibrillators, with defibrillation pads in two planes, such as anterior-lateral and anterior-posterior. Circulation. 2005;28:3-7.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. used BNP in the emergency department to differentiate heart failure from respiratory causes in infants and children with heart failure and those with no past medical history. We should use lactate to detect occult shock.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. Evaluation of fever in the emergency department. ng/mL (strongly recommended against antibiotics), 0.1-0.25

Infectious Diseases 90

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 90

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. Tracheoinnominate fistula: acute bleeding and hemorrhagic shock due to a trachea-innominate artery fistula. Laryngoscope. 1998;98:1061-64.

Operations 52

Operations Pediatrics Radiology Radiology 52

Taming the SRU

APRIL 13, 2023

stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e. Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Pediatric EM Morsels

JULY 21, 2023

Interrater reliability of Glasgow Coma Scale scores in the emergency department. Ann Emerg Med. Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma. Fun fact for animal lovers!- J Surg Res. 2019 Sep;241:112-118. doi: 10.1016/j.jss.2019.03.038.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

EB Medicine

NOVEMBER 1, 2018

But this month’s episode is special in its own way - we’ll be tackling Electrical Injuries in the emergency department - from low and high voltage injuries to the more extreme and rare lightning related injuries. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Taming the SRU

APRIL 26, 2023

First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis. Misdiagnosis of exertional heat stroke and improper medical treatment. Cooling Methods in Heat Stroke. J Emerg Med 2016. Evidence-Based Heatstroke Management in the Emergency Department.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

ACEP Now

MAY 9, 2024

Complications of Gluteal AFT The pale, prone patient with multiple surgical drains and a constrictive faja has become a common site in the Jackson Memorial Hospital Emergency Department. This should be suspected in patients with intraoperative cardiac arrest or shock. units per patient. Plast Reconstr Surg. 2015;136(1):58-66.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

EMDocs

DECEMBER 16, 2023

An 18-month-old boy presents to the emergency department with loss of consciousness. Both can result in heat exhaustion and heat stroke and have many overlapping symptoms. Patients with heat stroke have hot, dry skin and altered mental status (e.g., C, and heat stroke occurs at a core temperature > 40°C.

Hyperthermia / Hypothermia 93

Hyperthermia / Hypothermia EMS Stroke Seizures 93

EB Medicine

JANUARY 10, 2020

Show Notes Please click here and take our listener survey Emergency Department management of Non-St Segment Elevation Myocardial Infarction, by Drs Julianna Jung and Sharon Bord. MACE= Major Adverse Cardiovascular Event: including re-infarction, stroke, dysrhythmia, heart failure, cardiogenic shock, and death.

Emergency Department 40

Emergency Department Shock EKG/ECG Sepsis 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

Taming the SRU

JANUARY 26, 2024

Morbidity & MOrtality - Mini Lit Blitz - Post-Rosc Care - Qi/KT Morbidity & Mortality WITH Dr. Yates Case 1: Stroke and Stroke Mimics Early diagnosis of stroke improves stroke outcomes, where misdiagnosis is associated with an upwards of 4-time higher likelihood of mortality Missed strokes most often occur with atypical symptoms, in younger (..)

Stroke 59

Stroke EKG/ECG Seizures Outcomes 59

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Carly Eastin is an Associate Professor, Division of Research and Evidence Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences. Case: A 45-year-old female in the emergency department is being admitted to the intensive care unit (ICU) for septic shock secondary to urinary tract infection (UTI).

Sepsis 52

Sepsis Shock Outcomes Stroke 52

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. External Validity: It is unclear if this data applies to patient you see in your emergency department.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 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. Routine serum testing and urine toxicology testing are not recommended for psychiatric patients presenting to the emergency department.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

Taming the SRU

MAY 1, 2023

A retrospective evaluation of phenobarbital versus benzodiazepines for the treatment of alcohol withdrawal in a regional Canadian emergency department Link: [link] Bottom Line: This study in a small regional ED showed a QI project rolling out a Phenobarbital or Diazepam for Alchohol withdrawal syndrome. and NPV(50%).

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Taming the SRU

OCTOBER 25, 2023

The specific etiologies of GI bleeds are numerous and will not be covered individually in this article, as often the exact origin is unknown at the time of Emergency Department evaluation. Instead, we will focus on areas of interest that may guide or change your management of these patients in the Emergency Department.

Blood Transfusions 99

Blood Transfusions Stroke Hospitals Anaphylaxis 99

Pediatric Emergency Playbook

JANUARY 1, 2017

Use soothing sensory measures: speak softly, offer a pacifier, and stroke the skin softly. Unexplained tachycardia may be the early signs of shock. Intranasal ketamine for analgesia in the emergency department: a prospective observational series. Acad Emerg Med. Pediatr Emerg Care. Emerg Med Australas.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. 2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

RebelEM

DECEMBER 4, 2024

Cardioversion recommendations exclude patients with recent strokes or valvular heart disease. Ann Emerg Med 2015; 65(5): 532-9. PMID: 25701296 The SGEM: Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol) ALiEM: Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers.

Emergency Department 92

Emergency Department Stroke EMS Shock 92

EMDocs

FEBRUARY 1, 2025

Spoon Feed In a meta-analysis of patients with septic shock, starting norepinephrine earlier had no mortality benefit, though heterogeneity and bias limit clinically relevant conclusions. Source Comparison of Early and Late Norepinephrine Administration in Patients With Septic Shock: A Systematic Review and Meta-Analysis. 2024.05.042.

Stroke 60

Stroke Operations Shock Emergency Department 60

ACEP Now

MARCH 5, 2025

A 47-year-old male with a medical history of hypertension, and, prior left upper lobe Pancoast tumor status, post video-assisted left upper lobectomy with chest wall and ribs 1-3 resection, presented to the emergency department (ED) with dyspnea, chest heaviness, and near syncope.

Ultrasounds 52

Ultrasounds Resuscitation Shock Stroke 52

Don't Forget the Bubbles

NOVEMBER 18, 2024

Neonatal hypotension can result from inadequate cardiac output, low systemic vascular resistance, or a combination of both, which are influenced by: Cardiac Output: Neonates, particularly preterm ones, may have compromised cardiac output due to myocardial immaturity, leading to reduced stroke volume and heart rate. Fernandez, E.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 96

Sepsis Fractures Documentation/Coding Administration 96

Taming the SRU

JUNE 6, 2023

million presentation to ED’s throughout the US Usually occur due to falls Also commonly occur due to sports, MVC’s, etc.

Documentation/Coding 65

Documentation/Coding Seizures Psychiatric Wellness 65

Don't Forget the Bubbles

JULY 5, 2023

The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke. Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

JANUARY 6, 2025

Based on available hospital resources, the patient is treated for septic shock secondary to pneumonia and an infected wound using broad-spectrum antibiotics and IV crystalloid fluids. She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI.

Infectious Diseases 74

Infectious Diseases CDC PPE Rapid Diagnostic Testing 74