Broome Docs

DECEMBER 9, 2023

Welcome to another episode of the Emergency Medicine Journal Club with Dr Justin Morgenstern. Does BP management in haemorrhagic stroke matter? Overnight Stay in the Emergency Department and Mortality in Older Patients. Risk of Radiation Exposure to Emergency Department Personnel From Portable Radiographs.

Infectious Diseases 114

Infectious Diseases Emergency Department Stroke Pediatrics 114

EMDocs

JANUARY 11, 2025

A 75-year-old woman who is bedridden after a stroke presents to the ED from a nursing facility with abdominal pain and constipation. Stercoral colitis in the emergency department: a review of the literature. International journal of emergency medicine, 17(1), 3. Annals of emergency medicine, 82(1), 3746.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

AENJ: Current Issue

JULY 31, 2024

Stroke-like symptoms are a common complaint in the emergency department; however, signs of an acute cerebrovascular event in a patient under the age of 50 can be both alarming and unexpected. Originally deemed a “stroke code” in the field, the patient was immediately transferred to the computerized tomography scanner.

Stroke 42

Stroke Documentation/Coding Emergency Department Wellness 42

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

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

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 97

EMS Stroke Outcomes Hospitals 97

ACEP Now

APRIL 2, 2024

Posterior circulation strokes make up 20 percent of all strokes but account for 40 percent of stroke misdiagnoses. Dizziness is especially tricky, with up to 40 percent of strokes presenting with dizziness being missed. Bilateral symptoms are more frequent in posterior circulation strokes and can be deceptive.

Stroke 40

Stroke Documentation/Coding Poisoning Emergency Department 40

Taming the SRU

JULY 24, 2024

Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients. Ann Emerg Med 2024 Background Sepsis remains an increasingly common emergency department condition that is tied to higher morbidity and mortality across the United States as well as the rest of the world.

Sepsis 89

Sepsis Resuscitation Emergency Department Wellness 89

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Heart disease and stroke statistics-2022 update: A report from the American Heart Association. Heart disease and stroke statistics—2018 update: A report from the American Heart Association. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

ALiEM

MARCH 22, 2024

A 53-year-old woman with no significant past medical history presented to the emergency department with a 3-day history of double vision on leftward gaze. Usually, MS is seen in younger patients where both eyes are affected whereas strokes occur more often in older patients and only one eye is affected.

Stroke 67

Stroke Urgent Care Head Injuries Emergency Department 67

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

Clinical Correlations

MAY 1, 2024

By Alison Cline Peer Reviewed Let’s Start with a Case… A 79-year-old man with a history of atrial fibrillation and stroke presents to the emergency department with new focal neurologic deficits in the setting of a recent upper.

Stroke 52

Stroke Emergency Department 52

RebelEM

FEBRUARY 24, 2025

RESUS SCENARIO Picture this: you just arrived at your shift at the local emergency department. Of course, there are other methods of assessing fluid tolerance : Capillary refill evaluation, passive leg raise, central venous pressure measurement, pulmonary artery wedge pressures, stroke volume variation, pulse pressure variation, etc.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

ACEP Now

MARCH 11, 2025

Many patients with PE can be discharged directly from the emergency department (ED). Stubblefield WB, Helderman R, Strokes N, et al. The treatment of patients with pulmonary embolism (PE) has evolved substantially over the past few decades. Jimnez D, De Miguel-Dez J, Guijarro R, et al. J Am Coll Cardiol. 2016;67(2):162-170.

Hospitals 52

Hospitals Administration Outcomes Stroke 52

The Skeptics' Guide to EM

FEBRUARY 8, 2020

Stroke 2019 Guest Skeptic: Dr. Rory Spiegel is an EM/CC doctor who splits his time in the Emergency Department and Critical Care department. Stroke 2019 Guest Skeptic: Dr. Rory Spiegel is an EM/CC doctor who splits his time in the Emergency Department and Critical Care department.

Emergency Department 52

Emergency Department Stroke EMS Academics 52

EMDocs

SEPTEMBER 19, 2023

Also think about NCSE in patients with prior cerebral pathology (ie, ischemic stroke); a patient who was seizing, was treated, and is not coming out of their post ictal state; and in patients with unexplained altered mental status with no other cause. Official diagnosis requires EEG, which is not something we can typically obtain in the ED.

Seizures 100

Seizures Documentation/Coding EKG/ECG Emergency Department 100

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. She has a history of similar episodes. There are no other concerning aspects to her examination. Am J Hematol.

Administration 97

Administration Pediatrics Emergency Department Outcomes 97

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

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

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

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. If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

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. You wonder if you gotta be starting something?

Stroke 52

Stroke Urgent Care Critical Access Outcomes 52

Emergency Medicine Cases

JUNE 26, 2023

With increasing forest fires, heat waves, floods, storms, vector-borne illnesses and heat waves, the emergency department is uniquely positioned to declare sentinel events, advocate on behalf of vulnerable populations and lead by example.

EMS 73

EMS Emergency Department Stroke 73

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

Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. Written by Bobby Nicholson What do you think of this “STEMI”? Blood glucose was not low at 162 mg/dL.

EKG/ECG 114

EKG/ECG Documentation/Coding Emergency Department COPD 114

The Skeptics' Guide to EM

AUGUST 19, 2023

Case: A 67-year-old male presents to the emergency department obtunded with left hemiplegia. CT reveals a hemorrhage in the right internal capsule, suggestive of acute hypertensive hemorrhagic stroke. We still need to apply our clinical judgement and ask the patient about their values and preferences.

EMS 74

EMS Stroke Emergency Department 74

EM Curious

SEPTEMBER 9, 2015

LITERATURE OF INTEREST An Age-Adjusted D-dimer Threshold for Emergency Department Patients With Suspected Pulmonary Embolus: Accuracy and Clinical Implications. This will be your target. Learn more about this procedure here. Rob Orman breaks down this topic on ER Cast to help us better understand the evidence and demystify this issue.

Stroke 52

Stroke Pediatrics Best Practices EMS 52

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

Taming the SRU

AUGUST 4, 2024

to teach you and your learner something new on shift skin adhesives WITH dr. hill Dermabond is a polymer (octyl cyanoacrylate) that can be used to repair lacerations in the Emergency Department faster than sutures, allowing the ED physician to be more efficient.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

EM Literature of Note

JANUARY 9, 2022

[link] Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients With Acute Ischemic Stroke Stopped early due poor outcomes in patients receiving alteplase prior to endovascular therapy. the subsequent hospitalization rate was around 10%.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 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. There was again no intracranial hemorrhage.

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

Emergency Medicine Journal

FEBRUARY 20, 2024

McLatchie and colleagues present observational data on the prevalence of acute aortic syndromes (AAS) in 27 emergency departments (ED) in the UK, over 2–55 days.

Stroke 40

Stroke Emergency Department 40

ACEP Now

JULY 7, 2024

1 History and physical examination have been the cornerstone of seizure diagnosis in the emergency department (ED). Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with seizures. Ann Emerg Med. Am J Emerg Med. 2014;63(4):437-447.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

PEMBlog

SEPTEMBER 6, 2023

In fact, some Emergency Departments note that as many as one tenth of their patient volume is mental health. Medical clearance’ of patients with acute mental health needs in the emergency department: a literature review and practice recommendations. Ann Emerg Med. Ann Emerg Med. Health Aff (Millwood).

Psychiatric 52

Psychiatric Pediatrics Emergency Department EKG/ECG 52

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

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