The Skeptics' Guide to EM

AUGUST 28, 2021

Case: A forty-year-old woman presents to the emergency department […] The post SGEM#342: Should We Get Physical, Therapy for Minor Musculoskeletal Disorders in the ED? Case: A forty-year-old woman presents to the emergency department (ED) with a sore lower back after moving some boxes at home over the weekend.

ED 130

ED Emergency Department ALS OR 130

ACEP Now

JUNE 25, 2025

On January 22, 2025, the ACEP Board of Directors approved a clinical policy developed by the ACEP Clinical Policies Committee on the outpatient management of adult patients presenting to the emergency department (ED) with asymptomatic elevated blood pressure. Responses received were used to refine and enhance the final policy. None specified.

Heart Attack 64

Heart Attack ED Emergency Department OR 64

The Skeptics' Guide to EM

JULY 8, 2023

Case: A 57-year-old woman with hypertension, hyperlipidemia and type-2 diabetes mellitus presents to the emergency department (ED) with fever, cough, myalgias, headache and congestion. Managing editor of EM:RAP and Associate Editor at REBEL EM. It’s flu season and you’ve already seen 15 people with the same symptoms.

ALS 269

ALS Emergency Department EMS ED 269

EMDocs

DECEMBER 1, 2024

A 52-year-old male with a history of essential hypertension presents to your South Texas ED for his second visit this week complaining of indolent fever, shortness of breath, pleuritic chest pain, and a rash on his trunk and extremities. Flea-Borne Typhus: Epidemiology Summary 2013-2019. Flea-Borne Typhus. Accessed August 19, 2024.

E-9-1-1 97

E-9-1-1 EMS OR ED 97

The Skeptics' Guide to EM

FEBRUARY 18, 2023

Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. The SGEM has done two previous podcasts on APPs in the ED. Date: February 17, 2023 Reference: Gettel et al.

Emergency Department 130

Emergency Department ALS ED EMS 130

REBEL EM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.

ED 122

ED E-9-1-1 Emergency Department ALS 122

EMDocs

OCTOBER 9, 2023

Yoo, MD (Assistant Professor/Core Faculty, San Antonio, TX) // Reviewed by Brit Long, MD (@long_brit) Case An 18-year-old man with a history of asthma and medication noncompliance presents to the emergency department (ED) with acute onset shortness of breath. He states that he recently moved to Texas from Colorado. Which one do you select?

ED 94

ED Life Support Advanced Life Support CPR 94

EMergucate

MAY 30, 2013

A mid fifties male presents to your ED with 2 hours of chest pain and this ECG

ED 100

ED EMS 100

Pediatric EM Morsels

JULY 26, 2024

It is commonly missed during the first few ED visits. Keep a high index of suspicion for anti-NMDAr encephalitis in children and adolescents who have had multiple ED visits for new and worsening psych/behavioral concerns, seizures, and/or movement disorders over several months. Epub 2013 Dec 18. Serum AND CSF antibody titers!

Plasma 274

Plasma OR ED Critical Care 274

ALiEM

FEBRUARY 20, 2024

2013 Dec;15(4):90-2. Epub 2013 Nov 7. Successful treatment of flecainide-induced cardiac arrest with extracorporeal membrane oxygenation in the ED. Sivalingam SK, Gadiraju VT, Hariharan MV, Atreya AR, Flack JE, Aziz H. Flecainide toxicity–treatment with intravenous fat emulsion and extra corporeal life support.

Life Support 183

Life Support Overdose ED 183

ALiEM

AUGUST 30, 2024

A 5-year-old female presented to the emergency department (ED) with a one-year history of gradually increasing anterior neck swelling. She was discharged from the ED on levothyroxine 25 mcg daily with endocrinology outpatient follow-up. 2013 Mar;34(3):115-24; quiz 125. The patient had no significant past medical history.

ACS 161

ACS Emergency Department ED OR 161

Core EM

OCTOBER 16, 2024

In: Marx J, ed. In: Wolfson A, ed. 2013 Feb;160(4):434-44. Br J Haematol. 2009 Nov;147(4):431-43. link] Emery, M. Blood and blood components. Rosen’s emergency medicine. Philadelphia, PA: Elsevier; 2014:75-80. Transfusion Reactions and Complications. Harwood-Nuss’ Clinical Practice of Emergency Medicine. Hirayama F.

Allergic Reaction 188

Allergic Reaction Plasma ED Epinephrine 188

EMOttawa

FEBRUARY 22, 2024

In 2013, in the United States there were 7 million visits to the emergency department (ED) for lacerations making up a total of 5.2% of ED visits(1). Lacerations are a common presenting complaint to emergency department.

Emergency Department 94

Emergency Department ED OR 94

REBEL EM

DECEMBER 4, 2024

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. ALiEM: Beta Blockers Vs. Calcium Channel Blockers for Atrial Fibrillation Rate Control: Thinking Beyond the ED. Louis, Mosby, Inc.,

Emergency Department 89

Emergency Department ALS ED EMS 89

The Skeptics' Guide to EM

MAY 14, 2022

Case: A 45-year-old man without a significant past medical history presents to your emergency department (ED) with two days of severe lower back pain after shoveling some dirt. EDs annually (1). He is also one of the world’s leading researchers on pain management in the emergency department and specifically the use of ketamine.

ALS 130

ALS Emergency Department ED OR 130

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. Therefore, discharging the patient on lactulose (C) would not be recommended without additional treatment in the ED. Low threshold for antibiotics and escalation of care with surgery consultation.

E-9-1-1 95

E-9-1-1 EMS Emergency Department ALS 95

The Skeptics' Guide to EM

APRIL 24, 2021

Way back in 2013 we looked at haloperidol for agitation due to psychosis ( SGEM#45 ) and concluded that it was an effective treatment but had common side effects. Droperidol has been used widely, particularly in Australasia, for acute severe agitation. Droperidol has been used widely, particularly in Australasia, for acute severe agitation.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

The Skeptics' Guide to EM

OCTOBER 28, 2017

That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015. One medication that should not be use in children under 12 years of age is codeine. There is a RANThony on pediatric pain control and one of the interesting treatments was sucrose.

ALS 130

ALS Emergency Department ED OR 130

Pediatric EM Morsels

OCTOBER 27, 2023

Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. Good correlation to bed scale weight in trauma patients (Pearson coefficient 0.86), but there was some error in the highest weight category.

E-9-1-1 274

E-9-1-1 Emergency Medical Services Life Support ALS 274

REBEL EM

SEPTEMBER 13, 2023

J Emerg Med 2013; 44 (4): 764-772. In: UptoDate, Feldweg AM (ed.) N Engl J Med. 2015; 372(5):418-25. PMID 25629740 Hassen GW et al. Fresh frozen plasma for progressive and refractory angiotensin-converting enzyme inhibitor-induced angioedema. PMID: 23114109 Hessert MJ and Bennett BL. Wilderness and Environmental Medicine. 2012; 14(11).

Frozen Plasma 101

Frozen Plasma Allergic Reaction FFP Plasma 101

REBEL EM

MAY 11, 2023

PMID: 34697777 Clinical Question: In patients with moderate to severe alcohol withdrawal being discharged from the emergency department (ED), does treatment with phenobarbital alone and phenobarbital plus benzodiazepines compared to benzodiazepines alone decrease the odds of returning to the ED within 3 days after initial discharge?

Emergency Department 95

Emergency Department ED EMR OR 95

ALiEM

MARCH 7, 2024

Ann Emer Med , 2005 [7] Prospective, blinded, observational study performed in the pediatric ED, 3 month period N=44, < 2 years of age Created a bladder urinary index by multiplying the AP and transverse bladder diameters. Author, Title, Journal, Publication Year Study Type, Location, Time Frame N, Ages Summary Milling et al., Chen et al.,

E-9-1-1 177

E-9-1-1 Emergency Department ALS ED 177

Broome Docs

MAY 31, 2024

Do we need to intubate French drunkards in ED? 2013 Sep;24(9):1848-53. Epub 2013 Jul 17. Justin and I discuss 7 papers covering a range of topics from securing IVCs in kids to intubating in space and the use of religious sham artifacts in middle-age, French “psychiatry” Yep, it was a strange month on the pod!

E-9-1-1 81

E-9-1-1 ED Critical Care ICU 81

EMDocs

AUGUST 13, 2024

HTN was the primary diagnosis in over 1 million ED visits in 2023, and rates of HTN emergencies have increased over the past 20 years. From 2006-2013, HTN emergencies occurred in approximately 2 of every 1000 adult ED visits. In the ED setting, they recommend avoiding intensifying HTN medications.

ED 98

ED OR 98

The Skeptics' Guide to EM

MARCH 13, 2021

Lancet 2021 Case: You’re working a busy evening shift in your community emergency department (ED) when a 58 year old female presents with a rapid onset terrible intensity headache. Jeff was actually on the SGEM as the guest skeptic discussing this clinical decision instrument way back in 2013 ( SGEM#48 ).

ALS 100

ALS ED Emergency Department OR 100

Don't Forget the Bubbles

OCTOBER 25, 2023

It is often difficult to do this in an ED setting. 2013 Sep 24;81(13):1159-65. Epub 2013 Aug 21. Strabismus alone is a rare sign of a brain tumour in this age group; however, the associated papilloedema is concerning. The fact that fundoscopy has been carried out on this child is a feat. doi: 10.1212/WNL.0b013e3182a55f17.

ALS 123

ALS OR ED 123

EMDocs

NOVEMBER 21, 2023

In ED, repeat potassium level was 2.6 Permanent weakness usually affects the proximal lower extremities, happens in older patients, and develops late. Diagnosis: Can be made in the ED based on history, exam, lab testing. Consult neurology in the ED. ED workup should exclude alternate causes of symptoms. Muscle Nerve.

E-9-1-1 88

E-9-1-1 ALS ED OR 88

EMDocs

AUGUST 22, 2024

6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. 6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. One cohort study in a public ED found that 84.5%

Emergency Department 96

Emergency Department ALS E-9-1-1 ED 96

FOAMfrat

JULY 3, 2024

This is the mechanism that will eventually kill the patient as well with the high concentration (430 ppm+ exposure) Vajner JE 3rd (2013) references several studies on the inhalation of chlorine. Advanced Hazmat Life Support Provider Manual (4th ed.). (F. Thomas, Eds.) 2013, 9 9). Bronstein, A. Fernandez, M. Walter, J.

Life Support 106

Life Support ALS Emergency Response OR 106

EMDocs

FEBRUARY 22, 2024

A 43-year-old male, with no significant medical history, presents to the ED for right eye pain. 2013; 7362. In: Knoop KJ, Stack LB, Storrow AB, Thurman RJ, eds. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. Corneal Abrasion With Foreign Body Present.

ALS 95

ALS ED EMS OR 95

Core EM

OCTOBER 2, 2024

In: Marx J, ed. In: Wolfson A, ed. 2013 Feb;160(4):434-44. Br J Haematol. 2009 Nov;147(4):431-43. link] Emery, M. Blood and blood components. Rosen’s emergency medicine. Philadelphia, PA: Elsevier; 2014:75-80. Transfusion Reactions and Complications. Harwood-Nuss’ Clinical Practice of Emergency Medicine. Hirayama F.

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

Dr. Smith's ECG Blog

NOVEMBER 16, 2016

A prehospital ECG was similar to the first ED ECG, which is shown below. Here is her initial ED 12-lead ECG: There is atrial fibrillation with a rate of approximately 114. Thus, the ACC/AHA 2013 STEMI guidelines now list diffuse ST depression, with ST elevation in aVR, as an indication for thrombolytic therapy. 911 was called.

ACS 52

ACS Coronary ICU STEMI 52

Don't Forget the Bubbles

OCTOBER 2, 2023

mmol/L) with acute illness between 2013 and 2018. Younger age, higher bicarbonate levels and lower ketones in children with acute illness and hypoglycaemia on presentation to ED are potential predictors of establishing a hypoglycaemia diagnosis. There is a lack of data to indicate whether these children require endocrine evaluation.

ALS 138

ALS ED OR Emergency Department 138

ACEP Now

DECEMBER 11, 2023

The Emergency Department Benchmarking Alliance (EDBA) is a membership organization composed of high-performance emergency departments (EDs) that share a commitment to quality. Thus, the survey included data for about one-third of all patients seen in US ED’s in 2022. 1 Boarding time increases led to unprecedented ed walkaway rates.

Emergency Department 52

Emergency Department ED EMS ALS 52

REBEL EM

FEBRUARY 24, 2025

You need not be sad regarding the lack of Swan Ganz catheters in your ED. July 2013; PMID: 23774337 Cavallaro, F et al: Diagnostic accuracy of passive leg raising for prediction of fluid responsiveness in adults: systematic review and meta-analysis of clinical studies. Oct 2013; PMID: 24079262 Gohar E, et al. Marik P, et al.

ALS 67

ALS E-9-1-1 Critical Care OR 67

Don't Forget the Bubbles

SEPTEMBER 30, 2024

In the UK, as in most developed countries, more patients are presenting to Emergency Departments (EDs) with minor illnesses or injuries. examined 977,907 first-time ED presentations by children aged 0-15 across thirteen acute hospital trusts (between April 2014 and March 2017), trying to figure out how many were non-urgent.

Emergency Department 89

Emergency Department ALS ED OR 89

REBEL EM

JANUARY 25, 2023

3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

ED 52

ED ALS OR ICU 52