The Skeptics' Guide to EM

APRIL 26, 2025

Reference: Muldowney et al. A Comparison of Ketamine to Midazolam for the Management of Acute Behavioral Disturbance in the Out-of-Hospital Setting. Ann Emerg Med. 2025 Date: April 24, 2025 Guest Skeptic: Dr. Howie Mell received his Medical Doctorate (MD) from the University of Illinois at Chicago, College of Medicine at Rockford. Prior to that, he received a Master of Public Health (MPH) degree emphasizing Environmental and Occupational Health from the University of Illinois at Chicago, School

Hospitals 119

Hospitals Evidence-Based Practice Airway Management EMS 119

EM Ottawa

APRIL 24, 2025

In part 1 of this 2-part series on medicolegal risk in Emergency Medicine, we looked at two legal cases, with a primary focus on civil litigation and college complaints. In this section, we focus on risk assessment, documentation, and advice from lawyers and CMPA experts, with some frequently asked questions to conclude. Check out part […] The post Law and Order: Navigating Medicolegal risk in Emergency Medicine Part 2 appeared first on EMOttawa Blog.

Documentation/Coding 64

Documentation/Coding Wellness Hospitals 64

PEMBlog

APRIL 22, 2025

Autism spectrum disorder (ASD) is commonaffecting approximately 1 in 68 childrenand increasingly recognized in pediatric emergency departments (EDs). While we pride ourselves on providing high-quality care for all children, we must acknowledge that the noisy, fast-paced, and unpredictable environment of the ED can be especially distressing for autistic patients.

Pediatrics 89

Pediatrics Emergency Department Administration Hospitals 89

ACEP Now

APRIL 22, 2025

On a recent shift, I cared for a stroke patient with a story that, on the surface, was one that we hear all too often in Emergency Medicine. Mrs. A, as well call her, arrived hypertensive and aphasic with a hemiparesis and left-sided neglect. Family told EMS that she had no known past medical history, yet the paramedics suspected that she likely hadnt seen a doctor in many years.

Mobile Clinics 98

Mobile Clinics Stroke Ultrasounds Leadership 98

Speaker: Simran Kaur, Co-founder & CEO at Tattva.Health

AI is transforming clinical trials—accelerating drug discovery, optimizing patient recruitment, and improving data analysis. But its impact goes far beyond research. As AI-driven innovation reshapes the clinical trial process, it’s also influencing broader healthcare trends, from personalized medicine to patient outcomes. Join this new webinar featuring Simran Kaur for an insightful discussion on what all of this means for the future of healthcare!

Outcomes

Mind The Bleep

APRIL 22, 2025

Faltering growth (also known as failure to thrive ) describes when a child is not growing as expected. This may reflect underlying poor health or nutrition. By routinely assessing a childs height and weight throughout childhood, growth measurements can be plotted over time on centile charts and faltering growth can be identified. As causes and management of faltering growth differ by age, this article will address faltering growth in infants (children <1 year old).

Sepsis 52

Sepsis Dehydration Shock Ultrasounds 52

ECG Guru

APRIL 23, 2025

Here is a rhythm strip from a 3-lead Holter ECG. It comes from a 56-year-old man with arterial hypertension and no other previous cardiac diseases. Recently, the patient has noticed that pulse irregularities occur during blood pressure measurement (which he performs himself at home). On the ECG, first a sinus beat, then a PVC, then an AIVR occurs, which is interrupted by another PVC, then sinus rhythm again.

EKG/ECG 60

EKG/ECG 60

Sensible Medicine

APRIL 22, 2025

In the coming weeks Vinay, John, and I (Adam) will be getting together in person. We are meeting to work on what we think will be some really valuable Sensible Medicine content. Since we will have some time together, we thought it would be a good time to gather some more questions to answer. Same rules as last time: the comments are open to all paid subscribers to pose questions.

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The Bottom Line

APRIL 23, 2025

Whats new in the Critical Care literature monthly updates

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EMCrit

APRIL 24, 2025

Fall from standing with some pretty concerning symptoms of spinal cord injury. EMCrit Project by Scott Weingart, MD FCCM.

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Core Medical Group

APRIL 25, 2025

Welcome back Chris Leo! He's a passionate recruiter connecting clinicians with their dream jobs. Explore his journey and dedication to personalized healthcare recruitment in this blog.

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Emergency Medicine Journal

APRIL 22, 2025

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.

Research 52

Research 52

ECG Guru

APRIL 24, 2025

Sometimes a single Holter ECG can tell a whole story. Here we see a single-channel ECG, each line representing about 30 seconds. The ECG is from a 56-year-old man with severe ischemic cardiomyopathy who had an ICD implanted a few months ago due to recurrent ventricular tachycardia. The explanation of what can be seen on this ECG can be found on the 2nd image.

EKG/ECG 52

EKG/ECG Shock 52

The Bottom Line

APRIL 23, 2025

Whats new in the Critical Care literature monthly updates

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Pediatric Education

APRIL 27, 2025

PediatricEducation.org is taking a short spring break. The next case will be published on May 5, 2025. In the meantime, please take a look at the different Archives and Curriculum Maps listed at the top of the page. We appreciate your patronage, Donna DAlessandro and Michael DAlessandro, curators.

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The Trauma Pro

APRIL 22, 2025

I found an interesting paper published a couple of years ago that purports to examine individual surgeon outcomes after trauma laparotomy. This was presented at the annual AAST meeting in 2021 and then published in the Journal the following year. Everyone seems to be giving this paper a pass. I won’t be so easy on it. Let me provide some details.

Resuscitation 113

Resuscitation Outcomes Operations Shock 113

Emergency Medicine Journal

APRIL 22, 2025

This month’s update is by the Emergency Departments (EDs) from R Jolad Hospital, Lagos and University College Hospital, Ibadan, in Nigeria. We used a multimodal search strategy, drawing on free, open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and highlighted the main findings, key limitations and clinical bottom line for each paper.

Emergency Department 52

Emergency Department Hospitals Outcomes 52

Broome Docs

APRIL 27, 2025

G’day and welcome to another instalment of the Journal Club with Dr Justin Morgenstern. This month we cover some diltiazem papers, a few on airway hacks, some population studies and discuss some nerwer management options for big PEs, and kids seizures. Unfortunately, we had soe technical glitches which means that the usual video / Youtube version will not be available – so you will have to stare at a picture of Justin as you listen to the chat!

Seizures 67

Seizures Airway Management Pediatrics Burns 67

Sensible Medicine

APRIL 27, 2025

As an Intensivist, I see death almost every day. It is part of the job. That job requires that I help my patients conquer critical illness and make sure that those who will die do so with dignity. Given that I see death on a regular basis in the ICU, I also have reflected, as has Dr. Cifu , on how I want to die. Ideally, I want to die in my sleep, without the pain and suffering of a prolonged critical illness torturing me to death.

EKG/ECG 108

EKG/ECG Documentation/Coding 108

PulmCCM

APRIL 24, 2025

Email cut off? Click the title to view the whole post online or in the Substack app. -Ed. ARDS, Mechanical Ventilation Inhaled volatile anesthetics vs propofol for sedation in vented patients (SESAR Trial) All sedatives have side effects; other than limiting sedation to the minimal necessary dose during mechanical ventilation, the optimal approach (if one exists) has always been unclear.

Sepsis 52

Sepsis Shock Hospitals Academics 52

EM Literature of Note

APRIL 28, 2025

Periodic reminder theres lots of content over at our new home on evidencetriage.com Such great hits as: Run A Marathon And Drop Dead Paxlovid Spiralling Into Total Disutility Can Dr. Oz Really Replace Your Doctor With AI? The Bluejepa EAGLEs Have Landed and many others!

Wellness 52

Wellness 52

Emergency Medicine Journal

APRIL 22, 2025

A short systematic review was undertaken to establish whether the use of a nasal clip is superior to manual compression as first aid in patients presenting to the ED with epistaxis. A systematic keyword search of EMBASE, MEDLINE, Cochrane and Google Scholar databases returned two relevant papers. The author, year, country of publication, patient group studied, study type, key findings and weaknesses are tabulated.

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Ken Grauer, MD

APRIL 25, 2025

== INTRO: I have added this Tab on Technical "Misadventures" to the Menu at the top of every page in this ECG Blog: Where to find this LINK in the Top Menu! All-too-often lead reversals, unsuspected artifact, and other "technical misadventures" go unrecognized with resultant erroneous diagnostic and therapeutic implications. In the hope of facilitating recognition of these cases I am developing an ongoing listing on this page with LINKS to examples that Ive published in this ECG Blog, as we

EKG/ECG 289

EKG/ECG Hyperthermia / Hypothermia Wellness 289

Don't Forget the Bubbles

APRIL 28, 2025

Paramedics are increasingly required to assess patients and determine whether they can be safely managed at home with self-care or primary care or if they need to be transferred to the hospital. In line with HCPC requirements, paramedics must use evidence-based practice to make informed clinical decisions. This post explores the key information needed to support sound, evidence-based, and patient-centred decision-making in managing chickenpox in children.

Documentation/Coding 64

Documentation/Coding Hospitals Emergency Department Sepsis 64

Pediatric EM Morsels

APRIL 25, 2025

We have previously discussed our “love” of rashes ! Ok, maybe we are still lukewarm when it comes to skin eruptions, but we cannot deny the important clues that we may decipher from a good derm exam! This is especially true when we are facing the complaint of weakness and muscle pain. There are a lot of considerations on our list when we are pondering the child who complains of muscle weakness !

Pediatrics 144

Pediatrics Outcomes Research EMS 144

Sensible Medicine

APRIL 28, 2025

The picture below shows how a treatment can make patients better. I see four ways. The drug/procedure may work biologically. The Voltaire effect relates to his quote saying that the art of medicine consists of amusing the patient while nature cures the disease. AKA: natural history. Placebo effects can also contribute. I will show you an elegant experiment demonstrating how positive energy and words can add to improvement.

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Emergency Medicine Journal

APRIL 22, 2025

Background The role of video laryngoscopy in critically ill patients requiring emergency tracheal intubation remains controversial. This systematic review and meta-analysis aimed to evaluate whether video laryngoscopy could improve the clinical outcomes of emergency tracheal intubation. Methods We searched the PubMed, Embase, Scopus and Cochrane databases up to 5 September 2024.

Outcomes 52

Outcomes Emergency Department Operations Hospitals 52

Northwestern EM Blog

APRIL 22, 2025

Written by: Sasha Becker (NUEM 27) Edited by: Mike Tandlich (NUEM 24 ) Expert Commentary by: David Zull, MD Expert Commentary The emergency physician should be an expert regarding STEMI equivalents. This is the advanced course. Hyperacute T waves Hyperacute T waves refer to tall broad based symmetric T waves (not pointy Ts as seen in hyperkalemia). The hyperacute T wave may sometimes encroach upon the QRS leading to an upsloping ST segment.

Shock 96

Shock Hospitals Wellness 96

EMDocs

APRIL 23, 2025

Author: Chuck Pilcher, MD FACEP (Editor, Med Mal Insights) // Editors: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit) Heres another case from Medical Malpractice Insights Learning from Lawsuits , a monthly email newsletter for ED physicians. The goal of MMI-LFL is to improve patient safety, educate physicians, and reduce the cost and stress of medical malpractice lawsuits.

Stroke 95

Stroke Documentation/Coding EKG/ECG Patient Safety 95

ECG Guru

APRIL 23, 2025

Dawn recently posted an ECG with a 3rd degree AVB and an escape rhythm with narrow QRS complexes (junctional escape rhythm or escape rhythm from the area of the His bundle). In addition, my ECG today is about a 78-year-old man with DCM who has noticed a significant increase in his existing shortness of breath over the last few days.

EKG/ECG 80

EKG/ECG 80

Dr. Smith's ECG Blog

APRIL 25, 2025

This was written by Hans Helseth. Paramedics arrived at the house of a 59 year old man after his caretaker called 911 for altered mental status. He was lethargic and slow to respond to questions. He was found to be hypotensive with systolic pressures in the 70s and 80s. An EKG was recorded: What do you think? This EKG shows the same 2.5 seconds as recorded by all 12 leads, so it is not ideal for rhythm analysis.

EKG/ECG 79

EKG/ECG Hyperthermia / Hypothermia Sepsis Hospitals 79

Emergency Medicine Journal

APRIL 22, 2025

Background Female patients with lower limb fractures experience pain and loss of dignity when manoeuvered onto a bedpan. Poor bladder management, including urinary catheterisation for convenience, can lead to longer hospital stays and eventual loss of independence. Staff at Great Western Hospital Emergency Department modify disposable male urinal bottles to accommodate the female perineum without need to reposition the patient.

Fractures 52

Fractures Ambulance Services Trauma Department Emergency Department 52

RebelEM

APRIL 28, 2025

Bottom Line Up Top: Blood gas electrolytes closely correlate with serum measurements and can be used under most circumstances to guide clinical care. Clinical Scenario: A 62 year old woman with a history of HTN, ESRD on MWF dialysis presents to the Emergency Department with generalized weakness. Her vital signs are HR = 82, BP 153/72, O2 Sat 95%, Temp 98.7.

COPD 63

COPD Emergency Department EKG/ECG EMS 63

EMDocs

APRIL 25, 2025

Originally published at The Pediatric EMS Podcast on March 5, 2035. Reposted with permission. Please visit their site HERE to see all the amazing podcasts or subscribe to their RSS HERE. This is the Pediatric EMS Podcast with the mission to provide case-based discussion with evidence-based recommendations by content experts in prehospital pediatric medicine in order to advance the care of children outside the hospital.

Pediatrics 70

Pediatrics EMS Head Injuries Hyperthermia / Hypothermia 70

ECG Guru

APRIL 24, 2025

Sometimes a single Holter ECG can tell a whole story. Here we see a single-channel ECG, each line representing about 30 seconds. The ECG is from a 56-year-old man with severe ischemic cardiomyopathy who had an ICD implanted a few months ago due to recurrent ventricular tachycardia. The explanation of what can be seen on this ECG can be found on the 2nd image.

EKG/ECG 76

EKG/ECG 76

PEMBlog

APRIL 28, 2025

This is the only non-medical post I make every year. The annual Anniversary Video that I plan, film, edit, and produce for my wife. I’ve been sharing them with her every year since our third anniversary. This is number 18. Maybe someday I will get my act together and buy a nice card from Hallmark with a heartfelt message on it for my wife. They still sell those I’m told.

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Emergency Medicine Journal

APRIL 22, 2025

Introduction The pericapsular nerve group (PENG) block provides analgesia for patients with hip fractures and claims to provide a sensory-only block without motor weakness. 1 2 It targets the accessory branches of the femoral and obturator nerve as they course past the psoas muscle to innervate the anterior hip. However, recent studies have shown quadriceps weakness associated with the PENG block. 3 4 One theory is that anaesthetic spreads via accidental rupture of the iliopectineal bursa, allow

Fractures 52

Fractures 52