ALiEM

SEPTEMBER 13, 2024

A 32-year-old male with no significant past medical history presented to the emergency department (ED) from an outside hospital for further management of right eye pain and vision loss sustained after he was struck by a metal wire while at work. 2012 Feb;26(2):212-7. American Academy of Ophthalmology. 2023, March 23).

Emergency Department 64

Emergency Department Academics Hospitals Fractures 64

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter.

Documentation/Coding 81

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 81

ALiEM

OCTOBER 16, 2023

An otherwise healthy 34-year-old male presented to the Emergency Department with two weeks of anterior neck pain. Additional Images Physical Exam Vitals : BP 115/80; HR 120; T 101°F; RR 16; O2 sat 97% General : Well appearing in no acute distress HEENT : Poor dentition, mild trismus. 2012 Oct;12(10):808-15.

Wellness 60

Wellness Academics Emergency Department Hospitals 60

Taming the SRU

FEBRUARY 5, 2024

Traumatic brain injury (TBI) accounts for millions of Emergency Department visits annually. While moderate and severe TBI is often managed on an inpatient basis, patients presenting with mild TBI, or concussion, are often managed solely by Emergency physicians.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

Don't Forget the Bubbles

OCTOBER 10, 2024

Adopting this approach would reduce time in surgery for the child as well as the financial cost of nail bed repair. Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study. Arch Dis Child. Epub ahead of print.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

ACEP Now

FEBRUARY 13, 2024

A 77-year-old man presented to the emergency department (ED) with hip pain following a fall. See below: Fascia iliaca Serratus anterior Erector spinae The risks of opioid medications, especially in the elderly, has been well described. Trends in opioid prescriptions among part D medicare recipients from 2007 to 2012.

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Wellness 52

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]. Tilly is normally fit and well, with no significant past medical history. Pediatrics, 2012. by her father. Bachur, R.G.,

Emergency Department 105

Emergency Department Ultrasounds Pediatrics Best Practices 105

Northwestern EM Blog

SEPTEMBER 26, 2022

Written by: Diana Halloran (NUEM ‘24) & Andrew Long (NUEM ‘25) Edited by: Nick Wleklinski (NUEM ‘22) Expert Commentary by : John Bailitz, MD Introduction The Emergency Department is a challenging work environment for a variety of reasons.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

ALiEM

OCTOBER 20, 2023

A 50-year-old Caucasian female with a history of hypertension, coronary artery disease, and insulin-dependent diabetes mellitus presents to the emergency department with a complaint of painful sores on the top of her left foot. 2012 Jul;16(4):614-20. Additional Images Physical Exam Vitals : T 37.2°C; Indian J Endocrinol Metab.

Academics 64

Academics Emergency Department Wellness Research 64

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. World J Emerg Surg 2023 PMID: 36918947 3. Int J Emerg Med 2009 PMID: 20157465 4. Crit Care Med.

Resuscitation 105

Resuscitation Administration Emergency Department Hospitals 105

EB Medicine

MARCH 1, 2019

This month, after a few months of primarily medical topics, we’re talking trauma, specifically Blunt Cardiac Injury: Emergency Department Diagnosis and Management. Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

EMDocs

DECEMBER 11, 2023

In October 2022, the American College of Cardiology released an updated expert consensus decision regarding the evaluation of chest pain in the emergency department. This included the addition several new STEMI equivalents [4] on ECG that warrant “prompt evaluation for emergency coronary angiography.” Ann Emerg Med.

EKG/ECG 109

EKG/ECG Emergency Department Academics Operations 109

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. In our emergency department, the RTs do not spend a lot of time going around measuring cuff pressures and usually save that until the patient reaches the ICU.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

Taming the SRU

JULY 21, 2023

Eye Pathology Now let’s dive back into some common eye disease processes you may see on a typical day in the emergency department. Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. licensed under a Creative Commons Attribution 3.0 WHAT ARE TREATMENT OPTIONS? Microbial Keratitis.;

Emergency Department 87

Emergency Department EMS Burns Wellness 87

Taming the SRU

JUNE 12, 2023

Although not every person seeks health care for these injuries, the majority of those that do end up in the emergency department. In 2008, this led to greater than 316,000 emergency department (ED) visits and about 9,500 hospitalizations [1]. Annals of Emergency Medicine. Annals of Emergency Medicine.

Infectious Diseases 102

Infectious Diseases Emergency Department Administration Academics 102

Don't Forget the Bubbles

JANUARY 17, 2024

Curious Ken is brought into your emergency department. Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. Mirza and Sheikh reported perhaps the first unfortunate case in 2012.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

The Skeptics' Guide to EM

OCTOBER 3, 2020

Date: October 2nd, 2020 Guest Skeptic: Dr.Barbra Backus is an emergency physician at the Emergency Department of the Erasmus University Medical Center in Rotterdam, the Netherlands. The effect of the combination of ticagrelor and aspirin on prevention of stroke has not been well studied.

Stroke 40

Stroke Emergency Department Research Wellness 40

EMDocs

JULY 25, 2024

Do them well and document the process, preferably at the bedside. Literature-based Recommendations for Suicide Assessment in the Emergency Department: A Review. Oct 04, 2012. Assure and document the patient’s resources and safety net if discharged. Handoffs are a high-risk exchange. Applebaum PS. Ronquillo L et al.

Documentation/Coding 81

Documentation/Coding Hospitals Patient Safety Emergency Department 81

Taming the SRU

MARCH 14, 2023

Case 1 Fussy 1 month old A 1-month-old (ex-34 week premature) infant comes to your emergency department for fussiness. He appears well and is triaged to an ESI 4. Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

Taming the SRU

OCTOBER 28, 2024

When should I get a consultant involved in the emergency department? If their injury was from trauma, it would not be unreasonable to initiate trauma consult within the emergency visit, but also if the injury is isolated and the patient is well appearing, they could also follow up closely with the trauma clinic.

COPD 78

COPD Pediatrics Emergency Department Ultrasounds 78

The Skeptics' Guide to EM

DECEMBER 12, 2020

Case: A 52-year-old previously healthy woman presents to your emergency department (ED) with an abscess on her left forearm. She is systemically well and there is no sign of tracking, so you decide to perform incision and drainage in the ED. Kirsty is also the creator of the wonderful infographics called #PaperinaPic.

Operations 52

Operations Outcomes Research Academics 52

PEMBlog

MAY 11, 2023

Injectable lidocaine, when done well, is reliable – but it can take years to master the ideal technique that doesn’t create a giant mound of subcutaneous lidocaine that can impact needle entry and landmarks. Pediatr Emerg Care. 2012 Jul;28(7):687-90. Acad Emerg Med. doi: 10.1097/PEC.0b013e31825d210b.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Outcomes 52

PHEM Cast

MARCH 17, 2016

Taken from Weingart & Levitan 2012. Annals of Emergency Medicine. 2012; 59(3): 165-175. Annals of Emergency Medicine. Preoxygenation, reoxygenation, and delayed sequence intubation in the Emergency Department. The Journal of Emergency Medicine. 2014; 65(4): 349-355. Weingart SD.

Airway Management 52

Airway Management Burns Emergency Department Resuscitation 52

The Skeptics' Guide to EM

SEPTEMBER 30, 2017

Emlyn’s blog and podcast since 2012. Case: You are working the afternoon shift in the paediatric emergency department. Your shift is almost over and the department finally seems to be under control. She is a medical education enthusiast and has been an editor and regular contributor to the St.

Pediatrics 52

Pediatrics Emergency Department Sepsis Wellness 52

Sensible Medicine

SEPTEMBER 29, 2023

The promise is that well-constructed and validated prediction models will lead to diseases being diagnosed earlier and treatment for the right patients, in the right place, at the right time. In some cases, models that appear to perform well may pose risks to patients if used to make clinical decisions. 2012 05;9(5):1-13. [5]

Research 59

Research Hospitals Academics Emergency Department 59

The Skeptics' Guide to EM

MARCH 10, 2018

She has epistaxis that has not resolved despite twenty minutes of well applied anterior pressure. The American College of Chest Physicians published some evidence-based recommendations in 2012 on anticoagulation therapy [1]. We will put a link in the show notes to the protocol. Reference: Zahed et al.

Blood Transfusions 40

Blood Transfusions Emergency Department Shock Hospitals 40

Taming the SRU

MAY 22, 2023

Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. Fracture incidence in adults in relation to age and gender: A study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area. Most frequent reasons for emergency department visits, 2018.

Fractures 77

Fractures Dislocations Operations Radiology 77

Pediatric Emergency Playbook

AUGUST 1, 2017

One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain. Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. J Emerg Med. Lee HC et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

EMDocs

SEPTEMBER 9, 2023

Answer : Extensor tendon laceration Epidemiology: Hand extensor injuries make up >25% of orthopedic soft tissue injuries 2, 3 Common in young men in manual labor Dominant hand more likely to be injured 4 2012 study on 86 patients reported 83% men with a mean age of 34.2 Ann Emerg Med. J Emerg Med. Medicine (Baltimore).

EMS 77

EMS Fractures Soft Tissue Injuries Ultrasounds 77

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 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. ng/mL, 0.25-0.5

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

EMDocs

SEPTEMBER 23, 2023

Physical exam reveals a well-appearing female in no acute distress. A 23-year-old man with no significant medical history presents to the emergency department for evaluation of a syncopal episode. 2012 May;9(5):752-9. The patient states that this has never happened before. Neurological exam is also unremarkable.

EMS 83

EMS EKG/ECG Documentation/Coding Emergency Department 83

Pediatric Emergency Playbook

DECEMBER 1, 2016

If the otherwise healthy child one month and older is: Euvolemic Not hypoxic Well appearing He can likely go home. The short answer is that the American Academy of Pediatrics, the UK’s National Institute for Health and Care Excellence, as well as the Canadian Pediatric Society currently recommend against them. 2012 Mar;129(3):e605-10.

Pediatrics 40

Pediatrics Emergency Department Hospitals Wellness 40

EM Guide Wire

NOVEMBER 2, 2020

Nebulized Mg sulfate treatment shows no significant effect on respiratory function or hospital admission High-Dose Magnesium Sulfate Infusion for Severe Asthma in the Emergency Department Efficacy Study All patients of 6–16 years old who failed to improve after 2 hours of standard therapy for asthma. 2015;169(2):186-188.

Pediatrics 52

Pediatrics Anaphylaxis Administration Hospitals 52

ACEP Now

OCTOBER 9, 2023

percent) do not speak English as a primary language, and 25 million of those speak English less than well (known as “limited English proficiency” or LEP); many indicators show this number will only continue to grow. emergencies, patient’s request). 2012; 60(5): 545-553. Medical Interpreting According to the U.S. Annals of EM.

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

Sensible Medicine

SEPTEMBER 29, 2023

The promise is that well-constructed and validated prediction models will lead to diseases being diagnosed earlier and treatment for the right patients, in the right place, at the right time. In some cases, models that appear to perform well may pose risks to patients if used to make clinical decisions. 2012 05;9(5):1-13. [5]

Research 40

Research Hospitals Academics Emergency Department 40

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. Tikkanen, J. Wellens, H., &

EKG/ECG 122

EKG/ECG Documentation/Coding Wellness Emergency Department 122