Don't Forget the Bubbles

NOVEMBER 29, 2023

A 2012 study on paediatric patients showed that approximately 42% were intubated without medications, and 2% were intubated with paralysis only in the ED. Awake fiberoptic intubation where the patient consents, co-operative AND the airway is prepared with local anaesthesia. What are the only exceptions? DOI: 10.1097/PEC.0b013e3182713316

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

Don't Forget the Bubbles

OCTOBER 11, 2023

She spent around five days as an inpatient post-operatively. 2012 Sep 1;55(3):239-42. One magnet was found in the jejunum, and the other was in the ileum. They were stuck to each other with bowel wall in between. There was one perforation, which was repaired. She tolerated eating and drinking normally. Annals of emergency medicine.

Pediatrics 116

Pediatrics Operations Radiology Radiology 116

Sensible Medicine

DECEMBER 11, 2023

This is a picture I made in 2012. Standard meaning the operators spent time checking to make sure the vein was isolated. Current thinking holds that the way to ablate AF is to electrically isolate the muscle bundles going in and out of the pulmonary veins. Think of it as building an electric fence around the pulmonary veins.

Operations 115

Operations Hospitals 115

Don't Forget the Bubbles

JANUARY 17, 2024

Mirza and Sheikh reported perhaps the first unfortunate case in 2012. They passed away a few days after a second operation. In 2012, one brand of SAP beads – Water Balz – was recalled by the U.S. 2012 Jan;3(1):6. A six-month-old infant presented with sub-acute obstruction and needed an enterostomy.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Mind The Bleep

SEPTEMBER 14, 2024

Operative management: Surgical washout of the flexor sheath within 24 hours of the decision to operate. Non-operative management: An experienced hand surgeon should make the decision for non-operative management. Non-operative management: An experienced hand surgeon should make the decision for non-operative management.

Operations 52

Operations Sepsis Documentation/Coding 52

ALiEM

SEPTEMBER 13, 2024

An emergent ophthalmology consult is needed to plan for operative repair. 2012 Feb;26(2):212-7. Tonometry and ocular ultrasound (US) are generally not recommended as you could squeeze more liquid out of the eye or increase the intraocular pressure even more, pushing the iris further out. American Academy of Ophthalmology. Eye (Lond).

Emergency Department 64

Emergency Department Academics Fractures Hospitals 64

EMDocs

SEPTEMBER 7, 2024

In this patient with a penetrating posterior flank injury, trace-free fluid in the pelvis on eFAST, and ongoing signs of hemorrhagic shock despite fluid and blood product administration, transferring to the operating room for exploration is indicated, especially with high probability of zone III injury-related retroperitoneal bleeding.

EMS 93

EMS Fluid Resuscitation Resuscitation Radiology 93

RebelEM

APRIL 29, 2024

One may speculate that the US-guided CVC placement would have a higher first-pass success rate with fewer complications, however, this may potentially add time to the procedure depending on the operator and institution’s use of ultrasound during emergencies and maintaining sterile technique with the US probe. 2012 PMID: 21893125.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Resus Review

SEPTEMBER 28, 2015

Inappropriate delay of establishing a surgical definitive airway with a cricothyrotomy has been documented in field and hospital operations 1,2. J Spec Oper Med. 2012; 12:17. This can be attributed to many factors including: Failure to recognize Can’t Intubate-Can’t Ventilate scenario. Cook T, Woodall N, Frerk C.

Operations 52

Operations Documentation/Coding Hospitals 52

Cook County EM Blog

APRIL 7, 2022

Treatment can be achieved non-operatively if only the posterior ligaments of the tibiofibular syndesmosis are partially damaged. Otherwise, most cases require operative repair. Epub 2012 Oct 15. Additionally, repair of the deltoid ligament and distal tibiofibular syndesmosis aims to restore ankle mortise stability. J Emerg Med.

Fractures 52

Fractures Operations Hospitals 52

RebelEM

NOVEMBER 30, 2022

Pediatric Emer Care 2012; 28: 80-6. Epidemiology: Most common cause of acute scrotal pain in prepubertal boys Torsion present in 3.2% OR = 58.8 (Ben-Israel Physical exam, history and imaging all have significant limitations. 10, (-) LR = 0.13 A 25-year review of the acute scrotum in children. S Afr Med J. 1997;87(12) 1696-8.

Ultrasounds 52

Ultrasounds Pediatrics Operations EMS 52

The Skeptics' Guide to EM

DECEMBER 12, 2020

Way back in 2012 we looked at packing after incision and drainage (I&D) on SGEM#13 and concluded routine packing might not be necessary. When you ask your nursing colleague to set up the equipment, he wants to know if you will be using standard packing or a vessel loop drainage technique.

Operations 52

Operations Outcomes Research Academics 52

Don't Forget the Bubbles

APRIL 22, 2024

Occasionally, lacrimal probing does not work, and an operation is needed. 2012 Apr;14:137-46. After applying a topical anaesthetic, a small probe is inserted into the lower punctum of the lacrimal canal to relieve the obstruction. This might be balloon dacryoplasty, stenting, or dacryocystorhinostomy (DCR). 2021 Feb 15;37(5):482-7.

Infectious Diseases 85

Infectious Diseases Sepsis Pediatrics Operations 85

PHEM Cast

DECEMBER 1, 2017

Journal of Special Operations Medicine : a Peer Reviewed Journal for SOF Medical Professionals , 13 (4), 53–58. [link] Harcke, H. L., & Mazuchowski, E. Needle thoracentesis decompression: observations from postmortem computed tomography and autopsy. Branco, B. Eckstein, M., Martin, M. link] Inaba, K., McClure, K., Branco, B. Eckstein, M.,

Academics 52

Academics Radiology Radiology Resuscitation 52

EMDocs

DECEMBER 11, 2023

In addition to a posterior ECG, the ACC’s new recommendations emphasize consideration of an emergent TTE, though lack clarity in defining who should be the operator, stating “a clinician qualified in echocardiography” is necessary, without providing specific definitions. 2012 Dec;60(6):766-76. Ann Emerg Med. N Engl J Med.

EKG/ECG 119

EKG/ECG Emergency Department Academics Operations 119

Advanced Medical Reviews

SEPTEMBER 15, 2017

In 2012, they represented 2 percent of all primary care visits, and they are currently key catalysts of the broad move toward value-based care. Responding to millennial influence on healthcare technology and operations.

Operations 56

Operations Research Wellness Hospitals 56

EMDocs

FEBRUARY 7, 2024

3 Increasing Strikes and Unions Labor actions in healthcare can disrupt normal hospital operations, potentially impacting costs and threatening patient quality of care. 2012 Feb 1;4(1):127-57. Despite a plateau in overall union membership of around 10% in 2023 1 , major labor actions shook the U.S. 5 January 2023. Gruber J, Kleiner SA.

Hospitals 95

Hospitals Research Patient Safety Wellness 95

ACEP Now

MARCH 13, 2024

Unfortunately, many tertiary hospitals routinely operate at censuses of greater than 100 percent capacity, due to factors including insufficient acute care bed capacity, a shortage of nursing care, and misaligned incentive structures for health care more generally. 2012): 2470-2478. Click to enlarge. J Natl Med Assoc. 2015):157-165.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

mEq/L for Mg++ ) — given that ECF levels of these cations comprise only ~1-2% of total body stores ( Jahnen-Dechent and Ketteler — Clin Kidney J 5(Suppl 1):i3-i14, 2012 — and — Udensi and Tchounwou — Int J Clin Exp Physiol 4(3): 111-122, 2017 ). mEq/L for K+ and 1.76 Nossen — results of genetic testing for LQTS are pending.

Seizures 114

Seizures EKG/ECG EMS Stroke 114

The Skeptics' Guide to EM

JUNE 4, 2017

A systematic review by the authors of the present study confirmed a possible benefit of the pan scan, but it showed a need for a well-designed, large, prospective randomized clinical trial with patient oriented outcomes ( Sierink et al 2012 ). Reference: Sierink et al.

Radiology 52

Radiology Radiology CPR Hospitals 52

PHEM Cast

JULY 6, 2017

Cricothyrotomy performed with the Melker set or the QuickTrach kit: procedure times, learning curves and operators’ preference. and Gay, D. 2017), The height of the cricothyroid membrane on computed tomography scans in trauma patients. Anaesthesia. doi:10.1111/anae.13905 13905 Aslani, A., McCarthy, K. McNicholas, M., & McCaul, C.

Airway Management 52

Airway Management Academics Operations Resuscitation 52

Don't Forget the Bubbles

OCTOBER 10, 2024

Ten thousand children in the UK are operated on a year for fingertip injuries, and 96% of surgeons currently report replacing the nail plate intra-operatively. 2012 Aug 15;(8):CD004872. Fingertips are the most common site of injury in children’s hands , accounting for more than two-thirds of paediatric hand trauma.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

Downeast Emergency Medicine

FEBRUARY 9, 2022

He had an operative repair of his patellar fracture 10 days after his initial visit. 8, Elsevier Inc, 2012, pp. Credits: Andrew fried, md His left (normal) knee is shown below: Labeled combined still frames of the above ultrasound pointing out landmarks That should BE noted on every knee ultrasound. Roentgenol.

Ultrasounds 52

Ultrasounds Fractures Operations Emergency Department 52

Mind The Bleep

OCTOBER 22, 2024

Cardiology applications typically open around November, and since 2012, there has been no Round 2 for Cardiology. There are often outpatient echo lists to scan a variety of patients from a range of specialities; from pre-operative patients, pre-chemotherapy patients to chronic cardiology conditions. When and where to apply?

Evidence-Based Practice 52

Evidence-Based Practice Academics Operations Hospitals 52

Pediatric Emergency Playbook

JUNE 1, 2017

The Systemic Lupus International Collaborating Clinics (SLICC) revised the criteria in 2012. Fontan Operation and the Single Ventricle. 2012; AID 471759. 2012; 7:19796. Blog Post] July 22, 2012. 2012; 59(13):1123-1133. The patient should have ≥4/17 clinical and/or immunologic criteria. Congenit Heart Dis.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Advanced Emergency Nursing from AENJ

JULY 9, 2015

They may be entrapped; have limited access; may be midway in an operating position that can’t be changed; may need to be sitting due to pulmonary edema, morbid obesity, aspiration prevention or for awake intubation. Video] Oct 30, 2012. Pediatric Airway: brief intro for trauma providers} [Video] May 21, 2012. Nickson, Chris.

Airway Management 40

Airway Management Pediatrics Resuscitation Emergency Nursing 40

Advanced Emergency Nursing from AENJ

NOVEMBER 20, 2014

8, 2012 12:12 a.m. ET Hostile Fire Environments Murphy’s Law of Combat Operations [includes coarse military humor] Firearms in the Entertainment Industry International Movie Firearms Database Horman, GS. Spinal Cord (2014) 52, 504–510; doi:10.1038/sc.2014.56; By John Fund.

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Farrington] Rebuilding of outdated hospitals put emergency rooms on ground level with nearby X-ray service, and, ideally, sometimes closer to the Blood Bank and the Operating Rooms. We applied to "The Golden Hour" the attitudes and abilities that led to a man on the moon. Prehospital Emergency Care, 4(4), 285-289. Touchstone, Mike.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Don't Forget the Bubbles

MARCH 11, 2024

Craniosynostosis needs urgent referral and is usually corrected operatively before a child’s first birthday. Craniosynostosis can lead to raised intracranial pressure and failure to thrive. and can worsen and become harder to correct over time. This can lead to intracranial hypertension and neurodevelopmental delay. link] Wilbrand, J.-F.,

Radiology 59

Radiology Radiology Pediatrics Documentation/Coding 59

Northwestern EM Blog

MAY 16, 2022

Follow up CT should depend on the patient and ultrasound operator. Lastly the POCUS operators were ED physicians with training “recommended by ACEP.” In this study, 40.7% of those in the POCUS group and 27% in the formal ultrasound group underwent subsequent CT. Kidney international , 83 (3), 479-486. Coursey, C. Casalino, D.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Don't Forget the Bubbles

JULY 26, 2023

Cardiac testing and outcomes in infants after an ALTE, Hoki et al, Archives of Disease in Childhood 2012 showed significant cardiac disease was present in <1% of patients presenting with ALTE (although cardiac abnormalities were found in 4% overall). The only clinical predictor of cardiac disease was prematurity.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

ETM Course

MAY 3, 2017

Simple windlass-style tourniquets are relatively inexpensive, easy to apply and easy to operate. Ft Detrick, Maryland: Borden Institute; 2012. Studies comparing different commercially available tourniquets have produced mixed results so no single device can be recommended over another. References: Kragh J, Kirby J, Ficke J.

Military 52

Military Shock Hospitals Operations 52

Taming the SRU

FEBRUARY 19, 2024

Failure rates An ambispective, observational cohort study from 2012 - 2016 found that femoral arterial lines fail significantly less often than radial arterial lines with an absolute risk reduction of line failure of 20%. Higher doses of vasopressors subsequently leads to even less correlation between central and peripheral measurements (11).

Shock 59

Shock Resuscitation Ultrasounds Research 59

Taming the SRU

AUGUST 30, 2023

This finding was not significantly different among operators with different levels of experience, or between adults and children. Raised inflammatory markers BMJ 2012; 344 :e454 doi:10.1136/bmj.e454 Gabay C, Kushner I. 2012 Jul 23;2(1):32. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

EB Medicine

MARCH 1, 2019

In one RCT, the FAST exam reduced the time from arrival in the ED to operative care by 64% in the setting of trauma. Nachi: This is all well and good, and certainly accurate, but let’s not forget that hemodynamically unstable trauma patients, like those with myocardial rupture, need to be in the operating room, not the CT scanner.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Taming the SRU

MARCH 14, 2023

Ultimately, definitive management is in the operating room with revision or replacement of the VP shunt. Unfortunately, maneuvers to relieve a proximal occlusion in the emergency department are limited. Lumbar puncture is an option with limited data for success. Neuroradiology. 2008) Shprecher, Schwalb, Kurlan. Curr Neurol Neurosci Rep.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52