PEMBlog

APRIL 24, 2024

Retrospective use has been shown to be valid and reliable in one cross-sectional study ( Beslow 2012 ).This

Stroke 59

Stroke Pediatrics Blood Transfusions Radiology 59

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. 2012) “Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue”. 2012) “Implementation of a Rapid Post-Code Debrief Quality Improvement Project in a Community Emergency Department Setting”. Newell, J. &

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

EMDocs

AUGUST 22, 2024

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. 15 Ensuring bilingual providers are tested and credentialed. Lion KC, et al. Pediatrics.

Documentation/Coding 81

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

Don't Forget the Bubbles

AUGUST 9, 2023

There is no pain or discharge, no lymphadenopathy, and she is otherwise well. 2012 Aug;97(8):2732-40. Epub 2012 Jun 20. Her parents first noticed it when she was two years old, and since then, it has gradually been increasing in size. It is soft, cystic, and not tender. It moves on swallowing, and when she sticks out her tongue.

Ultrasounds 98

Ultrasounds Pediatrics Wellness 98

ALiEM

SEPTEMBER 27, 2023

What well-known adverse reaction results from ingestion of the pictured mushroom? Disulfiram-like reaction with ethanol consumption Coprinus atramentarius or Ink Cap mushroom is well known to cause a disulfiram-like reaction when it is consumed prior to ethanol. 2012 Jul;64(3):520-39. Koppaka V, Thompson DC, Chen Y, et al.

Seizures 67

Seizures Academics Wellness 67

Downeast Emergency Medicine

JUNE 7, 2021

Use a tourniquet when you LOOK for the vein as well as when you place the IV otherwise the pressure from the probe will compress the veins and you won’t find anything. 2012 Sep;30(7):1134-40 References Fields JM et al. 2012 Sep;30(7):1134-40. Consider the use of lidocaine if a patient has has repeated attempts at IV placement.

Ultrasounds 52

Ultrasounds Wellness 52

ALiEM

OCTOBER 20, 2023

Raised reddish-brown well-demarcated plaques with waxy centers were also noted on the dorsal forearms and hands. 2012 Jul;16(4):614-20. Additional Images Physical Exam Vitals : T 37.2°C; Laboratory Data Glucose : 539 (with a normal anion gap) Hemoglobin A1C : 10.9 Available from: [link] PMID:29083569. Indian J Endocrinol Metab.

Academics 64

Academics Emergency Department Wellness Research 64

ALiEM

AUGUST 14, 2023

Treatment is appropriate antibiotics and improved foley hygiene, foley exchange as well as improved bowel regimen to increase stool transit time. 2012 Dec;13(6):499-500. It is predominantly found in women, chronically catheterized, institutionalized, and constipated patients. References Meekins Pauline, Ramsay Amy, Ramsay Michael.

Academics 52

Academics Wellness Infectious Diseases 52

Don't Forget the Bubbles

JANUARY 17, 2024

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. 2012 Jan;3(1):6. From Mullens et al., Krisch et al. Mirza B, Sheikh A.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

PulmCCM

JUNE 26, 2023

Cervical and pancreatic cancer patients often do as well with less invasive surgery, and some patients with rectal cancer or Hodgkin lymphoma can safely get less radiation. An expert panel broadened the definition of acute respiratory distress syndrome (ARDS). They announced this at the American Thoracic Society meeting in May 2023.

Outcomes 98

Outcomes Ultrasounds Hospitals Wellness 98

Sensible Medicine

JULY 31, 2024

They slept well and thrived. The campaign was rebranded “Safe to Sleep” in 2012, to reflect the emphasis on more than just sleep position. I vividly remember whisper-sobbing: please don’t die. When our first grandchild arrived, her parents and I dutifully put her on her back.

Research 99

Research Pediatrics Outcomes Wellness 99

The Skeptics' Guide to EM

JUNE 2, 2021

We have discussed Choosing Wisely before on SGEM Episodes: * SGEM#15: Choosing Wisely * SGEM Xtra: CAEP Choosing Wisely * SGEM Xtra: Right, You’re Bloody Well Right, You’ve got the Bloody Right to Care Choosing Wisely Canada ( CWC ): It is the national voice for reducing unnecessary tests and treatments in health care.

Documentation/Coding 52

Documentation/Coding Hospitals Wellness 52

ACEP Now

FEBRUARY 13, 2024

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. J Gen Intern Med. 2016 May;31(5):478-85. Goodwin J. American Journal of Medicine. 2016;129(2):221.e21–221.e30.

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Wellness 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 94

Emergency Department Resuscitation COPD Shock 94

EMDocs

FEBRUARY 7, 2024

Unionization of healthcare providers can create opportunities to improve staff’s financial and general well-being, but may also facilitate future strikes. Trainees and attending providers should be informed about both the opportunities that come with unionization, as well as the challenges that come with managing strikes.

Hospitals 76

Hospitals Research Wellness Patient Safety 76

PHEM Cast

FEBRUARY 25, 2021

In the UK sea water is very unlikely to be icy or cold enough – however, small areas of water may well be, particularly in the winter months. References Szpilman D, Bierens JJ, Handley AJ, Orlowski JP (2012) Drowning. Water temperature is a key determinant: icy versus not. New Engl J Med. 366: 2102–10. Tipton & Golden (2011).

Resuscitation 52

Resuscitation Hospitals Outcomes Wellness 52

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. 2012 Feb;33(1):46-54. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood right in front of you. EM:RAP HD Videos.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

Northwestern EM Blog

SEPTEMBER 26, 2022

It is well-documented that ED physicians have historically high rates of burnout compared to other specialties as well as a high incidence of post-traumatic stress disorder (PTSD) compared to the general population. PTSD is 2 times more prevalent in physicians (14.8%), with EM resident physicians falling in the range from 11.9%-21.5%.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

Pediatric Education

MAY 19, 2024

Patient Presentation A 5-day-old male came to clinic for his well-examination. He was breastfeeding, stooling, and urinating well, and had no concerns for jaundice. doi:10.1136/bjophthalmol-2012-302539 Callaway NF, Ludwig CA, Blumenkranz MS, Jones JM, Fredrick DR, Moshfeghi DM. Li LH, Li N, Zhao JY, et al. Br J Ophthalmol.

Pediatrics 40

Pediatrics Wellness Hospitals 40

EMDocs

JULY 25, 2024

Do them well and document the process, preferably at the bedside. Oct 04, 2012. Assure and document the patient’s resources and safety net if discharged. If PA-C’s are allowed to care for suicidal patients, their privileges should so specify. Handoffs are a high-risk exchange. Applebaum PS. N Eng J Med 2007;357:1834-40 3.

Documentation/Coding 81

Documentation/Coding Hospitals Patient Safety Emergency Department 81

Don't Forget the Bubbles

DECEMBER 11, 2023

Naturally, it can seem obvious to us now that abuse and trauma in childhood can affect your health and well-being quite significantly, but what was surprising at the time was not just that these events had an impact but how much of an impact these adverse childhood events had. Could there be an element of causation as well as correlation?

Wellness 103

Wellness Research Outcomes Shock 103

Taming the SRU

JULY 21, 2023

Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. Corneal ulcers are most frequently caused by Pseudomonas (especially if they wear contact lens), as well as S. They report blurred vision as well as photophobia and redness / watery discharge of the eye. October 2012 revision.

Emergency Department 81

Emergency Department EMS Burns Wellness 81

PEMBlog

APRIL 26, 2023

Kit Carney and Dr. Kristen Humphrey discuss gun violence, its impact on our patients and their families, as well as practical tips on advocating for safe storage of firearms, and how we can support victims of violence. Pediatrics November 2012; 130 (5): e1416–e1423. 2012-2481 Haasz, M., Melzer-Lange, Joseph O’Neil, Wendy J.

Pediatrics 52

Pediatrics Wellness Poisoning Research 52

The Skeptics' Guide to EM

AUGUST 17, 2019

Attempting to decrease a patient’s pain to zero is certainly well-intentioned but you have to ask yourself how many patients are being harmed by such a goal? Pain 2012). ACEP has a clinical policy regarding prescribing of opioids for adult ED patients that was published in 2012 ( Cantrill et al ). Volkow et al. JAMA 2011).

Emergency Department 52

Emergency Department Academics Fractures Outcomes 52

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. 2012 PMID: 21893125. Resuscitation. 9 Zhang W et al. Medicine (Baltimore).

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

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. 2012; 60(5): 545-553. Medical Interpreting According to the U.S. Census Bureau, 60.6 million Americans (approximately 20.8

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

EMDocs

NOVEMBER 7, 2023

Antibiotics are recommended for those with complicated diverticulitis, as well as surgical specialist consult if necessary (e.g., 2012 Apr;99(4):532-9. 2012 Apr;99(4):532-9. perforation). Randomized Controlled Trials: The AVOD trial: Chabok A, Påhlman L, Hjern F, Haapaniemi S, Smedh K; AVOD Study Group. Randomized  Br J Surg.

Sepsis 88

Sepsis Best Practices Hospitals Outcomes 88

ACEP Now

JULY 7, 2023

The article also will not address severe agitation, which is already well covered elsewhere and is the topic of an ACEP clinical policy currently in development. 2012 Feb;13(1):17-25. 2012 Feb;13(1):26-34. This article focuses on calming medication in patients with mild to moderate agitation. West J Emerg Med. J Emerg Med.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

Taming the SRU

FEBRUARY 5, 2024

Several definitions have been set forth for this common injury, with perhaps the most well accepted definition being introduced by the Centers for Disease Control and World Health Organization. The history should focus on both the events surrounding the traumatic event, as well as current symptomatology. 2012 Jan 15;85(2):123-32.

Head Injuries 59

Head Injuries Emergency Department Seizures Pediatrics 59

PHEM Cast

MARCH 17, 2016

Taken from Weingart & Levitan 2012. 2012; 59(3): 165-175. Annals of Emergency Medicine. 2015; 65(4): 371-376. Weingart SD, Levitan RM. Preoxygenation and Prevention of Desaturation During Emergency Airway Management. Annals of Emergency Medicine. Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS.

Airway Management 52

Airway Management Burns Emergency Department Resuscitation 52

ACEP Now

MARCH 13, 2024

Consequences of this are well documented and include delayed treatment, exposure to error, increased length of stay, and increased mortality. 2012): 2470-2478. Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. J Natl Med Assoc.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

Taming the SRU

MARCH 31, 2023

Charon, Academic Med 2012) embracing fear in emergency medicine WITH dr. arlene chung What is fear? Narratives trigger changes of many kinds in both the teller and the listener, yielding meanings that are reciprocally produced by each teller-listener dyad.”

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

Well, don't we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)? 109 (20):361-368, 2012 — CLICK HERE ). But it is very distinct from hyperkalemia (and anything else, including VT), and such confusion can only be due to lack of familiarity, because, if you look closely, its morpholgoy is very different from anything else.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

The Skeptics' Guide to EM

OCTOBER 3, 2020

NEJM July 2020 Case: A 65-year-old man with a history of well controlled hypertension presents to the emergency department and is diagnosed with a mild stroke (NIHSS score 3). The effect of the combination of ticagrelor and aspirin on prevention of stroke has not been well studied. Reference: Claiborne Johnston S et al.

Stroke 40

Stroke Emergency Department Research Wellness 40

RebelEM

JULY 20, 2023

This can be plotted as a Forgetting Curve (Figure 2), the slope of which depends on many things – the quality of the teacher, if stress is included in the training, if you’re well fed, have good sleep, etc. This is the idea of learning something so well you bring yourself well above the line of competence.

EMS 71

EMS Burns Airway Management Wellness 71

Advanced Medical Reviews

SEPTEMBER 15, 2017

Especially since millennial satisfaction with the healthcare system is lower – only 32 percent report being treated well , according to an Accenture survey – than it is for preceding generations. Access to personalized recommendations, as well as public reviews, is a defining feature of the current media landscape.

Operations 56

Operations Research Wellness Hospitals 56

EMDocs

JULY 3, 2023

All patients with concern for SAH need a rapid primary survey to assess the airway, breathing, and circulation as well as a comprehensive neurologic exam to create a baseline for the patient. 27 Prudent transfer of patients to a center with neurosurgical capabilities should be considered in any SAH, though this is not well studied.

Seizures 85

Seizures Stroke Outcomes EMS 85