Taming the SRU

MAY 22, 2023

Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. weight-bearing status, operative vs. non-operative) If necessary/helpful to ensure adequate follow-up At time of discharge: Counsel on expected course of injury, supportive care (e.g., 2014 May;4(3):432-5.

Fractures 76

Fractures Dislocations Operations Radiology 76

Taming the SRU

MAY 23, 2023

BACKGROUND Foot injuries are common and can have significant implications for a patient’s well-being, functional capacity, and finances. Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. 2014 May;4(3):432-5. 2014 May;4(3):432-5. Ann Med Health Sci Res.

Fractures 57

Fractures Dislocations Operations EMS 57

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

Don't Forget the Bubbles

MAY 24, 2023

Crouzon syndrome, Pierre-Robin sequence, Down syndrome, Beckwith-Wiedemann syndrome) I njuries to the face, mandible, pharynx, or neck S leeping issues such as snoring due to adenotonsillar hypertrophy It’s essential to have a well-planned approach to managing the difficult airway. 2014 Jan;42(1):169–78 Krishna SG, Bryant JF, Tobias JD.

Airway Management 98

Airway Management Teamwork Pediatrics Emergency Department 98

Don't Forget the Bubbles

JUNE 17, 2024

Loss of psychological safety and mental well-being persist long after the episode and can impact future episodes of care. 2014 Jun 26;23(12):653-9. Exposure to incivility hinders clinical performance in a simulated operative crisis. The lasting effects of incivility cannot be understated. The Fearless Organization.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

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

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Although told several times, the story of the development by Henning Ruben of the prototypical modern manual resuscitator, the self-refilling bag with unidirectional non-rebreathing valves which now dominate the world of resuscitation, is still not well-known. What were its recent antecedents? What further developments occurred?

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). PLoS One 2014; 9(11): e112779. Resuscitation 2013; 84(11): 1500 – 4. PMID: 23911630 Kim WY et al. Chest 2000; 117(1): 260 – 7.

Emergency Department 66

Emergency Department Soft Tissue Injuries Airway Management Operations 66

ALiEM

MAY 13, 2024

They may be well-circumscribed or may have irregular borders. Well-circumscribed abscess with heterogeneous debris C. Larger abscess with well-circumscribed borders D. Superficial abscess with well-circumscribed borders Table 1. 2014 Feb;15(1):111-3. The rim may be echogenic or blend in with surrounding tissue.

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

Dr. Smith's ECG Blog

DECEMBER 16, 2024

The accuracy of bedside Echo is clearly a function of operator skill and experience and at times it may be difficult to exclude the possibility of WMA ( W all M otion A bnormality ) from bedside Echo alone. And this patient's initial ECG ( that I've reproduced and labeled in Figure-1 ) shows some interesting findings ( See below ).

Ultrasounds 86

Ultrasounds EKG/ECG Operations Emergency Department 86

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. Erratum in Mouth-to-Airway [adjunct] 4/22/2014. Reviewed and revised 4 December 2014. 1950s & 1960s Resuscitation Research. Nickson, Chris.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Advanced Emergency Nursing from AENJ

NOVEMBER 20, 2014

If you think your patient is the perpetrator, he may well be an innocent, or even an off-duty or undercover officer. Spinal Cord (2014) 52, 504–510; doi:10.1038/sc.2014.56; New CPRC Report: Errors in Bloomberg’s latest report on Mass Shootings October 2, 2014 Crime Prevention Research Center Lott, John R., de Barros Filho, T.

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

Greater Sydney Area HEMS

APRIL 26, 2023

Both the stuff of legend and go by multiple names including harness hang syndrome and orthostatic intolerance, as well as bigfoot and the abominable snowman, respectively. Although remember, as is observed intra-operatively from tourniquet application, muscle can tolerate hours of hypoxia. I thought you’d never ask. That’s it?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

Advanced Emergency Nursing from AENJ

MAY 27, 2014

Henderson , it would seem, was an enthusiast, well-convinced of his opinions, with missionary zeal, who would firmly argue his positions and tirelessly campaign them. Accessed May 17, 2014. The Therapeutic Use of Carbon Dioxid After Anesthesia and Operation. Accessed May 17, 2014. Accessed May 17, 2014.

Resuscitation 40

Resuscitation Poisoning Research Administration 40

Don't Forget the Bubbles

MARCH 11, 2024

There are many causes, and it is less well understood than plagiocephaly. Craniosynostosis needs urgent referral and is usually corrected operatively before a child’s first birthday. Craniosynostosis Craniosynostosis is rare. It is due to the premature closure of the sutures rather than positional changes to an otherwise normal skull.

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.” This is a great summary of the landmark randomized trial published in NEJM in 2014 assessing CT vs two types of US for patients with suspected renal colic in the ED setting.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Don't Forget the Bubbles

SEPTEMBER 23, 2023

The New South Wales Doctors Orchestra ‘Musicus Medicus’ – 2014 An orchestra is a complex system with many moving parts. There is leadership operating at many levels. Just like a hospital, or a health system, an orchestra needs every player doing their thing and doing it well. It’s a bit like the health system.

Leadership 136

Leadership Teamwork Hospitals Emergency Department 136

Pediatric Emergency Playbook

MARCH 1, 2016

Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. Often children even with high-grade splenic and liver lacerations can be managed non-operatively. 2014 Apr;63(4):460-2. 2014 Aug;49(8):1295-9. In children, this is simply not the case.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Mind The Bleep

SEPTEMBER 17, 2024

Management The management is guided by the examination findings which are covered in the respective chapter, this section will delve into the importance of a number of those steps, as well as further long-term care. Regular medications. Always consider management as per ATLS protocol and SEPSIS 6 if relevant. Lewis, K., & Pay, J.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

Pediatric Emergency Playbook

JANUARY 1, 2017

Tachycardia, tachypnea, and a change in behavior can be indicators not only to the presence of pain, but possibly to its etiology as well. Neonatal observational scales have been validated in the intensive care and post-operative settings; ED-specific quantitative scales are lacking. They do not understand rational or logical thinking.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Jeff: A 2014 study even showed an up to 80% reduction in the likelihood of developing DM2 postoperatively at the 7-year mark. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. While it was < 15% in 1990, by 2016 it reached 40%.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

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. Flexibility of mind and skill bodes well. Wiget, Urs & Torres, Eric. Video] Sep 15, 2014. YouTube.com.

Airway Management 40

Airway Management Pediatrics Resuscitation Emergency Nursing 40

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Afro-Caribbean patients should be screened for sickle cell before anaesthesia for possible pre-operative transfusion. 2014; 349–356. Macharia AW et al.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Advanced Emergency Nursing from AENJ

APRIL 8, 2014

The idea of placing one's mouth on the mouth of an apparently dead victim, particularly where the mouth may be covered with foam, mucus or blood, as often the case in asphyxia victims, as well as the fear of possible transmittal of disease is revolting to the average person and is difficult to overcome." Bauer, Robert O. Sands Jr, R.

Resuscitation 40

Resuscitation Ambulance Services Research Military 40

Advanced Emergency Nursing from AENJ

SEPTEMBER 4, 2014

It wrongly frightened some medical personnel as it was operated by a 50 psi wall source or from a step-down regulator from a tank (some thought the patient received wall 50 psi or 1500 psig from the tank directly to the lung. It was extremely well-liked by field personnel, but virtually unknown in hospitals. Grainge, C.

Resuscitation 40

Resuscitation CPR Documentation/Coding Military 40

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. This finding was not significantly different among operators with different levels of experience, or between adults and children. Epub 2014 Dec 3. Epub 2014 Oct 27. Int J Rheum Dis. 2015 Mar;18(3):352-9. doi: 10.1111/1756-185X.12496.

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

Pediatric Emergency Playbook

FEBRUARY 1, 2016

Protocols work well for adults, but trauma in children requires that we exercise our clinical muscles just a bit more. REBOA If you have access to resuscitative endovascular balloon occlusion of the aorta or REBOA, this may be an option to temporize the child to get him to the relative control of the operating room. Pediatrics.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Pediatric Education

NOVEMBER 12, 2023

weeks was seen for well-care. Pierre-Robin Sequence) and post-operative congenital heart disease. 2014-3527 Davis NL, Shah N. Patient Presentation A former 35 week, appropriate for gestational age male, now 37.5 neuromuscular problems, Down syndrome), micrognathia (e.g. Pediatrics. 2009;123(5):1424-1429. doi:10.1542/peds.2009-0559

Pediatrics 40

Pediatrics Poisoning Hospitals Documentation/Coding 40

PEMBlog

JUNE 5, 2024

2014 May;133(5):e1179-88. Infants can get a cervical spine injury during breech delivery or, unfortunately, during non accidental trauma as well. That’s a spine or neurosurgery operation. Hopefully they will find it helpful as well. Cervical spine injury patterns in children. Pediatrics. doi: 10.1542/peds.2013-3505.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

Pediatric Emergency Playbook

APRIL 1, 2017

Neodymium magnet toys (“buckyballs”) were recalled in 2014 (but are still out there!) Steady the operating hand by placing your hypothenar eminence on the child’s zygoma or temporal scalp, to avoid jutting the instrument into the ear canal with sudden movement. Not all magnets are created equal. due to their highly attractive nature.

Pediatrics 52

Pediatrics CPR Operations Resuscitation 52

EMDocs

OCTOBER 23, 2023

She had been feeling well until yesterday when she had a follow-up with her surgeon, at which time she reported that they performed an internal exam and inserted a ‘medication disk’ into her vagina. The patient is noted to be mildly tachycardic as well as febrile. difficile infection, and post-operative hemorrhage.

OB/GYN 67

OB/GYN Operations EMS Ultrasounds 67

Advanced Emergency Nursing from AENJ

MAY 27, 2015

If mere criminality was the only matter, there’s some cash, personal electronics, appliances, and business machines; if not merely criminal, and well-studied beforehand, there are to be had radioactive materials, drugs, toxins, chemicals, and many who would pay a ransom for the loved ones within. Los Angeles Times, March 5, 2014.

Federal Emergency Management Agency 40

Federal Emergency Management Agency Military Hospitals Administration 40

Don't Forget the Bubbles

MAY 3, 2023

There was no difference between the low-dose and high-dose insulin infusion groups regarding the time to resolution of hyperglycaemia, time to resolution of acidosis as well as the rate of blood glucose change. Because of the retrospective nature of the study, the decision to use the bougie was operator-dependent. Low-dose ( 0.05

CPR 52

CPR Airway Management Emergency Department Resuscitation 52

Don't Forget the Bubbles

SEPTEMBER 23, 2024

suprapubic catheters, gastrostomy tubes, haemodialysis or peritoneal dialysis lines – may have been left in situ in the initial post-operative period), and central vascular catheters. Look for scars indicating previous central lines, peritoneal dialysis catheters or operations. If in doubt, ask. CAKUT, catheterization requirement).

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

Advanced Emergency Nursing from AENJ

FEBRUARY 27, 2015

There are increasingly many writings upon the health of our Presidents either factual or speculative, and even in contention whether the office is inherently detrimental to wellness and longevity of its occupants. February 16, 2014. December 14, 2014. December 15, 2014. Franklin D. DuPont, Drew, MD, MSPH. "Illness

Stroke 40

Stroke COPD Emergency Nursing Sepsis 40

EMDocs

DECEMBER 18, 2023

When analyzing the receiver operating characteristic (ROC) curve of the pooled data, optimal diagnostic accuracy of MDW for sepsis prediction was seen (pooled sensitivity of 0.838 and specificity of 0.704 for Sepsis-3 criteria). Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009–2014.

Sepsis 65

Sepsis Fluid Resuscitation Resuscitation Shock 65