ACEP Now

MARCH 13, 2024

Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. 1 Hospital boarding is the main driver of ED crowding, with patients nearly always awaiting transfer to inpatient beds and now more commonly, to other hospitals.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

Downeast Emergency Medicine

DECEMBER 1, 2021

While the ongoing COVID-19 pandemic has contributed to overdose deaths and taxed constrained Emergency Department (ED) resources, it has also clarified the important role that emergency physicians have in expanding access to life-saving medications to treat opioid use disorder. 2015; 313(16):1636-1644.[ D’Onofrio, et al.

Emergency Department 52

Emergency Department Documentation/Coding Leadership Administration 52

Don't Forget the Bubbles

AUGUST 19, 2024

Sione, a young Pacific Islander boy, is brought to the emergency department with a 3-day history of acute onset, progressively worsening central chest pain. of child emergency department presentations. References Children’s Health Queensland Hospital and Health Service. 2015 Apr;34(4):e92-e101. Sept 5, 2022.

Infectious Diseases 104

Infectious Diseases Pediatrics Emergency Department Hospitals 104

ALiEM

OCTOBER 30, 2024

Bupe Allergy Buprenorphine induction has been the mainstay of emergency department treatment of opioid use disorder for more than a decade [11, 12]. Emergency department-initiated buprenorphine for opioid dependence with continuation in primary care: outcomes during and after intervention. 2015 Apr 28;313(16):1636-44.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

RebelEM

APRIL 29, 2024

In these situations, the American Heart Association (AHA) and the European Resuscitation Council (ERC) of 2015 recommend the intraosseous (IO) route after the peripheral route and before the central venous route ( 1). Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Don't Forget the Bubbles

SEPTEMBER 30, 2024

In the UK, as in most developed countries, more patients are presenting to Emergency Departments (EDs) with minor illnesses or injuries. examined 977,907 first-time ED presentations by children aged 0-15 across thirteen acute hospital trusts (between April 2014 and March 2017), trying to figure out how many were non-urgent.

Emergency Department 89

Emergency Department Research Pediatrics Hospitals 89

RebelEM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

Northwestern EM Blog

MARCH 1, 2025

While a randomized control trial should be done to evaluate the effect of early proning in a controlled environment, these studies suggest that we should consider using this in our Emergency Department for patients who present with hypoxia and concern for mild to moderate ARDS without urgent need for intubation. Crit Care Med.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

Taming the SRU

JULY 2, 2023

End-Tidal CO2 monitoring has a variety of uses in the Emergency Department. The Glories of End Tidal CO2 EtCO2 vs Standard Triage Vitals for Predicting In-Hospital Mortality References Long, Brit, Alex Koyfman, and Michael A. Capnography in the emergency department: a review of uses, waveforms, and limitations."

Emergency Department 88

Emergency Department Pediatrics CPR Resuscitation 88

Don't Forget the Bubbles

MARCH 19, 2024

This has coincided with a widespread shortage of specialist placements for children facing behavioural, psychiatric, and child protection challenges, leading to an over-reliance on the placement of these children in hospitals. A paediatric social admission is one where a child is admitted to the hospital but not for a medical reason.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

Don't Forget the Bubbles

JANUARY 22, 2024

Repeated GP and hospital attendance might stimulate increased testing and unnecessary prescriptions. 2015) highlighted that a poor understanding of statistics often results in a belief that screening is more beneficial than it actually is. 2015 ;24(2):167-74. Families and patients may drive over-investigation. Malhotra et al.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

RebelEM

JUNE 5, 2023

One study from a county in Massachusetts found that of all nonfatal opioid doses seen in the emergency department from 2011-2015, 1 in 20 patients subsequently died within one year of initial visit with 66% of these deaths being directly related to an opioid overdose (4). Initial doses ranged between 0.2 PMID 33392580.

Emergency Department 97

Emergency Department Hospitals Outcomes EMS 97

RebelEM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Funding: The Cardinal Health Laboratory provided Turkel thoracentesis kits to two hospitals Trial Registry: Clinicaltrials.gov: NCT01008228.

Outcomes 104

Outcomes Hospitals Research Emergency Department 104

Don't Forget the Bubbles

NOVEMBER 20, 2023

Neck lumps are a common presenting complaint to the paediatric emergency department with many aetiologies, sometimes resulting in a diagnostic conundrum. Royal Children’s Hospital. Royal Children’s Hospital, Melbourne. Thorough history taking and detailed examination can aid in diagnosis. DOI 10.1016/j.cpha.2017.12.003

Pediatrics 124

Pediatrics Documentation/Coding Emergency Department Ultrasounds 124

Emergency Medicine Journal

DECEMBER 22, 2023

Methods Discrete event simulation was used to model a large urban teaching hospital in the UK, as a case study, with a colocated GP service. The Centre for Urgent and Emergency Care research database patient-level database (May 2015–April 2016), secondary literature and expert elicitation were used to inform the model.

Emergency Department 52

Emergency Department Research Outcomes Hospitals 52

The Skeptics' Guide to EM

JUNE 15, 2018

Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation. AEM June 2018 Guest Skeptic: Dr. Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario.

Emergency Department 52

Emergency Department Fluid Resuscitation Sepsis Hospitals 52

Don't Forget the Bubbles

JANUARY 8, 2024

In paediatric emergency care, addressing the challenge of adolescent agitation is a complex and evolving task. Dr Elyssia Bourke, based at Ballarat Base Hospital, is actively engaged in this area through her ongoing PhD research. As we are not used to sedating children in this way, choosing drugs and doses can be difficult.

Research 105

Research Emergency Department Psychiatric Academics 105

Don't Forget the Bubbles

JUNE 17, 2024

Introduction: Civility Matters Healthcare environments, particularly emergency departments, are characterised by high levels of Volatility, Uncertainty, Complexity, and Ambiguity ( VUCA ). Riskin (2015) showed that rudeness accounted for a 12% reduction in diagnostic and procedural performance in a simulated resuscitation.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Taming the SRU

AUGUST 30, 2023

In a small study involving 79 hospitalized children, PCT was found to be elevated in bacterial infections, with a decrease after appropriate antibiotic therapy, and decreased in viral infections [24]. . + Procalcitonin (PCT) Etiology: PCT was first discovered in 1984. However, it was not until a 1993 study that its significance was realized.

Infectious Diseases 89

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

EMDocs

MAY 25, 2023

population at large Enrollment was terminated at an interim analysis due to predefined futility criteria that suggested that there was a 1% chance that carrying the trial to completion would demonstrate a most effect or least effective treatment.

Seizures 89

Seizures Administration Anaphylaxis Outcomes 89

The Skeptics' Guide to EM

MAY 21, 2017

The American Heart Association (AHA) discussed opioid overdoses and the use of naloxone Part 10: Special Circumstances of Resuscitation in their 2015 Guidelines (3). CanadiEM summarized the Top 5 changes to AHA 2015 Guidelines in a series of infographics (4). There were two new recommendations. Reference: Willman et al.

Emergency Department 52

Emergency Department Administration Academics EMS 52

The Skeptics' Guide to EM

MAY 20, 2023

Guest Skeptic: Dr. Kat Priddis is a paediatric emergency medicine consultant and trauma director at Watford General Hospital. Kat Priddis is a paediatric emergency medicine consultant and trauma director at Watford General Hospital. Which hospital should you transfer the patient to? NEJM Evidence. N Engl J Med.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics CPR Hospitals 52

The Skeptics' Guide to EM

SEPTEMBER 10, 2022

Single-dose dexamethasone is not inferior to 2 doses in mild to moderate pediatric asthma exacerbations in the emergency department. Pediatr Emerg Care. 2022 Guest Skeptic: Dr. Harrison Hayward is a Pediatric Emergency Medicine fellow at Children’s National Hospital. Pediatr Emerg Care. Pediatr Emerg Care.

Pediatrics 52

Pediatrics Emergency Department Urgent Care Hospitals 52

Broome Docs

MARCH 28, 2024

A non-inferiority randomized controlled trial comparing nebulized ketamine to intravenous morphine for older adults in the emergency department with acute musculoskeletal pain. Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. Kampan S, Thong-On K, Sri-On J.

PPE 96

PPE Ultrasounds Resuscitation Emergency Department 96

EMDocs

SEPTEMBER 27, 2023

This would be similar to how all other Medicare providers (long-term care facilities, hospital payments, etc.) The MIPS system was established in 2015 as part of an effort to combat the perverse incentive to provide more care in a traditional fee-for-service model. are already reimbursed (5).

Emergency Department 88

Emergency Department Research Outcomes Hospitals 88

Emergency Medicine Journal

DECEMBER 22, 2023

Using CPMs to identify patients, rather than prespecified criteria, accommodates for the dynamic hospital user population and for sufficient time to provide preventative support. However, it is unclear how this care model would negatively impact survival.

Emergency Department 52

Emergency Department Hospitals Outcomes 52

Emergency Medicine Journal

MAY 23, 2023

Methods In this retrospective study, we included all adult patients who visited the ED of a single urban academic tertiary-care university hospital in South Korea for five consecutive years (1 January 2015 to 31 December 2019). The AUPRC values of the NEWS+L Score for outcomes were 0.331~0.415. and 58.5%, respectively.

Outcomes 40

Outcomes Emergency Department Academics Operations 40

ALiEM

DECEMBER 4, 2023

A 49-year-old male presented to the emergency department of an academic hospital with the chief concern of penile pain. The patient was recently admitted to the hospital eight days prior to presentation for purulent urethral discharge where he received a course of topical antibiotics and was discharged. Epub 2015 May 7.

Academics 60

Academics Seizures Hospitals Emergency Department 60

EB Medicine

NOVEMBER 1, 2018

But this month’s episode is special in its own way - we’ll be tackling Electrical Injuries in the emergency department - from low and high voltage injuries to the more extreme and rare lightning related injuries. Thankfully, fatalities are declining, with just 565 in 2015. Jeff: You’re right. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Don't Forget the Bubbles

JUNE 30, 2023

However, patients in the 1:1 group had the lowest 24-hour mortality ( 14% vs 18% vs 22% vs 24% ; p = 0.01), and in-hospital mortality ( 32% vs 36% vs 40% vs 44% ; p = 0.01). Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. 2015 Jul;115(1):76-83.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EMDocs

JUNE 12, 2024

Ionised calcium levels in major trauma patients who received blood in the Emergency Department. Emerg Med J. Abnormal Calcium Levels During Trauma Resuscitation Are Associated With Increased Mortality, Increased Blood Product Use, and Greater Hospital Resource Consumption. Anaesth Intensive Care. 2011;39(1):46-54.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 105

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Written by Pendell Meyers A teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. Between 81-95% of life-threatening ventricular dysrhythmias and acute cardiac failure occur within 24-48 hours of hospitalization. 2015, March 1).

EKG/ECG 115

EKG/ECG Wellness Fractures Emergency Department 115

RebelEM

MARCH 23, 2023

REBEL Cast Ep115 – Phenobarbital vs Lorazepam in Alcohol Withdrawal Click here for Direct Download of the Podcast Clinical question : Is a phenobarbital-based or lorazepam-based alcohol detoxification protocol associated with a lower hospital length of stay compared to Ativan for alcohol withdrawal? Paper : Hawa F et al.

Emergency Department 52

Emergency Department Burns Outcomes Hospitals 52

PHEM Cast

APRIL 10, 2016

One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study. Severe Sepsis in Pre-Hospital Emergency Care. Am J Emerg Med. 2015 Aug 26;:1–31. Am J Emerg Med. 2015 Oct 17;:1–16.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

EB Medicine

SEPTEMBER 1, 2018

Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Northwestern EM Blog

MAY 9, 2022

There is no gold standard with respect to its definition, and it requires a medication history (which we typically don't do very well in the emergency department). For this reason, carbidopa/levodopa should never be discontinued during hospital admission - or ED boarding. [1] 12 March 2015. References 1. Juurlink JN.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Emergency Department 52

EMDocs

OCTOBER 21, 2023

In hospital mortality estimated at 30-40%. 17 65-78% of survivors have significant disability one month after hospital discharge. 2015 Jul;5(3):142-50. Application of the ABCD2 score to identify cerebrovascular causes of dizziness in the emergency department. 2015 Jan;46(1):102-7. link] January 24, 2007.

EMS 97

EMS Stroke Outcomes Hospitals 97