Taming the SRU

OCTOBER 23, 2023

THE CASE A female in her early 20s, G4P2012, presents to the emergency department (ED) with a 5 day history of left lower quadrant abdominal pain which has been worsening since onset. At this point, the patient is taken to the operating room for a diagnostic laparoscopy. Diagnosing ectopic pregnancy in the emergency setting.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

Don't Forget the Bubbles

JANUARY 8, 2024

Dr Bourke’s work is not only about deepening academic understanding but also about forging practical approaches to help healthcare professionals navigate the nuanced and often uncertain waters of adolescent care in emergency settings. Recent studies have indicated a significant rise in mental health disorders among young people.

Research 105

Research Emergency Department Psychiatric Academics 105

PHEM Cast

DECEMBER 12, 2016

For an entertaining and insightful discussion about the impact of undertaking thoracotomy, listen to Dr John Hinds talk from SMACC 2015. Journal of the Royal Society of Medicine 2015. Emergency thoracotomy: “how to do it”. Emergency thoracotomy in thoracic trauma: a review. World Journal of Emergency Surgery; 2006: 1:4.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

EMDocs

SEPTEMBER 25, 2023

Improved Visualization: Video laryngoscopes allow for the use of standard or hyperangulated geometry, essentially allowing the operator to “look around the corner” on an anterior airway. Operators can manipulate the blade with less force to optimize the view, making it easier to identify and navigate the endotracheal tube into the trachea.

Emergency Department 92

Emergency Department Soft Tissue Injuries Airway Management Operations 92

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

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

The Skeptics' Guide to EM

JUNE 9, 2018

Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial. Ann Emerg Med 2018 Guest Skeptic: Meghan Groth is a pharmacist who has been practicing in emergency medicine for the past six years. We covered that paper on the SGEM in Episode #144.

Emergency Department 52

Emergency Department Academics Operations Administration 52

Taming the SRU

AUGUST 30, 2023

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. They recommended synovial fluid analysis as essential to the diagnosis [30].

Infectious Diseases 89

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

Don't Forget the Bubbles

JANUARY 17, 2024

Curious Ken is brought into your emergency department. 2015 But we all know that what happens in the lab does not always mirror what happens in real life. They passed away a few days after a second operation. Pediatric Emergency Care , 31 (6), pp.416-418. Pediatric Emergency Care, 31 (8), pp.605-607.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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. The data is strong that in the hands of trained Emergency Clinicians, when parasternal, apical, and subcostal views are obtained, US has an accuracy of 97.5%

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

ALiEM

AUGUST 9, 2023

Child with Cough and Fever: Case Introduction A 6-year-old boy presents to the emergency department complaining of cough for 3 days and fever for the last day. The lung POCUS is also operator-dependent, and it has a steep learning curve. 2015 Apr;135(4):714-22. His fever was 103°F this morning and he received ibuprofen.

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

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 data set was randomly split into train and test sets (1:1) for internal validation.

Outcomes 40

Outcomes Emergency Department Academics Operations 40

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. These patients often require emergent operative intervention.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

The Skeptics' Guide to EM

NOVEMBER 20, 2021

You wonder if any emergency department (ED)-based interventions would help her and people like her be safe. Background: We looked at geriatric falls on an SGEM Xtra in 2015. Moving the Needle on Fall Prevention: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement.

Geriatric Emergencies 52

Geriatric Emergencies Elder Abuse Research Academics 52

ALiEM

MAY 13, 2024

Case Introduction: Child with abdominal pain Wendy is a 7-year-old girl who comes into the emergency department with redness, swelling, and pain on her left calf. 63M with an Erythematous Abdomen Limitations of POCUS As with all ultrasound applications, soft tissue POCUS is operator dependent. Pediatr Emerg Care.

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

RebelEM

MARCH 9, 2023

However, evaluating and managing patients with acute alcohol intoxication in the emergency department can be challenging. Barr 2016 , Trevejo-Nunez 2015) Patients are at high risk of bleeding from the GI tract due to clotting factor impairment or devastating hemorrhage from esophageal varices in the setting of portal hypertension.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

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. Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity. More on this below as we work through a few cases….

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

Pediatric Emergency Playbook

FEBRUARY 1, 2016

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. Pediatric emergency department thoracotomy: a large case series and systematic review. 2015 Jan;50(1):177-81. 2015 Oct 19.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

ACEP Now

NOVEMBER 7, 2023

The 2015 Edition Cures Act sought to promote “transparency, modern standards, and enhanced health IT capabilities by fostering innovation in the health care technology ecosystem to deliver better information to patients, clinicians, and other users.” 2015 Edition Cures Update fact sheet. HealthIT.gov website. Public law 114–255—Dec.

Documentation/Coding 52

Documentation/Coding Best Practices Ethical Issues Academics 52

Northwestern EM Blog

DECEMBER 20, 2021

Written by: Tommy Ng, MD (NUEM ‘24) Edited by: Patricia Bigach, MD (NUEM ‘22) Expert review by : Terese Whipple, MD '20 So your kid won’t walk One of the most common complaints in a pediatric Emergency Department is a child refusing or inability to ambulate. Management is orthopedic consultation for operative stabilization [12].

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

Advanced Emergency Nursing from AENJ

JUNE 16, 2015

This is not a feasible practice in the Emergency Department which must deal immediately with an undifferentiated patient. It would be kept in an anteroom of an Isolation Room (the only one with a private bathroom for the patient) which had cabinetry and sink, and an electric outlet to operate the battery charger.

PPE 40

PPE Infectious Diseases Emergency Nursing Operations 40

ETM Course

MAY 3, 2017

Simple windlass-style tourniquets are relatively inexpensive, easy to apply and easy to operate. 2015 Aug;79(2):232-7 2008 Feb;64(2 Suppl):S38-49 Tourniquet use for civilian extremity trauma. Inaba K, Siboni S, Resnick S, Zhu J, Wong MD, Haltmeier T, Benjamin E, Demetriades D. J Trauma Acute Care Surg.

Military 52

Military Shock Hospitals Operations 52

Don't Forget the Bubbles

JULY 26, 2023

Prioritise listening to the first 30 minutes which given a good overview of aetiology and treatment (53 mins) Basics of cardiac rhythm problems in the ED Palpitations are a common reason for children to present to the emergency department, the majority of these will be benign from a cardiac perspective and instead related to stress or anxiety.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

Act V, scene I [Text from Folger Shakespeare Library] [Audio recording of Dramatic Reading; Chapter Vox] [Video recording of Act V, scene1] Most deaths that are brought to, or occur in, an emergency department will require, at least, discussion with the local Coroner or Medical Examiner. Published January 15, 2015.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

PEMBlog

JUNE 5, 2024

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

EMDocs

NOVEMBER 16, 2024

4 Pain is the most common reason for presentation in the early post operative period. 5 Highest risk of dislocation early in the post operative course due to laxity of the soft tissue after surgery. 6 Hip flexion or adduction in the early post-operative period can cause atraumatic dislocations (typically avoided for 6 weeks post-op).

EMS 98

EMS Dislocations Fractures Operations 98

Pediatric Emergency Playbook

APRIL 1, 2017

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. A commonly available suction catheter is the Frazier suction tip ( right ), a single-use device used in the operating room. Am J Emerg Med. 2008.01.013.

Pediatrics 52

Pediatrics CPR Operations Resuscitation 52

Dr. Smith's ECG Blog

NOVEMBER 24, 2017

Acad Emerg Med 2015 Oct; 22(10):1139-44. A receiver operating characteristic graph over all the different percentage cutoffs might help more formally make those tradeoffs. Plotting the Receiver Operating Characteristic (ROC) curve compared to each formula as the gold standard, and labeling the cutoffs (i.e.

EKG/ECG 52

EKG/ECG Outcomes Wellness Hospitals 52

EB Medicine

JUNE 6, 2019

Jeff: Abdominal pain is the one of most frequent complaint in US emergency departments, representing 8% of all adult ED visits, with admission rates for all patients with abdominal pain ranging between 18-42% and reaching as high as 60% for the elderly. Emerg Med Clin North Am. Nachi: This is another really important point.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Don't Forget the Bubbles

JANUARY 27, 2025

We dont often cover gynaecological presentations in the emergency department and most chronic gynaecological problems go through the primary care referral pathway. However, CT scans remain largely more obtainable in a time critical case, in an emergency department setting. 2015 Aug;33(8):487-93. Epub 2015 Jun 29.

Ultrasounds 76

Ultrasounds Emergency Department Pediatrics Dehydration 76

Dr. Smith's ECG Blog

APRIL 8, 2015

The ROSE (Risk Stratification of syncope in the emergency department) Study. 2009.09.049 Objectives: The aim of this study was to develop and validate a clinical decision rule (CDR) to predict 1-month serious outcome and all-cause death in patients presenting with syncope to the emergency department.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

ACEP Now

AUGUST 28, 2024

TeamHealth, which is a physician staffing and contract management company owned since 2010 by the private equity firm Blackstone, has managed the emergency department at Ascension St. John Hospital since 2015, when it acquired ownership of the hospital’s ED physician group, St. John’s Emergency Services, PC.

Emergency Department 98

Emergency Department Hospitals Patient Safety Leadership 98

Don't Forget the Bubbles

MAY 24, 2023

Airway complications are also more likely to occur in the emergency department (ED) than in the operating theatre. The Difficult Airway Society (DAS) published guidelines for difficult pediatric airways in children age one to eight back in 2015. Intubation of the Critically Unwell Child in the Emergency Department.

Airway Management 98

Airway Management Pediatrics Teamwork Emergency Department 98

Pediatric Emergency Playbook

JANUARY 1, 2017

Neonatal observational scales have been validated in the intensive care and post-operative settings; ED-specific quantitative scales are lacking. CRIES ( Table 1 ) was validated for post-operative patients; to adapt its use for the ED, the most conservative approach is to substitute “preoperative baseline” with normal range for age.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

EMDocs

JUNE 3, 2023

In fact, the World Society of Emergency Surgery (WSES) classification assigns grades I-III depending on their Young-Burgess classification, but any patient hemodynamically unstable from their pelvic fracture is automatically WSES grade IV regardless of their fracture pattern.

Fractures 64

Fractures Resuscitation Operations EMS 64

Advanced Emergency Nursing from AENJ

MAY 27, 2015

An ambulance pulls up, in haste, to the Receiving door of the Emergency Department with a last squeal of the siren. 15/01/2015). September 2005) Terrorism and Other Public Health Emergencies Reference Guide for Media. [ Emergency Preparedness. 2008) Mumbai Combined Arms Operation November 26-28, 2008.

Federal Emergency Management Agency 40

Federal Emergency Management Agency Military Hospitals Administration 40

Taming the SRU

SEPTEMBER 1, 2023

2015) reported a sensitivity of 98.9% to divert the plane). for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al.,

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95