EMDocs

DECEMBER 14, 2023

If a physician is allowed to be on call for more than one hospital – or to be in the OR when on call – define the procedure for simultaneous calls as well as when a surgeon is operating. Reference : See similar case in “ Where ’ s all that blood coming from” in the November 2015 issue of MMI-LFL. Patient dies in ED.

Hospitals 85

Hospitals Patient Safety Operations Wellness 85

Taming the SRU

OCTOBER 23, 2023

At this point, the patient is taken to the operating room for a diagnostic laparoscopy. She was taken to the operating room and found to have a right tubal ectopic pregnancy with a pseudogestational sac. 2007), Free Fluid in Morison's Pouch on Bedside Ultrasound Predicts Need for Operative Intervention in Suspected Ectopic Pregnancy.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

Taming the SRU

MAY 22, 2023

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., A comparison between pre-operative ultrasonography and surgical findings. 2015 Dec;8(1):76. Epub 2015 Jul 25. 2001;220:406-12.

Fractures 77

Fractures Dislocations Operations Radiology 77

EMDocs

NOVEMBER 1, 2023

McGraw-Hill Education; 2015. Answer : Esophageal Perforation 1-6 Epidemiology : Most frequent etiology is iatrogenic injury from instrumentation accounting for 60% of cases (e.g. upper endoscopy, transesophageal echo, etc.). 2 Additional etiologies include caustic ingestion, trauma, foreign body, or malignancy. Am J Emerg Med. 2022;53:29-36.

Operations 78

Operations Radiology Radiology Fluid Resuscitation 78

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. Highly recommended. Traumatic Cardiac Arrest. 108(1): 11-16. Wise et al. Emergency thoracotomy: “how to do it”.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

Taming the SRU

MAY 23, 2023

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., 2015 Apr 28]. 2015 Dec;8(1):76. Epub 2015 Jul 25. RICE), and symptomatic management (e.g., Calcaneus fractures. What's in a name?

Fractures 57

Fractures Dislocations Operations EMS 57

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. 2015 Nov 25;351. Retrieved from www.sciencedaily.com/releases/2015/11/151125233018.htm 5 Quality : Results on quality impacts are mixed. ” ScienceDaily.

Hospitals 89

Hospitals Research Patient Safety Wellness 89

Don't Forget the Bubbles

JANUARY 8, 2024

O ral sedation if the patient will co-operate Diazepam 0.2mg/kg up to 10mg orally – up to two doses OR Olanzapine 5mg (if <40kg) and 10mg (if >40kg) – one dose only – acts within 20 minutes OR Risperidone 0.02-0.04mg/kg Recent studies have indicated a significant rise in mental health disorders among young people.

Research 105

Research Emergency Department Psychiatric Academics 105

RebelEM

JANUARY 25, 2024

Point-of-care ultrasound (PoCUS) is inherently operator-dependent, which may have led to inconsistencies in the quality and findings of the ultrasound exams across different operators. 2015 Oct;50(4):480-7. Epub 2015 May 22. J Pain Symptom Manage. PMID: 26004401.

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

SheMD

NOVEMBER 27, 2023

As physicians, we cannot leave our office, clinic or operating room at 1030am to attend a school event in our child’s classroom—it just doesn’t work that way. In 2015, I took my children with me to a meeting in Washington DC where I was presenting my research. Unconditional love—it’s all about quality, not necessarily quantity.

Pediatrics 98

Pediatrics Research Operations 98

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. 2015):157-165. Click to enlarge. Critical care medicine 40.8

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

The Skeptics' Guide to EM

JUNE 9, 2018

A new Cochrane Review by Hines et al published in 2018 looked at aromatherapy for post-operative nausea and vomiting. There’s some data supporting the use of an inhalation of isopropyl alcohol in emergency department patients (Beadle, et al Ann Emerg Med 2015 ). We covered that paper on the SGEM in Episode #144.

Emergency Department 52

Emergency Department Academics Operations Administration 52

The Skeptics' Guide to EM

NOVEMBER 20, 2021

Background: We looked at geriatric falls on an SGEM Xtra in 2015. Case: Mid-shift, you realise that the next patient you are about to see is the third in a row aged over 70 who has fallen at home, and that this is her third attendance for a fall in the last two months. Reference: Hammouda et al.

Geriatric Emergencies 52

Geriatric Emergencies Elder Abuse Research Academics 52

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

Medical Law

FEBRUARY 4, 2021

Santa Barbara also continues to move forward on implementing its 2015 Bicycle Master Plan Update, which will include the construction of several new multiuse bike pathways for bicyclists and pedestrians. In 2015, California updated its bicycle laws to accommodate E-bikes. See www.sbbike.org/sb for more detailed information).

Documentation/Coding 52

Documentation/Coding Legal Issues Operations 52

ALiEM

AUGUST 9, 2023

The lung POCUS is also operator-dependent, and it has a steep learning curve. Pediatrics 2015 8 studies; 765 patients 96% 93% Evidence supports lung POCUS as an alternative for diagnosis of pneumonia in children. 2015 Apr;135(4):714-22. A lung consolidation needs to extend to the pleural surface to be visualized on lung POCUS.

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

PulmCCM

OCTOBER 16, 2024

Animal studies have suggested that the body could be prepped or trained to better withstand ischemic-reperfusion injury, by inducing mild ischemia in another tissue bed before the operation. The mechanism is unclear. Circulation. 2024 Sep 25. doi: 10.1161/CIRCULATIONAHA.124.071408. 124.071408. Epub ahead of print. PMID: 39319450.

Outcomes 52

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

Outcomes 40

Outcomes Emergency Department Academics Operations 40

Dr. No

DECEMBER 1, 2021

Nonetheless, by summing the narrow bands used in 2020 and 2021 to the broader bands used in previous years, we can get comparable weekly data going back to 2015, and could even go back further, but Dr No needs to get out more often. Figures 1 to 6: weekly deaths over summer and autumn from 2015 to date, all ages and by age band.

Forensics 52

Forensics Wellness Operations 52

Advanced Medical Reviews

SEPTEMBER 15, 2017

The number of respondents to the annual Makovsky Pulse of Online Search Survey claiming to have done treatment research online climbed from 24 percent in 2015 to 29 percent in 2016. Responding to millennial influence on healthcare technology and operations.

Operations 56

Operations Research Wellness Hospitals 56

PulmCCM

APRIL 1, 2024

Authors included 130 studies published 2015-2023, “to ensure that included studies were representative of current medical practices, including ultrasonography guidance.” Authors also had no information on operators’ experience levels. In skilled hands using ultrasound, CVC complications are much lower than 3%.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

AED Leader

SEPTEMBER 22, 2024

With simple operation and minimal maintenance requirements, these AEDs are designed for ease of use – even for non-medical folks! Simple to operate, and it won’t hit your budget as hard as you might think. Even those without training can operate it effectively in critical situations. They might seem high. Absolutely not!

CPR 52

CPR Shock Operations Hospitals 52

33 Charts

OCTOBER 2, 2021

The fundamental problem: we turned on 24/7/365 access for patients (who of course like it) with no operational or business model to handle it. Bob Wachter from UCSF had this to say on Twitter recently: We’re seeing huge uptick in in-box messages for MDs during Covid – now seems like biggest driver of MD burnout.

Leadership 75

Leadership Operations Administration Hospitals 75

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

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. Purnell, C. Santiago, C.

Radiology 59

Radiology Radiology Pediatrics Documentation/Coding 59

ALiEM

MAY 13, 2024

63M with an Erythematous Abdomen Limitations of POCUS As with all ultrasound applications, soft tissue POCUS is operator dependent. J Pediatr 2015 [8] 151 Prospective cohort study of patients 3mo-21yrs comparing clinical assessment to POCUS 96% (90-99%) 87% (74-95%) POCUS changed management in 27% of cases.** Epub 2015 Nov 10.

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

Taming the SRU

MAY 27, 2024

This often is seen in trauma, cancer, post-operatively, and end-stage metabolic conditions with excessive colloid or protein leak. If the volume of fluid is anticipated to re-accumulate quickly, a drain should be placed. a) left image: normal pleural cavity, image accessed from 2313 The Lung Pleurea - Pleural cavity - Wikipedia ; under CC 3.0

Emergency Department 86

Emergency Department Ultrasounds Radiology Radiology 86

RebelEM

MARCH 9, 2023

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. Epub 2015 Sep 14. Osteopathic Family Physician. 2014 Mar;6(2). Barr T, Helms C, Grant K, Messaoudi I. 2016 Feb 4;65:242-51.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 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. 2015 Jan;50(1):177-81. 2015 Oct 19. Pediatric emergency department thoracotomy: a large case series and systematic review.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Advanced Emergency Nursing from AENJ

JUNE 16, 2015

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. They are costly, too. I was to store, charge, retrieve, and order resupply for it.

PPE 40

PPE Infectious Diseases Emergency Nursing Operations 40

Don't Forget the Bubbles

JULY 26, 2023

REVERT trial (adults); Appelboam et al, Lancet 2015 showed that by modifying the traditional valsalva manoeuvre to be done semi-recumbent with a passive leg raise immediately afterwards increased the success from 17% cardioversion to 43%. Image from: [link] with thanks How often does the Valsalva manoeuvre work?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Northwestern EM Blog

DECEMBER 20, 2021

Management is orthopedic consultation for operative stabilization [12]. 2015 Nov 15;92(10):908-16. Presentation is classically chronic hip pain with antalgic gait however may present with knee pain. Physical exam classically shows external rotation and abduction of the hip during hip flexion. References Smith E, Anderson M, Foster H.

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

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 Studies comparing different commercially available tourniquets have produced mixed results so no single device can be recommended over another. 2008 Feb;64(2 Suppl):S38-49 Tourniquet use for civilian extremity trauma.

Military 52

Military Shock Hospitals Operations 52

PulmCCM

JANUARY 6, 2025

Their spread has coincided with the Centers for Medicare and Medicaid’s “sepsis bundle quality measure” (SEP-1) going live in 2015. Instead of clinical micromanagement, in its new form it would incentivize continuous improvement in systemwide operational processes. And have they fired.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

Taming the SRU

FEBRUARY 19, 2024

12) Axillary While axillary arterial line placement has been uncommon, in the age of facile ultrasound operators it may become a more advantageous and accessible site particularly in patients with high BMIs. 2015 Sep;94(39):e1557. They also found that when femoral lines did fail, they did so later in the patient’s clinical course. (12)

Shock 59

Shock Resuscitation Ultrasounds Research 59

Pediatric Emergency Playbook

JUNE 1, 2017

Fontan Operation and the Single Ventricle. 2015; 19(2):e107-e109. 2015; AID 953826. 2015; AID 905097. Summary Acute MI is a challenging presentation in children: Easily missed: uncommon and atypical Varied etiology Respect vague symptoms with a non-reassuring H&P Try to detect it: CATH IT! Congenit Heart Dis.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

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. Lancet Neurol. Marmarou, Young, Aygok. Neurosurg Focus.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52