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. Unionization of healthcare providers can create opportunities to improve staff’s financial and general well-being, but may also facilitate future strikes.

Hospitals 77

Hospitals Research Patient Safety Wellness 77

Don't Forget the Bubbles

JUNE 17, 2024

Riskin (2015) showed that rudeness accounted for a 12% reduction in diagnostic and procedural performance in a simulated resuscitation. Loss of psychological safety and mental well-being persist long after the episode and can impact future episodes of care. 2015 May;30:656-74. 2015 Sep 1;136(3):487-95. BMC medicine.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

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. Conclusion/Recommendation ED crowding is a national patient safety issue driven by hospitals routinely operating over capacity. 2015):157-165. ED crowding impairs this mission.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

RebelEM

APRIL 17, 2023

However, It is unclear how well POCUS performs in ruling in or ruling out the diagnosis of PTA. Question: How well does the US perform in diagnosing PTA compared to CT, needle aspiration, or Incision and Drainage? While operator dependent, the dynamic ability of POCUS augments bedside diagnosis and can assist with drainage.

Ultrasounds 130

Ultrasounds Radiology Radiology Operations 130

PulmCCM

APRIL 1, 2024

That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials. Authors included 130 studies published 2015-2023, “to ensure that included studies were representative of current medical practices, including ultrasonography guidance.”

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. Be wise, stay safe, and perhaps even smile, knowing you’re well-equipped. Keep in mind, it’s about being ready.

CPR 52

CPR Shock Operations Hospitals 52

Don't Forget the Bubbles

JANUARY 17, 2024

2015 But we all know that what happens in the lab does not always mirror what happens in real life. 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. ” ( Ed. After Darracq et al., Darracq, M.A.,

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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. The rim may be echogenic or blend in with surrounding tissue. Lam et al., 94.7%) 80% (70.0-87.4%)

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. These procedures require an experienced operator. These procedures require an experienced operator. These procedures require an experienced operator. 2015 Jul;115(1):76-83. Epub 2015 May 19. The trauma call goes out.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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. CHF, in particular, lends itself well to diagnosis and treatment with PoCUS, as it readily reveals the presence of B lines. 2015 Oct;50(4):480-7.

Ultrasounds 130

Ultrasounds Outcomes COPD Hospitals 130

Dr. No

DECEMBER 1, 2021

The way to get round this slippery data problem, as regular readers of this blog will know only too well, is to look at all cause mortality. Well, Dr No did try a bit of figuring, by looking at all cause deaths by age band in recent years, downloaded from this page. Just as it seems a strand is emerging, it slithers away again.

Forensics 52

Forensics Wellness Operations 52

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. References Kennedy, S.

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. A 2015 prospective, cross-sectional study of 78 Thai patients published in the International Journal of Rheumatic Disease demonstrated a sensitivity of 59% and specificity of 84% for PCT with a cut-off of 0.5

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

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). WJEM 2015; 16(7): 1109 – 17. PMID: 25402500 Forsythe SM et al. Sodium Bicarbonate for the Treatment of Lactic Acidosis.

Emergency Department 65

Emergency Department Soft Tissue Injuries Operations Airway Management 65

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 Documentation/Coding Administration Fractures 95

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. difficult intubations in neonates and infants.

Airway Management 98

Airway Management Teamwork Pediatrics Emergency Department 98

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

Dr. Smith's ECG Blog

DECEMBER 19, 2023

Unfortunately, we do not have those images for review, but the operators described a ruptured LAD plaque and they stented this area, which ensures the stability of the plaque. The patient did well afterward without any recurrence of symptoms. Fortunately, that is exactly what happened. His echocardiogram showed normal wall motion.

EKG/ECG 118

EKG/ECG EMS Wellness Operations 118

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

ALiEM

AUGUST 9, 2023

F Heart Rate 138 bpm Blood Pressure 102/61 Respiratory Rate 32 Oxygen Saturation (room air) 100% He is well appearing but has increased work of breathing. The lung POCUS is also operator-dependent, and it has a steep learning curve. 2015 Apr;135(4):714-22. On arrival, his vital signs are: Vital Sign Finding Temperature 99.7

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

EMDocs

JUNE 3, 2023

4 This is the framework the ED resuscitationist should be operating under, as hemodynamically unstable pelvic trauma patients require a different approach compared to stable patients who will undergo CT, routine pelvic fixation, and definitive surgical repair. Figure 5: Pelvic binding with a sheet.

Fractures 54

Fractures Resuscitation Operations EMS 54

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. Pretty simple as well. Crucial that we fix this. The problem with human communication is that it’s nuanced. And engagement around disease is more complex. Pretty simple. A cue for an action.

Leadership 74

Leadership Administration Operations Hospitals 74

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. 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%.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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

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. Anemia ; 2015.DOI:10.1155/2015/791498.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Taming the SRU

MARCH 14, 2023

He appears well and is triaged to an ESI 4. Ultimately, definitive management is in the operating room with revision or replacement of the VP shunt. She was doing well, but recently has had the “stomach flu” with a couple weeks of abdominal pain, nausea and vomiting. More on this below as we work through a few cases….

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

PEMBlog

JUNE 5, 2024

2015 Apr;22(4):441-6. Epub 2015 Mar 16. 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. Leonard JC, Jaffe DM, Olsen CS, Kuppermann N. Acad Emerg Med.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

EB Medicine

MARCH 1, 2019

Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST. But don’t be reassured by normal vitals, especially in the young, who may be compensating well despite being quite ill. Nachi: Definitely. for pericardial effusion. Jeff: Exactly.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Northwestern EM Blog

DECEMBER 20, 2021

Typically well appearing with normal labs, however, this is a diagnosis of exclusion and a septic joint should be ruled out. Management is orthopedic consultation for operative stabilization [12]. 2015 Nov 15;92(10):908-16. Affects ages 3-8, males to females 2:1 [3]. References Smith E, Anderson M, Foster H. 2012;97(5):185-193.

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

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. 2015 Oct 19.

Resuscitation 40

Resuscitation Pediatrics Fractures 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. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision.

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] Jan 28, 2015.

Airway Management 40

Airway Management Pediatrics Resuscitation Documentation/Coding 40

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. We applied to "The Golden Hour" the attitudes and abilities that led to a man on the moon. 1950s & 1960s Resuscitation Research. Accessed 2/2/2016.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 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 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

PHEM Cast

SEPTEMBER 6, 2017

H Spontaneously breathing carbon dioxide waveforms where phase III is not well delineated. 2013;118(1):192-201. doi:10.1097/ALN.0b013e318278c8b6 0b013e318278c8b6 A Prolonged phase II, increased α angle, and steeper phase III suggest bronchospasm or airway obstruction. I Dual capnogram in one lung transplantation patient.

CPR 52

CPR Resuscitation Operations Wellness 52

Advanced Emergency Nursing from AENJ

AUGUST 2, 2016

" [Coroners Society] King Richard I (the Lionheart) needed vast sums of money for the Third Crusade, operation of the kingdom, and for his ransom fro m Duke Leopold of Austria. All efforts to identify the decedent by hospital staff, law enforcement agencies or social service agencies should be well documented in the medical records.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40