The Skeptics' Guide to EM

SEPTEMBER 2, 2023

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. She is an Assistant Professor and Director of Research in the Department of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. Date: August 30, 2023 Reference: Griffey et al. He is otherwise healthy.

Operations 78

Operations Diabetic Emergencies Hospitals Research 78

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. It can also able to be applied in multiple scenarios, not just the operating theatre, and it more accurately depicts real-world practice. Intubation of the Critically Unwell Child in the Emergency Department.

Airway Management 98

Airway Management Teamwork Pediatrics Emergency Department 98

RebelEM

JUNE 8, 2023

If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist. Clinical Bottom Line: Acute hypotension must be treated emergently in order to decrease morbidity and mortality. Am J Emerg Med. J Med Toxicol. Epub 2019 Jul 3.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

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. While it was < 15% in 1990, by 2016 it reached 40%. Jeff: Even more shockingly, some series showed a 52% repeat operation rate.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Don't Forget the Bubbles

JANUARY 17, 2024

Curious Ken is brought into your emergency department. Forrester reported data from the Texas Poison Centers surrounding 110 cases of superabsorbent polymer bead ingestions between 2011 and 2016. They passed away a few days after a second operation. What are the risks of water beads? Children will swallow almost anything.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Taming the SRU

JANUARY 29, 2024

She was concerned that this was not improving and decided to come to the emergency department (ED). Hospital Course The patient was initiated on a therapeutic heparin drip in the emergency department with vascular surgery consultation. 2016 Feb;50(2):98-101. Epub 2016 Feb 11. Vasc Endovascular Surg.

Emergency Department 92

Emergency Department Fractures Hospitals Operations 92

ALiEM

SEPTEMBER 9, 2024

A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today. 2016 Dec 28;7(Suppl 44):S1150-S1153.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

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., Most frequent reasons for emergency department visits, 2018. A comparison between pre-operative ultrasonography and surgical findings.

Fractures 76

Fractures Dislocations Operations Radiology 76

The Skeptics' Guide to EM

JULY 30, 2022

Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: A 63-year-old woman presents to your emergency department (ED) with two-day history of nausea, vomiting and constipation. Charles Brower is a second-year resident training in Emergency Medicine at the University of Cincinnati.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 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

Taming the SRU

JUNE 11, 2023

End-tidal carbon dioxide measured at emergency department triage outperforms standard triage vital signs in predicting in-hospital mortality and intensive care unit admission. Acad Emerg Med 2023; 10.1111/acem.14703 Enrollment period was from February 2016 to August 2018. Am J Emerg Med. Acad Emerg Med.

Hospitals 86

Hospitals Emergency Department EMS Outcomes 86

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. 2016 Jul;150(1):131-8. His fever was 103°F this morning and he received ibuprofen.

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

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 66

Emergency Department Soft Tissue Injuries Airway Management Operations 66

Don't Forget the Bubbles

JANUARY 31, 2024

Article 1: What predicts parental anxiety in the Paediatric Emergency Department? Predictors of parental anxiety in a paediatric emergency department. Emergency Medicine Journal. Prehospital pain has implications for pain assessments in our emergency department. Martin, S.R., Heyming, T.W.,

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

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. Accessed 07/30/2016. Accessed 07/30/2016.

Documentation/Coding 40

Documentation/Coding Forensics CDC Fractures 40

Dr. Smith's ECG Blog

DECEMBER 16, 2024

male who hasn't doctored in several years presented to the emergency department by ambulance for chief complaint of chest pain. 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.

Ultrasounds 86

Ultrasounds EKG/ECG Operations Emergency Department 86

The Skeptics' Guide to EM

MAY 28, 2017

Case: It is 7pm on a quiet evening in the emergency department and Bobby comes in. This is called Non Operative Treatment of Appendicitis (N.O.T.A). David Talan ( Ann Emerg Med 2016 ). Clinical Question: Is non-operative treatment (N.O.T.) We have covered N.O.T.A. on the SGEM#115 – Complicated.

Pediatrics 40

Pediatrics Operations Emergency Department Ultrasounds 40

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. In the operating room, there was minimal urinary output and the bladder pressures were 35 mmHg under sedation and analgesia.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

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 Documentation/Coding Fractures 52

EMDocs

DECEMBER 6, 2024

5 Orogastric lavage may also be considered for GI decontamination but likely to be limited by location, size of tablets, and operator familiarity. Tintinallis Emergency Medicine: A Comprehensive Study Guide, 8e. McGraw Hill; 2016. Pediatric Emergency Care, 27 (10), 978-985. 2 L/hr in adults. Hernandez SH, Nelson LS.

Poisoning 77

Poisoning Fluid Resuscitation Seizures Resuscitation 77

EMDocs

OCTOBER 30, 2023

Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. Retrospective study done by Monash University in Melbourne (largest radiology department in Australia) (Average daily scans plotted).

Radiology 74

Radiology Radiology Emergency Department Hospitals 74

EMDocs

SEPTEMBER 9, 2023

2021.0052 Emergency Department Management of Extensor Tendon Lacerations – Page 3 of 4. Ann Emerg Med. Emergency Medicine Residents’ Association; 2022:10-11. Extensor tendon repair in the emergency department. J Emerg Med. Emergency Orthopedics. July 11, 2016. Medicine (Baltimore).

EMS 79

EMS Fractures Soft Tissue Injuries Ultrasounds 79

ACEP Now

NOVEMBER 7, 2023

1 In 2016, the 21st Century Cures Act (Cures Act) took additional steps to authorize the Secretary of Health and Human Services to identify and define information blocking and associated exceptions. Published December 16, 2016. Department of Health and Human Services. 2015 Edition Cures Update fact sheet. HealthIT.gov website.

Documentation/Coding 52

Documentation/Coding Best Practices Ethical Issues Academics 52

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 54

Fractures Resuscitation Operations EMS 54

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. 2016 Dec;115(6):317-21. Evaluation of fever in the emergency department. ng/mL, 0.25-0.5

Infectious Diseases 87

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

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

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

Don't Forget the Bubbles

NOVEMBER 1, 2023

This month, Bubble Wrap has teamed up with Sheffield Children’s Hospital Emergency Department to have a look at what’s new in paediatric literature. Lactate as a screening tool for critical illness in a pediatric emergency department. Pediatric Emergency Care. 2023 Oct 1;39(10):735-8. What’s it about?

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

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. Step one is always the same - diagnose pregnancy!

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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 77

EMS Dislocations Fractures Operations 77

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The children’s Emergency department sees approximately 50,000 presentations per year. Emerg Med J. Paediatr Int Child Health. 2024 Jan 11:1-7.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

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). 1 This is a change from the 2016 SSC guidelines which suggested against corticosteroids. 2021;47:1181–1247.

Sepsis 66

Sepsis Fluid Resuscitation Resuscitation Shock 66

ACEP Now

APRIL 4, 2024

3 The majority of those who arrive to the emergency department (ED) live for 2 hours or more, leaving a small window for surgical intervention. Other exceptions are patient refusal, patient death or immediate transfer to the operating room. Eur J Emerg Med. 2016; 23:386-90. 5 Untreated, nearly all patients die.

Operations 40

Operations Ultrasounds Emergency Department 40

Dr. Smith's ECG Blog

APRIL 8, 2015

Finally, much of this correlates well with The new Canadian Syncope Arrhythmia Risk Score , just published in 2016, results of which are given below in the Annotated Bibliography. The ROSE (Risk Stratification of syncope in the emergency department) Study. J Am Coll Cardiol, 2010; 55:713-721, doi:10.1016/j.jacc.2009.09.049

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

NOVEMBER 4, 2024

The Treatment of Acute Pain in the Emergency Department: A White Paper Position Statement Prepared for the American Academy of Emergency Medicine. J Emerg Med. Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial. Acad Emerg Med.

Emergency Department 99

Emergency Department Fractures Burns EMS 99

EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. in 2016, is a more succinct evaluation for LVO that has been shown to be as sensitive and more specific than the NIHSS. 1 One study found that CTA head and neck was ordered for 2.5% Forman, H.

Stroke 87

Stroke Radiology Radiology Emergency Department 87

RebelEM

DECEMBER 18, 2024

The “syringe” technique: a hands-free approach for the reduction of acute nontraumatictemporomandibulardislocations in the emergency department. J Emerg Med. Rosens Emergency Medicine: Concepts and Clinical Practice, 7 ed. Accessed on April 20, 2016.) 2014; 47(6):676-81. PMID 25278137 Marx JA et al.

Dislocations 52

Dislocations Fractures Operations EMS 52