Pediatric EM Morsels

NOVEMBER 17, 2023

2018 Mar;28(3):210-217. 0.41), p < 0.001. PMID: 8021785. de Wit M, Peelen LM, van Wolfswinkel L, de Graaff JC. The incidence of postoperative respiratory complications: A retrospective analysis of cuffed vs uncuffed tracheal tubes in children 0-7 years of age. Paediatr Anaesth. doi: 10.1111/pan.13340. PMID: 29436138. West J Emerg Med.

Pediatrics 187

Pediatrics Emergency Department Outcomes Sepsis 187

The Trauma Pro

OCTOBER 25, 2024

This is probably because there is no need to perform repeated operations to insert and remove the preperitoneal packs when angiography is used. Here are the factoids: The original data were derived from a 17-center study conducted from 2018-2020; this study only included 1,387 patients who had pelvic fractures (as well as other injuries).

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

Sensible Medicine

JUNE 17, 2024

Proponents wrote back in 2018 that longer-term safety studies are needed that specifically assess…”cerebral microemboli assessed by magnetic resonance imaging.” The bubbles seen on ultrasound imaging during PFA was enough for the proponents to write in 2018 that brain safety was an issue to be studied.

Shock 127

Shock Stroke Operations Ultrasounds 127

Taming the SRU

MARCH 12, 2024

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. ED visits per 1000 adults with diabetes based on 2018 data resulting in over 500,000 annual hospital days. The study’s primary outcomes were the operational impacts of the SQuID protocol on EDLOS and ICU admission rates.

Operations 97

Operations Hospitals Best Practices Wellness 97

Greater Sydney Area HEMS

FEBRUARY 20, 2024

This would therefore remove some of the limitations (perceived or real) around time delays associated with using ultrasound for central access as there would be no need for probe covers and positioning of the portable ultrasound (which often needs the help of a second operator, a significant limitation in a small prehospital medical team).

Ultrasounds 98

Ultrasounds Shock Research Operations 98

RebelEM

APRIL 17, 2023

However, in a small retrospective study of 214 patients, investigators found that abscesses >2cm in size were more likely to fail antibiotic treatment (Urban 2018). While operator dependent, the dynamic ability of POCUS augments bedside diagnosis and can assist with drainage.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

ACEP Now

JULY 7, 2023

One operator should perform defibrillation in the anterolateral position, followed by another operator providing a second shock in the anteroposterior position after a delay of less than one second. Heart disease and stroke statistics—2018 update: A report from the American Heart Association. Circulation. 2022;145(8):e153-e639.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

EMDocs

DECEMBER 11, 2023

In addition to a posterior ECG, the ACC’s new recommendations emphasize consideration of an emergent TTE, though lack clarity in defining who should be the operator, stating “a clinician qualified in echocardiography” is necessary, without providing specific definitions. Fourth Universal Definition of Myocardial Infarction (2018).

EKG/ECG 119

EKG/ECG Emergency Department Academics Operations 119

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. Obstet Gynecol 2018. 2018 Jan;37(1):78-87 8 - Moore, C., Tubal Ectopic Pregnancy. ACOG Practice Bulletin No.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

Don't Forget the Bubbles

JUNE 30, 2023

These procedures require an experienced operator. A joint statement released by the American College of Surgeons/American College of Emergency Physicians recommends that zone 1 REBOA should only be performed if the anticipated time to start the operation is less than 15 minutes. These procedures require an experienced operator.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

ACEP Now

JUNE 21, 2023

Therefore, applicant, funding, and operational factors may influence programs to offer a particular curriculum length. American board of emergency medicine report on residency and fellowship training information (2017-2018). 15 Some of these training opportunities previously considered unique (i.e., Ann Emerg Med. Jul 2022;80(1):74-83.e8.

EMS 114

EMS Academics Telemedicine Operations 114

EMDocs

MAY 25, 2024

Published 2018 Nov 15. Rosh Review Website Link Further Reading: Further #foamed: [link] [link] References: Kessler AT, Bhatt AA. Review of the Major and Minor Salivary Glands, Part 1: Anatomy, Infectious, and Inflammatory Processes. J Clin Imaging Sci. doi:10.4103/jcis.JCIS_45_18. Salivary Gland Diseases. 2020;64:87-104. Sialolithiasis.

EMS 96

EMS Dehydration Operations Hospitals 96

The Skeptics' Guide to EM

JUNE 9, 2018

[display_podcast] Date: June 8th, 2018 Reference: April MD, et al. Ann Emerg Med 2018 Guest Skeptic: Meghan Groth is a pharmacist who has been practicing in emergency medicine for the past six years. display_podcast] Date: June 8th, 2018 Reference: April MD, et al. Reference: April MD, et al.

Emergency Department 52

Emergency Department Academics Operations Administration 52

ACEP Now

APRIL 5, 2024

There was no analysis of operator experience or expertise. 2 A study published in JAMA in 2018 found that among patients with a difficult airway characteristic, bougie use resulted in higher first attempt intubation success (96 percent), compared to endotracheal tube with stylet (82 percent). percent with use of a bougie and 83.0

Airway Management 73

Airway Management Operations Emergency Department Research 73

RebelEM

NOVEMBER 20, 2023

Comparator: The control group received standard care provided at a major trauma center, including intubation, blood product transfusion, interventions like tourniquet application, and early operative or endovascular hemorrhage control. Advanced Resuscitative Care in Tactical Combat Casualty Care: TCCC Guidelines Change 18-01:14 October 2018.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

ALiEM

NOVEMBER 27, 2023

One case report published in 1993 used RUQ abdominal ultrasound to identify septations (violin-string adhesions) and ascites to ultimately diagnose FHCS, later confirmed by serologic and operative evidence [2]. Yeungnam Univ J Med 35(1), 127-129 (2018). References Moon, Y.H., Theofanakis, C.P., Kyriakidis, A.V. link] van Dongen PW.

Ultrasounds 64

Ultrasounds Academics Operations OB/GYN 64

The Skeptics' Guide to EM

MAY 11, 2019

JAMA Surgery 2018 Guest Skeptic: Dr. Robert Leeper is an assistant professor of surgery at Western University and the London Health Sciences Centre. J AMA Surgery 2018 Guest Skeptic: Dr. Robert Leeper is an assistant professor of surgery at Western University and the London Health Sciences Centre. Reference: Sceats et al.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

The Skeptics' Guide to EM

JULY 30, 2022

Background: Somewhere between two and four percent of patients presenting to US EDs with abdominal pain have a small bowel obstruction (SBO) – those who are managed operatively (who are only 20-30%) account for 60,000 hospitalizations and 565,000 inpatient care days per year. sensitivity and 96.6% specificity with ultrasound [1].

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

Taming the SRU

MAY 13, 2024

Acute stump appendicitis without evidence of perforation or abscess (Figure 1) HOSPITAL Course Acute Care Surgery was consulted from the ED and recommended admission for operative resection of a 3 cm remnant of the appendix. World J Emerg Surg 13, 22 (2018). No free intraperitoneal air. 2018;2(3):211-214. Dikicier, E., Altintoprak, F.,

Ultrasounds 98

Ultrasounds Emergency Department Wellness Operations 98

ALiEM

SEPTEMBER 9, 2024

General surgery and neurosurgery should be consulted emergently for further operative interventions. Imaging should be obtained to confirm diagnosis, and broad-spectrum antibiotics with CNS coverage should be started early. References Paff, M, Alexandru-Abrams, D, Muhonen, M, Loudon, W. Ventriculoperitoneal shunt complications: A review.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

Emergency Medicine Journal

NOVEMBER 28, 2023

Methods This multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands. The secondary outcomes were time to complete reduction and treatment plan at ED discharge (conservative or operative repair).

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

ACEP Now

JUNE 7, 2023

Software attacks crippled operations in large hospital chains, and physical assaults on ED staff continued unabated. The overall length of stay for all ED patients increased to 199 minutes in 2022, up from 182 minutes in 2018 (see graph above). Executive Summary of ED Operations in 2022 Volume was up from 2021.

Emergency Department 52

Emergency Department Documentation/Coding Operations EMS 52

RebelEM

AUGUST 22, 2024

Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Although the OCT machines were designed to be user-friendly, variability in image acquisition by different operators could affect the quality of the images and, consequently, the accuracy of remote diagnoses.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Emergency Medicine Ireland

FEBRUARY 8, 2021

SBS is not a common thing to find in the ICU and the most likely context here is going to be receiving someone from the operating theatre who has had. 2018 Dec;37(6 Pt A):1798-1809. Epub 2018 Aug 18. Read More » Welcome back to the tasty morsels of critical care podcast. doi: 10.1016/j.clnu.2018.07.036. 2018.07.036.

Operations 40

Operations Outcomes 40

Don't Forget the Bubbles

JUNE 17, 2024

John Wiley & Sons, 2018 Edward KL, Ousey K, Warelow P, Lui S. Exposure to incivility hinders clinical performance in a simulated operative crisis. Creating a culture of safety and respect through professional accountability: case study of the Ethos program across eight Australian hospitals. Australian Health Review.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

ACEP Now

MAY 9, 2024

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon. Or Helly Larson describing the first week after her Miami BBL as “absolute hell” to a Vox reporter.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

RebelEM

JANUARY 25, 2024

A 2018 systematic review and meta-analysis of 25 studies focusing on the accuracy of emergency lung ultrasound showed sensitivity of 85-95% and specificity of 75-90% for pneumonia, sensitivity of 78% and specificity of 94% for COPD/asthma, and sensitivity of 75-90% and specificity of 80-90% for acute heart failure [4].

Ultrasounds 125

Ultrasounds Outcomes COPD Hospitals 125

The Skeptics' Guide to EM

APRIL 16, 2022

The level of high-quality evidence had not changed much when looking at the ACC/AHA guidelines from 2008-2018. Clinical Question: What is the effectiveness of common elective orthopaedic procedures compared with no treatment, placebo, or non-operative care? An update was published by Fanaroff et al in JAMA 2019. Reference: Blom et al.

Military 40

Military Operations Emergency Department Pediatrics 40

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. 2018):e0203316. Click to enlarge. References Morley, Claire, et al.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

ALiEM

MAY 13, 2024

63M with an Erythematous Abdomen Limitations of POCUS As with all ultrasound applications, soft tissue POCUS is operator dependent. J Emerg Med 2018 [6] 327 Prospective cohort study of children 6mo-18yrs comparing clinical assessment to POCUS 90.3% (83.4-94.7%) 2018 Jan;54(1):96-101. 2018 Nov;55(5):693-701. Lam et al.,

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

ALiEM

AUGUST 9, 2023

The lung POCUS is also operator-dependent, and it has a steep learning curve. Pediatr Pulmonol 2018 12 studies; 1510 patients 96% 95% Lung POCUS had significantly better sensitivity than chest X-ray, which had a sensitivity of 87%. 2018 Aug;53(8):1130-1139. Study N Sensitivity Specificity Comments Pereda et al., Balk et al.,

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

Taming the SRU

AUGUST 30, 2023

This finding was not significantly different among operators with different levels of experience, or between adults and children. A 2018 USA multi-center prospective RCT involving 1,656 adult patients published in NEJM used varying PCT cut-offs to guide antibiotic initiation in the emergency department. 2018 Aug 1;10(8):a028456.

Infectious Diseases 89

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

Don't Forget the Bubbles

JULY 26, 2023

Paediatric survivors of out-of hospital VF: etiologies and outcomes, Silka et al, Heart Rhythm 2018 : Survival rates for paediatric out of hospital arrest are 12-29%, however, in cases where there was a sustained return of circulation, more than 80% had an underlying cardiac aetiology identified.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

The Skeptics' Guide to EM

FEBRUARY 2, 2018

[display_podcast] Date: January 31st, 2018 Reference: Frohlich LC, et al. display_podcast] Date: January 31st, 2018 Reference: Frohlich LC, et al. Might his examination be enough to convince the urologists to take him straight to the operating room without a preceding diagnostic ultrasound? AEM Dec 2017. AEM Dec 2017.

Pediatrics 40

Pediatrics Ultrasounds Emergency Department Research 40

PulmCCM

APRIL 1, 2024

In a 2018 survey of 136 ED and ICU attendings and trainees in the state of Maryland (limited by its small size and response bias), 96% reported using ultrasound for internal jugular central line placements. Authors also had no information on operators’ experience levels.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

ACEP Now

MARCH 14, 2024

In our case, the patient had a CT of the head, cervical spine, and chest, abdomen, and pelvis with intravenous contrast demonstrated a C2, C7 compression fracture with significant bowel edema (Figure 4), and was taken to the operating room for left arm disarticulation, left below knee amputation and right above knee amputation.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Taming the SRU

JUNE 11, 2023

Utilized in the pre-hospital setting, ICU and the Operating Room, it is a non-invasive measurement that reflects a patient’s current state of metabolism, circulation and ventilation. Enrollment period was from February 2016 to August 2018. EtCO2 is a valuable tool in many medical specialties.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88