ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Heart disease and stroke statistics—2018 update: A report from the American Heart Association.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Taming the SRU

MAY 13, 2024

The patient is a well-appearing male who is awake, alert, and oriented. There is also a well-appearing, healed surgical scar. There is also a well-appearing, healed surgical scar. The skin is warm and well perfused with brisk capillary refill. World J Emerg Surg 13, 22 (2018). Notable diagnostics CBC : WBC 19.2,

Ultrasounds 98

Ultrasounds Emergency Department Wellness Operations 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

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

ALiEM

SEPTEMBER 9, 2024

Past surgical history was significant for laparoscopic ventral hernia repair with mesh and lysis of adhesions (three years ago), as well as prior appendectomy, cholecystectomy, c-section, and right nephrectomy. C); BP 110/56; HR 64; RR 16; SpO2 100% General : No acute distress, well appearing. Interdisciplinary Neurosurgery, 13, 66-70.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

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. The trauma call goes out. So, what are your key priorities? Really, in a 14-year-old?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

RebelEM

AUGUST 22, 2024

1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Patients whose last known well (LKW) time was within 24 hours of presentation. 2020;51(7):2018-2025. J Craniofac Surg.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

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

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. 97.4%) 85.4% (78.9-90.2%)

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

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]. vs. 18.3%).

Ultrasounds 125

Ultrasounds Outcomes COPD Hospitals 125

Don't Forget the Bubbles

JUNE 17, 2024

Loss of psychological safety and mental well-being persist long after the episode and can impact future episodes of care. John Wiley & Sons, 2018 Edward KL, Ousey K, Warelow P, Lui S. Exposure to incivility hinders clinical performance in a simulated operative crisis. The lasting effects of incivility cannot be understated.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

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. On arrival at hospital the child was well with normal observations. The Fontan circulation was an operation initially developed around 50 years ago to treat tricuspid atresia. Family history. What are the important investigations?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

ALiEM

OCTOBER 30, 2023

The same goes for clinical operations and research – interesting, but there hasn’t been any “a ha” moment to illuminate her calling. Well, instead of passively waiting for Godot, you can seize the initiative and bend the arc of your career into alignment with your values, strengths, and passions, and, by extension, toward fulfillment.

Academics 64

Academics Leadership Wellness Research 64

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. 2018):e0203316. ED crowding impairs this mission.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 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. It’s reflection of underlying metabolism, circulation and ventilation may serve well to identify patients with early dysfunction of physiologic functions.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

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. 2018 Aug;53(8):1130-1139. On arrival, his vital signs are: Vital Sign Finding Temperature 99.7

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

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 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

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. This finding was not significantly different among operators with different levels of experience, or between adults and children. 2018 Aug 1;10(8):a028456. Epub 2018 Oct 19. 2018 Jul 31;138(5):e78-e79. ng/mL, 0.25-0.5

Infectious Diseases 89

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

ACEP Now

MARCH 14, 2024

These can be delayed, up to weeks later, so it’s important to educate patients on the importance of follow-up with burn care well-versed with electrical injuries or neurology if they have or develop these symptoms. 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

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

His ED cardiac ultrasound (which is not at all ideal for detecting wall motion abnormalities, and is also very operator dependent for this finding) was significant for depressed global EF. Overall voltage is decreased as well. With his ESRD, he does have an elevated baseline troponin at ~0.40 What would you do in this scenario?

EKG/ECG 52

EKG/ECG Wellness Operations Ultrasounds 52

PEMBlog

JUNE 5, 2024

Infants can get a cervical spine injury during breech delivery or, unfortunately, during non accidental trauma as well. For It is superior to CT for visualizing soft tissues and identifying intervertebral disc herniation, ligamentous injuries, and spinal cord edema, as well as hemorrhage, compression, and transection type injuries.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

EB Medicine

JUNE 6, 2019

For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. Jeff: Well that’s scary - I know I’ve already missed a case, but luckily, he returned thanks to good return precautions, which we’ll get to in a few minutes. Low dose ketamine at 0.3

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EMDocs

FEBRUARY 22, 2025

Well keep it short, while you keep that EM brain sharp. 2018 Aug;116:50-55. Epub 2018 May 17. Epub 2018 Dec 7. A 37-year-old male comes in with facial trauma after his head slammed into the steering wheel during an MVC. He was able to walk away from the scene with no loss of consciousness, nausea, or vomiting.

EMS 61

EMS Fractures Operations Wellness 61

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 60

Fractures Resuscitation Operations EMS 60

EB Medicine

AUGUST 1, 2018

I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the August 2018 issue of Emergency Medicine Practice. Nachi: To attain the most up to date information for this article, Dr. Williams searched the PubMed and Cochrane Databases from 1950 to 2018. Jeff: Let’s get started with the pathophysiology.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

RebelEM

DECEMBER 19, 2022

While many healthcare systems across the world operate in a similar fashion, the United States does not. This study should certainly prompt discussions about the operational feasibility when it comes to implementing DED across institutions and EMS agencies. REFERENCES: Cheskes S, et al.

EMS 52

EMS CPR Shock Resuscitation 52

EM SIM Cases

AUGUST 23, 2022

Because this case can be triggering, especially for individuals having experienced previous microaggressions, careful selection of actors and participants, as well as pre-briefing the resident leading the case far ahead of time are crucial. Seed the Way; 2018. The other trainees watched the case. Acad Med; 2020 Jul. 95(7):1020-1025.

Operations 40

Operations Resuscitation Wellness Hospitals 40

EMDocs

NOVEMBER 13, 2023

2019) argue against a minimum NIHSS score to trigger the use of CTA, instead purporting that clinical suspicion of acute ischemic stroke presenting within 24 hours of the last known well was sufficient evidence to order the study. Stroke 2018, 49 (10), 2323-2329. Stroke 2018, 49 (3), e46-e99. 8 The data in Mayer et al.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

Taming the SRU

MAY 22, 2023

Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. 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., 12): e0244291. 9(1):31-36.

Fractures 77

Fractures Dislocations Operations Radiology 77

RCEM Learning

NOVEMBER 28, 2022

Only 50% were positioned correctly according to a survey done in 2018 7. It is important to closely monitor the patient’s haemodynamic status and repeat the pelvic x-ray post binder removal because a well-applied pelvic binder can mask fracture. Learning bite All unstable pelvic fractures require operative management.

Fractures 40

Fractures Blood Transfusions Sepsis Operations 40

EMDocs

NOVEMBER 4, 2024

She denies any trauma, swelling, or redness in the joints, as well as fever or weight loss. 2018 Nov;19(6):952-960. Epub 2018 Sep 10. Pharmacologic therapy should only be utilized for chronic low back pain for patients who have not responded adequately to the aforementioned options. West J Emerg Med. doi: 10.5811/westjem.2018.8.37875.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

Don't Forget the Bubbles

OCTOBER 14, 2024

The government recognizes they cannot return to their country of origin owing to a well-founded fear of being persecuted for the reasons provided for in the United Nations Refugee Convention or European Convention on Human Rights (such as persecution due to race, sexuality, political opinions, or religion).

Documentation/Coding 59

Documentation/Coding Hospitals Wellness Operations 59

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. What could be the differential diagnosis?

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

RebelEM

NOVEMBER 25, 2024

Included patients from out-of-hospital, emergency department, intensive care unit, and operating-room intubations. Intubation performed in all settings (out-of-hospital, emergency department, ICU, and operating room). Still, most patients undergoing intubation probably have well-visualized anatomy.

Emergency Department 97

Emergency Department Outcomes Operations Hospitals 97

SheMD

APRIL 23, 2023

Today Dr. Sabrina Gerkowicz, a reproductive endocrinologist (aka fertility doctor) shares with us some very important findings and statistics about #physicianinfertility as well as what a fertility workup looks like, who should have one, and 5 things you MUST know! Aghajanova et al. So when and why should I have a fertility work up?

Ultrasounds 52

Ultrasounds Wellness Operations 52

PulmCCM

MARCH 7, 2025

Any self-respecting surgeon or anesthesiologist will tell you that patients undergoing surgery before the weekend receive just as high a quality of care as those operated on earlier in the week. The Weekend Effect in Other Countries The weekend effect has been observed in multinational studies as well. Is it true?

Outcomes 116

Outcomes Hospitals Operations Radiology 116

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. Eplasty, 13, e27. Tulloch, J.S.P.,

Fractures 52

Fractures Infectious Diseases Documentation/Coding Hospitals 52