Taming the SRU

OCTOBER 23, 2023

THE CASE A female in her early 20s, G4P2012, presents to the emergency department (ED) with a 5 day history of left lower quadrant abdominal pain which has been worsening since onset. At this point, the patient is taken to the operating room for a diagnostic laparoscopy. Diagnosing ectopic pregnancy in the emergency setting.

Ultrasounds 96

Ultrasounds Operations Radiology Radiology 96

SheMD

MAY 4, 2023

Article Summary What they looked at: This article aimed to look at career trajectory differences between genders in faculty who have attained academic chair roles in emergency medicine. Women were more likely to be first appointed to educational rather than operational roles (52.6% Female chairs obtained more advanced degrees (47.4%

Leadership 52

Leadership Academics Operations Administration 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. Point-of-care ultrasound diagnosis of Stump appendicitis in the emergency department. Clin Case Rep.

Ultrasounds 96

Ultrasounds Emergency Department Wellness Operations 96

Mind The Bleep

JUNE 21, 2024

This will not be an issue if oil is used, though this will require another operation to be removed and gain full visual potential. Laser/cryotherapy is applied to seal the break intra-operatively. Note: vitrectomy is associated with a very rapid post-operative progression/development of a cataract which will then necessitate surgery.

Operations 52

Operations Emergency Department Ultrasounds 52

The Skeptics' Guide to EM

APRIL 16, 2022

Case: A 55-year-old man comes into the emergency department (ED) for increasing knee pain and decrease in function. Background: Musculoskeletal complaints are one of the most common presentations to emergency departments. An update was published by Fanaroff et al in JAMA 2019. Reference: Blom et al.

Military 40

Military Operations Emergency Department Pediatrics 40

EB Medicine

JULY 8, 2019

I’m Jeff Nusbaum and I’m back with Nachi Gupta for the 30 th episode of EMplify and the first Post-Ponte Vedra Episode of 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.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Dr. Smith's ECG Blog

AUGUST 4, 2024

Context: a man in his 40s presented to the emergency department with 1 day of sudden onset chest pain. QOH versions 1 and 2 both say Not OMI, with high confidence, without any clinical context, despite the abnormal STE meeting STEMI criteria. I sent this to our group without information and Dr. Smith responded: "Not OMI.

EKG/ECG 98

EKG/ECG Wellness Emergency Department Operations 98

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

Taming the SRU

MARCH 14, 2023

Case 1 Fussy 1 month old A 1-month-old (ex-34 week premature) infant comes to your emergency department for fussiness. Case 2 19 year old seizure A 19-year-old male is brought into your emergency department via EMS for witnessed seizure-like activity. More on this below as we work through a few cases….

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

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. Acad Emerg Med. 2019 Sep;26(9):1074-1088. Balk et al., Tsou et al.,

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

The Skeptics' Guide to EM

FEBRUARY 16, 2019

Date: February 15th, 2019 Reference: Gottileb, Holladay and Peksa. AEM January 2019. Guest Skeptic: Dr. Daniel Theodoro is an Assistant Professor of Emergency Medicine at Washington University School of Medicine in St. Louis and the Emergency Medicine Point of Care Ultrasound Section Chief. AEM January 2019.

Ultrasounds 52

Ultrasounds Emergency Department Operations 52

EMDocs

NOVEMBER 18, 2023

Liver Transplantation: Operative Techniques and Medical Management. Emergency department visits and unanticipated readmissions after liver transplantation: A retrospective observational study. Published 2019 Dec 27. doi:10.1155/2019/9108903 18) Fang A, Ashwani K. The Journal of Emergency Medicine.

EMS 69

EMS Ultrasounds Emergency Department Outcomes 69

Don't Forget the Bubbles

JANUARY 17, 2024

Curious Ken is brought into your emergency department. They passed away a few days after a second operation. Pediatric Emergency Care , 31 (6), pp.416-418. Pediatric Emergency Care , 35 (6), pp.426-427. The Journal of Emergency Medicine , 56 (6), pp.e115-e117. What are the risks of water beads? Darracq, M.A.,

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Don't Forget the Bubbles

MAY 22, 2023

You’ve just started working in the Children’s Emergency Department (CED). In 2019, there were 2,383 LTV patients in the UK. These can be operated and maintained by patients and their families at home. The triage nurse comes to let you know about Robin. There has been a 2.5x

Radiology 98

Radiology Radiology Hospitals Wellness 98

RebelEM

MARCH 27, 2023

Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients. More pertinent and relevant takeaway messages have to do with staffing and operations.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). Acad Emerg Med. West J Emerg Med.

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

Emergency Medicine Journal

JULY 22, 2024

This retrospective study compared the performance of 21 EWS scores to predict clinical deterioration using vital signs (VS) measured in the prehospital or emergency department (ED) setting. The discriminative ability of the EWS scores was assessed using the area under the receiver operating characteristic curve (AUROC).

Ambulance Services 52

Ambulance Services Hospitals Emergency Department Operations 52

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. In 7 studies with 4164 patients, PCT with a cut-off > 0.1

Infectious Diseases 86

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 86

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

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 65

Emergency Department Soft Tissue Injuries Operations Airway Management 65

RebelEM

NOVEMBER 20, 2023

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial [published online ahead of print, 2023 Oct 12]. J Spec Oper Med. Paper: Jansen JO, Hudson J, Cochran C, et al. 97% of patients sustained blunt trauma.

Resuscitation 89

Resuscitation Outcomes Operations Hospitals 89

Don't Forget the Bubbles

JUNE 17, 2024

Introduction: Civility Matters Healthcare environments, particularly emergency departments, are characterised by high levels of Volatility, Uncertainty, Complexity, and Ambiguity ( VUCA ). Exposure to incivility hinders clinical performance in a simulated operative crisis. 2019 May 31:bmjqs-2019.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

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 Hospitals 40

ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. Still, this wave of private equity acquisitions in emergency medicine has come crashing down on the heads of many early-career physicians. Published September 5, 2019. Published July 22, 2019. J Hosp Med.

Hospitals 69

Hospitals Radiology Radiology Administration 69

Don't Forget the Bubbles

JUNE 30, 2023

These procedures require an experienced operator. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. b) Emergency thoracotomy Let’s be clear: YOU will not be doing any of this. These procedures require an experienced operator. c) Or, do both?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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. Epub 2019 Jul 3. Am J Emerg Med. J Med Toxicol.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Increased mortality has been observed among older people whose systolic pressure was at least 7mmHg below their baseline primary care value when they attended the emergency department (ED). Receiver operating characteristics were compared to NEWS2 models with and without incorporation of relative systolic pressure.

Emergency Department 40

Emergency Department Operations Hospitals 40

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

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Patients who attend the Emergency Department (ED) often present with undifferentiated pathology. Method and Design Emergency attendances in 2019 from three East London EDs were included in this study. Routinely collected structured data were extracted from electronic health records.

Outcomes 40

Outcomes Emergency Department Operations 40

RebelEM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

Northwestern EM Blog

MAY 16, 2022

1 Low-dose non-contrast abdominal CT has become the gold standard for diagnosis as it has become readily available in emergency departments nationwide, with some studies touting sensitivity and specificity of 97% and 95%, respectively.2 Follow up CT should depend on the patient and ultrasound operator. J Urol 2019.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 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

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

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 73

Radiology Radiology Emergency Department Hospitals 73

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

PEMBlog

JUNE 5, 2024

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. Pearls and Pitfalls CT Angiography has become a more readily available tool for diagnosis in the emergency department though requires an understanding of its specific uses and indications.

Stroke 87

Stroke Radiology Radiology Emergency Department 87