EM Updates

JUNE 15, 2021

Maimonides Medical Center (MMC) is Brooklyn’s largest hospital, an academic quaternary care center with, in normal times, 711 total beds, 66 intensive care beds, and an Emergency Department that treats approximately 120,000 patients per year. On March 9, the first patient with a novel coronavirus infection was admitted to MMC.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Emergency Medicine Journal

APRIL 22, 2024

Objective We sought to validate the clinical performance of a rapid assessment pathway incorporating the Siemens Atellica IM high sensitivity cardiac troponin I (hs-cTnI) assay in patients presenting to the emergency department (ED) with suspected acute myocardial infarction (AMI).

Emergency Department 98

Emergency Department Outcomes EKG/ECG Hospitals 98

ACEP Now

JULY 11, 2024

Deaths from drinking increased 25 percent from 2019 to 2020 and another 10 percent in 2021. The percentage of suicides while intoxicated with alcohol has increased, particularly among women, and traffic fatalities in 2020 were at their highest point in over a decade. 2020:8;279. problem drinking has reached a steady state.

Emergency Department 98

Emergency Department Psychiatric Outcomes Wellness 98

Pediatric EM Morsels

AUGUST 9, 2024

Neonates presenting to the Emergency Department often cause a lot of uncertainty. Let’s review how Congenital Syphilis may present to our Emergency Departments: Congenital Syphilis : Basics Occurs when the spirochete Treponema pallidum is transmitted from mother to fetus. doi: 10.1136/bcr-2020-240532.

Hyperthermia / Hypothermia 152

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 152

Emergency Medicine Journal

MARCH 21, 2024

This month’s journal covers a wide variety of topics, from COVID-19 and fever in the Emergency Department (ED) to prehospital care. Reflecting backwards to early 2020, it thus far remains one of the most challenging times in my career. One of the notable outcomes was the disparities among different ethnic groups.

Emergency Department 52

Emergency Department Outcomes 52

EMDocs

AUGUST 3, 2024

He Was Right Spoon Feed This systematic review found that approximately 4%-27% of patients presenting to the ED with presyncope experienced serious outcomes within a 30-day period. Source Serious outcomes among emergency department patients with presyncope: A systematic review. Acad Emerg Med. Ann Emerg Med.

Emergency Department 74

Emergency Department Outcomes Hospitals 74

Don't Forget the Bubbles

MAY 31, 2023

Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. During the COVID-19 pandemic , we noticed a change in the type of patients presenting to the Emergency Department. Arch Dis Child.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Emergency Medicine Journal

MAY 23, 2023

Background To identify the impact of enrolment onto a national pulse oximetry remote monitoring programme for COVID-19 (COVID-19 Oximetry @home; CO@h) on health service use and mortality in patients attending Emergency Departments (EDs).

Emergency Department 52

Emergency Department Outcomes Hospitals 52

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 primary outcome was the proportion of patients requiring more than one reduction attempt.

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

Taming the SRU

MARCH 27, 2024

The parent trial was conducted from October 2020 to July 2022 in the capital region of Denmark. The primary outcome was cumulative norepinephrine use during the first 48 hours of admission. That said, outcomes for these patients are generally poor and the use of steroids as a one-time dose likely has little risk. Hill, J.

Resuscitation 98

Resuscitation Outcomes CPR Hospitals 98

Taming the SRU

SEPTEMBER 25, 2023

Musculoskeletal injuries are a common occurrence, representing a substantial number of Emergency Department visits on an annual basis. 1) Oftentimes, Emergency Physicians are the first provider patients encounter after an injury. 2020 Feb 12;4(2):e20.00005. 2020 Dec;12(6):1644-1651. Epub 2020 Sep 7.

Fractures 101

Fractures Operations Emergency Department EMS 101

EMDocs

SEPTEMBER 30, 2024

Inhaled Corticosteroids Rarely Prescribed at Emergency Department Discharge Despite Low Rates of Follow-Up Care. J Emerg Med. 2020 Feb;8(2):605-617.e6. The primary outcome was hospital admission rates. They reduce inflammation and improve the sensitivity of beta-receptors to improve beta-agonist efficacy.

Outcomes 82

Outcomes Academics Documentation/Coding Administration 82

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Emergency Medicine Journal

JANUARY 22, 2024

The primary outcome was reduction in VAS score 15–20 min after randomisation.

Emergency Department 40

Emergency Department Outcomes 40

PulmCCM

NOVEMBER 6, 2023

The therapy was approved for emergency use in 2020 by FDA after an observational study of 10 patients showed likely benefit (yes, 10, which should remind us of our collective desperation). patients infected with the Wuhan/Delta variants in 2020-2021). Thromboelastometry (e.g., The balloon generally required 30 minutes to insert.

Blood Transfusions 93

Blood Transfusions Operations Resuscitation Infectious Diseases 93

The Skeptics' Guide to EM

NOVEMBER 21, 2020

Date: November 19th, 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. The impact of advanced practice provider staffing on emergency department care: productivity, flow, safety, and experience. AEM November 2020.

Emergency Department 52

Emergency Department Telemedicine Academics Outcomes 52

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? Certified interpreter use can improve communication and patient outcomes. An implementation science approach improves language access in the emergency department. One cohort study in a public ED found that 84.5% 45:446-458. Taira B, et al.

Documentation/Coding 81

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 81

ACEP Now

OCTOBER 15, 2023

prescriptions annually per 100 persons in 2020. 1 The emergency department remains an important frontier for work in judicious prescribing, but opiate analgesia remains a valuable tool for the initial treatment of a variety of presentations. In this respect, the conclusion is absolutely true.

Emergency Department 52

Emergency Department Outcomes CDC Research 52

The Skeptics' Guide to EM

OCTOBER 14, 2023

Case: A 5-year-old boy presents to the emergency department (ED) with his parents for fever and fatigue. Time to change the reference ranges of children’s physiological observations in emergency care? He has had three days of high fevers at home. A prospective study. J Paediatr Child Health.

Pediatrics 88

Pediatrics Sepsis Urgent Care Emergency Department 88

The Skeptics' Guide to EM

AUGUST 22, 2020

Date: August 18th, 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Diagnosing COVID-19 in the Emergency Department: A Scoping Review of Clinical Exam, Labs, Imaging Accuracy and Biases. Reference: Carpenter et al.

Emergency Department 52

Emergency Department Academics Research Administration 52

Don't Forget the Bubbles

JULY 19, 2023

Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation. This data was collected over a five-year period (2016-2020) had true papilloedema. 2020 and Hyde et al. 2020 Oct [cited 2023 May 14];10:966–7.

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

Northwestern EM Blog

JANUARY 2, 2023

In a survey from June 2020, 11% of adults reported thoughts of suicide in the past 30 days [1]. They found that suicide rates in 2020 were increased in October and November for men and in July through November for women when compared to 2016-2019. Deaths, isolation, loss of work, and countless other hardships abound.

Emergency Department 52

Emergency Department Research CDC Pediatrics 52

The Skeptics' Guide to EM

MARCH 18, 2023

Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020.

Pediatrics 40

Pediatrics Infectious Diseases Administration Outcomes 40

EMDocs

JUNE 12, 2024

HypoCa is common in trauma patients and is associated with poor outcomes. We need RCTs to determine if Ca administration in trauma impacts mortality and other patient-centered outcomes. Ionised calcium levels in major trauma patients who received blood in the Emergency Department. Emerg Med J. doi:10.1097/TA.0000000000002570

Hyperthermia / Hypothermia 89

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 89

Northwestern EM Blog

SEPTEMBER 26, 2022

Written by: Diana Halloran (NUEM ‘24) & Andrew Long (NUEM ‘25) Edited by: Nick Wleklinski (NUEM ‘22) Expert Commentary by : John Bailitz, MD Introduction The Emergency Department is a challenging work environment for a variety of reasons. Any team member of the resuscitation may lead the hot debrief.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

PulmCCM

JUNE 12, 2023

TTM2 found no improvement in survival or neurologic outcome among patients randomized to cooling to a target of 33 °C, as compared to controls receiving fever prevention (e.g. with acetaminophen) until temperatures reached 37.8 °C who then received external cooling to maintain a target temperature of 37.5 °C.

Hyperthermia / Hypothermia 102

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 102

RebelEM

JUNE 5, 2023

One study from a county in Massachusetts found that of all nonfatal opioid doses seen in the emergency department from 2011-2015, 1 in 20 patients subsequently died within one year of initial visit with 66% of these deaths being directly related to an opioid overdose (4). PMID 33392580. mg tablet) 1 Buprenorphine 0.5

Emergency Department 98

Emergency Department Hospitals Outcomes EMS 98

Don't Forget the Bubbles

JANUARY 8, 2024

Dr Bourke’s work is not only about deepening academic understanding but also about forging practical approaches to help healthcare professionals navigate the nuanced and often uncertain waters of adolescent care in emergency settings. Mulraney, M., Coghill, D., Sciberras, E., and Sawyer, M., Mulraney, M., Coghill, D., Sciberras, E.,

Research 105

Research Emergency Department Psychiatric Academics 105

ACEP Now

JULY 7, 2023

CASE A 30-year-old woman presents to the emergency department with left arm pain from a chronic wound. Since 2020 to 2021, the Drug Enforcement Administration has reported a sharp rise in xylazine use across the U.S., percent of all overdose deaths in 2020. US Department of Justice, Drug Enforcement Administration.

Forensics 98

Forensics Airway Management Administration Emergency Department 98

The Skeptics' Guide to EM

APRIL 25, 2020

Date: April 21st, 2020 Reference: Juergens et al. Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. Date: April 21st, 2020 Reference: Juergens et al. Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke.

Stroke 40

Stroke Emergency Department Outcomes Administration 40

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 ). High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. 2020 Aug 20.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

The Skeptics' Guide to EM

DECEMBER 12, 2020

Date: December 10th, 2020 Reference: Ladde et al. AEM December 2020 Guest Skeptic: Dr. Kirsty Challen (@KirstyChallen) is a Consultant in Emergency Medicine and Emergency Medicine Research Lead at Lancashire Teaching Hospitals Trust (North West England). Date: December 10th, 2020 Reference: Ladde et al.

Operations 52

Operations Outcomes Research Academics 52

The Skeptics' Guide to EM

AUGUST 28, 2021

Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergency department: Results of a randomized controlled trial. Case: A forty-year-old woman presents to the emergency department […] The post SGEM#342: Should We Get Physical, Therapy for Minor Musculoskeletal Disorders in the ED?

Emergency Department 52

Emergency Department Research Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting." Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. References: 1. Lindahl B, Baron T, Erlinge D, et al.

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

The Skeptics' Guide to EM

JANUARY 18, 2020

Date: January 16th, 2020 Reference: Troponin Testing and Coronary Syndrome in Geriatric Patients With Nonspecific Complaints: Are We Overtesting? AEM January 2020 Guest Skeptics: Dr. James VandenBerg: James has a master’s degree in clinical investigation from Washington University in St. Reference: Wang et al.

Emergency Department 52

Emergency Department Hospitals Outcomes 52

The Skeptics' Guide to EM

JULY 8, 2023

Case: A 57-year-old woman with hypertension, hyperlipidemia and type-2 diabetes mellitus presents to the emergency department (ED) with fever, cough, myalgias, headache and congestion. There was a large unblinded RCT of over 3,000 patients published in the Lancet in 2020.

CDC 95

CDC Hospitals EMS Emergency Department 95

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98