Don't Forget the Bubbles

JUNE 26, 2023

Whilst waiting for an operation, they need to be managed medically. Too much pulmonary blood flow and we will see well-oxygenated blood ( SpO2 >85% ) but insufficient systemic blood flow (pallor/mottling, cool peripheries, delayed capillary refill time, weak pulses, hypotension, narrow pulse pressure) and hypoxia (lactic acidosis).

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

Ken Grauer, MD

SEPTEMBER 6, 2024

Depending on which of above considerations is operative — the differential diagnosis of the rhythm in ECG #1 will be between: i ) A reentry SVT rhythm with retrograde atrial conduction; ii ) ATach ( A trial T achycardia ) ; — or — iii ) Junctional Tachycardia. What is happening in today's case is different.

EKG/ECG 245

EKG/ECG Administration Operations Wellness 245

EMDocs

NOVEMBER 1, 2023

ECG – May show tachycardia or rate related ST depressions Laboratory evaluation: CBC w/ differential – may reveal leukocytosis with left shift CMP, Lipase – can reveal alternative intra-abdominal diagnoses as well as show findings of end-organ hypoperfusion (elevated serum creatinine, transaminitis, etc.) McGraw-Hill Education; 2020.

Operations 86

Operations Radiology Radiology Fluid Resuscitation 86

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. Respiratory and cardiovascular exams are normal. BMP : Na 136, K 4.3,

Ultrasounds 98

Ultrasounds Emergency Department Wellness Operations 98

Ken Grauer, MD

FEBRUARY 9, 2024

Awareness of this common association made me instantly suspect that some type of Wenckebach conduction is probably operative in today's rhythm — even though I admittedly do not see any pattern of consistent group beating, or any repetitive PR intervals that typically clue me in to Mobitz I conduction defects.

EKG/ECG 262

EKG/ECG Operations Wellness 262

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. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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

EMDocs

MAY 25, 2024

Cham: Springer International Publishing; 2020:387-395. Accessed June 22, 2023. link] Haidar H, Menon A, Al Duhirat E. Diseases of the salivary glands. In: Textbook of Clinical Otolaryngology. Abdel Razek AAK, Mukherji S. Imaging of sialadenitis. Neuroradiol J. 2017;30(3):205-215.

EMS 96

EMS Dehydration Operations Hospitals 96

Don't Forget the Bubbles

JANUARY 17, 2024

After Meshram et al, 2020 When Orbeez are exposed to water, the water molecules diffuse into the polymer network through osmosis. Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. From Mullens et al.,

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). Epub 2020 Dec 9. Driver BE, Prekker ME, Reardon RF, Sandefur BJ, April MD, Walls RM, Brown CA 3rd. J Emerg Med. 2020.10.042.

Emergency Department 84

Emergency Department Soft Tissue Injuries Airway Management Operations 84

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. 2020 Aug 20. 2020 Jan 1;35(1):70-6. Exposure to incivility hinders clinical performance in a simulated operative crisis. The lasting effects of incivility cannot be understated. 2019 May 31:bmjqs-2019.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Regarding my Systematic assessment of ECG #1: There is significant baseline artifact , as well as baseline wander. P.S.: For another clinical example of how EASY-it-is to overlook a long QTc if one is not systematic in approach — Please check out the May 3, 2020 post in Dr. Smith's ECG Blog.

Seizures 114

Seizures EKG/ECG EMS Stroke 114

American Medical Compliance

MAY 13, 2024

Ensuring a safe and secure environment for both patients and staff is crucial for the effective operation of any dental facility. workers were victims of workplace homicides in 2020. Workplace violence is an issue that can affect any professional setting, and dental practices are no exception.

Operations 52

Operations Wellness 52

SheMD

MAY 4, 2023

Women were more likely to be first appointed to educational rather than operational roles (52.6% vs 61.2%, p=0.02) as well as to be in those roles immediately prior to first chair appointment (p=0.01). There were no gender differences in residency type, board certification, or fellowship position. Why do we care about this article?

Leadership 52

Leadership Academics Operations Administration 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

Unfortunately, we do not have those images for review, but the operators described a ruptured LAD plaque and they stented this area, which ensures the stability of the plaque. The patient did well afterward without any recurrence of symptoms. Fortunately, that is exactly what happened. His echocardiogram showed normal wall motion.

EKG/ECG 128

EKG/ECG EMS Wellness Operations 128

Taming the SRU

NOVEMBER 3, 2023

The thought with introducing the serratus anterior plane block was that regional anesthesia is well within the purview of EM physicians and can offer a safe alternative to systemic pain medications. 50% were male, 50% were female and they had a median # of 4 rib fractures with a range 2-8. SD 3.28) and 6.5, respectively.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

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. Ann Emerg Med 2020 [5] 2,656 Systematic review of adult and pediatric studies 94.6% (89.4-97.4%)

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

RebelEM

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability. Comparison of the RIFLE, AKIN and KDIGO criteria to predict mortality in critically ill patients.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Intensive Blog

AUGUST 17, 2023

Show answer Commonly, clinicians use a trigger of 80g/L (Tenure et al, 2020). Epub 2020 Sep 10. Epub 2020 Sep 10. Alfred Health (2020, April 18). The many causes of anaemia include: Decreased production Malnutrition Bone marrow suppression (e.g., Cannula site bleeding. Cannula site bleeding. What is your action now?

Blood Transfusions 52

Blood Transfusions Operations Wellness 52

The Skeptics' Guide to EM

JANUARY 23, 2021

That SGEMHOP episode asked how the productivity of APPs compare to emergency physicians and what is its impact on ED operations? A joint statement on the issue was published in 2020 by AAEM/RSA, ACEP, ACOEP/RSO, CORD, EMRA, and SAEM/RAMS. The difference in training between and emergency medicine physician and APPs is well recognized.

Poisoning 52

Poisoning Research Documentation/Coding Operations 52

Pediatric Education

JULY 14, 2024

He was overall well but his father noted that he had a “bump” on the side of his forehead. The patient had no post-operative complications. Treatment is excision with or without pre-operative radiological imaging depending on patient age and location. It was not bothering the patient. Occipital 43 7, 16.3%

Radiology 52

Radiology Radiology Pediatrics Operations 52

Northwestern EM Blog

SEPTEMBER 12, 2022

This post will discuss a brief overview of hospital planning and operational setup with key elements of a disaster response from events that cause high numbers of blunt trauma, penetrating trauma, burns or crush injuries that may be seen following explosive events, mass shootings, or large scale motor vehicle collisions, to name a few.

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Hazardous Materials 52

Greater Sydney Area HEMS

APRIL 26, 2023

Both the stuff of legend and go by multiple names including harness hang syndrome and orthostatic intolerance, as well as bigfoot and the abominable snowman, respectively. Although remember, as is observed intra-operatively from tourniquet application, muscle can tolerate hours of hypoxia. 2020 Jun 8;12(6):e8514. That’s it?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

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

33 Charts

OCTOBER 2, 2021

According to Epic, the number of patient messages spiked 151 percent nationally from the period covering the first 11 weeks of 2020 through the end of the year. The fundamental problem: we turned on 24/7/365 access for patients (who of course like it) with no operational or business model to handle it. Pretty simple as well.

Leadership 75

Leadership Operations Administration Hospitals 75

Advanced Medical Reviews

MAY 15, 2018

VR’s possible applications in healthcare, particularly in WC, extend well beyond these improved visuals. billion market by 2020. Implemented well, VR could reduce expensive trips to clinics and hospitals and also deliver results that help payers understand the utility of specific telehealth and home care treatments in WC.

Telemedicine 45

Telemedicine Hospitals Operations Ultrasounds 45

Dr. Smith's ECG Blog

DECEMBER 10, 2022

Seen together, these 2 ECG findings suggest possible RVH ( For review on "My Take" for the ECG diagnosis of RVH — Please see My Comment at the bottom of the page in the March 6, 2022 post and in the September 1, 2020 post of Dr. Smith's ECG Blog ). My Impression: After seeing ECG #1 — I was not at all sure what was going on with this patient.

EKG/ECG 52

EKG/ECG Operations Shock EMS 52

Don't Forget the Bubbles

SEPTEMBER 23, 2023

There is leadership operating at many levels. Just like a hospital, or a health system, an orchestra needs every player doing their thing and doing it well. Please consider including music and the other performing arts in your conference wellness activities for those who don’t feel comfortable in Lycra. Think about the composer.

Leadership 136

Leadership Teamwork Hospitals Emergency Department 136

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. Pneumonia A 2020 meta-analysis of 8 studies including 2,215 adults with confirmed community acquired pneumonia in different settings found PCT with a cutoff of 0.5 2020 Nov 20;99(47):e23315. J Med Virol. 2021; 93: 4358–4369.

Infectious Diseases 89

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

Dr. Smith's ECG Blog

AUGUST 30, 2023

Meyers' interpretation and the High-Confidence OMI interpretation by QOH ( Q ueen O f H earts ) — I'll add the following perspective: As per Dr. Meyers — there are QS complexes in leads V1,V2,V3 ( as well as an r wave that is still of small amplitude in lead V4 ). This left 2 additional considerations.

EKG/ECG 72

EKG/ECG Operations Wellness 72

Taming the SRU

MARCH 14, 2023

He appears well and is triaged to an ESI 4. Ultimately, definitive management is in the operating room with revision or replacement of the VP shunt. She was doing well, but recently has had the “stomach flu” with a couple weeks of abdominal pain, nausea and vomiting. More on this below as we work through a few cases….

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

PulmCCM

FEBRUARY 28, 2022

What they did Adult patients admitted to one of 53 intensive care units in New Zealand or Australia between September 2017 and December 2020 were eligible. 45% of patients were admitted to the ICU directly from operating or recovery rooms, 79% were mechanically-ventilated and 42% had sepsis. On the other hand, those randomized to 0.9%

Fluid Resuscitation 40

Fluid Resuscitation Resuscitation Outcomes Sepsis 40

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

This is a case written by Dan Lee (One of our fantastic Hennepin Residents, class of 2020 ) edits by Smith A 60 something-year-old man with a history of ESRD, LVH and prior CABG presented after an episode of hypotension during his hemodialysis, run followed by a syncopal episode which caused his run to be terminated early.

EKG/ECG 52

EKG/ECG Wellness Operations Ultrasounds 52

Dr. Smith's ECG Blog

DECEMBER 20, 2013

At this point the team debated about whether to send him home with cardiology follow up, or to get a D-dimer (despite the fact that he was clearly PERC negative and Wells 0-1). His physical exam findings, history, symptoms, ECG, and clinical course all support this as well.

EKG/ECG 52

EKG/ECG Wellness Operations 52

Dr. Smith's ECG Blog

JANUARY 28, 2023

I am immediately worried that this OMI will not be understood, for many reasons including lack of sufficient STE for STEMI criteria, as well as the common misunderstanding of "no reciprocal findings" which is very common with this particular pattern. Another lesion in the proximal LAD with 80% stenosis was stented as well.

EKG/ECG 52

EKG/ECG Operations Wellness 52

Mind The Bleep

FEBRUARY 7, 2024

Your histogram allows you to visualise how well your patient is oxygenating over a longer time period rather just a snapshot, and this gives you the opportunity to optimise oxygenation by altering ventilator settings if required. One of the few exceptions would be if the patient is paralysed, e.g. for an operation.

Wellness 52

Wellness Seizures Documentation/Coding Operations 52