RebelEM

APRIL 17, 2023

A repeat search was completed in May 2021 & November 2022. While operator dependent, the dynamic ability of POCUS augments bedside diagnosis and can assist with drainage. 2021 May 12:34894211015590. Published on October 25, 2021. Accessed on December 3, 2021. AJR Am J Roentgenol. 2015 May;204(5):1064-8.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

Don't Forget the Bubbles

JANUARY 31, 2024

As a Trauma Unit within the Thames Valley Trauma Network, Wexham Park Hospital hosts trainees from across the spectrum of acute specialties. Two really important patient groups were excluded – those who were admitted to hospital and families who were not fluent in English. the pre-hospital setting. Why does it matter?

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

RebelEM

OCTOBER 2, 2023

Mild to moderate DKA represents a subgroup of patients that often require admission to the ICU due to hospital policies not allowing insulin infusions outside of this clinical setting. The SQuID Protocol (Subcutaneous Insulin in /diabetic Ketoacidosis): Impacts on ED Operational Metrics. Paper: Griffey RT et al. Acad Emerg Med 2023.

Operations 104

Operations Academics Fluid Resuscitation Outcomes 104

ALiEM

OCTOBER 30, 2024

Clinical impact: Rather than arguing with the patient about the likelihood of this phenomenon occurring and whether this is a true allergy, the patient is informed that they do not need to immediately start treatment to receive care in the hospital. Your patient ultimately is diagnosed with a spinal epidural abscess requiring operative care.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

RebelEM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Point-of-care ultrasound (PoCUS) is inherently operator-dependent, which may have led to inconsistencies in the quality and findings of the ultrasound exams across different operators.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

EMDocs

MAY 25, 2024

recent hospitalization, residence in a long-term care facility, HIV infection, previous antibiotic use, hemodialysis), then vancomycin , linezolid , or daptomycin should be added. McGraw Hill; 2021. If patients have risk factors for methicillin-resistant Staphylococcus aureus infection (e.g., Am Fam Physician. 2014;89(11):882-888.

EMS 98

EMS Dehydration Operations Hospitals 98

ACEP Now

JUNE 21, 2023

2,3 In the 2021-2022 academic year, categorical (non-combined) EM residency lengths included 221 (80 percent) PGY 1-3 and 55 (20 percent) PGY 1-4 programs. 14 On the contrary, hospitals may operationally and financially benefit from longer training lengths thus indirectly influencing curricula decisions. Ann Emerg Med.

EMS 114

EMS Academics Telemedicine Operations 114

RebelEM

APRIL 29, 2024

Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure. Intravenous vs.intraosseous vascular access during out-of-hospital cardiac arrest – protocol for a randomized clinical trial. 2021 PMID: 34273470 12 Petitpas F et al. Resusc Plus. Resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

PulmCCM

MAY 16, 2024

FDA approved the tool in part based on a 2021 study concluding that among 1400 patients at two Illinois hospitals, the score had an area under the receiver operating curve (AUROC) of 0.83 for diagnosis of sepsis was 0.83. Hey, that’s pretty good! Compared to what reference standard?

Sepsis 52

Sepsis Operations Hospitals 52

ACEP Now

JUNE 7, 2023

The performance of EDs in 2020 and into 2021 changed abruptly, and that carried through into 2022. Software attacks crippled operations in large hospital chains, and physical assaults on ED staff continued unabated. Patient volume losses in 2020 reversed in 2021. This necessarily increased ED walkaway rates.

Emergency Department 52

Emergency Department Documentation/Coding Operations EMS 52

EB Medicine

NOVEMBER 1, 2021

EMplify – November 2021 Announcements: The EB Medicine app is live and available for free in the Apple Store. Coming to Google Play soon. It is in Beta and your feedback is welcome. Also, this month use code ACEP21! It is in Beta and your feedback is welcome. ,* Also, this month use code ACEP21!

Fractures 52

Fractures Documentation/Coding Operations Emergency Department 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. The patient was discharged on hospital day 5. 2021; 9:e04871. No free intraperitoneal air.

Ultrasounds 98

Ultrasounds Emergency Department Wellness Operations 98

The Skeptics' Guide to EM

NOVEMBER 20, 2021

Date: November 16th, 2021 Reference: Hammouda et al. AEM November 2021 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: November 16th, 2021 Reference: Hammouda et al.

Geriatric Emergencies 52

Geriatric Emergencies Elder Abuse Research Academics 52

Taming the SRU

OCTOBER 23, 2023

At this point, the patient is taken to the operating room for a diagnostic laparoscopy. After a short period of recovery in the hospital, she is discharged home in stable condition with follow-up with OBGYN. She was taken to the operating room and found to have a right tubal ectopic pregnancy with a pseudogestational sac.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

RebelEM

AUGUST 22, 2024

Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Finally, most hospitals lack the necessary protocols and processes to coordinate the complex interdisciplinary care patients with RAO may require. Published 2021 Feb 16. Clin Ophthalmol. 2021;15:601-608.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

33 Charts

SEPTEMBER 21, 2021

And uncertainty is the new core operating condition for healthcare leaders. As doctors and healthcare leaders we have traditionally operated in a field of relative certainty. We’ve got to operate in dynamic state where we are willing to move with the unknowns and change our views on a regular basis.

Leadership 58

Leadership Operations Hospitals Wellness 58

Emergency Medicine Journal

MAY 23, 2023

Methods Traditional and grey-literature searches were performed on 1 June 2021. We report overall sensitivity, specificity, positive and negative predictive values, and the hierarchical summary receiver operating characteristic curve for LUS. Meta-analysis was carried out using established open-source packages in R.

Ultrasounds 52

Ultrasounds Operations Research Hospitals 52

RebelEM

NOVEMBER 6, 2023

So with yet another confounding variable added (sicker patients at baseline in methylene blue group), the comparison of these two medications is yet again even more difficult There was no difference in ICU and hospital length of stays or hospital mortality between the two groups. J Cardiothorac Vasc Anesth. 2023 Jul 19.

Shock 71

Shock Administration Academics Hospitals 71

ACEP Now

DECEMBER 11, 2023

Most Important Data Trends for Emergency Physicians and ED Leaders Large losses (around 14 percent) in ED volume in 2020 reversed in 2021 and volumes increased further during 2022. The overall length of stay for all ED patients increased to 211 minutes in 2022, up from 194 minutes in 2021, 184 minutes in 2020, and 182 minutes in 2019.

Emergency Department 52

Emergency Department Hospitals EMS Operations 52

ACEP Now

MARCH 13, 2024

1 Hospital boarding is the main driver of ED crowding, with patients nearly always awaiting transfer to inpatient beds and now more commonly, to other hospitals. When considering inter-hospital transfer, the patient’s goals of care should be paramount in guiding the process.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

SheMD

JULY 23, 2023

Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. One individual I knew wanted to run his own clinic or hospital. Therefore, he worked with the primary care innovation department and learned hospital administration and clinical operations during his residency.

Research 98

Research Academics Hospitals Operations 98

Taming the SRU

JANUARY 29, 2024

Hospital Course The patient was initiated on a therapeutic heparin drip in the emergency department with vascular surgery consultation. She had improvement of the swelling in her left arm with return of sensation and function during her five-day hospital course. 2021 Oct;76:601.e7-601.e11. Epub 2021 Jun 25. Ann Vasc Surg.

Emergency Department 94

Emergency Department Fractures Hospitals Operations 94

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. 2021 Mar;60(3):273-284. J Emerg Med.

EKG/ECG 120

EKG/ECG Emergency Department Academics Operations 120

ACEP Now

NOVEMBER 16, 2023

2,3 In the 2021-2022 academic year, categorical (non-combined) EM residency lengths included 221 (80 percent) PGY 1-3 and 55 (20 percent) PGY 1-4 programs. 12 On the contrary, hospitals may operationally and financially benefit from longer training lengths thus indirectly influencing curricula decisions. government. Ann Emerg Med.

Academics 52

Academics EMS Telemedicine Research 52

Taming the SRU

AUGUST 30, 2023

In a small study involving 79 hospitalized children, PCT was found to be elevated in bacterial infections, with a decrease after appropriate antibiotic therapy, and decreased in viral infections [24]. This finding was not significantly different among operators with different levels of experience, or between adults and children.

Infectious Diseases 89

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

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

Northwestern EM Blog

JUNE 16, 2024

Operational definition of normal sinus heart rate. 2021, October 1). Seth Trueger, MD, MPH, FACEP Associate Professor of Emergency Medicine Northwestern Memorial Hospital How To Cite This Post: [Peer-Reviewed, Web Publication] Kilbane, K. Bishop, R. L., & Rifkin, R. The American Journal of Cardiology , 69 (14), 1245–1246.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Infectious Diseases Stroke Poisoning 52

Taming the SRU

FEBRUARY 19, 2024

Arterial lines require specialized monitoring and nursing resources which are not available in all hospital settings. 12) Axillary While axillary arterial line placement has been uncommon, in the age of facile ultrasound operators it may become a more advantageous and accessible site particularly in patients with high BMIs. Gelmann, D.,

Shock 59

Shock Resuscitation Ultrasounds Research 59

RebelEM

NOVEMBER 3, 2022

What They Did: Performed a search of the following databases: Pubmed, Embase, Cochrane, and ClinicalTrials.gov up to and including June 1, 2021. The environment, operator-related factors, and equipment are different in a pre-hospital vs. ED setting. Granular details of the dosing of induction agents were not given.

Emergency Department 52

Emergency Department Outcomes Sepsis Operations 52

Northwestern EM Blog

DECEMBER 20, 2021

Management is orthopedic consultation for operative stabilization [12]. Terese Whipple, MD Assistant Professor Department of Emergency Medicine University of Iowa Hospitals and Clinics How To Cite This Post: [Peer-Reviewed, Web Publication] Ng, T. 2021, Dec 20). References Smith E, Anderson M, Foster H. 2012;97(5):185-193.

Pediatrics 52

Pediatrics Ultrasounds Emergency Department Radiology 52

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. Then she began complaining of severe dizziness and quickly went into ventricular fibrillation and resuscitation was initiated by hospital staff.

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

EMDocs

NOVEMBER 16, 2024

4 Pain is the most common reason for presentation in the early post operative period. 5 Highest risk of dislocation early in the post operative course due to laxity of the soft tissue after surgery. 6 Hip flexion or adduction in the early post-operative period can cause atraumatic dislocations (typically avoided for 6 weeks post-op).

EMS 98

EMS Dislocations Fractures Operations 98

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. Sheffield Children’s Hospital is a stand-alone tertiary children’s hospital in the heart of Sheffield with a paediatric MTC. mmol/L with the median of 2.6

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

Pediatric EM Morsels

NOVEMBER 3, 2023

This allowed US hospitals to stock the drug to ensure quick treatment of suspected severe cases, rather than having to ship it from the CDC under the prior expanded-access protocol (Thomas 2023). Both have a range of detection limits, which can be greatly dependent on operator. Travel Medicine and Infectious Disease 44 (2021) 102196.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

EMDocs

FEBRUARY 7, 2024

3 Increasing Strikes and Unions Labor actions in healthcare can disrupt normal hospital operations, potentially impacting costs and threatening patient quality of care. One study from the National Bureau of Economic Research on nursing strikes in New York State from 1984 to 2004 found that hospital mortality increased by 19.4%

Hospitals 98

Hospitals Research Patient Safety Wellness 98

The Skeptics' Guide to EM

SEPTEMBER 18, 2021

Date: September 16th, 2021 Reference: Sippola et al. JAMA 2021 Guest Skeptic: Dr. Rob Leeper is an assistant professor of surgery at Western University and the London Health Sciences Center. Date: September 16th, 2021 Reference: Sippola et al. The APPAC II Randomized Clinical Trial. The APPAC II Randomized Clinical Trial.

Operations 52

Operations Academics Ultrasounds Hospitals 52

Don't Forget the Bubbles

JUNE 12, 2023

I first watched “ Just a Routine Operation “, – the story of the events that led to the tragic death of Elaine Bromiley. Elaine Bromiley went into hospital for a routine operation. I remember how I felt when. When Max entered the healthcare system, he was alert and could ask for help.

Resuscitation 145

Resuscitation Anaphylaxis Best Practices Operations 145