EMDocs

DECEMBER 11, 2023

In October 2022, the American College of Cardiology released an updated expert consensus decision regarding the evaluation of chest pain in the emergency department. This included the addition several new STEMI equivalents [4] on ECG that warrant “prompt evaluation for emergency coronary angiography.” J Am Coll Cardiol.

EKG/ECG 118

EKG/ECG Emergency Department Academics Operations 118

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. Thus, treatment of Maisonneuve fractures often involves operative repair. (5) References 1.

Fractures 101

Fractures Operations Emergency Department EMS 101

Emergency Medicine Journal

FEBRUARY 20, 2024

Methods This was a multicentre observational cohort study of adults attending 27 UK EDs between 26 September 2022 and 30 November 2022, with potential AAS symptoms: chest, back or abdominal pain, syncope or symptoms related to malperfusion. Reference standard was radiological or operative confirmation of AAS.

Emergency Department 52

Emergency Department Operations Radiology Radiology 52

ACEP Now

JANUARY 5, 2025

A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. Secondary hemorrhage occurs between days five and 14 post-operatively, peaking around days five to seven. He is the founder and host of the Emergency Medicine Cases podcast and website. 2022 ;279(3):1601-1607.

Airway Management 98

Airway Management Operations Resuscitation Pediatrics 98

Emergency Medicine Journal

FEBRUARY 20, 2024

The Chief Coroner’s annual report details the operation of the coroner’s service and does not collate PFD findings. 4 We identified and analysed PFD reports relating to emergency departments (EDs), aiming to identify common themes in coroners’ concerns.

Emergency Department 40

Emergency Department Operations 40

Taming the SRU

MARCH 12, 2024

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. Acad Emerg Med 2023;30(8):800–8. The study’s primary outcomes were the operational impacts of the SQuID protocol on EDLOS and ICU admission rates. Acad Emerg Med 2023;30(8):800–8. Acad Emerg Med 2023;30(8):800–8.

Operations 96

Operations Hospitals Best Practices Wellness 96

PulmCCM

NOVEMBER 6, 2023

open label) at 17 sites in Belgium in 2020-2022, 35% of those receiving plasma died at 28 days, vs. 45% of the usual care patients — a number needed to treat of 10 to save one life. The intervention took place in the emergency department, with device placement by ED physicians.

Blood Transfusions 98

Blood Transfusions Operations Resuscitation Infectious Diseases 98

RebelEM

APRIL 29, 2024

One may speculate that the US-guided CVC placement would have a higher first-pass success rate with fewer complications, however, this may potentially add time to the procedure depending on the operator and institution’s use of ultrasound during emergencies and maintaining sterile technique with the US probe. 2022 PMID: 35206981 2.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

RebelEM

NOVEMBER 25, 2024

2 Moreover, the American Society of Anesthesiologists’ 2022 Practice Guidelines for Management of the Difficult Airway recommend the use of adjuncts like bougies in anticipated difficult airways but stop short of endorsing their routine universal use. Randomized controlled trials or comparative non-randomized observational studies.

Outcomes 93

Outcomes Emergency Department Operations Hospitals 93

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. One operator should perform defibrillation in the anterolateral position, followed by another operator providing a second shock in the anteroposterior position after a delay of less than one second.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Chest drains are commonly inserted in the Emergency Department (ED) with a complication rate of 30-40%. Training in chest drain insertion is essential in Emergency Medicine (EM) as approximately 25,000 patients undergo in England and Wales undergo this procedure annually.

Emergency Department 40

Emergency Department EMS Research Operations 40

RebelEM

JUNE 8, 2023

Am J Emerg Med. 2022 Sep 5. 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. Am J Emerg Med.

Administration 97

Administration Emergency Department Outcomes Documentation/Coding 97

RebelEM

NOVEMBER 6, 2024

2022 Aug 2. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998 Jan-Feb;6(1):15-23. doi: 10.5435/00124635-199801000-00002. PMID: 9692937 Decker N, Norse A. Anterior Elbow Dislocation. Shoulder Elbow.

Dislocations 103

Dislocations Fractures Soft Tissue Injuries Outcomes 103

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

Taming the SRU

MAY 22, 2023

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., Most frequent reasons for emergency department visits, 2018. Updated 2022 Nov 23]. Updated 2022 Apr 7]. Int J Emerg Med.

Fractures 77

Fractures Dislocations Operations Radiology 77

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. The ST/T wave ratio ( ie, the ratio of ST elevation compared to T wave amplitude ) in lead V6 is well over 0.24 ( See My Comment in the June 8, 2022 post for more on this Ratio ). Pericarditis maybe." Spodick sign is present.

EKG/ECG 120

EKG/ECG Wellness Operations Emergency Department 120

EMDocs

JANUARY 11, 2025

Operative management is necessary for signs of peritonitis, evidence of perforation, extensive bowel involvement >40cm, or after failed medical management. 2-4, 6, 8, 9, 12, 13, 14 Operative intervention typically consists of emergency laparotomy with bowel resection, colostomy formation, and Hartmann pouch creation.

EMS 88

EMS Sepsis Shock Fluid Resuscitation 88

The Skeptics' Guide to EM

MARCH 25, 2023

Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Trauma Surg Acute Care Open 2022 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care.

Ultrasounds 52

Ultrasounds Emergency Department Dislocations Radiology 52

The Skeptics' Guide to EM

JULY 30, 2022

Date: July 28th, 2022 Reference: Brower et al. AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: July 28th, 2022 Reference: Brower et al. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

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% Dig Dis Sci 67, 364–366 (2022). JAMA Netw Open.

Leadership 52

Leadership Academics Operations Administration 52

EMDocs

DECEMBER 2, 2023

Updated 2022 Jul 4]. Available from: [link] yousef, CC BY-SA 4.0 <[link] via Wikimedia Commons The post EM@3AM: Oculomotor Nerve Palsy appeared first on emDOCs.net - Emergency Medicine Education. He has no known medical history and has never been to the doctor. Risk factors for ischemic ocular motor nerve palsies.

EMS 78

EMS Operations Pediatrics Emergency Department 78

The Skeptics' Guide to EM

APRIL 16, 2022

Date: April 16th, 2022 Reference: Blom et al. It’s Not Always Hammer Time first appeared on The Skeptics Guide to Emergency Medicine. Date: April 16th, 2022 Reference: Blom et al. Case: A 55-year-old man comes into the emergency department (ED) for increasing knee pain and decrease in function.

Military 40

Military Operations Emergency Department Pediatrics 40

The Skeptics' Guide to EM

DECEMBER 3, 2022

Date: November 16th, 2022 Reference: Lipsett SC, Monuteaux MC, Shanahan KH, et al. Pediatrics 2022 Guest Skeptic: Dr. Angelica DesPain is an Assistant Professor of Pediatrics and a pediatric emergency medicine physician at the Baylor College of Medicine Children’s Hospital of San Antonio in San Antonio, TX.

Pediatrics 40

Pediatrics Operations Ultrasounds Emergency Department 40

Don't Forget the Bubbles

MAY 22, 2023

You’ve just started working in the Children’s Emergency Department (CED). These can be operated and maintained by patients and their families at home. The triage nurse comes to let you know about Robin. He is eight years old, with a background of cerebral palsy and severe scoliosis. You go to see Robin.

Radiology 98

Radiology Radiology Hospitals Wellness 98

Don't Forget the Bubbles

MAY 17, 2023

Post-operative pain in children: Comparison of pain scores between parents and children. 2023 Apr 20:fetalneonatal-2022-324835. Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study. 2023 Apr 4:archdischild-2022-325281.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Taming the SRU

JUNE 11, 2023

End-tidal carbon dioxide measured at emergency department triage outperforms standard triage vital signs in predicting in-hospital mortality and intensive care unit admission. Acad Emerg Med 2023; 10.1111/acem.14703 Am J Emerg Med. Acad Emerg Med. 2023;(December 2022):1-10. Ladde JG, Miller S, Chin K, et al.

Hospitals 87

Hospitals Emergency Department EMS Outcomes 87

ACEP Now

DECEMBER 10, 2023

Boarding in the emergency department is a systemic crisis with emergency physicians at the center. ACEP said as much to the White House by writing a powerful letter in November 2022 supported by 34 organizations to show how serious the issue has become. This can be prevented.”

Emergency Department 52

Emergency Department Leadership Hospitals Administration 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. West J Emerg Med. 2022 Jun 5;23(4):497-504. 2011 Oct;140(4):859-866.

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

Don't Forget the Bubbles

SEPTEMBER 23, 2023

This talk, from Clare Skinner, on music, medicine and leadership , comes from our 2022 DFTB conference in Brisbane. Facilitator-in-chief’ is my role when leading the ED Musos virtual choir and orchestra, and this also applies to my job in the hospital as Director of the Emergency Department. Think about the composer.

Leadership 136

Leadership Teamwork Hospitals Emergency Department 136

ACEP Now

MAY 4, 2023

A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. On hospital day 2, he was taken to the operating room for surgical rib fixation. 2022; 22(11):432-439. 2022; 276:221-234. Click to enlarge.) BJA Education.

EMS 52

EMS Fractures Operations Ultrasounds 52

Taming the SRU

MAY 23, 2023

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., Updated 2022 Nov 23]. Foot injuries in the emergency department. Updated 2022 May 14]. Foot & Ankle Int. 2015 Apr 28].

Fractures 57

Fractures Dislocations Operations EMS 57

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

RebelEM

MARCH 9, 2023

However, evaluating and managing patients with acute alcohol intoxication in the emergency department can be challenging. Unsuspected Critical Illness Among Emergency Department Patients Presenting for Acute Alcohol Intoxication. Annals of Emergency Medicine. 2022 Jul;46(7):1306-1312. J Emerg Med.

Psychiatric 52

Psychiatric Emergency Department Documentation/Coding Fractures 52

ALiEM

MAY 13, 2024

Case Introduction: Child with abdominal pain Wendy is a 7-year-old girl who comes into the emergency department with redness, swelling, and pain on her left calf. 63M with an Erythematous Abdomen Limitations of POCUS As with all ultrasound applications, soft tissue POCUS is operator dependent. Pediatr Emerg Care.

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

SheMD

JULY 23, 2023

Some of the interview information may not be relevant during the 2020-2021 & 2021-2022 academic years. Therefore, he worked with the primary care innovation department and learned hospital administration and clinical operations during his residency. Disclaimer: This post was written before the COVID-19 pandemic.

Research 98

Research Academics Hospitals Administration 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

RebelEM

NOVEMBER 3, 2022

Matchett 2022). Indian J Crit Care Med 2022. Inclusion: Articles compared the safety and efficacy of etomidate compared to k etamine, in patients of all age groups, as induction agents for RSI in the Emergency Department (ED) and prehospital settings. in the ketamine cohort compared to 12.4% in the etomidate cohort.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52