EMDocs

OCTOBER 30, 2023

Pillai, MBBS (@sspillai01, EM Resident Physician, University of Kentucky) and Christopher N. ” – Musings of an American ED resident in July 2022 when US healthcare was affected simultaneously by supply chain issues from GE Healthcare (contrast media) and Abbott Laboratories (Similac baby formula). Authors: Saran S.

Radiology 99

Radiology Radiology Emergency Department Hospitals 99

EMDocs

DECEMBER 2, 2023

We’ll keep it short, while you keep that EM brain sharp. 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.

EMS 93

EMS Operations Pediatrics Emergency Department 93

EMDocs

AUGUST 12, 2023

We’ll keep it short, while you keep that EM brain sharp. Management consists of intravenous antibiotics , and hand surgery should be consulted to consider operative debridement. Emergency Medicine Residents’ Association; 2022:10-11. A 41-year-old male with no significant past medical history presents with a deep hand laceration.

EMS 95

EMS Fractures Operations Ultrasounds 95

Pediatric EM Morsels

NOVEMBER 17, 2023

2022 May 11;10:864766. 2022 Apr;29(4):406-414. Epub 2022 Jan 12. The post Cuffed Endotracheal Tubes for Children: ReBaked Morsel appeared first on Pediatric EM Morsels. 0.41), p < 0.001. Bibl K, Pracher L, Küng E, Wagner M, Roesner I, Berger A, Hermon M, Werther T. Front Pediatr. doi: 10.3389/fped.2022.864766.

Pediatrics 187

Pediatrics Emergency Department Outcomes Sepsis 187

RebelEM

FEBRUARY 1, 2024

What they Did : Investigator-initiated, Multicenter, Parallel-ground, Open-label, Registry-linked, Randomized, Controlled, Non-Inferiority trial 22 Canadian Primary and Comprehensive Stroke Centers from December 2019 to January 2022 Eligible ischemic stroke patients randomized 1:1 to receive intravenous tenecteplase (0.25 vs Alteplase 34.8%

Stroke 135

Stroke Blood Transfusions Outcomes EMS 135

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 arrival by EMS increased and more of those patients were admitted. percent in 2022, compared to 2.7

Emergency Department 52

Emergency Department Documentation/Coding Operations EMS 52

Emergency Medicine Journal

SEPTEMBER 25, 2024

Background Emergency Medical Services (EMS) studies have shown that prehospital risk stratification and triage decisions in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) can be improved using clinical risk scores with point-of-care (POC) troponin. The primary end point was the hospital diagnosis of NSTE-ACS.

EMS 97

EMS EKG/ECG Operations Hospitals 97

ALiEM

OCTOBER 30, 2024

Case A patient arrives via EMS from the bus station complaining of fever, vomiting, and back pain. Our experience: It was not long ago that we instructed our staff that: ‘COWS >8, give ’em 8 (mg of buprenorphine).’ Your patient ultimately is diagnosed with a spinal epidural abscess requiring operative care.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

Pediatric EM Morsels

JUNE 16, 2023

2022) Morel-lavallee lesions – diagnosis and practical management of these troublesome injuries! Arch Orthop Trauma Surg 2013;133(5):635-640.23443527 The post Morel-Lavallée Lesion in Children appeared first on Pediatric EM Morsels. Shen 2013, Nickerson 2014, Scolaro 2016 ] Singh et al proposed an algorithm to guide treatment.

Soft Tissue Injuries 154

Soft Tissue Injuries Dehydration Fractures Operations 154

Taming the SRU

SEPTEMBER 25, 2023

This places a significant responsibility on the EM physician to diagnose and treat fractures. Specifically, EM physicians should be able to recognize fractures that will likely require operative management and facilitate close follow up, such as a Maisonneuve fracture. 2022 May 16;10(14):4684-4690. World J Clin Cases.

Fractures 101

Fractures Operations Emergency Department EMS 101

ACEP Now

MAY 4, 2023

EMS recognized a chest wall deformity with movement of the chest wall, and a splint was devised and taped around his chest for what was suspected to be a 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. References Mistry RN, Moore JE.

EMS 52

EMS Fractures Operations Radiology 52

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. In all, this 2022 update from the ACC provides diagnosis and management pathways intended to guide the approach to chest pain in the emergency department. PMID: 36241466.

EKG/ECG 119

EKG/ECG Emergency Department Academics Operations 119

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. appeared first on REBEL EM - Emergency Medicine Blog. Two investigators independently assessed and screened all studies for eligibility.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

ACEP Now

JULY 7, 2023

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. Heart disease and stroke statistics-2022 update: A report from the American Heart Association. Published December 19, 2022.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 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

MAY 27, 2024

What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy. appeared first on REBEL EM - Emergency Medicine Blog.

Outcomes 137

Outcomes Research Operations Hospitals 137

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. Reference: Brower et al. Also joining us is Dr. Andrew Goldsmith.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

ACEP Now

SEPTEMBER 12, 2023

one of the country’s largest physician staffing firms, announced on July 17 through an email to its employees its intention to cease operations July 31, the chilling effects were felt across a workforce of 2,500 APP-employed physicians and advanced practice clinicians working at the 153 hospital emergency departments it managed in 18 states.

Emergency Department 105

Emergency Department Hospitals Operations Legal Issues 105

Taming the SRU

NOVEMBER 3, 2023

41, 2695–2701 (2022). Broad strokes In this prospective, non-randomized study published by Kring et al in January 2022 out of Maine Medical Center, researchers compared mean pain scores at rest and during incentive spirometry before, at 15 minutes after, and then 60 minutes after treatment with a serratus anterior plane block.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

RebelEM

DECEMBER 19, 2022

At REBEL EM, we’ve done an extensive write up that details some of the different types of DED and the electrophysiology behind it. 2022 Nov 6 PMID: 36342151 Clinical Question: How does double defibrillation and vector change defibrillation compare to standard therapy in OHCA patients with refractory ventricular fibrillation?

EMS 52

EMS CPR Shock Resuscitation 52

RebelEM

JANUARY 25, 2024

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. 2022 Dec;106:9-38. Epub 2022 Aug 1. Published on February 28, 2022. appeared first on REBEL EM - Emergency Medicine Blog.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

She took an oxycodone and called EMS. The cut points for what constitute OMI and not OMI as well as confidence levels are calibrated to maximize sensitivity and specificity according to the receiver operating characteristic. In a large proportion of cath labs, the operator would probably have ended the case at this point.

EKG/ECG 66

EKG/ECG Operations Wellness Ultrasounds 66

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. Hegeman EM, et al. Schwindt EM, et al. 2023 Apr 4:archdischild-2022-325281. J Pediatr Gastroenterol Nutr. 2023 Apr 24. Cetinkaya PG, et al. Eur J Pediatr. 2023 Apr 12. Niu T, et al.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

ACEP Now

DECEMBER 11, 2023

The preliminary 2022 report contained performance measures for 938 EDs that managed more than 46 million patient visits, plus 222 additional freestanding EDs that served more than 4 million patients. Thus, the survey included data for about one-third of all patients seen in US ED’s in 2022. percent in 2022. percent in 2021, 2.8

Emergency Department 52

Emergency Department Hospitals EMS Operations 52

ACEP Now

NOVEMBER 16, 2023

emergency medicine (EM) residency training length has been a decades-long dilemma: four versus three years. First, is three years enough time to become an EM physician? But critical questions remain unanswered when it comes to specialization, career trajectory, and actual competence as an EM physician. percent versus 90.8

Academics 52

Academics EMS Telemedicine Research 52

RebelEM

JUNE 8, 2023

2022 Sep 5. 2022 2022 Sep 5. Rezaie, MD (Twitter: @srrezaie ) The post The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults appeared first on REBEL EM - Emergency Medicine Blog. Paper: Singer S, et al. The safety and efficacy of push dose vasopressors in critically ill adults. Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Emergency Medicine Journal

NOVEMBER 28, 2023

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. This study was conducted by the Irish Trainee Research Network (ITERN) from May 2022 until February 2023.

Emergency Department 40

Emergency Department EMS Research Operations 40

RebelEM

MARCH 27, 2023

First ED-based study to evaluate how operational effects such as crowding can affect patient care in the form of LPV Included ARDS criteria relating to the usage of LPV in the ED allowing evaluation as to whether patients with ARDS were more likely to receive LPV settings. 2022 Feb 8; PMID: 35156050 Higgins TL et al. N Engl J Med.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

RebelEM

NOVEMBER 6, 2023

Methylene Blue for Vasoplegic Syndrome After Cardiac Operation: Early Administration Improves Survival. 2022 Aug 22. PMID: 37586951 Mehaffey JH, et al. Ann Thorac Surg. Epub 2017 May 24. PMID: 28551045 Bak MA, et al. High-Dose Hydroxocobalamin for Refractory Vasoplegia Post Cardiac Surgery.

Shock 71

Shock Administration Academics Hospitals 71

RebelEM

SEPTEMBER 11, 2023

Published 2022 Sep 2. Similarly, surgeons might hesitate to operate on older patients with multiple comorbidities due to higher associated risks. appeared first on REBEL EM - Emergency Medicine Blog. Article: Hilsden R, Mitrou N, Hawel J, Leeper R, Thompson D, Myslik F. Trauma Surg Acute Care Open. 2022;7(1):e000944.

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68

EMDocs

NOVEMBER 16, 2024

We’ll keep it short, while you keep that EM brain sharp. 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. 2% of THA will have a post operative deep space infection.

EMS 98

EMS Dislocations Fractures Operations 98

Dr. Smith's ECG Blog

DECEMBER 10, 2022

Per EMS report, the patient had a syncopal episode at work. MY Comment, by K EN G RAUER, MD ( 12/10 /2022 ): == Sometimes an ECG raises more questions than it answers! I was texted this ECG by one of my partners, with the following history: A 60-something male with diabetes and HTN presented with syncope.

EKG/ECG 52

EKG/ECG Operations Shock EMS 52

RebelEM

MARCH 9, 2023

Keyes 2022) Auditory and Visual Hallucinations (AH/VH) : The differential diagnosis for hallucinations is broad and includes medical pathology, psychiatry pathology, and transient causes such as acute drug intoxication. 2022 Jul;46(7):1306-1312. Epub 2022 Jun 9, PMID: 35581530 Prerost FJ, Sefcik D, Smith B. Alcohol Clin Exp Res.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

ALiEM

MAY 13, 2024

63M with an Erythematous Abdomen Limitations of POCUS As with all ultrasound applications, soft tissue POCUS is operator dependent. 2022 Feb 1;38(2):e674-e677. 2022 Jan;79(1):90. Lam SHF, Sivitz A, Alade K, Doniger SJ, Tessaro MO, Rabiner JE, Arroyo A, Castillo EM, Thompson CA, Yang M, Mistry RD. Pediatr Emerg Care.

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

RebelEM

NOVEMBER 3, 2022

Matchett 2022). Indian J Crit Care Med 2022. The environment, operator-related factors, and equipment are different in a pre-hospital vs. ED setting. Rezaie, MD (Twitter: @srrezaie ) The post Etomidate Vs. Ketamine: A Systematic Review and Meta-Analysis appeared first on REBEL EM - Emergency Medicine Blog.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

RebelEM

AUGUST 31, 2023

Rezaie, MD (Twitter/X: @srrezaie ) The post The PACER Trial: Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia appeared first on REBEL EM - Emergency Medicine Blog. vs No Transfusion 4.9% Rate of Platelet Transfusion within 24 hours: 0.14 Rate of Red-Cell Transfusion within 24 hours: 0.48 Acute Lung Injury: 0.5%

Ultrasounds 58

Ultrasounds Outcomes Wellness Research 58

Dr. Smith's ECG Blog

MAY 14, 2022

See this post: Idiopathic Ventricular Tachycardias for the EM Physician. T his delay in initial conduction of the QRS makes it much less likely that a supraventricular mechanism i s operative ( since initial conduction with AVNRT and orthodromic AVRT is usually fast, being transmitted over the normal AV nodal pathway ).

EKG/ECG 52

EKG/ECG Shock Operations EMS 52