Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). Acad Emerg Med. West J Emerg Med.

Pediatrics 187

Pediatrics Emergency Department Outcomes Sepsis 187

Don't Forget the Bubbles

MAY 17, 2023

2023 Apr 17. 2023 Apr 25;329(16):1386-1398. 2023 Apr 29. 2023 Apr 24. 2023 Apr 12. Post-operative pain in children: Comparison of pain scores between parents and children. 2023 Apr 28. 2023 Apr 25. 2023 Apr 25. 2023 Apr 25. 2023 Apr 24. 2023 Apr 18:S0890-8567(23)00185-5.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

ACEP Now

JUNE 7, 2023

ED leaders worked to develop new physician documentation and coding guidelines that needed to be implemented at the beginning of 2023. Software attacks crippled operations in large hospital chains, and physical assaults on ED staff continued unabated. Executive Summary of ED Operations in 2022 Volume was up from 2021.

Emergency Department 52

Emergency Department Documentation/Coding Operations EMS 52

ACEP Now

DECEMBER 11, 2023

The Emergency Department Benchmarking Alliance (EDBA) is a membership organization composed of high-performance emergency departments (EDs) that share a commitment to quality. In 2023, ED volumes are approaching those seen pre-pandemic at 66 percent. Published August 1, 2023. Accessed November 29, 2023.

Emergency Department 52

Emergency Department Hospitals EMS Operations 52

ACEP Now

MAY 9, 2024

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon. 1 The Rise of the Miami BBL An entire industry has emerged around gluteal AFTs in Miami.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. AEM August 2023 Guest Skeptic: Dr. Suchismita Datta. Date: August 30, 2023 Reference: Griffey et al. AEM August 2023 Guest Skeptic: Dr. Suchismita Datta.

Diabetic Emergencies 110

Diabetic Emergencies Operations Hospitals Research 110

Taming the SRU

SEPTEMBER 22, 2023

389, 418–429 (2023). million adults undergo tracheal intubation outside of the operating room each year in the United States. The operator reported a subjective assessment of the anticipated difficulty. Most intubations (69.7%) were performed in the emergency department, with the remainder occurring in an intensive care unit.

Operations 105

Operations Outcomes Emergency Department Academics 105

The Skeptics' Guide to EM

JUNE 15, 2024

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. Enhanced Operative Strategies - Damage control surgery with truncated interventions, energy devices, hemostatic foams/gels/packs, etc. Reference: Jansen et al.

Resuscitation 120

Resuscitation Patient Safety Operations Emergency Department 120

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. Management consists of intravenous antibiotics , and hand surgery should be consulted to consider operative debridement. Accessed June 24, 2023.

EMS 95

EMS Fractures Operations Ultrasounds 95

Don't Forget the Bubbles

JUNE 30, 2023

These procedures require an experienced operator. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. b) Emergency thoracotomy Let’s be clear: YOU will not be doing any of this. These procedures require an experienced operator. c) Or, do both?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EMDocs

OCTOBER 30, 2023

Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. Production levels increased steadily back to baseline, achieving normal supply levels in February 2023. West J Emerg Med.

Radiology 99

Radiology Radiology Emergency Department Hospitals 99

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. Crit Care Med.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

ALiEM

SEPTEMBER 13, 2024

A 32-year-old male with no significant past medical history presented to the emergency department (ED) from an outside hospital for further management of right eye pain and vision loss sustained after he was struck by a metal wire while at work. An emergent ophthalmology consult is needed to plan for operative repair.

Emergency Department 64

Emergency Department Academics Fractures Hospitals 64

Don't Forget the Bubbles

OCTOBER 10, 2024

2023 Mar 30;110(4):432-438. Ten thousand children in the UK are operated on a year for fingertip injuries, and 96% of surgeons currently report replacing the nail plate intra-operatively. 2024 Jul 10:archdischild-2023-326727. doi: 10.1136/archdischild-2023-326727. doi: 10.1136/archdischild-2023-326247.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

ACEP Now

APRIL 5, 2024

A 68-year-old man presents to the emergency department (ED) with altered mental status and fever. There was no analysis of operator experience or expertise. As with any procedural device, operator expertise is an important component of its successful use. Ann Emerg Med. 2023: online ahead of print.

Airway Management 73

Airway Management Operations Emergency Department Research 73

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

Taming the SRU

OCTOBER 23, 2023

THE CASE A female in her early 20s, G4P2012, presents to the emergency department (ED) with a 5 day history of left lower quadrant abdominal pain which has been worsening since onset. At this point, the patient is taken to the operating room for a diagnostic laparoscopy. Updated 2023 Jan 16]. 3 - Baker M, dela Cruz J.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

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

ACEP Now

SEPTEMBER 3, 2024

6,17-18 In a 2023 systematic review, no studies showed decreased costs to patients or payors, and the effect of PE ownership on quality of care measures was “mixed to harmful,” a pattern that has continued in subsequent studies. While secrecy surrounds the operations of many PE-owned groups, Envision serves as a case study.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

JournalFeed

APRIL 15, 2023

The JournalFeed podcast for the week of April 10-14, 2023. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.

Academics 52

Academics Pediatrics Operations Emergency Department 52

ACEP Now

MARCH 6, 2024

The Sisyphean task remains to try to keep up—and, in that vein—here is a light round of the emergency medicine literature from 2023. 7 The operators involved in the trial were mostly emergency medicine residents or critical care fellows, but this fact does not diminish the generalizability of these observations.

Research 52

Research Airway Management Stroke Outcomes 52

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 129

Ultrasounds Outcomes COPD Hospitals 129

EMDocs

SEPTEMBER 25, 2023

Improved Visualization: Video laryngoscopes allow for the use of standard or hyperangulated geometry, essentially allowing the operator to “look around the corner” on an anterior airway. Operators can manipulate the blade with less force to optimize the view, making it easier to identify and navigate the endotracheal tube into the trachea.

Emergency Department 92

Emergency Department Soft Tissue Injuries Airway Management Operations 92

Greater Sydney Area HEMS

FEBRUARY 20, 2024

This would therefore remove some of the limitations (perceived or real) around time delays associated with using ultrasound for central access as there would be no need for probe covers and positioning of the portable ultrasound (which often needs the help of a second operator, a significant limitation in a small prehospital medical team).

Ultrasounds 98

Ultrasounds Shock Research Operations 98

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The children’s Emergency department sees approximately 50,000 presentations per year. Emerg Med J. Paediatr Int Child Health. 2024 Jan 11:1-7.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

ACEP Now

JUNE 14, 2024

Two years ago, an ACEP Now article covered the issue of transfer challenges resulting from early pandemic operations. 1 As fresh challenges of the pandemic and hospital operations changed emergency medicine practice, one of the more challenging areas was the movement of admitted patients out of the first emergency department (ED).

Emergency Department 52

Emergency Department Operations Hospitals Leadership 52

EMDocs

DECEMBER 2, 2023

Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 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. Arch Ophthalmol.

EMS 93

EMS Operations Pediatrics Emergency Department 93

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. 6/11/2023

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

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. NOTE: By way of reference — I've added below an ADDENDUM excerpted from My Comment in the May 16, 2023 post in Dr. Smith's ECG Blog, summarizing "My Take" regarding diagnostic considerations for pericarditis.

EKG/ECG 117

EKG/ECG Wellness Operations Emergency Department 117

EMDocs

NOVEMBER 18, 2023

Liver Transplantation: Operative Techniques and Medical Management. Accessed April 21, 2023. UpToDate; 2023. Accessed May 7, 2023 5) Oh SY, Lee JM, Lee H, et al. Accessed May 7, 2023 5) Oh SY, Lee JM, Lee H, et al. The Journal of Emergency Medicine. 2023; [link]. Acad Emerg Med. In: Post T, ed.

EMS 95

EMS Ultrasounds Emergency Department Outcomes 95

The Skeptics' Guide to EM

MARCH 25, 2023

Date: March 22, 2023 Reference: Hilsden et al. 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

ALiEM

SEPTEMBER 9, 2024

A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today. Interdisciplinary Neurosurgery, 13, 66-70.

Sepsis 60

Sepsis Academics Operations Emergency Department 60

ACEP Now

OCTOBER 15, 2023

Additionally, in the current era of ubiquitous emergency department (ED) boarding, ED length of stay is of critical importance. Diabetes care in the hospital: standards of care in diabetes-2023. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. Acad Emerg Med.

Hospitals 80

Hospitals Operations Emergency Department Research 80

RebelEM

NOVEMBER 20, 2023

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial [published online ahead of print, 2023 Oct 12]. 2023;e2320850. J Spec Oper Med. Paper: Jansen JO, Hudson J, Cochran C, et al. 2018;18(4):37-55.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. 2023 Feb 2;388(5):439-452. In 7 studies with 4164 patients, PCT with a cut-off > 0.1 ng/mL, 0.25-0.5

Infectious Diseases 89

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

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 ). Exposure to incivility hinders clinical performance in a simulated operative crisis. 2023 Mar 13. 2023 Oct 31;21(1):403.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

RebelEM

SEPTEMBER 11, 2023

1 It is a quickly deployable and easily interpreted study that can be done in real time to guide decisions in the Emergency Department. Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. 2023 Mar 26;13(7):1248. and specificity of 88.0%

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68