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 Wellness Emergency Department 60

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

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 Administration Emergency Department 52

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 Hospitals Operations Leadership 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.

Operations 83

Operations Diabetic Emergencies Hospitals Research 83

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 93

Resuscitation Patient Safety Emergency Department Operations 93

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 Emergency Department Operations Research 73

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

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. Accessed March 5, 2023. Updated 2023 Apr 22]. 9(1):31-36.

Fractures 75

Fractures Dislocations Operations Radiology 75

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 69

EMS Fractures Operations Ultrasounds 69

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 102

Resuscitation Administration Emergency Department Hospitals 102

Critical Care Now

JULY 7, 2024

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. 2023;e2320850. Reading Time: 3 minutes Jansen JO, Hudson J, Cochran C, et al.

Resuscitation 52

Resuscitation Military Outcomes Hospitals 52

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 96

Ultrasounds Operations Radiology Radiology 96

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. In the operating room, there was minimal urinary output and the bladder pressures were 35 mmHg under sedation and analgesia.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

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

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., Foot injuries in the emergency department. Updated 2023 Apr 22]. Updated 2023 Mar 30]. Updated 2023, Apr 14].

Fractures 57

Fractures Dislocations Operations EMS 57

Taming the SRU

MAY 27, 2024

Shortness of breath is one of the most common complaints presenting to emergency departments. A less common but more emergent scenario is the presentation of a patient to the emergency department with a large pleural effusion causing hypoxia and respiratory distress. Updated 2023 Jan 16]. Thoracentesis.

Emergency Department 84

Emergency Department Ultrasounds Radiology Radiology 84

EMDocs

SEPTEMBER 9, 2023

The Atlas of Emergency Medicine, 5e. Accessed June 24, 2023. Accessed June 8, 2023. Accessed June 6, 2023. 2021.0052 Emergency Department Management of Extensor Tendon Lacerations – Page 3 of 4. Accessed June 7, 2023. Ann Emerg Med. Emergency Medicine Residents’ Association; 2022:10-11.

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

Don't Forget the Bubbles

MAY 24, 2023

Airway complications are also more likely to occur in the emergency department (ED) than in the operating theatre. It can also able to be applied in multiple scenarios, not just the operating theatre, and it more accurately depicts real-world practice. Intubation of the Critically Unwell Child in the Emergency Department.

Airway Management 98

Airway Management Teamwork Pediatrics Emergency Department 98

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 98

EKG/ECG Wellness Emergency Department Operations 98

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 67

EMS Operations Pediatrics Emergency Department 67

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 69

EMS Ultrasounds Emergency Department Outcomes 69

ACEP Now

OCTOBER 15, 2023

On arrival to the emergency department (ED) she was awake and breathing with stridor. She was transported to the operating suite where a tracheostomy was performed. In this particular case, a tracheostomy could be performed in the operating suite under somewhat controlled circumstances. Accessed September 16, 2023.

Fractures 52

Fractures Dislocations Airway Management Operations 52

ACEP Now

NOVEMBER 7, 2023

In turn, concerns have arisen regarding when information blocking is appropriate and what ethical issues emergency department (ED) physicians must consider prior to information blocking. Accessed: October 11, 2023. Accessed October 11, 2023. Department of Health and Human Services. Accessed October 11, 2023.

Documentation/Coding 52

Documentation/Coding Best Practices Ethical Issues Academics 52

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

ACEP Now

AUGUST 28, 2024

TeamHealth, which is a physician staffing and contract management company owned since 2010 by the private equity firm Blackstone, has managed the emergency department at Ascension St. John’s Emergency Services, PC. John and five other hospital sites in Detroit. It feels like progress.” Forming a Union Clinicians from St.

Emergency Department 85

Emergency Department Hospitals Patient Safety Leadership 85

Don't Forget the Bubbles

JANUARY 17, 2024

Curious Ken is brought into your emergency department. They passed away a few days after a second operation. What are the risks of water beads? Although the beads themselves are non-toxic, they can still cause significant morbidity and mortality. Roy was less than impressed when young Kendall tried to eat his Orbeez.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

ACEP Now

SEPTEMBER 5, 2024

While some issues are handled locally, many issues cannot be solved in our emergency department or hospital. As a community “pit doctor,” I believe I have a good understanding of the needs of emergency physicians. We must have a community of like-minded individuals working towards shared goals.

Leadership 52

Leadership PPE EMS Wellness 52

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 183

Pediatrics Emergency Department Outcomes Sepsis 183

Taming the SRU

MARCH 11, 2024

Acute knee dislocations are rare orthopedic injuries that have high morbidity and need to be recognized quickly by the emergency physician; if unrecognized or inadequately treated, these injuries can lead to vascular and limb compromise (1,2). Knee dislocations make up less than 0.5% An abnormal ABI (<0.9) No open wound. ABI’s were 1.1

Dislocations 106

Dislocations Emergency Department Fractures Operations 106

RebelEM

JULY 31, 2023

Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults [published online ahead of print, 2023 Jun 16]. 11 medical centers in the United States enrolled 1417 patients from 17 sites, including 7 emergency departments and 10 intensive care units. of intubations were performed in the emergency department.

Operations 98

Operations Outcomes Emergency Department Airway Management 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 69

Hospitals Radiology Radiology Administration 69

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 103

Operations Outcomes Emergency Department Academics 103

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 86

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 86

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 65

Emergency Department Soft Tissue Injuries Operations Airway Management 65

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

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