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 Hospitals Fractures 64

Pediatric EM Morsels

JULY 19, 2024

If bleeding, the only lab that is needed in the Emergency Department is a type and cross. 2023 Aug;171:111644. Epub 2023 Jul 6. If bleeding has completely stopped, most of these children still come into the hospital for observation so access will likely be necessary and helpful should patient have rebleed event.

Pediatrics 286

Pediatrics Airway Management Wellness Administration 286

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

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

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

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 104

Operations Outcomes Emergency Department Academics 104

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 Operations 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 80

Operations Diabetic Emergencies Hospitals Research 80

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

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 107

Dislocations Emergency Department Fractures Operations 107

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 Wellness 60

RebelEM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

Dislocations 59

Dislocations Fractures Soft Tissue Injuries Outcomes 59

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

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 90

Resuscitation Patient Safety Operations Emergency Department 90

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 77

Fractures Dislocations Operations Radiology 77

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 105

Resuscitation Administration Emergency Department Hospitals 105

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

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 73

Radiology Radiology Emergency Department Hospitals 73

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

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

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

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

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

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

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

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 104

Hospitals Operations Emergency Department Research 104

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 87

Hospitals Emergency Department EMS Outcomes 87

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

Don't Forget the Bubbles

JANUARY 31, 2024

Article 1: What predicts parental anxiety in the Paediatric Emergency Department? Predictors of parental anxiety in a paediatric emergency department. Emergency Medicine Journal. Testicular torsion is a surgical emergency that can lead to loss of the testis if not diagnosed and treated quickly. Martin, S.R.,

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

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

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

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 130

Ultrasounds Outcomes COPD Hospitals 130

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 77

EMS Fractures Soft Tissue Injuries Ultrasounds 77

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

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 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88