Don't Forget the Bubbles

OCTOBER 12, 2024

doi: 10.1136/archdischild-2023-326773 Two-year-old Moyo is brought to the emergency department because her parents were concerned about noisy breathing. Most children can be discharged from the emergency department after a dose of corticosteroids and an appropriate safety net. Published 2023 Jan 10.

Airway Management 85

Airway Management Emergency Department Administration Hospitals 85

The Skeptics' Guide to EM

JULY 8, 2023

Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023. Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at Staten Island University Hospital. first appeared on The Skeptics Guide to Emergency Medicine. Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023.

CDC 100

CDC Hospitals EMS Emergency Department 100

ACEP Now

AUGUST 22, 2023

Regardless of the domain, somewhere an expert panel has convened to issue a pronouncement informing all of the ideal care of patients under their specialty umbrella, indirectly extending to their care in the emergency department. 2-4 A fourth is planned for publication in late 2023, and will address non-opioid substance dependence.

Emergency Department 98

Emergency Department Academics Critical Access Research 98

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% No open wound. ABI’s were 1.1 bilaterally.

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Emergency Department (ED) crowding has dominated discourse around Emergency Medicine (EM) in recent years and is now well recognised as contributing towards patient harm. Less is known about the implications of crowded departments on staff. Because you’ve got patients in, well, everywhere.’

Emergency Department 40

Emergency Department Wellness EMS Patient Safety 40

ALiEM

OCTOBER 23, 2023

A 32-year-old man with a history of traumatic globe rupture from a stab wound two months ago, status post repair, presented to the emergency department for worsening right eye pain and green malodorous drainage for the past three days. There was a well-healed scar on the bottom eyelid. Indian J Otolaryngol Head Neck Surg.

Academics 111

Academics Emergency Department Ultrasounds Wellness 111

Taming the SRU

DECEMBER 17, 2024

Fluid management in the Emergency Department (ED) is crucial in the adequate resuscitation of the acutely ill and decompensating patient. Out of 18 patients receiving ORT, 4 failed to respond well and were escalated to IV therapy. Updated 2023 Oct 22]. Emerg Med Australas 2013;25(6):52734. AtherlyJohn et al.

Dehydration 83

Dehydration Fluid Resuscitation Administration Resuscitation 83

Broome Docs

APRIL 6, 2023

2023 Jan 21. Am J Emerg Med. 2023 Feb;64:206.e1-206.e3. 2023 Jan 30. A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments. 2023 Jan 13;76(2):185-191. 2023 Feb 03;: PMID: 36367144 Justin’s excellent critical appraisal and Full write up here.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

The Skeptics' Guide to EM

JULY 29, 2023

Date: July 21, 2023 Reference: McDonald et al. AEM July 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. Date: July 21, 2023 Reference: McDonald et al. Patterns of change in prehospital spinal motion restriction: a retrospective database review.

Head Injuries 84

Head Injuries EMS Research Emergency Department 84

ALiEM

APRIL 12, 2023

The thin alcohol layer serves to eliminate any air bubbles under the adhesive cover as well as minimizes residual adhesive material sticking to the probe when removing the cover. Accessed April 5, 2023. Accessed April 5, 2023 Afzal S, Zahid M, Rehan ZA, et al. emDOCs.net – Emergency Medicine Education.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

Don't Forget the Bubbles

AUGUST 7, 2023

2023 Mar;59(3):480-486 Who were the patients? This prospective cohort study included patients between 0-16 years old, who presented to one of four NHS hospital sites in Greater Manchester (a large metropolitan area in the North of England), consisting of an Urgent Care Centre and three Emergency Departments. Acad Emerg Med.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

Taming the SRU

DECEMBER 11, 2023

1,2] Patients at risk for suicide often interact with emergency medical care. Suicide-related behavior (SRB) accounts for 1% of all Emergency Department (ED) visits; additionally, greater than 8% of patients visiting emergency departments are likely experiencing suicidal ideation at the time of the encounter.[3-5]

EMS 96

EMS Psychiatric Emergency Department Poisoning 96

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter.

Documentation/Coding 94

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 94

ALiEM

JUNE 1, 2023

Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? Well not exactly. The Journal of Emergency Medicine. Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives. 2012.07.056.

Administration 98

Administration Emergency Department Seizures Hospitals 98

Don't Forget the Bubbles

JULY 19, 2023

Olivia, a previously well 13-year-old girl, is referred to the paediatric ED from the Ophthalmology ED. Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation. 2023 and Kovarik et al., Clin Ophthalmol.

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. In our emergency department, the RTs do not spend a lot of time going around measuring cuff pressures and usually save that until the patient reaches the ICU.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98

Emergency Medicine Journal

JULY 22, 2024

Introduction Episodes of physical and verbal violence, as well as psychological humiliation, are experienced daily by ED staff. Methods We conducted a prospective observational study in the ED of Merano Hospital, Italy (52 000 ED admission in 2022) from 1 January 2022 to 31 August 2023. The ED staff include 38 nurses and 11 physicians.

Emergency Department 52

Emergency Department Hospitals Wellness 52

Dr. Smith's ECG Blog

OCTOBER 18, 2023

If you were working in a busy emergency department, would you like to be interrupted to interpret these ECGs or can these patients safely wait to be seen because of the normal computer interpretation? Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. Am J Emerg Med.

EKG/ECG 122

EKG/ECG Documentation/Coding Emergency Department Outcomes 122

PulmCCM

JANUARY 23, 2025

Overly general case definitions and sloppy EMR algorithms result in a high rate of overtreatment with antibiotics due to false positives, as well as delayed treatment from false negatives. Bands 2 and 3 did not discriminate well and did not provide useful or actionable information. emergency departments. Acad Emerg Med.

Sepsis 45

Sepsis Wellness Emergency Department Research 45

ACEP Now

MAY 10, 2024

Patients often seek care in the emergency department (ED) setting when flares of pain affect their ability to ambulate, climb stairs, or even stand up from sitting. We prefer an in-plane, superior to inferior approach, but an out-of-plane technique can be performed, as well. J Emerg Med. 2023 Jul;13(7):373-378.

Ultrasounds 92

Ultrasounds Emergency Department Hospitals Wellness 92

Taming the SRU

NOVEMBER 14, 2023

Chief complaints involving the ear are a common occurrence in Emergency Departments across the US and include presenting symptoms such as ear pain or fullness, hearing loss, redness, trauma, vertigo, and foreign bodies. A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011 identified 8.6

Emergency Department 93

Emergency Department Pediatrics Wellness Documentation/Coding 93

EMDocs

SEPTEMBER 14, 2024

Source Use of Glucagon-Like Peptide-1-Agonists and Increased Risk of Procedural Sedation and Endotracheal Intubation in the Emergency Department. Ann Emerg Med. The AI performed well in both accuracy and in improving sensitivity. Ann Emerg Med. 2023-064364. 2024 Aug;84(2):226-227. DOI: 10.1016/j.annemergmed.2024.03.007.

Emergency Department 83

Emergency Department Resuscitation Pediatrics Research 83

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization. On arrival in the emergency department, invasive blood pressure was 35/15mmHg and the patient was in profound cardiogenic shock with severe confusion secondary to brain hypoperfusion. There is now some flow in the LMCA!

EKG/ECG 131

EKG/ECG Shock Emergency Department Ambulance Services 131

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

ALiEM

JULY 17, 2023

The Study In an Annals of Emergency Medicine paper , Preiksaitis et al. sought to identify program factors associated with unfilled post-graduate year 1 (PGY-1) emergency medicine (EM) positions in the 2023 Match [1]. as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4].

EMS 52

EMS Burns Emergency Department Shock 52

EMDocs

JUNE 8, 2024

Post septal (retrobulbar) is higher risk to vision and requires CT imaging to diagnose as well as thorough exam to check for proptosis, afferent pupillary defect, increased intraocular pressure [7]. A 32-year-old man presents to the emergency department with eye pain. Overview of Eye Injuries in the Emergency Department.”

EMS 92

EMS Allergic Reactions Poisoning Emergency Department 92

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. World J Emerg Surg 2023 PMID: 36918947 3. Int J Emerg Med 2009 PMID: 20157465 4.

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. Consult ophthalmology emergently. 2023, March 23). Eye (Lond).

Emergency Department 64

Emergency Department Academics Fractures Hospitals 64

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Admission allows for close monitoring, given the risks of perforation, ischemic bowel, and ulceration, as well as appropriate management of the condition and patient symptoms. Stercoral colitis in the emergency department: a review of the literature. In StatPearls.

EMS 88

EMS Sepsis Shock Fluid Resuscitation 88

ACEP Now

MAY 10, 2024

Patients with flank pain (which would suggest pyelonephritis) as well as patients meeting two or more SIRS criteria (which would suggest sepsis) comprise a higher risk group. Published online 2023. Let’s look at three young female patients with differing symptom severities. New England Journal of Medicine. 2000;343(14):992-997.

Infectious Diseases 98

Infectious Diseases Sepsis Administration Emergency Department 98

Dr. Smith's ECG Blog

SEPTEMBER 8, 2023

A 50 year old presented to the emergency department of a remote rural community (where the nearest cath lab is a plane ride away) with one hour of mild chest pain radiating to the back and jaw, and an ECG labeled ‘normal’ by the computer interpretation.

EKG/ECG 133

EKG/ECG Emergency Department Wellness 133

The Trauma Pro

JUNE 30, 2023

But now, in 2023, virtually every trauma center uses one of the major brands of EHR. A best practice would be to scan (or copy) the paper trauma flow sheet just before the patient leaves the emergency department for good so an interim version can be placed in the EHR.

Hospitals 100

Hospitals Administration Resuscitation Best Practices 100

Taming the SRU

JUNE 12, 2023

Although not every person seeks health care for these injuries, the majority of those that do end up in the emergency department. In 2008, this led to greater than 316,000 emergency department (ED) visits and about 9,500 hospitalizations [1]. Accessed April 28, 2023. Annals of Emergency Medicine.

Infectious Diseases 102

Infectious Diseases Emergency Department Administration Academics 102

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 patient did well. == MY Comment , by K EN G RAUER, MD ( 8/4 /2024 ): == I thought today's case by Dr. Meyers is an important one for emergency providers for a number of reasons. Pericarditis maybe."

EKG/ECG 120

EKG/ECG Wellness Operations Emergency Department 120

Don't Forget the Bubbles

OCTOBER 10, 2024

2023 Mar 30;110(4):432-438. Adopting this approach would reduce time in surgery for the child as well as the financial cost of nail bed repair. Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

RebelEM

NOVEMBER 25, 2024

A medical librarian with expertise in systematic reviews, searched Cochrane, Embase, Medline, Scopus, and Web of Science for relevant randomized controlled trials and comparative observational studies from inception to June 2023. Included patients from out-of-hospital, emergency department, intensive care unit, and operating-room intubations.

Outcomes 93

Outcomes Emergency Department Operations Hospitals 93

Taming the SRU

JULY 21, 2023

Eye Pathology Now let’s dive back into some common eye disease processes you may see on a typical day in the emergency department. Accessed June 11, 2023. Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. licensed under a Creative Commons Attribution 3.0

Emergency Department 87

Emergency Department EMS Burns Wellness 87