ACEP Now

NOVEMBER 13, 2023

Physicians, nurses, and staff in emergency departments (EDs) across the country have encountered workplace violence for years. 1,2 In a 2018 study by ACEP, nearly half of emergency physicians polled reported a physical assault while at work. Accessed October 10, 2023. J Emerg Nurs. 2023;(3):415-424.

Emergency Department 52

Emergency Department Documentation/Coding Psychiatric Best Practices 52

EM Literature of Note

SEPTEMBER 13, 2024

These are each awful, of course, in their own way from a patient- and parent-oriented standpoint, but they’re also quite awful at the population level, overburdening limited pediatric and emergency department resources. since August 2023. RSV, in particular, is a vicious scourge of young and vulnerable infants.

Emergency Department 86

Emergency Department Pediatrics Administration Wellness 86

ACEP Now

DECEMBER 17, 2024

But we should not have to sacrifice our own well-being in the process. In spring 2023, nearly 95 percent of house staff voted to unionize with the Committee of Interns and Residents (CIR), a branch of the Service Employees International Union (SEIU) and the largest and oldest house staff union in the country. In Washington, D.C.,

Burns 105

Burns Hospitals Documentation/Coding Emergency Department 105

Pediatric EM Morsels

JULY 21, 2023

Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Interrater reliability of Glasgow Coma Scale scores in the emergency department. Ann Emerg Med. 1976 May 15;1(7968):1031-4. doi: 10.1016/s0140-6736(76)92215-7. PMID: 57446. Jain S, Iverson LM. Glasgow Coma Scale. Updated 2022 Jun 21]. In: StatPearls [Internet].

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

ALiEM

NOVEMBER 17, 2023

A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. kg General : Well-appearing 4-year-old female acting appropriately with grandmother and mother at the bedside. C; Wt 18.2 link] Published 2021.

Pediatrics 100

Pediatrics Emergency Department Academics OB/GYN 100

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

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

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

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

ACEP Now

AUGUST 14, 2024

Rate Versus Rhythm in the ED The 2023 AHA/ACC guideline doesn’t give explicit recommendations or preference regarding initial rate or rhythm control strategy for new-onset AF patients who are hemodynamically stable. as well as conversion to sinus rhythm (OR 1.75; 95 percent CI 1.08-2.84).7 In fact, few studies compare the two classes.

Emergency Department 105

Emergency Department Outcomes Research Wellness 105

Don't Forget the Bubbles

JULY 17, 2023

2023 Jun;38(6):1733-1751. 2023 May 16;28(3):172-183. 2023 Jun 6;28(4):205-251. 2023 Jun 6;28(4):252-266. 2023 Jun 1;177(6):559-560. 2023 Jun;182(6):2785-2792. 2023 May 16;28(3):184-202. 2023 Jun 15. 2023 Jun 1;42(6):456-460. 2023 Jun;182(6):2567-2575. 2023 Jun 29.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

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

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 94

CDC Hospitals EMS Emergency Department 94

PEMBlog

OCTOBER 18, 2023

The night prior to presentation, mom noticed he was not feeding as well and seemed fussy. Initially in the emergency department he was generally well-appearing with normal vital signs. Infants with NTED generally remain well-appearing and do not meet toxic shock syndrome (TSS) criteria. 2023; 40( 2): 349- 351.

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

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

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. There are well preserved R-waves in Wellens waves. What do you think? ng/mL, BNP 2790, and lactate 3.7.

EKG/ECG 135

EKG/ECG Emergency Department Shock Ultrasounds 135

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 82

Dehydration Fluid Resuscitation Administration Resuscitation 82

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

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

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 95

EMS Psychiatric Emergency Department Poisoning 95

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

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

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

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 92

Emergency Department Pediatrics Wellness Fractures 92

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 118

EKG/ECG Documentation/Coding Emergency Department Outcomes 118

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 76

Head Injuries EMS Research Emergency Department 76

ACEP Now

OCTOBER 26, 2023

Using Maryland state law as a guide, the American College of Emergency Physicians (ACEP) and the Emergency Department Practice Management Association (EDPMA) lobbied for passage of federal protections beginning in the mid-1990s. 1997: Congress enacts the PLP for Medicare and Medicaid managed care plans via BBA ’97.

Documentation/Coding 124

Documentation/Coding Hospitals Administration Emergency Department 124

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

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 124

EKG/ECG Shock Emergency Department Ambulance Services 124

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 82

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 82

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 Fractures Academics Hospitals 64

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

Don't Forget the Bubbles

JULY 31, 2023

Our team have scoured what’s new (well, mostly new!) A Diagnostic Accuracy Study to Evaluate Standard Rapid Diagnostic Test (RDT) Alone to Safely Rule Out Imported Malaria in Children Presenting to UK Emergency Departments. 2023 May 31;12(5):290-297. Pediatric Emergency Care March 15, 2023. |

Rapid Diagnostic Testing 98

Rapid Diagnostic Testing Resuscitation Emergency Department Pediatrics 98