ACEP Now

JULY 7, 2023

Last month’s article focused on ACEP’s efforts and resources to support EDs and patients with psychiatric emergencies. Emergency departments (EDs) focus on rapid initiation of medical treatment. First, oral administration is preferred, as this route can often be as effective as intramuscular administration.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

EB Medicine

APRIL 6, 2021

Mt Sinai COVID-19 Treatment Protocols have been updated and are available for free here: [link] The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. Pathophysiology: What causes it? The RNA virus Lyssavirus How is it transmitted? How does it reach the brain? How does it reach the brain?ED

Emergency Department 52

Emergency Department Administration 52

ACEP Now

JUNE 7, 2023

The preliminary results of the 2022 Emergency Department Benchmarking Alliance performance measures survey found a significant deterioration in patient processing due to inpatient boarding. Preliminary results of the survey are being released to help emergency physicians understand that current challenges are occurring nationwide.

Emergency Department 52

Emergency Department Documentation/Coding Operations EMS 52

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. This article serves to briefly discuss IV fluids administration in the ED and the instances where they are not indicated. IV fluid administration was more associated with phlebitis.

Dehydration 82

Dehydration Fluid Resuscitation Administration Resuscitation 82

Emergency Medicine Journal

AUGUST 23, 2023

Results We recruited 27 participants (10 nurses, 9 doctors and 8 administrator/managers) working in ED/UCCs serving areas with high deprivation and mixed sociodemographic profiles.

Urgent Care 75

Urgent Care Emergency Department Documentation/Coding Patient Safety 75

ACEP Now

OCTOBER 13, 2023

The CHRISTUS Health-Texas A&M Spohn Emergency Medicine Residency Program announced Friday that its program will close in June 2026 after the current emergency medicine residents complete their training. We feel that this decision was made without adequate assessment of the negative impacts this WILL have on our patients.

Patient Safety 132

Patient Safety Administration Emergency Department EMS 132

EM Literature of Note

AUGUST 25, 2024

A heartening trend for a simpler administration and adherence strategy – and non-inferior, overall, while entirely reasonable to judiciously select a higher-risk patient in whom it might be plausible to prescribe prednisone/prednisolone instead. emergency departments” [link] Tweet

Administration 94

Administration Emergency Department Wellness Pediatrics 94

Downeast Emergency Medicine

DECEMBER 1, 2021

While the ongoing COVID-19 pandemic has contributed to overdose deaths and taxed constrained Emergency Department (ED) resources, it has also clarified the important role that emergency physicians have in expanding access to life-saving medications to treat opioid use disorder. Annals of Emergency Medicine. Hawk, et al.

Emergency Department 52

Emergency Department Documentation/Coding Leadership Administration 52

RebelEM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). Amiodarone versus digoxin for acute rate control of atrial fibrillation in the emergency department. Am J Emerg Med. Am J Emerg Med. 2022 Sep 7.

Emergency Department 52

Emergency Department Administration EMS Dehydration 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. “Nirsevimab and Acute Bronchiolitis Episodes in Pediatric Emergency Departments” [link] Tweet

Emergency Department 86

Emergency Department Pediatrics Administration Wellness 86

PEMBlog

JUNE 7, 2023

Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $3M with 0 percent financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S.

Pediatrics 123

Pediatrics Psychiatric Emergency Department EMS 123

EB Medicine

JUNE 12, 2024

Eckler, MD interview Corey Hazekamp, MD, MS, one of authors of the June 2024 Emergency Medicine Practice article, Managing Emergency Department Patients With Opioid Use Disorder Current State of Opioid Epidemic Overview of overdose deaths and trends. Anecdotal insights on changing naloxone administration dosages.

Emergency Department 81

Emergency Department Administration EMS Research 81

ALiEM

JULY 22, 2023

You can not seem to find your pressure infusion cuff to squeeze the IV bag and accelerate fluid administration. Note that conventional pressure bags may not be readily available in emergency departments and could blow the line you worked hard to secure. In the unused port, attach a 10 or 20 cc syringe.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Emergency Department Administration 96

Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. Pediatric Endotracheal Intubations for Airway Management in the Emergency Department.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

Northwestern EM Blog

JULY 15, 2024

Edmonson and Adler for this infographic that concisely emphasizes key concepts for the recognition and initial management of acute respiratory distress syndrome (ARDS) in the Emergency Department. Chest imaging and an arterial blood gas are essential to establishing the diagnosis and severity of disease.

Resuscitation 98

Resuscitation Burns Emergency Department Sepsis 98

RebelEM

JUNE 8, 2023

The retrospective design of this study omitted assessment of ventricular dysrhythmias related to push dose pressor administration, as they were reliant on information in the EMR. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

PEMBlog

MAY 31, 2023

Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $3M with 0 percent financed with nongovernmental sources. Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry.

Psychiatric 93

Psychiatric Emergency Department Pediatrics Administration 93

RebelEM

SEPTEMBER 29, 2022

Background: Standard emergency department management of acute pancreatitis has focused on aggressive hydration, analgesia and investigation for an underlying reversible cause (eg gallstones). The aggressive fluid administration arm is far less aggressive than what was historically recommended for pancreatitis.

Administration 52

Administration Fluid Resuscitation Resuscitation Outcomes 52

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 Online First: 15 April 2024.

Airway Management 85

Airway Management Emergency Department Administration Hospitals 85

Kings County Downstate EM

DECEMBER 14, 2024

Conway, MD Resident Editor: Philippe Ayres, MD Guest Faculty Editor: James Willis, MD Its nearly midnight in your busy urban emergency department (ED).

Emergency Department 40

Emergency Department EMS Administration 40

PEMBlog

JUNE 14, 2023

Thousands of children and adolescents spend days at time in Emergency Departments waiting for definitive mental health disposition. Department of Health and Human Services (HHS) as part of an award (U07MC37471) totaling $3M with 0 percent financed with nongovernmental sources. West J Emerg Med. 2019 Jul 22;20(5):690-695.

Psychiatric 98

Psychiatric Emergency Department Pediatrics Best Practices 98

The Skeptics' Guide to EM

NOVEMBER 16, 2024

Case: The Chief of Emergency Medicine (EM) at a large urban hospital recently approached the AI Committee at Unity Health, intrigued by the CMAJ article describing the apparent success of CHARTWatch in detecting early signs of patient deterioration. Reference: Verma et al.

Administration 87

Administration Emergency Department Outcomes Patient Safety 87

The Trauma Pro

JUNE 30, 2023

Typically, hospital administrators pressure trauma programs to adopt an eTFS at some point after implementing the hospital-wide use of an electronic health record (EHR). Epic Systems became the first, and hospital administrators eventually became aware of it. The biggest question is, why does your hospital want you to use it?

Hospitals 100

Hospitals Administration Resuscitation Best Practices 100

The Skeptics' Guide to EM

JUNE 17, 2023

Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Date: June 15, 2023 Reference: Rees CA et al. Date: June 15, 2023 Reference: Rees CA et al. Reference: Rees CA et al.

Emergency Department 72

Emergency Department Pediatrics Head Injuries Administration 72

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. Ong MEH, Chan YH, Oh JJ, et al.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

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)? Administration of benzodiazepines or barbiturates to these patients risk inducing a prolonged comatose state. The Journal of Emergency Medicine. Open Access Emerg Med.

Administration 98

Administration Emergency Department Seizures Hospitals 98

ACEP Now

NOVEMBER 7, 2023

And in our comment letter responding to the FTC and Department of Justice’s proposed updates to health care merger guidelines, ACEP urged the agencies to finalize these changes that would bring more scrutiny to health care mergers and slow down consolidation.

Leadership 98

Leadership Administration Research Risk Management 98

The Trauma Pro

AUGUST 15, 2023

Two sets of documentation are crucial: accurate records of blood product administration (on the trauma flow sheet), and documentation of just about everything else (in the blood bank). In the emergency department, the surgeon or emergency physician can do this. Coolers get delivered, products get transfused.

Documentation/Coding 130

Documentation/Coding Best Practices Resuscitation Administration 130

RebelEM

JULY 3, 2023

Impact of intravenous calcium with diltiazem for atrial fibrillation/flutter in the emergency department. Am J Emerg Med. What They Did: Researchers conducted a multicenter, retrospective cohort study in three community hospitals and two freestanding emergency departments. Article: Rossi N et al. received CaCl 89.3%

Administration 93

Administration Outcomes Documentation/Coding Emergency Department 93

Pediatric EM Morsels

MAY 24, 2024

Ann Emerg Med. PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study. 2013;62:107-116. doi:10.1016/j.annemergmed.2012.11.009. 2012.11.009. Holmes JF, Yen K, Ugalde IT, et al. Lancet Child Adolesc Health.

Pediatrics 161

Pediatrics Blood Transfusions EMS Fractures 161

Emergency Medicine Journal

NOVEMBER 28, 2023

Introduction Most Irish emergency departments (EDs) do not record diagnosis in a standardised way at the conclusion of each patient care episode. This lack of data hampers service planning and the transformation of ED funding from a block grant system to one based on activity.

Documentation/Coding 40

Documentation/Coding Emergency Department Administration Operations 40

The Skeptics' Guide to EM

OCTOBER 19, 2024

Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial. Case: You’re working your usual day shift in the emergency department (ED) from 9 am to 5 pm on a Tuesday.

Emergency Department 76

Emergency Department EMS Research Administration 76

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]. Annals of Emergency Medicine. Annals of Emergency Medicine.

Infectious Diseases 102

Infectious Diseases Emergency Department Administration Academics 102

ACEP Now

DECEMBER 6, 2024

Repeat ECG following return of spontaneous circulation after administration of intravenous nitroglycerin. The decision was made to communicate directly with the on-call interventional cardiologist with specific and direct intent to discuss the administration of intravenous (IV) NTG. Click to enlarge.) What Would You Do Next?

Resuscitation 98

Resuscitation EKG/ECG Documentation/Coding COPD 98

The Skeptics' Guide to EM

AUGUST 27, 2022

He is also an avid FOAM supporter/producer through various online outlets including TheSGEM. […] The post SGEM#374: Bad Habits – Medications for Opioid Use Disorder in the Emergency Department first appeared on The Skeptics Guide to Emergency Medicine. Date: August 23rd, 2022 Reference: Schoenfeld et al.

Emergency Department 40

Emergency Department Research Administration Resuscitation 40

EM Updates

JUNE 15, 2021

Maimonides Medical Center (MMC) is Brooklyn’s largest hospital, an academic quaternary care center with, in normal times, 711 total beds, 66 intensive care beds, and an Emergency Department that treats approximately 120,000 patients per year. On March 9, the first patient with a novel coronavirus infection was admitted to MMC.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

EMDocs

JUNE 29, 2024

. #2: Nebulized vs IV Sub-dissociative Ketamine for Pain Spoon Feed Ketamine has been shown to be efficacious in managing acute pain conditions in the emergency department (ED), and this study showed equal efficacy between nebulized and intravenous administration of sub-dissociative ketamine (IV-SDK).

Shock 70

Shock Emergency Department Administration Resuscitation 70