ACEP Now

JUNE 7, 2023

Software attacks crippled operations in large hospital chains, and physical assaults on ED staff continued unabated. The preliminary results of the 2022 Emergency Department Benchmarking Alliance performance measures survey found a significant deterioration in patient processing due to inpatient boarding. Maame Y, et al.

Emergency Department 52

Emergency Department Documentation/Coding Operations EMS 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. 0.41), p < 0.001.

Pediatrics 187

Pediatrics Emergency Department Outcomes Sepsis 187

ALiEM

OCTOBER 30, 2024

Case A patient arrives via EMS from the bus station complaining of fever, vomiting, and back pain. Bupe Allergy Buprenorphine induction has been the mainstay of emergency department treatment of opioid use disorder for more than a decade [11, 12]. They report insufflating ‘a bundle’ of tranq dope per day. 2017 Jun;32:660-6.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

The Skeptics' Guide to EM

MARCH 2, 2024

Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Case: A 59-year-old man walks into your community emergency department (ED) complaining of chest pain.

Emergency Department 132

Emergency Department Stroke Operations Hospitals 132

Mind The Bleep

DECEMBER 27, 2024

Im currently in my third year of working in a rural district general hospital Accident and Emergency Department, and one of the things that has struck me most is the use of pre-hospital medicine. Throughout university, I always sought out opportunities for experience in emergency and pre-hospital care.

Hospitals 52

Hospitals Ambulance Services Operations Teamwork 52

ACEP Now

DECEMBER 11, 2023

The Emergency Department Benchmarking Alliance (EDBA) is a membership organization composed of high-performance emergency departments (EDs) that share a commitment to quality. EMS arrivals increased; many of those patients (35 percent) were admitted. American College of Emergency Physicians. ED boarding.

Emergency Department 52

Emergency Department Hospitals EMS Operations 52

Taming the SRU

SEPTEMBER 25, 2023

Musculoskeletal injuries are a common occurrence, representing a substantial number of Emergency Department visits on an annual basis. 1) Oftentimes, Emergency Physicians are the first provider patients encounter after an injury. This places a significant responsibility on the EM physician to diagnose and treat fractures.

Fractures 101

Fractures Operations Emergency Department EMS 101

RebelEM

MARCH 27, 2023

Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients. More pertinent and relevant takeaway messages have to do with staffing and operations.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

EMDocs

DECEMBER 6, 2024

5 Orogastric lavage may also be considered for GI decontamination but likely to be limited by location, size of tablets, and operator familiarity. A partner at bedside reports recent depressed mood, abdominal pain, and vomiting yesterday. 9 Typical dose: Polyethylene glycol (Go-Lytely ) 25 mL/kg/hr in small children and 1.5-2

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

EMDocs

OCTOBER 3, 2023

Emergency Physician and founder of Orman Physician Coaching Host of the Stimulus Podcast Learn more at roborman.com If you want to hear the coaching session where Brit and Rob deconstructed his shift and came up with this strategy, it’s here. Episode 87: Conquering Mid-Shift Overwhelm Mid-shift in an emergency department is a special beast.

Documentation/Coding 122

Documentation/Coding EMS Operations Emergency Department 122

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. Learn more at openbook.acep.org.

Leadership 98

Leadership Administration Research Risk Management 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

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 92

Emergency Department Soft Tissue Injuries Airway Management Operations 92

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Chest drains are commonly inserted in the Emergency Department (ED) with a complication rate of 30-40%. Training in chest drain insertion is essential in Emergency Medicine (EM) as approximately 25,000 patients undergo in England and Wales undergo this procedure annually.

Emergency Department 40

Emergency Department EMS Research Operations 40

ACEP Now

MAY 4, 2023

A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. EMS recognized a chest wall deformity with movement of the chest wall, and a splint was devised and taped around his chest for what was suspected to be a flail chest.

EMS 52

EMS Fractures Operations Radiology 52

EMDocs

DECEMBER 11, 2023

As we all know, a critical concern for emergency physicians is identifying patients with heart tissue-threatening ischemia that could benefit from percutaneous catheterization via stent deployment by an interventional cardiologist. Notably, only 0.5mm of elevation is necessary in V7-9 to meet criteria. J Am Coll Cardiol. PMID: 36241466.

EKG/ECG 119

EKG/ECG Emergency Department Academics Operations 119

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

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 Ultrasounds 105

EMDocs

OCTOBER 30, 2023

Pillai, MBBS (@sspillai01, EM Resident Physician, University of Kentucky) and Christopher N. 2 In response to the constrained availability of contrast media, emergency medicine (EM) and radiology departments were compelled to enact modifications in their imaging techniques. Authors: Saran S. 11 Table 1.

Radiology 99

Radiology Radiology Emergency Department Hospitals 99

Don't Forget the Bubbles

JUNE 19, 2024

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Children in the validation cohort were admitted to the intensive care unit or operating room less frequently than those in the derivation cohort.

CPR 124

CPR Research Documentation/Coding Outcomes 124

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 Study protocol involved investigators measuring EtCO2 of patients arriving via the lobby or EMS.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

EB Medicine

MARCH 1, 2019

This month, after a few months of primarily medical topics, we’re talking trauma, specifically Blunt Cardiac Injury: Emergency Department Diagnosis and Management. Jeff: And don’t forget to get the crash details from the EMS crew before they depart! I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

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

AUGUST 4, 2024

The largest retrospective cohort study to date (Beyde et al.) shows that most will improve with empiric antibiotics.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

PHEM Cast

DECEMBER 12, 2016

Emergency thoracotomy in thoracic trauma: a review. Emergency Department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World Journal of Emergency Surgery; 2006: 1:4. Survival after Emergency Department thoracotomy: review of published data for last 25 years.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

RebelEM

JUNE 8, 2023

If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist. Clinical Bottom Line: Acute hypotension must be treated emergently in order to decrease morbidity and mortality. Am J Emerg Med. J Med Toxicol. Epub 2019 Jul 3.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

The Skeptics' Guide to EM

SEPTEMBER 3, 2017

EmergeNcy Department use of Apneic Oxygenation versus usual care during rapid sequence intubation: A randomized controlled trial (The ENDAO Trial). EmergeNcy Department use of Apneic Oxygenation versus usual care during rapid sequence intubation: A randomized controlled trial (The ENDAO Trial). Reference: Caputo et al.

Emergency Department 52

Emergency Department Resuscitation Operations EMS 52

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 129

Ultrasounds Outcomes COPD Hospitals 129

ACEP Now

SEPTEMBER 5, 2024

Our state chapter members and leaders are uniquely positioned to follow EMRA’s lead in partnering with local EM residency programs to improve communication of ACEP’s value to EM-bound medical students and EM residents by hosting residency visits or local events relevant to our shared mission.

Leadership 98

Leadership PPE EMS Wellness 98

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Resus Review

APRIL 10, 2015

Important properties for the include: Highly conductive at frequencies used by the flow sensor Non-marring Does not dry out Easy to remove Non toxic The most popular ultrasound gel found in emergency departments and intensive care units is Parker Labs Aquasonic. A better product to use is Em-tec Ultrasonic Coupling Paste.

Ultrasounds 52

Ultrasounds Operations Emergency Department EMS 52

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]. J Spec Oper Med. PMID: 30566723 Bulger EM, Perina DG, Qasim Z, et al. 2018;18(4):37-55.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

Downeast Emergency Medicine

DECEMBER 17, 2021

Emergency medicine (EM) was first recognized as a specialty by the American Medical Association (AMA) in 1972. Since that time, EM residencies have grown and evolved to provide academic support and training for graduating medical students interested in pursuing a career in the field.

EMS 52

EMS Academics Operations Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound.

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

RebelEM

SEPTEMBER 11, 2023

1 It is a quickly deployable and easily interpreted study that can be done in real time to guide decisions in the Emergency Department. Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Acad Emerg Med. and specificity of 88.0% 2022;7(1):e000944.

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68

RebelEM

DECEMBER 19, 2022

At REBEL EM, we’ve done an extensive write up that details some of the different types of DED and the electrophysiology behind it. Within the United States, due to paramedic shortages, this dual-medic setup does not exist in many EMS systems. This was in addition to a phenomenally fast EMS response time.

EMS 52

EMS CPR Shock Resuscitation 52

Don't Forget the Bubbles

MAY 17, 2023

Post-operative pain in children: Comparison of pain scores between parents and children. Hegeman EM, et al. Schwindt EM, et al. Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study. J Pediatr Gastroenterol Nutr. 2023 Apr 24.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72