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Putting Clinical Gestalt to Work in the Emergency Department

ACEP Now

On a busy day shift in the emergency department, our seasoned triage nurse comes to me after I finish caring for a hallway patient, “Hey, can you come see this guy in the triage room? This is the essence of emergency medicine. 4 However, emergency physicians rely on gestalt to predict outcomes well.

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ToxCard: Iron

EMDocs

7 Workup other than serum iron concentration at 4 hours after ingestion not shown to accurately predict clinical outcomes or severity of toxicity. Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. A partner at bedside reports recent depressed mood, abdominal pain, and vomiting yesterday.

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The 90th Bubble wrap DFTB X The Bridge

Don't Forget the Bubbles

The value of white blood cell count in predicting serious bacterial infections in children presenting to the emergency department: a multicentre observational study Archives of Disease in Childhood 2025;110:191196. This was a secondary analysis of the Management and Outcome of Fever in Children in Europe (MOFICHE) study.

Sepsis 59
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EM@3AM: Stercoral Colitis

EMDocs

If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Stercoral colitis in the emergency department: a review of the literature. International journal of emergency medicine, 17(1), 3. Tran, J., & Shah, K. Campbell, R.

EMS 98
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EM@3AM: Leukopenia

EMDocs

Management is directed based on underlying etiology, but consider fluid resuscitation, antipyretics, and antibiotics as indicated. A 45-year-old outdoor enthusiast presents to the emergency department with fever, headache, myalgias, and malaise. An update on the diagnosis and treatment of chronic idiopathic neutropenia.

EMS 96
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Less is More. Again: Speed of IV Fluid Administration in Pancreatitis (WATERFALL Trial)

RebelEM

Background: Standard emergency department management of acute pancreatitis has focused on aggressive hydration, analgesia and investigation for an underlying reversible cause (eg gallstones). Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Median Fluid Received: Aggressive: 7.8L (Range 6.5

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Episode 7: Sepsis

PHEM Cast

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. The impact of emergency medical services on the ED care of severe sepsis. Am J Emerg Med. Academic Emergency Medicine. Emergency Medicine Journal.

Sepsis 52