Don't Forget the Bubbles

MAY 10, 2023

You’re in the paediatric emergency department, typing some notes for the child you’ve just discharged. As you arrive in resus, so too do half the children’s hospital. A study in Denmark in 2021 explored barriers to effective resuscitation in over 900 in-hospital resuscitations across six hospitals in Denmark.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

RebelEM

MAY 11, 2023

Background: The emergency department is frequently visited by patients suffering from symptomatic alcohol withdrawal, and the traditional management has been dominated by repeated doses of benzodiazepines. Return Encounters in Emergency Department Patients Treated with Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal.

Emergency Department 91

Emergency Department Administration Hospitals Academics 91

The Skeptics' Guide to EM

NOVEMBER 2, 2024

He is the Vice Chair of the Emergency Department and Program Director of the EM residency program at Nassau University Medical Center in East Meadow, NY, the safety net hospital for Nassau County. As you finish a note on a complex critically ill patient, you hear howls of pain coming from the EMS triage desk.

Emergency Department 96

Emergency Department Administration EMS Outcomes 96

ACEP Now

OCTOBER 29, 2024

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.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

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 Acad Emerg Med 2023; 10.1111/acem.14703 The primary outcome was in-hospital mortality.

Hospitals 86

Hospitals Emergency Department EMS Outcomes 86

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. A 12-year-old male is being transported by ambulance after a road traffic accident. His name is Ben.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

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 127

Ultrasounds Outcomes COPD Hospitals 127

Don't Forget the Bubbles

JANUARY 31, 2024

As a Trauma Unit within the Thames Valley Trauma Network, Wexham Park Hospital hosts trainees from across the spectrum of acute specialties. Article 1: What predicts parental anxiety in the Paediatric Emergency Department? Predictors of parental anxiety in a paediatric emergency department. Martin, S.R.,

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

The Skeptics' Guide to EM

JUNE 29, 2019

Prospective Validation of a Checklist to Predict Short-term Death in Older Patients After Emergency Department Admission in Australia and Ireland. Prospective Validation of a Checklist to Predict Short-term Death in Older Patients After Emergency Department Admission in Australia and Ireland. AEM June 2019. AEM June 2019.

Emergency Department 52

Emergency Department COPD Hospitals Outcomes 52

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 119

Emergency Department Stroke Operations Hospitals 119

RebelEM

JULY 1, 2024

Comparison of BPAP S/T and Average Volume-Assured Pressure Support Modes for Hypercapnic Respiratory Failure in the Emergency Department: A Randomized Controlled Trial. Comparison of BPAP S/T and Average Volume-Assured Pressure Support Modes for Hypercapnic Respiratory Failure in the Emergency Department: A Randomized Controlled Trial.

COPD 131

COPD Emergency Department Outcomes EMS 131

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives The prevalence of multimorbidity, the presence of two or more long-term conditions (LTCs) is increasing, and it is associated with poor health outcomes. Multimorbidity is likely to impact on care delivery in emergency department(ED) settings due to time-critical decision-making in the context of patient complexity.

Emergency Department 40

Emergency Department Outcomes Hospitals 40

RebelEM

DECEMBER 23, 2024

There has been ongoing study about the clinical significance of these effects, as well as whether and for whom LR might provide meaningfully better clinical outcomes ( Myburgh 2013 , Self 2018 , Semler 2018 , Self 2020 ). saline affect hospital-free days by day 30? Cross-validation was performed.

Fluid Resuscitation 124

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 124

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. When seven South Florida gluteal AFT patients died tragically in one year alone, the Florida Board of Medicine issued an emergency regulation restricting fat injection to the subcutaneous space rather than injecting into muscle. units per patient. References Garcia SE.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

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

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. 2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. Paper: Owyang CG, et al. J Crit Care. J Crit Care.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

Emergency Medicine Journal

APRIL 22, 2024

Objective We sought to validate the clinical performance of a rapid assessment pathway incorporating the Siemens Atellica IM high sensitivity cardiac troponin I (hs-cTnI) assay in patients presenting to the emergency department (ED) with suspected acute myocardial infarction (AMI).

Emergency Department 98

Emergency Department Outcomes EKG/ECG Hospitals 98

Emergency Medicine Journal

AUGUST 21, 2024

The Clinical Frailty Scale (CFS) is a 9-point frailty assessment instrument that has shown promise to identify frail emergency department (ED) patients at increased risk of adverse outcomes. Background Older patients living with frailty have an increased risk for adverse events. days versus 2.7 days, a difference of 2.2

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

The Skeptics' Guide to EM

NOVEMBER 16, 2024

He leads an AI team intending to improve patient outcomes and healthcare system efficiency. 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.

Administration 87

Administration Emergency Department Outcomes Patient Safety 87

Emergency Medicine Journal

NOVEMBER 28, 2023

Background Comprehensive geriatric assessment (CGA) has been shown to improve outcomes in hospitalised older adults; however, there is currently no compelling evidence to support CGA interventions within the emergency department (ED). The primary outcome was incidence of hospital admission following the index ED attendance.

Emergency Department 40

Emergency Department Outcomes Hospitals 40

EMDocs

DECEMBER 18, 2024

A 36-year-old male presents to the emergency department after being found down at home by his spouse. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold

Seizures 88

Seizures Emergency Department Hyperthermia / Hypothermia EMS 88

Emergency Medicine Journal

NOVEMBER 21, 2024

Emergency department (ED) encounters among patients experiencing non-fatal opioid-involved overdoses continue to increase. PRCs help to reduce ED utilisation and improve care outcomes 4 ; however, ED infrastructure and scarcity of qualified personnel limit access to PRCs.

Emergency Department 52

Emergency Department Outcomes Hospitals 52

The Trauma Pro

JULY 5, 2024

Improper care during an emergency This situation can occur in the emergency department when the emergency physician calls a specialist to assist with management. In urgent or elective situations, always discuss the procedure completely, and provide realistic information on expected outcomes and possible complications.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

Taming the SRU

MARCH 27, 2024

Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial. The primary outcome was cumulative norepinephrine use during the first 48 hours of admission. Crit Care 2024;28(1):28. There were 114 patients included in the final analysis.

Resuscitation 97

Resuscitation Outcomes CPR Hospitals 97

Emergency Medicine Journal

NOVEMBER 28, 2023

This study utilised 12 months’ of routinely collected data from Emergency Departments (EDs) and acute Admitted Patient Care Episodes (APCs) to understand trends in demand for emergency care. Specifically, we examined factors associated with seasonal variation in overall demand and avoidable usage of emergency care.

Emergency Department 40

Emergency Department Hospitals Outcomes Research 40

JournalFeed

OCTOBER 26, 2024

While hypertensive emergency requires prompt treatment to lower BP, treatment of asymptomatic elevated BP in acute care settings may be harmful. Tuesday Spoon Feed : This was a multi-hospital retrospective study of patients who presented to the emergency department with severe hypertension without end organ damage.

Outcomes 52

Outcomes Emergency Department Hospitals 52

EMDocs

OCTOBER 25, 2024

. #2: Do Discharged Patients With Severe Hypertension Have Poor Outcomes? Spoon Feed This was a multi-hospital retrospective study of patients who presented to the emergency department with severe hypertension without end organ damage. JAMA Netw Open. 2024 Sep 3;7(9):e2431673. doi: 10.1001/jamanetworkopen.2024.31673.

Emergency Department 69

Emergency Department Outcomes Hospitals 69

The Trauma Pro

OCTOBER 4, 2024

Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. ” This means they probably did not. J Ped Surg 54:335-339, 2019.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

RebelEM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Funding: The Cardinal Health Laboratory provided Turkel thoracentesis kits to two hospitals Trial Registry: Clinicaltrials.gov: NCT01008228.

Outcomes 101

Outcomes Hospitals Research Emergency Department 101

The Skeptics' Guide to EM

OCTOBER 21, 2023

Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Implementation of a Clinical Management Tool for Spinal Epidural Abscess Early Diagnosis. AEM October 2023.

Emergency Department 104

Emergency Department Radiology Radiology Hospitals 104

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth. Case: It is a steady Saturday afternoon in your rural emergency department (ED). He has been a guest skeptic on the SGEM multiple times. Reference: Snelling et al.

Fractures 122

Fractures Ultrasounds Pediatrics Outcomes 122

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

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. Circulation. 2018;137(12). Kimblad H, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

EM Literature of Note

NOVEMBER 20, 2024

This article regarding the cost of upgrading emergency departments to be “ready” for sick children has been bouncing around in the background since its publication, with some initial lay press coverage. Then, they use these data and salary estimates to come up with the institutional costs of readiness.

Pediatrics 87

Pediatrics Emergency Department Critical Access Outcomes 87

The Skeptics' Guide to EM

APRIL 22, 2023

Effect of early high-flow nasal oxygen vs standard oxygen therapy on length of hospital stay in hospitalized children with acute hypoxemic respiratory failure: the PARIS-2 randomized clinical trial. Case: A 14-month-old boy presents to the emergency department (ED) with two days of upper respiratory symptoms and respiratory distress.

Hospitals 52

Hospitals Pediatrics Emergency Department Outcomes 52

RebelEM

JULY 17, 2023

Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. RSI inherently carries with it risks of complications such as post-intubation hypotension and cardiac arrest in the most extreme cases. Range 5 to 9) Diff -0.2;

Outcomes 95

Outcomes Administration Emergency Department Resuscitation 95