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Chuck Pilcher, MD, FACEP Editor, Medical Malpractice Insights Editor, Med Mal Insights Radiology over-reads – Who’s responsible? Patient not informed of enlarged heart, dies 3 weeks post ED visit Miscommunicated radiology findings are a hot topic. Defense : Cardiomegaly is a chronic problem, not an emergency.
Literally every practicing physician working in a hospital environment knows there is a broad spectrum of skill, approach to acute illness, and level of risk-tolerance. These attributes manifest in different ways, and, in emergency physicians, one is the differing likelihood two clinicians might have to admit same patient to the hospital.
Darnall Army Medical Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, (@long_brit) Disclaimer: The views expressed in this post are those of the authors and do not reflect the official policy or position of the Department of the Army, DoD, or the US Government.
Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. PECARN prediction rule for cervical spine imaging of children presenting to the emergencydepartment with blunt trauma: a multicentre prospective observational study. J Emerg Med. Resuscitation.
This necessitates an inter-hospital transfer that is subject to scrutiny by the trauma performance improvement program of both trauma centers. The practice at many centers is to bring all transfer patients in through the emergencydepartment. The work-up from the referring hospital can be re-evaluated.
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.
1 The shortage in supply posed difficulties for hospitals that significantly depend on GE Healthcare as their supplier, which encompassed approximately 50% of hospitals in the United States (US). Preparation 9 Hospitals had to prepare for the impending contrast shortage as soon as potential shortage news occurred. 11 Table 1.
This exploration of LLMs in the emergencydepartment is a bit unique in its conceptualization. and GPT-4T – is asked: Should this patient be admitted to the hospital? Does this patient require radiologic investigations? Specifically, the LLM – here GPT-3.5T Does this patient require antibiotics?
Emergency medicine was approved as the 23rd medical specialty in 1979, shortly after a young Elsburgh Clarke, MD, discovered the burgeoning specialty. 1 Just one year prior, Dr. Clarke had begun an emergency medicine residency at what was then known as LA CountyUSC Hospital, Los Angeles. Click to enlarge.) Click to enlarge.)
Pediatric Emergency Care, 27 (10), 978-985. Radiology in the management of acute iron poisoning. Iron Ingestion: an Evidence-Based Consensus Guideline for Out-of-Hospital Management. link] The post ToxCard: Iron appeared first on emDOCs.net - Emergency Medicine Education. doi: 10.1097/PEC.0b013e3182302604. Hosking CS.
The parents of 18-month-old Susie brought her to the EmergencyDepartment after she had a seizure at home. The American College of Radiology guidelines provide further detail on imaging recommendations based on different age and seizure type variants. 2006;67(9):1542-1550 Royal Children’s Hospital Melbourne. Pediatrics.
Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. Christopher’s Hospital for Children by private equity (PE) firm Paladin Healthcare Capital for 170 million dollars. 14 Dr. Stinson remembers what it was like to work for a PE-owned hospital early in her career. “I
In addition to the reduced risk for major bleeding, use of mechanical thrombectomy techniques has been shown to decrease hospital costs by reducing the need for post-procedural critical care following intervention.
7-year-old Tilly is brought to your emergencydepartment at 11 p.m. Abdominal pain in children is common, accounting for over 1 in 20 attendances to paediatric emergencydepartments [1]. She had a low-grade fever and an episode of vomiting before coming to the hospital. Hospital Admitted Patient Care Activity.
Aims and Objectives CT Head scans are commonly requested in the EmergencyDepartment (ED), but the increasing demand has led to longer radiology report turnaround times, affecting ED flow. Emergency medicine clinicians of various grades and backgrounds participated. to 83%) and specificity (65.8%
March 2023 Date: January 30, 2024 Guest Skeptic: Dr. Alexandra (Ali) Espinel is an Associate professor of pediatrics and otolaryngology at Children’s National Hospital and George Washington University. For Pediatric Oropharyngeal Trauma first appeared on The Skeptics Guide to Emergency Medicine. Laryngoscope. I’m the Problem.
Sean Baldwin is an Emergency Physician practising in Sydney, Australia in both a large tertiary emergencydepartment and a small regional emergencydepartment. Case: A 67-year-old male presents to your hospitalemergencydepartment (ED) after a fall from his bicycle. Reference: Partyka et al.
THE CASE A female in her early 20s, G4P2012, presents to the emergencydepartment (ED) with a 5 day history of left lower quadrant abdominal pain which has been worsening since onset. After a short period of recovery in the hospital, she is discharged home in stable condition with follow-up with OBGYN. Epub 2019 Mar 21.
You’ve just started working in the Children’s EmergencyDepartment (CED). Robin is an LTV patient and will likely need some extra planning should he need to be admitted to hospital. Gemma responds, ‘Ask the hospital physio to come and see him?’ The triage nurse comes to let you know about Robin. You think fast.
I break bad news almost every shift in the emergencydepartment. An email with a sad face to a woman jacked up hormones was not the best approach. A colleague met me at the hospital and performed an ultrasound once more to confirm. My husband left the fire station and rushed to the hospital to be with me.
This post aims to broadly cover the types of PTX, the diagnostic modalities available, and the ideal management by PTX type in the EmergencyDepartment. May be considered first line in the future however results may be dependent upon provider training and hospital resources [17].
Point of care biliary ultrasound in the emergencydepartment (BUSED) predicts final surgical management decisions. Trauma Surg Acute Care Open 2022 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. Date: March 22, 2023 Reference: Hilsden et al.
Johnson, MD ( Community EM, Salina Regional Health Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (Cleveland Clinic Foundation, EM-CCM); Brit Long, MD (@long_brit) Case A 40-year-old woman presents to a rural emergencydepartment (ED) with left leg pain and swelling for the past 5 days.
ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED? ETT onto a fiberoptic scope.
1 Low-dose non-contrast abdominal CT has become the gold standard for diagnosis as it has become readily available in emergencydepartments nationwide, with some studies touting sensitivity and specificity of 97% and 95%, respectively.2 were hospitalizations during f/u period; 26.4% were hospitalizations during f/u period; 26.4%
Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. Patients in the standard care alone group had more intensive care unit-free and hospital-free days. Paper: Jansen JO, Hudson J, Cochran C, et al. 97% of patients sustained blunt trauma.
Diagnostic Performance of Emergency Physician-Performed Point-of-Care Ultrasonography for Acute Appendicitis: A Meta-Analysis. Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant (PA) working primarily in rural Missouri in community hospitals. first appeared on The Skeptics Guide to Emergency Medicine.
Background: Depending on the time of year, fever and cough can be one of the most common presentations seen in the emergencydepartment. However, being an evidence-based medicine enthusiast, you wonder what aspects of the patient’s presentation are going to be truly helpful in making a diagnosis.
It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergencydepartment (ED). Active extravasation of blood into the hematoma was identified, and the patient was referred to interventional radiology. Ann Emerg Med.
Pneumonia diagnosis supported by clinical and radiologic criteria. Lastly, although C-reactive protein (CRP) is not typically used in the emergencydepartment to diagnose bacterial pneumonia, patients with CRP levels exceeding 15mg/dL (or > 150 mg/L) may derive benefits from corticosteroid therapy. Lancet 2011;377:2023-30.
Laboratory evaluations that return after admission to the hospital are remarkable for microcytic hypochromic anemia (hemoglobin 9.2 Mortality predictors of Pneumocystis jirovecii pneumonia in human immunodeficiency virus-infected patients at presentation: Experience in a tertiary care hospital of northern Taiwan. 1999;6(2):149-155.
THE CASE A male in his 60s presented to the emergencydepartment for right upper quadrant abdominal pain. The following day, Interventional Radiology placed a percutaneous cholecystostomy tube. coli) empyema due to complicated pneumonia, and a prior perisplenic abscess requiring percutaneous drainage.
A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the EmergencyDepartment (ED) for evaluation after noticing a “string” coming out of her anus today.
One of the most hair-raising presentations to the emergencydepartment (ED) can be massive hemoptysis with respiratory failure. Dr. Helman is an emergency physician at North York General Hospital in Toronto. The emergencydepartment evaluation and management of massive hemoptysis. Am J Emerg Med.
A 58-year-old male with a history of alcohol abuse presented to the emergencydepartment (ED) as a category 2 trauma for a fall with a reported flail chest. On hospital day 2, he was taken to the operating room for surgical rib fixation. Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). Click to enlarge.)
THE CASE An elderly female patient presents to the emergencydepartment (ED) with 1 week of generalized weakness leading to numerous falls. Outside hospital records were obtained and upon review, it was noted that the patient had recently been diagnosed with a horseshoe kidney on CT imaging. and hyponatremia to 125.
Written by: Tommy Ng, MD (NUEM ‘24) Edited by: Patricia Bigach, MD (NUEM ‘22) Expert review by : Terese Whipple, MD '20 So your kid won’t walk One of the most common complaints in a pediatric EmergencyDepartment is a child refusing or inability to ambulate. 2021, Dec 20). Hip Pain in Pediatrics. Expert Commentary by Whipple, T].
PECARN prediction rule for cervical spine imaging of children presenting to the emergencydepartment with blunt trauma: a multicentre prospective observational study. PECARN prediction rule for cervical spine imaging of children presenting to the emergencydepartment with blunt trauma: a multicentre prospective observational study.
After balloon occlusion, blood pressure improved sufficiently to take the patient either to interventional radiology or to the OR. Pediatric emergencydepartment thoracotomy: a large case series and systematic review. Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest.
Taylor and Shaukat of Emory and Coney Island Hospital respectively for their efforts in peer reviewing this huge topic. CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: All valid points, but let’s dive in too some actual detail.
The Choosing Wisely Pediatric Emergency Medicine Recommendations The Choosing Wisely Campaign Toolkit Expert Contributors Paul Mullan, MD Children’s Hospital of the King’s Daughters Norfolk, VA, USA mullan20@gmail.com Jim Chamberlain Children’s National Hospital Washington, DC, USA JCHAMBER@childrensnational.org During your time in the EmergencyDepartment (..)
16 found that of 142 patients evaluated at a single site university hospital, 61 had a foreign body. Am J Emerg Med. Emergencydepartment management of foreign bodies of the external ear canal in children. Radiologic Cases in Pediatric Emergency Medicine; University of Hawaii. Radiol Cases Emerg Med.
We have teamed up with the team from the EmergencyDepartment at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The children’s Emergencydepartment sees approximately 50,000 presentations per year. Paediatr Int Child Health. 2024 Jan 11:1-7. Epub ahead of print.
16 US or CT guided biopsy/joint aspiration (typically performed by Orthopedic surgery or Interventional Radiology). 9,23 Disposition: Dislocation : If successfully reduced in the emergencydepartment may discharge with strict mobility restrictions and Orthopedic follow up. Hospitals, 2018. 2021 Aug 31. Bone Jt Open.
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