Emergency Medicine Journal

MARCH 25, 2025

This month’s update is by the Emergency Department Team, Wexham Park Hospital, Slough, Frimley Health NHS Foundation Trust. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches.

Sepsis 52

Sepsis Emergency Department Administration Outcomes 52

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

The Trauma Pro

JUNE 30, 2023

The biggest question is, why does your hospital want you to use it? 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). When I started this series nearly 15 years ago, many hospitals still used paper charting.

Hospitals 100

Hospitals Administration Resuscitation Best Practices 100

Pediatric EM Morsels

JUNE 2, 2023

Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! Admission to hospital depending on severity of symptoms and need for further hydration Moral of the Morsel Diseases, just like our patients, are unique and varied!

Dehydration 193

Dehydration Shock Pediatrics Emergency Department 193

Emergency Medicine Journal

NOVEMBER 28, 2023

Poor sonic environments in hospitals have been found to ‘impede the recovery process’ for patients and reduce staff performance. Sonic environments are often overlooked in hospital design, leading to spaces which are not supportive for care. We introduced them to deep listening through a series of listening exercises.

Emergency Department 74

Emergency Department Patient Safety Hospitals Research 74

PEMBlog

MARCH 4, 2025

In this episode we dive into the resurgence of Mycoplasma pneumoniae an atypical bacterial cause of community-acquired pneumonia thats making waves in pediatric emergency medicine. Well cover its clinical presentation, epidemiology, diagnostic approach, and management, including why standard beta-lactam antibiotics wont work.

Pediatrics 94

Pediatrics Military CDC Hospitals 94

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 88

Hospitals Emergency Department EMS Outcomes 88

ACEP Now

MARCH 10, 2025

You work as the medical director at a suburban, community emergency department (ED). At your monthly meeting with the chief medical officer (CMO) and chief nursing officer (CNO), they inform you of the hospitals plan to start a Sexual Assault Nurse Examiner (SANE) Program. As expected, you have several questions.

Sexual Assault 52

Sexual Assault Forensics Leadership Pediatrics 52

ACEP Now

NOVEMBER 13, 2023

Physicians, nurses, and staff in emergency departments (EDs) across the country have encountered workplace violence for years. 1,2 In a 2018 study by ACEP, nearly half of emergency physicians polled reported a physical assault while at work. are caused by a behavioral crisis.

Emergency Department 52

Emergency Department Documentation/Coding Psychiatric Best Practices 52

EM Ottawa

NOVEMBER 2, 2023

Introduction Frostbite is a frequent presenting complaint to emergency departments (EDs) in cold climates. It is more common among those without housing, those with mental health disorders as well as those who work or engage in outdoor activities.(1)

Emergency Department 123

Emergency Department Wellness Hospitals Resuscitation 123

ACEP Now

MARCH 13, 2024

Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. Consequences of this are well documented and include delayed treatment, exposure to error, increased length of stay, and increased mortality. ED crowding impairs this mission.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

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

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Admission allows for close monitoring, given the risks of perforation, ischemic bowel, and ulceration, as well as appropriate management of the condition and patient symptoms. Stercoral colitis in the emergency department: a review of the literature. In StatPearls.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

The Trauma Pro

JULY 5, 2024

But under-prescribing can create problems as well. Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Make sure all is documented well on the consent or in the EHR.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

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

ACEP Now

MARCH 11, 2025

Many patients with PE can be discharged directly from the emergency department (ED). 2-4 A study in Annals of Emergency Medicine of almost 300,000 patients hospitalized with acute PE between 2011-2020 found that the use of UFH increased from 41.9 percent to 56.3 percent despite guideline recommendations.

Hospitals 52

Hospitals Administration Outcomes Stroke 52

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. Logistic regression was used to adjust for confounders.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

EMDocs

NOVEMBER 19, 2024

1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. He was extubated on hospital day 2 and was able to be discharged to psychiatry on hospital day 5.

Poisoning 111

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

RebelEM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. Paper: Owyang CG, et al. J Crit Care. J Crit Care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Northwestern EM Blog

MARCH 1, 2025

In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Position arms in a comfortable position, avoiding any position that could cause a brachial plexus injury, and ensure they are well-supported to avoid pressure ulcers.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

EMDocs

AUGUST 22, 2024

3,4 Notably, institutions receiving federal funding (such as hospitals receiving Medicare reimbursement) must abide by Title VI of the 1964 Civil Rights Act, which entitles persons with NELP to language assistance. 12 How do we address these disparities in the emergency department? Lion KC, et al. Pediatrics. 135:e709-e716.

Documentation/Coding 105

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 105

ALiEM

OCTOBER 30, 2024

The Wounds Common among patients who use xylazine, the necrotic and exudative wounds are still not fully understood [5-8], but are likely due in part to direct cytotoxic effects of the drug and its impurities, as well as possible nutritional deficiencies common in those with dependence. Journal of general internal medicine. 2017 Jun;32:660-6.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

The Skeptics' Guide to EM

JULY 8, 2023

Evaluation of oseltamivir used to prevent hospitalization in outpatients with influenza: a systematic review and meta-analysis. Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at Staten Island University Hospital. Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023.

CDC 108

CDC Hospitals EMS Emergency Department 108

ACEP Now

OCTOBER 30, 2024

ACEP Now : Boarding What obstacles exist in Congress to address hospital boarding? We don’t incentivize experience in our systems and our laws – both the provider’s experience as well as the patient’s experience, so when it comes to hospital boarding, it falls right in line with that. ACEP MEMBER TIMOTHY C.

Telemedicine 40

Telemedicine Critical Access Emergency Department Hospitals 40

ACEP Now

DECEMBER 6, 2024

His health care focus included hospital efficiency, physician and patient satisfaction, and emergency department (ED) wait times, as well as a host of nonhealth issues. That changed when, as a college student, he joined a friend on a volunteer shift at Highland Hospital in Oakland, Calif. Click to enlarge.)

Emergency Department 98

Emergency Department Hospitals Wellness 98

ACEP Now

OCTOBER 10, 2024

He completed residency in emergency medicine through Emory while training at Grady Hospital in Atlanta. Most recently, Dr. McCormick served as an emergency physician at Northside Hospital. In the Atlanta region, we had AMC, one of the largest hospitals in the region closed. Overburden the other hospital systems.

Telemedicine 105

Telemedicine Critical Access Hospitals Emergency Department 105

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. AVAPS may be useful, but we still need a well conducted RCT to find out if it is (i.e Paper: Goren NZ et al. Balkan Med J 2021. AVAPS: 0.07 AVAPS: 10.20

COPD 132

COPD Emergency Department Outcomes EMS 132

Don't Forget the Bubbles

MARCH 31, 2025

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. Am J Emerg Med. The sepsis screening tool in paediatric emergency departments can help. 2025.01.054.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

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. Adherence to guidelines was assessed by a follow-up phone call two months after injury.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

ACEP Now

AUGUST 22, 2023

Regardless of the domain, somewhere an expert panel has convened to issue a pronouncement informing all of the ideal care of patients under their specialty umbrella, indirectly extending to their care in the emergency department. 1 To date, there have been three GRACE publications. 1 To date, there have been three GRACE publications.

Emergency Department 98

Emergency Department Academics Critical Access Research 98

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

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

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

SEPTEMBER 14, 2024

Source Use of Glucagon-Like Peptide-1-Agonists and Increased Risk of Procedural Sedation and Endotracheal Intubation in the Emergency Department. Ann Emerg Med. The AI performed well in both accuracy and in improving sensitivity. Ann Emerg Med. 2024 Aug;84(2):226-227. DOI: 10.1016/j.annemergmed.2024.03.007.

Emergency Department 97

Emergency Department Resuscitation Pediatrics EKG/ECG 97

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. There are well preserved R-waves in Wellens waves. What do you think? ng/mL, BNP 2790, and lactate 3.7.

EKG/ECG 139

EKG/ECG Emergency Department Shock Ultrasounds 139

The Skeptics' Guide to EM

APRIL 20, 2024

Efficacy and safety of ultrasound-guided erector spinae plane block compared to sham procedure in adult patients with rib fractures presenting to the emergency department: A randomized controlled trial. It did not perform as well which is not unusual for a clinical decision instrument [5].

Fractures 87

Fractures Ultrasounds Emergency Department CDC 87

ACEP Now

MAY 10, 2024

Patients often seek care in the emergency department (ED) setting when flares of pain affect their ability to ambulate, climb stairs, or even stand up from sitting. We prefer an in-plane, superior to inferior approach, but an out-of-plane technique can be performed, as well. J Emerg Med. Surg Technol Int. Ragab, A.R.,

Ultrasounds 92

Ultrasounds Emergency Department Hospitals Wellness 92