Taming the SRU

MARCH 12, 2024

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. Acad Emerg Med 2023;30(8):800–8. as well as patients less than 18 years old were excluded from analysis. The study’s primary outcomes were the operational impacts of the SQuID protocol on EDLOS and ICU admission rates.

Operations 96

Operations Hospitals Best Practices Wellness 96

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

RebelEM

NOVEMBER 25, 2024

Included patients from out-of-hospital, emergency department, intensive care unit, and operating-room intubations. Intubation performed in all settings (out-of-hospital, emergency department, ICU, and operating room). Still, most patients undergoing intubation probably have well-visualized anatomy.

Outcomes 98

Outcomes Emergency Department Operations Hospitals 98

PulmCCM

NOVEMBER 6, 2023

Intuitively, plasma seemed even less likely to help the very sickest of the sick— those mechanically ventilated with ARDS from Covid-19, whose mortality rate was well over 50% at many centers. The intervention took place in the emergency department, with device placement by ED physicians. Only it turns out, it did help.

Blood Transfusions 98

Blood Transfusions Operations Resuscitation Infectious Diseases 98

Taming the SRU

MAY 13, 2024

The patient is a well-appearing male who is awake, alert, and oriented. There is also a well-appearing, healed surgical scar. There is also a well-appearing, healed surgical scar. The skin is warm and well perfused with brisk capillary refill. Respiratory and cardiovascular exams are normal. BMP : Na 136, K 4.3,

Ultrasounds 97

Ultrasounds Emergency Department Wellness Operations 97

EM Literature of Note

OCTOBER 1, 2023

The clinician teams (either an internal medicine or emergency medicine resident, plus a supervising specialist) and ChatGPT were asked to generate a “top 5” of differential diagnoses, and then settle upon one “most likely” diagnosis. However, what is lacking from these studies are any sort of comparison.

Documentation/Coding 86

Documentation/Coding Operations Emergency Department Wellness 86

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

Greater Sydney Area HEMS

FEBRUARY 20, 2024

The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i]. In fact, it’s use is so ubiquitous that the newer generation of emergency physicians are largely inexperienced in the insertion of central lines as a blind technique. i] Leibowitz A, Oren-Grinberg A, Matyal R.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

Don't Forget the Bubbles

JUNE 19, 2024

Well-designed multicentre large studies in children were warranted; cue Leonard et al. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Lancet Child Adolesc Health. 2024 Jun 3:S2352-4642(24)00104-4.

CPR 124

CPR Research Outcomes Documentation/Coding 124

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. These procedures require an experienced operator. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. These procedures require an experienced operator.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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. Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

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

EMDocs

DECEMBER 11, 2023

In October 2022, the American College of Cardiology released an updated expert consensus decision regarding the evaluation of chest pain in the emergency department. This included the addition several new STEMI equivalents [4] on ECG that warrant “prompt evaluation for emergency coronary angiography.” J Am Coll Cardiol.

EKG/ECG 110

EKG/ECG Emergency Department Academics Operations 110

Don't Forget the Bubbles

OCTOBER 10, 2024

Ten thousand children in the UK are operated on a year for fingertip injuries, and 96% of surgeons currently report replacing the nail plate intra-operatively. Adopting this approach would reduce time in surgery for the child as well as the financial cost of nail bed repair. Arch Dis Child. 2024 Jul 10:archdischild-2023-326727.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. World J Emerg Surg 2023 PMID: 36918947 3. Int J Emerg Med 2009 PMID: 20157465 4. Crit Care Med.

Resuscitation 105

Resuscitation Administration Emergency Department Hospitals 105

ALiEM

SEPTEMBER 13, 2024

A 32-year-old male with no significant past medical history presented to the emergency department (ED) from an outside hospital for further management of right eye pain and vision loss sustained after he was struck by a metal wire while at work. An emergent ophthalmology consult is needed to plan for operative repair.

Emergency Department 64

Emergency Department Academics Hospitals Fractures 64

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. J Med Toxicol. Epub 2019 Jul 3. Intensive Care Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 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. Jeff: Well that’s kind worrisome. 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

Dr. Smith's ECG Blog

AUGUST 4, 2024

Context: a man in his 40s presented to the emergency department with 1 day of sudden onset chest pain. The patient did well. == MY Comment , by K EN G RAUER, MD ( 8/4 /2024 ): == I thought today's case by Dr. Meyers is an important one for emergency providers for a number of reasons. Pericarditis maybe."

EKG/ECG 103

EKG/ECG Wellness Operations Emergency Department 103

Don't Forget the Bubbles

MAY 24, 2023

Crouzon syndrome, Pierre-Robin sequence, Down syndrome, Beckwith-Wiedemann syndrome) I njuries to the face, mandible, pharynx, or neck S leeping issues such as snoring due to adenotonsillar hypertrophy It’s essential to have a well-planned approach to managing the difficult airway. difficult intubations in neonates and infants. Anaesthesia.

Airway Management 98

Airway Management Teamwork Pediatrics Emergency Department 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). He writes an excellent […] The post SGEM#186: Apneic and the O, O, O2 for Rapid Sequence Intubation first appeared on The Skeptics Guide to Emergency Medicine.

Emergency Department 52

Emergency Department Resuscitation Operations EMS 52

ALiEM

SEPTEMBER 9, 2024

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 Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today. Interdisciplinary Neurosurgery, 13, 66-70.

Sepsis 60

Sepsis Academics Operations Wellness 60

Don't Forget the Bubbles

MAY 22, 2023

You’ve just started working in the Children’s Emergency Department (CED). These can be operated and maintained by patients and their families at home. Gemma tells you that as well as the physio, Robin’s LTV Consultant has also prescribed some oral antibiotics. Since then, he has been well in himself.

Radiology 98

Radiology Radiology Hospitals Wellness 98

EMDocs

AUGUST 12, 2023

He presented to the emergency department because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. A 41-year-old male with no significant past medical history presents with a deep hand laceration. Examination reveals the following: What is the diagnosis?

EMS 70

EMS Fractures Operations Ultrasounds 70

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

Taming the SRU

MAY 22, 2023

Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. weight-bearing status, operative vs. non-operative) If necessary/helpful to ensure adequate follow-up At time of discharge: Counsel on expected course of injury, supportive care (e.g., 12): e0244291. 9(1):31-36.

Fractures 77

Fractures Dislocations Operations Radiology 77

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 97

Documentation/Coding EMS Operations Emergency Department 97

Taming the SRU

AUGUST 4, 2024

We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift. The largest retrospective cohort study to date (Beyde et al.) shows that most will improve with empiric antibiotics.

Emergency Department 85

Emergency Department Dislocations Documentation/Coding Burns 85

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 Am J Emerg Med. Acad Emerg Med. Ladde JG, Miller S, Chin K, et al. 2014;32(2):160-165.

Hospitals 87

Hospitals Emergency Department EMS Outcomes 87

EMDocs

SEPTEMBER 25, 2023

These clinically challenging intubations prompted emergency clinicians to turn to a KOBI technique and forgoing the use of an NMBA, which are not without risk. Additionally, many if not most emergency physicians do not receive adequate training on topical awake intubations (TAI) (11). Resuscitation 2013; 84(11): 1500 – 4.

Emergency Department 66

Emergency Department Soft Tissue Injuries Operations Airway Management 66

ACEP Now

SEPTEMBER 5, 2024

Creation of an accurate database of emergency physicians living and working within a state, as well as a network of each states’ EM groups and ED medical directors would help chapter leaders disseminate relevant information, strengthen advocacy efforts, and plan regional solutions summits to focus on unique challenges.

Leadership 98

Leadership PPE EMS Wellness 98

ACEP Now

DECEMBER 10, 2023

Boarding in the emergency department is a systemic crisis with emergency physicians at the center. The summit participants examined the multifactorial causes of boarding through the lens of transparency, regulatory challenges, mental health, financial drivers, operational modifications, workforce, and other categories.

Emergency Department 52

Emergency Department Leadership Hospitals Administration 52

SheMD

MAY 4, 2023

Article Summary What they looked at: This article aimed to look at career trajectory differences between genders in faculty who have attained academic chair roles in emergency medicine. Women were more likely to be first appointed to educational rather than operational roles (52.6% Why do we care about this article?

Leadership 52

Leadership Academics Operations Administration 52

ACEP Now

JULY 8, 2024

1 Other, non-transformer-based ML methods can be used on clean, well-structured data sets, but LLMs are frequently capable of feats of unanticipated competence right out of the box. Recently published experiments with LLMs in the emergency department fall into a handful of primary areas of interest. 2024;26(1):40-46.

Emergency Department 52

Emergency Department Operations Documentation/Coding Research 52

The Skeptics' Guide to EM

DECEMBER 12, 2020

Case: A 52-year-old previously healthy woman presents to your emergency department (ED) with an abscess on her left forearm. She is systemically well and there is no sign of tracking, so you decide to perform incision and drainage in the ED. Kirsty is also the creator of the wonderful infographics called #PaperinaPic.

Operations 52

Operations Outcomes Research Academics 52

ALiEM

AUGUST 9, 2023

Child with Cough and Fever: Case Introduction A 6-year-old boy presents to the emergency department complaining of cough for 3 days and fever for the last day. F Heart Rate 138 bpm Blood Pressure 102/61 Respiratory Rate 32 Oxygen Saturation (room air) 100% He is well appearing but has increased work of breathing.

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

Taming the SRU

OCTOBER 30, 2024

Case #2: Facial Swelling CT imaging has seen a significant increase in the last 20 years. ​ Although there has been an increase in imaging, diagnostic yield has remained relatively stable​ Factors the impact imaging decision includes reliability of the physical exam as well as extrinsic factors such as consultants and admitting services.​

Hospitals 52

Hospitals Emergency Department Documentation/Coding EKG/ECG 52