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On a busy day shift in the emergencydepartment, 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.
Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. Casey currently splits his time […] The post SGEM#415: Buckle Down for some Ultrasound to Diagnosis Distal Forearm Fractures first appeared on The Skeptics Guide to Emergency Medicine. Reference: Snelling et al.
Diarrhea is one of the most common complaints in the pediatric emergencydepartment, especially in the summer and early fall. It is critical to detect HUS early in its disease course to ensure the best outcomes. Predicting Adverse Outcomes for Shiga Toxin-Producing Escherichia coli Infections in EmergencyDepartments.
Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. In many emergencydepartments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. Emerg Med J. 2023;40(10):700-707.
Dr. Westafer serves as the Social Media Editor and a research methodology editor for Annals of Emergency Medicine. Case: A 57-year-old woman presents to the emergencydepartment (ED) with pleuritic posterior chest/back pain, shortness of breath, and left leg swelling.
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. A bedside ultrasound is completed to assess the location of the pregnancy. She reports that her previous ectopic pregnancy was treated medically.
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.
Background and objectives The ability to rule appendicitis in or out using ultrasound is limited by studies where the appendix is not visualised. For those patients who had formal ultrasound, direct and indirect findings of ultrasound were abstracted from the ultrasound report. 95% CI 1.7 95% CI 3.8 95% CI 1.4
Case A 50-year-old woman presents to the emergencydepartment (ED) complaining of epigastric pain and nausea for 36 hours. You perform a biliary ultrasound (US) in the ED (BUSED) which shows a gallbladder (GB) full of stones, some GB wall thickening and a positive Murphy’s sign. Click to enlarge. Reference: Hilsden, et al.
Point-of-Care Ultrasound-First for the Evaluation of Small Bowel Obstruction: National Cost Savings, Length of Stay Reduction, and Preventable Radiation Exposure. AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. specificity with ultrasound [1].
A 59-year-old man presents to your community emergencydepartment (ED) with chest pain that is radiating to his back. Ultrasonographers: POCUS was performed by PGY1–PGY3 emergency medicine residents. They received a four-hour introductory course taught by emergencyultrasound faculty. Eur Heart J.
Should we use ultrasound to diagnose distal forearm fractures in children and adolescents? X-ray (radiography) is the standard imaging technique used in emergencydepartments. However, ultrasound is gaining popularity due to its portability, affordability, and lack of ionising radiation.
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. Emerg Med J. Paediatr Int Child Health. 2024 Jan 11:1-7.
3,4 In addition, for patients with contraindications or those who have failed thrombolysis, catheter-directed thrombolysis and surgical thrombectomy are useful treatment modalities that are associated with low major complication rates and improved patient outcomes. 6 The second common catheter-directed approach is mechanical thrombectomy.
Clinical outcomes assessed at 60 days included an unplanned return to the emergencydepartment (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.
Clinical impact: The patient’s DVT ultrasounds were negative. Bupe Allergy Buprenorphine induction has been the mainstay of emergencydepartment treatment of opioid use disorder for more than a decade [11, 12]. PMID 35774687 D’Onofrio G, Chawarski MC, O’Connor PG, et al. Journal of general internal medicine. Am J Prev Med.
Background: Point of care ultrasound (POCUS) has a demonstrated sensitivity of 89.8% 1 It is a quickly deployable and easily interpreted study that can be done in real time to guide decisions in the EmergencyDepartment. Background: Point of care ultrasound (POCUS) has a demonstrated sensitivity of 89.8%
If you were working in a busy emergencydepartment, would you like to be interrupted to interpret these ECGs or can these patients safely wait to be seen because of the normal computer interpretation? Emergent cardiac outcomes in patients with normal electrocardiograms in the emergencydepartment.
A point of care ultrasound of the liver reveals the following: Image 1: Ultrasound of the liver showing abnormal hepatic artery flow and resistance index 1 Question: What is the diagnosis? Emergencydepartment visits and unanticipated readmissions after liver transplantation: A retrospective observational study.
Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts. Patients aged ≥16 years presenting to the ED with a distal radius fracture requiring closed reduction were randomised to either point-of-care ultrasound (PoCUS)-guided or standard reduction.
Bimodal age of distribution: at birth and 12-18 years 14% of cases occur in adults; older patients have worse outcomes Bell clapper deformity – bilateral in 80% of patients Prior episode of torsion Family history Trauma (can be minor) Clinical Presentation: Sudden/severe testicular pain Often unilateral, may radiate.
The current standard of practice has moved away from landmark-based central line placement given the efficacy and safety of ultrasound-based techniques. World J Emerg Surg 2023 PMID: 36918947 3. Intraosseous vascular access in adults using the EZ-IO in an emergencydepartment. Int J Emerg Med 2009 PMID: 20157465 4.
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 hospital emergencydepartment (ED) after a fall from his bicycle. Reference: Partyka et al.
Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergencydepartment (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). doi.org/10.1016/j.resuscitation.2018.11.004
Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in EmergencyDepartment Patients With Abnormal Vital Signs. AEM November 2019 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Reference: Daley et al.
If you want to see Justin in the video format and his new Youtube series then click here: [link] If you would like to check out my current ultrasound training project then click here: WACHS Ultrasound Otherwise – enjoy the show and see you in a few weeks. Emerg Med J. 2024 Jan 22;41(2):96-102. Is our PPE evidence-based?
emergencydepartments and ICUs were randomized to undergo either DL or VL for intubation. More than 90% of the intubations were performed by emergency medicine residents (~70%) or critical care fellows (~23%). (Who At six months of followup, there was no difference in the rate of good neurologic outcome (43.5%
This month's episode of EMplify, the podcast corollary to the Emergency Medicine Practice journal, focuses on acute decompensated heart failure. The podcast is based on the full-length review published in the May 2017 issue of Emergency Medicine Practice.
Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergencydepartment for evaluation of chest pain. Speckle Tracking Echocardiography may provide another useful adjunct.
The Case: A 56-year-old male with no significant past medical history presents to the emergencydepartment with worsening swelling, pain, and erythema of the right elbow. Patient Course: In the emergencydepartment, the patient received lab work that was remarkable for WBC 11.8, and ESR 26. 2017 Dec;45(6):781-786.
What is your initial imaging test of choice, ultrasound (US) or non-contrast CT, and why? Would you be confident in a point-of-care-ultrasound evaluation or a formal ultrasound? Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? How do you proceed?
There are greater than 2 million annual emergencydepartment visits for suspected renal colic in the US, and Ct scanning is performed for more than 90% of patients who receive a diagnosis of kidney stone. CT in Detecting Urinary Tract Calculi: Influence on Patient Imaging and Clinical Outcomes Radiology. 2011; 18(7):699-707.
This month, after a few months of primarily medical topics, we’re talking trauma, specifically Blunt Cardiac Injury: EmergencyDepartment Diagnosis and Management. Nachi: Which is why you’ll have to turn to our good friend the ultrasound, for more useful data. Early defibrillation is linked to better outcomes.
Article 1: What predicts parental anxiety in the Paediatric EmergencyDepartment? Predictors of parental anxiety in a paediatric emergencydepartment. Emergency Medicine Journal. The authors compared 100 POCUS (Point-Of-Care-UltraSound ) images captured by trained physicians (in FUSIC/CACTUS). Martin, S.R.,
This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. Takotsubo is a sudden event, not one with crescendo angina.
ULTRASOUND GOODIE BAG ULTRASOUND FOR LATE PREGNANCY [PODCAST]: While not a routine exam we perform other than confirming fetal heart tones, definitely some great pearls on more advanced US topic. Consider an ultrasound guided ulnar nerve block. Part 1 here. US GUIDED ULNAR NERVE BLOCK [BLOG]: Boxer's fracture need a reduction?
This was sent by anonymous The patient is a 55-year-old male who presented to the emergencydepartment after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.
Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. Signs Shafer’s sign (tobacco dust) May see a Weiss ring when the posterior vitreous (PV) detaches from the optic disc margin Visualization with ultrasound. EmergencyDepartment Management: Emergency ophthalmology consultation.
Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - EmergencyDepartment Management of North American Snake envenomations.
Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergencydepartment with 2 days of heavy substernal chest pain and nausea. The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. Do not treat AIVR. Washam, J.
89% agree that violence in the emergencydepartment has harmed patient care. Phenobarbital has been proven to be equivalent to benzodiazepines with regard to clinical, pharmacologic and utilization outcomes. None of the physicians in the study believe that the rate of violence has decreased at all.
One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture: A meta-analysis of randomized controlled trials. Case: A 32-year-old male construction worker presents to the emergencydepartment (ED) after falling on his right dominant hand.
Point-of-care ultrasound for non-angulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes. Acad Emerg Med May 2017. Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Acad Emerg Med May 2017.
This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on EmergencyDepartment Management of Patients With Complications of Bariatric Surgery. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. Jeff: Next up is ultrasound.
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