Taming the SRU

JANUARY 10, 2024

89% agree that violence in the emergency department has harmed patient care. None of the physicians in the study believe that the rate of violence has decreased at all. It usually takes 4-6 weeks for a coronary artery to heal from dissection.

EKG/ECG 92

EKG/ECG Shock Fractures Emergency Department 92

RebelEM

APRIL 29, 2024

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 emergency department. Int J Emerg Med 2009 PMID: 20157465 4.

Resuscitation 105

Resuscitation Administration Emergency Department Hospitals 105

EB Medicine

NOVEMBER 1, 2018

But this month’s episode is special in its own way - we’ll be tackling Electrical Injuries in the emergency department - from low and high voltage injuries to the more extreme and rare lightning related injuries. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A bedside cardiac ultrasound was normal, with no effusion. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Assessment was severe sudden cardiogenic shock. He remained hypotensive and in shock. He was intubated and then went pulseless.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

ACEP Now

MAY 4, 2023

Case A 37-year-old white male with no past medical history presented to the emergency department (ED) for left testicular pain, redness, and swelling. Diagnosis: Complex Hydrocele (Pyocele) The testicular ultrasound revealed a small left complex hydrocele suspicious for pyocele. Scrotal pyocele: uncommon urologic emergency.

Urgent Care 52

Urgent Care Ultrasounds Sepsis Emergency Department 52

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. Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

EMDocs

NOVEMBER 4, 2023

An ultrasound of the testes reveals the following: What is the diagnosis? aureus infections among patients in the emergency department. Skin and Soft Tissue Infections in the Emergency Department. Emerg Med Clin North Am. Scrotal pyocele: Uncommon urologic emergency. J Emerg Trauma Shock.

EMS 68

EMS Ultrasounds Emergency Department Infectious Diseases 68

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. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. Jeff: Next up is ultrasound.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EB Medicine

SEPTEMBER 1, 2018

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 - Emergency Department Management of North American Snake envenomations.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest.

Ultrasounds 81

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 81

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Am J Emerg Med. doi.org/10.1016/j.resuscitation.2018.11.004

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation CPR EMS 84

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

She arrives in the emergency department (ED) with decreased level of consciousness and shock. Her point-of-care ultrasound (POCUS) shows appropriate-appearing global ejection fraction and no marked wall motion abnormalities.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Taming the SRU

SEPTEMBER 15, 2023

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?

CPR 89

CPR Burns Airway Management Wellness 89

Northwestern EM Blog

DECEMBER 27, 2021

Marc Sala, summarize the current literature on the peripheral infusion of vasopressors, which is becoming more and more commonplace as the evidence evolves to support earlier initiation of pressors and more judicious use of crystalloid for many forms of shock. Dr. Seth Trueger, NUEM faculty, provides expert commentary.

Dislocations 52

Dislocations Emergency Department Burns Shock 52

EB Medicine

AUGUST 6, 2019

But next we should talk about ultrasound. Jeff: That is simply shocking! Jeff: Interestingly, though only a small retrospective study of 156 patients, one study found markedly reduced mortality, 4.9% in those on DOACs vs warfarin with traumatic intracranial hemorrhage. Jeff: And we’ll get to that in a few minutes.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Taming the SRU

MAY 1, 2023

A retrospective evaluation of phenobarbital versus benzodiazepines for the treatment of alcohol withdrawal in a regional Canadian emergency department Link: [link] Bottom Line: This study in a small regional ED showed a QI project rolling out a Phenobarbital or Diazepam for Alchohol withdrawal syndrome. and NPV(50%).

Poisoning 52

Poisoning Hyperthermia / Hypothermia Emergency Department Seizures 52

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. Leave it alone. Bigger et al.

EKG/ECG 85

EKG/ECG EMS Emergency Department Outcomes 85

PEMBlog

OCTOBER 2, 2024

Now, in the pediatric emergency department, the diagnosis of reflux is primarily clinical. Maybe parents will have to thicken the feeds, but I do not recommend this in the emergency department. or somebody who appears pale, dehydrated, in severe pain, or worse, even in shock. it’s probably not going to be H.

Pediatrics 52

Pediatrics Emergency Department Ultrasounds Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

A emergent cardiology consult can be helpful for equivocal cases. This finding does not alter the need to pursue emergent reperfusion, although it might suggest a poorer prognosis.”[3] New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Taming the SRU

OCTOBER 1, 2023

This post aims to broadly cover the types of PTX, the diagnostic modalities available, and the ideal management by PTX type in the Emergency Department. Ann Emerg Med. J Emerg Trauma Shock. The "lung point": an ultrasound sign specific to pneumothorax. Ann Emerg Med. Clin Pract Cases Emerg Med.

Fractures 95

Fractures COPD Hospitals Emergency Department 95

EM Curious

JULY 1, 2015

ULTRASOUND IN CHEST PAIN: [BLOG]: It is never a bad idea to throw an ultrasound probe on your patient with chest pain. Onto the FOAMed WEINGART ON HFNC [PODCAST]: The new oxygen wonder child is taking critical care by storm. Should we all be jumping on board? Weingart discusses some background, the evidence and his opinions here.

EMS 52

EMS Ultrasounds EKG/ECG Fractures 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. The screening physician ordered an EKG and noted his ashen appearance and moderate distress. Triage EKG: What do you think?

EKG/ECG 52

EKG/ECG Shock Emergency Department Ultrasounds 52

EM Curious

SEPTEMBER 9, 2015

LITERATURE OF INTEREST An Age-Adjusted D-dimer Threshold for Emergency Department Patients With Suspected Pulmonary Embolus: Accuracy and Clinical Implications. SEE YOU NEXT WEEK Online Advanced Ultrasound Education Northwestern EM Residency Education Coming soon.

Stroke 52

Stroke Best Practices Pediatrics EMS 52

EMDocs

JULY 17, 2023

3 Point of care ultrasound (POCUS) can be highly sensitive for free fluid and pneumoperitoneum when used by a trained physician in the appropriate patient population. Bowel perforation demonstrated by CT, hard signs of peritonitis, or an overall toxic appearance warrant emergent surgical consultation.

Operations 77

Operations EMS Fluid Resuscitation Resuscitation 77

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. Then ACS (STEMI) might be primary; this might be cardiogenic shock. He had this ECG recorded. Are the lungs clear? Is the patient cool and pale?

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. A patient in their 40s with type 1 diabetes mellitus and hyperlipidemia presented to the emergency department with 5 days of “flu-like” illness. Edits by Willy Frick.

EKG/ECG 64

EKG/ECG Wellness Point-of-Care Testing Shock 64

Dr. Smith's ECG Blog

MAY 19, 2020

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). In this case, profound shock for 1 hour would result in the same degree of infarction. The Type 2 MI would then have been a result of the prolonged severe shock while in arrest.

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. ng/mL, 0.25-0.5

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: Diagnosis of appendicitis, in a pregnant patient, ultrasound vs. mri. You can also use the shock index, which as a reminder is simply the HR/SBP. Sounds familiar.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Pediatric Emergency Playbook

AUGUST 1, 2017

One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain. Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. J Ultrasound. 2008; 15-21.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The children’s Emergency department sees approximately 50,000 presentations per year. International Consensus Criteria for Pediatric Sepsis and Septic Shock.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

ACEP Now

SEPTEMBER 3, 2024

Still, this wave of private equity acquisitions in emergency medicine has come crashing down on the heads of many early-career physicians. As of 2022, 1 in 4 emergency departments in the United States were staffed by a private equity-owned physician group. References Pomorski C. The death of Hahnemann Hospital. The New Yorker.

Hospitals 69

Hospitals Radiology Radiology Administration 69

Dr. Smith's ECG Blog

JULY 18, 2014

Case Continued 2 days later the patient became increasingly tachycardic, hypotensive, ashen, clammy (in cardiogenic shock) and had a new murmur. Rupture can be either free wall rupture (causing tamonade) or septal rupture, causing ventricular septal defect with left to right flow and resulting pulmonary edema and shock. Apr 28, 2009.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

Here, then, are some links for Third Trimester Emergencies. Keep your ultrasound handy. Understand the application of the EMTALA law (Emergency Medical Treatment and Active Labor Act [ USA ]) to your situation. Preeclampsia/ Eclampsia - Emergency Department Resources. {3 abstracts} Luckett-Gatopoulos, S.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Written by Destiny Folk MD, with edits by Meyers, peer reviewed by Smith and Grauer A woman in her late 20s with a past medical history of cervical cancer status post chemotherapy and radiation therapy presented to the emergency department for shortness of breath, chest tightness, and two episodes of syncope. Her pulse is 125.

EKG/ECG 52

EKG/ECG Ultrasounds Documentation/Coding COPD 52

Pediatric Emergency Playbook

DECEMBER 1, 2015

It’s a high-flow artery to the face, and if disrupted, the child may have significant bleeding and possibly hemorrhagic shock. Ultrasound can be used to troubleshoot when needed. J Emerg Med. Electrical Injuries: Shocking or Subtle?” In Avoiding Common Errors in the Emergency Department, 2nd Edition.

Burns 40

Burns Emergency Department EKG/ECG Shock 40