Taming the SRU

JANUARY 1, 2024

For laboratory testing, it is important to be aware that not all values obtained via an intraosseous line correlate well with peripheral venous samples (11). Additional Resources Please see a previous Taming the SRU post for extra tips and trouble-shooting tricks, as well as a video demonstration for IO access. Ann Emerg Med.

Emergency Department 91

Emergency Department Ultrasounds Administration Burns 91

Emergency Medicine Journal

NOVEMBER 28, 2023

We propose using a qualitative approach called ‘deep listening’ to explore the sonic environment of emergency departments. We organised a public participation workshop to explore perspectives on the sonic environment of an emergency department as well as their perceptions and experiences of the deep listening methodology.

Emergency Department 74

Emergency Department Patient Safety Hospitals Research 74

Emergency Medicine Journal

APRIL 22, 2024

This edition of the EMJ contains a randomised controlled multicentre trial of smoking cessation initiated in the emergency department (ED).

Emergency Department 52

Emergency Department Wellness 52

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)! You may not make the diagnosis, but detecting the clues is important for the family!

Dehydration 189

Dehydration Shock Pediatrics Emergency Department 189

ACEP Now

JULY 7, 2023

Last month’s article focused on ACEP’s efforts and resources to support EDs and patients with psychiatric emergencies. Emergency departments (EDs) focus on rapid initiation of medical treatment. Clinical Policy: Critical Issues in the Diagnosis and Management of the Adult Psychiatric Patient in the Emergency Department.

Emergency Department 52

Emergency Department Psychiatric Administration 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. Academic Emergency Medicine 22.2

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 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. days versus 2.7 days, a difference of 2.2

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Emergency Medicine Journal

JULY 24, 2023

Introduction Pain is the most common presenting feature within the ED, yet undertreatment of pain in the ED is a well-documented problem worldwide. Despite the development of interventions to address this problem, there is still limited understanding of how pain management can be improved within the ED.

Emergency Department 74

Emergency Department Documentation/Coding Research Wellness 74

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

Emergency Medicine Journal

MARCH 21, 2024

Background Staff retention in Emergency Medicine (EM) is at crisis level and could be attributed in some part to adverse working conditions. This study aimed to better understand current concerns relating to working conditions and working practices in Emergency Departments (EDs).

Emergency Department 52

Emergency Department Leadership EMS Wellness 52

Taming the SRU

MARCH 11, 2024

Acute knee dislocations are rare orthopedic injuries that have high morbidity and need to be recognized quickly by the emergency physician; if unrecognized or inadequately treated, these injuries can lead to vascular and limb compromise (1,2). Knee dislocations make up less than 0.5% No open wound. ABI’s were 1.1 bilaterally.

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

Dr. Smith's ECG Blog

FEBRUARY 16, 2024

He presented soon afterward at the Emergency Department with ongoing symptoms. The patient did well and was referred for ablation. Written by Pendell Meyers A teenager was playing basketball when he suddenly developed palpitations and lightheadedness. Mentation and blood pressure were normal.

EKG/ECG 138

EKG/ECG Emergency Department Wellness 138

EM Literature of Note

AUGUST 25, 2024

Move over ketamine and TXA, there’s another medication gradually approaching do-it-all darling status in Emergency Medicine: dexamethasone. Well, yes to all of the above, in the appropriate clinical context – But, most prominently, as featured in this brief report, for asthma – particularly childhood asthma. Sore throats?

Administration 94

Administration Emergency Department Wellness Pediatrics 94

EM Literature of Note

SEPTEMBER 13, 2024

These are each awful, of course, in their own way from a patient- and parent-oriented standpoint, but they’re also quite awful at the population level, overburdening limited pediatric and emergency department resources. “Nirsevimab and Acute Bronchiolitis Episodes in Pediatric Emergency Departments” [link] Tweet

Emergency Department 87

Emergency Department Pediatrics Administration Wellness 87

Taming the SRU

JULY 24, 2024

Early Physician Gestalt Versus Usual Screening Tools for the Prediction of Sepsis in Critically Ill Emergency Patients. Ann Emerg Med 2024 Background Sepsis remains an increasingly common emergency department condition that is tied to higher morbidity and mortality across the United States as well as the rest of the world.

Sepsis 89

Sepsis Resuscitation Emergency Department Wellness 89

The Skeptics' Guide to EM

OCTOBER 12, 2024

A national survey of children’s experiences and needs when attending Canadian pediatric emergency departments. June 2024 Date: Oct 1, 2024 Guest Skeptic: Dr. Andrew (Andy) Tagg is an Emergency Physician with a special interest in education and lifelong learning. Reference: Ma K et al. He is accompanied by his worried parents.

Emergency Department 93

Emergency Department Pediatrics Outcomes EMS 93

PulmCCM

JANUARY 23, 2025

Overly general case definitions and sloppy EMR algorithms result in a high rate of overtreatment with antibiotics due to false positives, as well as delayed treatment from false negatives. Bands 2 and 3 did not discriminate well and did not provide useful or actionable information. emergency departments. Acad Emerg Med.

Sepsis 45

Sepsis Wellness Emergency Department Research 45

EMDocs

DECEMBER 18, 2024

A 36-year-old male presents to the emergency department after being found down at home by his spouse. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. Acad Emerg Med.

Seizures 97

Seizures Hyperthermia / Hypothermia Emergency Department EMS 97

Taming the SRU

DECEMBER 17, 2024

Fluid management in the Emergency Department (ED) is crucial in the adequate resuscitation of the acutely ill and decompensating patient. Out of 18 patients receiving ORT, 4 failed to respond well and were escalated to IV therapy. Emerg Med Australas 2013;25(6):52734. Am J Emerg Med 2016;34(4):7136. Intravenous 0.9%

Dehydration 83

Dehydration Fluid Resuscitation Administration Resuscitation 83

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

EM Literature of Note

AUGUST 18, 2023

We do love to give out opiates in the emergency department. The OPAL trial, published in The Lancet , is yet another in a series of trials decrying the disutility of virtually anything for back pain – in the context of prior work diminishing the efficacy of skeletal muscle relaxants , as well as even acetaminophen added to ibuprofen.

Emergency Department 86

Emergency Department Wellness 86

AENJ: Current Issue

SEPTEMBER 30, 2023

The overuse of computed tomographic (CT) scans for patients who present to the emergency department (ED) after mild traumatic brain injury (mTBI) has been well-documented. The Canadian Computed Tomography Head Rule (CCHR) is a validated tool to guide ED providers in determining the need for emergent CT of mTBI patients.

Emergency Department 52

Emergency Department Documentation/Coding Outcomes Wellness 52

SheMD

OCTOBER 15, 2023

Yes, I am a woman, yes I am a feminist, yes I am a physician, yes I am in academic leadership for a well-known emergency department… The yes’s are many, but what do I have to say that is so meaningful or useful that people would want to publish it? Well first of all, I didn’t do it in my 20’s, and I didn’t do it in residency.

Emergency Department 52

Emergency Department EMS Leadership Academics 52

ACEP Now

JULY 11, 2024

2 Although the opiate epidemic is certainly worthy of attention, it accounts for only about half of the number of deaths annually and only around a quarter of the number of emergency department visits annually relative to alcohol use. He returned to the emergency department, and you had the great privilege of saving his life.

Emergency Department 98

Emergency Department Psychiatric Outcomes Wellness 98

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. References: Goren NZ et al.

COPD 127

COPD Emergency Department Outcomes EMS 127

ALiEM

NOVEMBER 17, 2023

A 4-year-old female with no significant past medical history is brought to the Emergency Department by her grandmother for concern for two days of progressive vaginal bleeding. kg General : Well-appearing 4-year-old female acting appropriately with grandmother and mother at the bedside. C; Wt 18.2

Pediatrics 100

Pediatrics Emergency Department Academics OB/GYN 100

EM Literature of Note

JANUARY 27, 2024

A brief post collating a few bits of my various work published across the interwebs … The Annals of Emergency Medicine Podcast continues to summarise the meatiest articles from each month, featuring a cycle of new co-hosts, as well: Apple Podcasts Google Podcasts Soundcloud Naturally, there are continuing Journal Club features, covering the (..)

Resuscitation 96

Resuscitation Emergency Department Shock Wellness 96

Don't Forget the Bubbles

AUGUST 23, 2023

In most Emergency Departments, staff are allotted little of that scarce resource, time, to begin processing what has just occurred. Definitive emotional support is critical to our emotional and psychological well-being. The Pause Jonathon Bartels worked as an Emergency Nurse in America in 2009. & Liska, H. 23 (2), pp.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

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 82

Fractures Ultrasounds Emergency Department CDC 82

Taming the SRU

DECEMBER 11, 2023

1,2] Patients at risk for suicide often interact with emergency medical care. Suicide-related behavior (SRB) accounts for 1% of all Emergency Department (ED) visits; additionally, greater than 8% of patients visiting emergency departments are likely experiencing suicidal ideation at the time of the encounter.[3-5]

EMS 96

EMS Psychiatric Emergency Department Poisoning 96

AENJ: Current Issue

SEPTEMBER 30, 2023

Managing agitation in pregnancy is a challenging dilemma due to the fear of adverse maternal and neonatal outcomes as well as the legal risk involved. Should medication be necessary, first-generation antipsychotics, second-generation antipsychotics, antihistamines, or benzodiazepines may be considered.

Psychiatric 52

Psychiatric Emergency Department Outcomes Wellness 52

Don't Forget the Bubbles

NOVEMBER 8, 2023

7-year-old Tilly is brought to your emergency department at 11 p.m. Abdominal pain in children is common, accounting for over 1 in 20 attendances to paediatric emergency departments [1]. Tilly is normally fit and well, with no significant past medical history. by her father. She is obviously uncomfortable.

Emergency Department 105

Emergency Department Ultrasounds Pediatrics Best Practices 105

Dr. Smith's ECG Blog

OCTOBER 18, 2023

If you were working in a busy emergency department, 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 emergency department. Am J Emerg Med.

EKG/ECG 122

EKG/ECG Documentation/Coding Emergency Department Outcomes 122

Emergency Medicine Journal

JULY 22, 2024

Introduction Episodes of physical and verbal violence, as well as psychological humiliation, are experienced daily by ED staff. 1 These incidents are increasing exponentially and can cause workplace disaffection contributing to severe burnout of ED healthcare personnel.

Emergency Department 52

Emergency Department Hospitals Wellness 52

EMDocs

SEPTEMBER 28, 2024

It was ruled out as well with good specificity, with a bubble time < 40 seconds. Ann Emerg Med. Source Full-dose challenge of moderate, severe, and unknown beta-lactam allergies in the emergency department. Acad Emerg Med. 2024 Aug;84(2):182-194. doi: 10.1016/j.annemergmed.2024.02.005. 2024.02.005.

Ultrasounds 87

Ultrasounds Pediatrics Emergency Department Wellness 87

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