The Skeptics' Guide to EM

JULY 30, 2022

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].

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

ACEP Now

FEBRUARY 11, 2024

The ultrasound-guided clavipectoral plane block (CPB) is a newly described technique in the emergency medicine literature. Ultrasound Survey Scan FIGURE 1A: Ultrasound probe should be placed at the clavicle with the probe marker facing cephalad (toward the head). FIGURE 1B: Ultrasound image with labeled relevant anatomy.

Ultrasounds 52

Ultrasounds Fractures Emergency Department Hospitals 52

PulmCCM

FEBRUARY 5, 2024

Depends On the Patient, and Who You Ask The Centers for Disease Control and Prevention defines a fever (for general hospitalized patients) as >38°C. Ultrasound can quickly and more accurately identify significant biliary disease (e.g., You can read the document here. What’s a Fever? °C (100.9°F).

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

The Trauma Pro

OCTOBER 25, 2024

To sum up, both are equally effective in controlling hemorrhage, but the hospital costs for patients undergoing angioembolization are significantly less. This is probably because there is no need to perform repeated operations to insert and remove the preperitoneal packs when angiography is used. DVT, and 1.9%

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

Taming the SRU

OCTOBER 14, 2024

Ocular point-of-care-ultrasound (POCUS) was performed as seen below. Tissue cultures obtained in the operating room grew nonspecific gram positive cocci in chains and pairs and gram positive bacilli. The patient was transitioned to a 10 day course of cefpodoxime and was discharged on hospital day 3 with ENT and ophthalmology follow up.

Ultrasounds 52

Ultrasounds Urgent Care Emergency Department Documentation/Coding 52

The Skeptics' Guide to EM

SEPTEMBER 18, 2021

His practice is in trauma, […] The post SGEM#345: Checking In, Checking Out for Non-Operative Treatment of Appendicitis first appeared on The Skeptics Guide to Emergency Medicine. His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation.

Operations 52

Operations Academics Ultrasounds Hospitals 52

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. ” This means they probably did not.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

Taming the SRU

MAY 13, 2024

Acute stump appendicitis without evidence of perforation or abscess (Figure 1) HOSPITAL Course Acute Care Surgery was consulted from the ED and recommended admission for operative resection of a 3 cm remnant of the appendix. The patient was discharged on hospital day 5. The Ultrasound Journal, 11(1). Clin Case Rep.

Ultrasounds 96

Ultrasounds Emergency Department Wellness Operations 96

EB Medicine

OCTOBER 21, 2024

Eckler, MD discuss the October 2024 Pediatric Emergency Medicine Practice article, Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Departmen t 00:00 Welcome and Introduction 00:13 Free Subscription for Emergency Medicine Residents 01:05 Introduction to Pediatric Emergency Medicine Practice 01:37 Discussion (..)

Pediatrics 59

Pediatrics Elder Abuse Risk Management Emergency Department 59

RebelEM

APRIL 29, 2024

Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure. The current standard of practice has moved away from landmark-based central line placement given the efficacy and safety of ultrasound-based techniques. PMID: 33350794 10 Meilandt C. Resusc Plus. Resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Taming the SRU

APRIL 5, 2023

Given her age, history of nephrolithiasis, and frequent urinary tract infections, a bedside renal ultrasound was performed to assess for hydronephrosis due to concern her generalized weakness may be secondary to an infected stone or obstructive uropathy. She had a foley placed and was admitted to the hospital. Images are seen below.

Ultrasounds 52

Ultrasounds Pediatrics Radiology Radiology 52

Emergency Medicine Journal

MAY 23, 2023

Background Point-of-care (POC) lung ultrasound (LUS) is widely used in the emergency setting and there is an established evidence base across a range of respiratory diseases, including previous viral epidemics. Meta-analysis was carried out using established open-source packages in R. Heterogeneity was determined using the I 2 statistic.

Ultrasounds 52

Ultrasounds Operations Research Hospitals 52

Taming the SRU

NOVEMBER 3, 2023

Ultrasound‐Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. Ultrasound Med. Results 24 patients were eligible during the study period from January 2019 to June 2020 and 20 patients age 33-95 were ultimately enrolled by the 6 operators. 41, 2695–2701 (2022). SD 3.28) and 6.5,

Fractures 97

Fractures Ultrasounds Outcomes Research 97

Don't Forget the Bubbles

JANUARY 1, 2024

The Bubble Wrap Plus is a monthly paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). However, children who had an operation experienced improvements in behaviour, symptoms, and quality of life and had lower blood pressure.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

Emergency Medicine Journal

NOVEMBER 28, 2023

Manipulation performed under ultrasound guidance has the potential to decrease the number of reduction attempts. Methods This multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands.

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

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 Fractures Academics Hospitals 64

ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. Christopher’s Hospital for Children by private equity (PE) firm Paladin Healthcare Capital for 170 million dollars. 14 Dr. Stinson remembers what it was like to work for a PE-owned hospital early in her career. “I

Hospitals 113

Hospitals Radiology Radiology Administration 113

RebelEM

JUNE 19, 2023

Primary Results Patients enrolled from 15 emergency medical services at 21 hospitals across 3 countries over 7 years. Patients were actively screened for DVT (all received lower extremity ultrasound on or around day 7). Resides in a facility for older persons. 1310 patients were recruited and randomized.

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

EB Medicine

NOVEMBER 1, 2021

AnatomyFig 1* Pre-hospital* ED evaluationHistory Physical Exam* ImagingNexus Chest Decision Instrument in Blunt TraumaACR criteria for imagingCT vs xrayUltrasound * TreatmentMedsBindersKinesiotaping – Fig 4Respiratory supportOperative fixation* Special PopulationsElderlyCancer patientsPediatrics* DispositionBattle ScoreRib ScoreFVC

Fractures 52

Fractures Documentation/Coding Operations Emergency Department 52

PulmCCM

APRIL 24, 2024

When a ventilator-dependent patient survives their acute illness but will be dependent on hospital care for weeks or months, they often need a tracheostomy and a percutaneous gastrostomy tube before discharge to a long-term acute care hospital (LTACH). On balance, those are all good things.

Ultrasounds 52

Ultrasounds Hospitals Operations Outcomes 52

ACEP Now

JUNE 21, 2023

14 On the contrary, hospitals may operationally and financially benefit from longer training lengths thus indirectly influencing curricula decisions. Therefore, applicant, funding, and operational factors may influence programs to offer a particular curriculum length.

EMS 114

EMS Academics Telemedicine Operations 114

ACEP Now

MAY 9, 2024

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon. 1 The Rise of the Miami BBL An entire industry has emerged around gluteal AFTs in Miami.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Northwestern EM Blog

MAY 16, 2022

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? were hospitalizations during f/u period; 26.4% were hospitalizations during f/u period; 26.4% How do you proceed?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

The Skeptics' Guide to EM

MARCH 25, 2023

Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Do they need surgery, an ERCP or just analgesia and non-operative care?

Ultrasounds 52

Ultrasounds Emergency Department Dislocations Radiology 52

Don't Forget the Bubbles

MAY 17, 2023

The Bubble Wrap Plus is a monthly paediatric journal club reading list from Anke Raaijmakers, working with Professor Jaan Toelen and his team at the University Hospitals in Leuven. Post-operative pain in children: Comparison of pain scores between parents and children. Can’t get enough of Bubble Wrap? 2023 Apr 24. Eur J Pediatr.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

ACEP Now

JULY 7, 2024

Traumatic aortic injury (TAI) is the second most common cause of mortality in non-penetrating traumatic injury; nearly 80 percent of cases die before hospitalization, and, of those who are hospitalized, mortality remains greater than 45 percent, with untreated mortality increasing one percent per hour. Click to enlarge.)

Operations 59

Operations Hospitals Administration Outcomes 59

The Skeptics' Guide to EM

MAY 11, 2019

His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. first appeared on The Skeptics Guide to Emergency Medicine.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

PulmCCM

APRIL 1, 2024

That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials. ” But less than half of the included studies used ultrasound guidance during central line placements.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

The Skeptics' Guide to EM

DECEMBER 3, 2022

Pediatrics 2022 Guest Skeptic: Dr. Angelica DesPain is an Assistant Professor of Pediatrics and a pediatric emergency medicine physician at the Baylor College of Medicine Children’s Hospital of San Antonio in San Antonio, TX. You order an ultrasound and find that he has acute appendicitis without evidence of perforation or appendicolith.

Pediatrics 40

Pediatrics Operations Ultrasounds Emergency Department 40

Sensible Medicine

MAY 31, 2024

As part of his evaluation, a doppler ultrasound of his carotid arteries is ordered. percent of ER visits and 6% of hospital admissions in the US. Some of these disagreements will be critical: what drug needs to be given, does this person need to go the operating room, does JD need a chest tube?

Operations 57

Operations Wellness Academics Ultrasounds 57

Total Medical ComplianceHIPAA

OCTOBER 9, 2024

Mold buildup, sanitary sewer systems operating correctly, surfaces being free of microorganisms, equipment being cleaned/disinfected/sterilized properly, and supplies being free of damage are just a few other issues to look out for. Clean and disinfect surfaces with an EPA registered hospital level disinfectant.

Hazardous Materials 59

Hazardous Materials Infectious Diseases PPE Shock 59

RebelEM

AUGUST 31, 2023

CVC placement under ultrasound guidance has decreased overall complication rates and there is increased awareness of transfusion reactions, alloimmunization, acute lung injury, circulatory overload, as well as infection. vs 0% ICU length-of-stay: 9 days vs 7 days In-Hospital Mortality: 28.2% Non-inferiority margin was set at 2.5%

Ultrasounds 59

Ultrasounds Outcomes Wellness Research 59

EMDocs

NOVEMBER 18, 2023

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? Liver Transplantation: Operative Techniques and Medical Management. Vital signs: HR 118, BP 103/68, RR 20, T 99.8. Pediatr Radiol.

EMS 69

EMS Ultrasounds Emergency Department Outcomes 69

ACEP Now

MAY 4, 2023

On hospital day 2, he was taken to the operating room for surgical rib fixation. The direct movement of air into the chest wall was improved with the placement of a pigtail catheter and ultimately treated with operative repair. He is also system-wide clinical ultrasound co-chair at MetroHealth Medical Center in Cleveland, Ohio.

EMS 52

EMS Fractures Operations Radiology 52

ACEP Now

JUNE 6, 2023

POCUS: Point-of-care ultrasound for AD is highly specific, but operator-dependent, and lacking in sensitivity—although late–model units can have sensitivity as high as 80-85 percent. Dr. Dajer was emergency department medical director at NY Presbyterian Lower Manhattan Hospital for 13 years.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

SheMD

JULY 23, 2023

Another emergency medicine colleague I knew did a 2-week rotation in South America to teach ultrasound to physicians. One individual I knew wanted to run his own clinic or hospital. Therefore, he worked with the primary care innovation department and learned hospital administration and clinical operations during his residency.

Research 98

Research Academics Hospitals Administration 98

Taming the SRU

AUGUST 4, 2024

The largest retrospective cohort study to date (Beyde et al.) shows that most will improve with empiric antibiotics.

Dislocations 84

Dislocations Emergency Department Documentation/Coding Burns 84