Taming the SRU

MARCH 12, 2024

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. ED visits per 1000 adults with diabetes based on 2018 data resulting in over 500,000 annual hospital days. This amounts to annual hospital costs of $5.1 as well as patients less than 18 years old were excluded from analysis.

Operations 96

Operations Hospitals Best Practices Wellness 96

The Trauma Pro

APRIL 26, 2024

In the last post in the series, I’ll discuss a paper in press that compares the efficacy and hospital charges of the two techniques. Unfortunately, it’s generally not feasible to operatively fix the pelvis acutely, and external fixation has limited impact on ongoing hemorrhage.

Fractures 147

Fractures Head Injuries Radiology Radiology 147

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.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

American Medical Compliance

MARCH 18, 2024

Although anyone working at a hospital can be a victim of violence, nurses and aides who have the most direct contact with patients are especially vulnerable. To become certified, please visit us at: American Medical Compliance (AMC). Reach out for other courses by visiting the AMC Course Library. Who is at Risk for Workplace Violence?

Psychiatric 91

Psychiatric Operations Hospitals Wellness 91

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. The patient is recommended to undergo admission to hospital for serial observation and intravenous antibiotics.

Operations 52

Operations Academics Ultrasounds Hospitals 52

Don't Forget the Bubbles

JUNE 26, 2023

Whilst waiting for an operation, they need to be managed medically. Too much pulmonary blood flow and we will see well-oxygenated blood ( SpO2 >85% ) but insufficient systemic blood flow (pallor/mottling, cool peripheries, delayed capillary refill time, weak pulses, hypotension, narrow pulse pressure) and hypoxia (lactic acidosis).

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

The Trauma Pro

OCTOBER 4, 2024

And unfortunately, I’m not able to guess the numbers well enough to do the power calculation for this study. This was reduced based on our experience of no delayed complications and guidance from our sister pediatric trauma center at Children’s Hospital in Minneapolis. If not, then we still don’t know the answer.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

The Trauma Pro

MARCH 5, 2024

Here are some tips: Do not rely on the medical record and previous operative note. If the surgery occurred at an outside hospital and was then transferred, you must call the initial surgeon to have this discussion before going to the OR! How can this be accomplished? Don’t believe it.

Leadership 113

Leadership Operations Hospitals Wellness 113

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Taming the SRU

MARCH 11, 2024

Reports of a pre-hospital deformity, “popping” sensation, or reduction attempts should raise suspicion for a spontaneously reduced knee dislocation. It is also important for the emergency physician to ask about previous surgeries on the affected knee, as well as anticoagulation status. An abnormal ABI (<0.9)

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

RebelEM

JANUARY 25, 2024

Point-of-care ultrasound (PoCUS) is inherently operator-dependent, which may have led to inconsistencies in the quality and findings of the ultrasound exams across different operators. CHF, in particular, lends itself well to diagnosis and treatment with PoCUS, as it readily reveals the presence of B lines. vs. 18.3%).

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

The Trauma Pro

AUGUST 18, 2023

What happens next varies by hospital. Presentation at your transfusion committee is fine, but this data is most suitable for presentation at the trauma operations committee. product ratios are way off) then it should also be discussed at your multidisciplinary trauma PI committee as well.

Administration 100

Administration Operations Hospitals Wellness 100

Greater Sydney Area HEMS

FEBRUARY 20, 2024

The cohort of patients that require this intervention in the pre-hospital setting are likely to be the most critically unwell patients we encounter. The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i]. i] Leibowitz A, Oren-Grinberg A, Matyal R.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

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

RebelEM

APRIL 17, 2023

However, It is unclear how well POCUS performs in ruling in or ruling out the diagnosis of PTA. Question: How well does the US perform in diagnosing PTA compared to CT, needle aspiration, or Incision and Drainage? While operator dependent, the dynamic ability of POCUS augments bedside diagnosis and can assist with drainage.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

Sensible Medicine

OCTOBER 20, 2023

She came to the hospital with three days of weakness, fever, chills, and anorexia. i] My third year of medical school began with a night in the operating room with a man with an aorto-enteric fistula. When smells and sounds, as well as sights, come together, the impact of an entire location can be powerful.

Hospice 81

Hospice Hospitals Operations Sepsis 81

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. The patient was discharged on hospital day 5. BMP : Na 136, K 4.3,

Ultrasounds 97

Ultrasounds Emergency Department Wellness Operations 97

The Trauma Pro

MAY 26, 2023

We developed our first iteration of a solid organ injury practice guideline at Regions Hospital way back in 2002. Possible interventions were none, operation, angioembolization, or blood transfusion. Here’s the final post on my series covering serial hemoglobin testing in the management of solid organ injury.

Blood Transfusions 100

Blood Transfusions Operations Pediatrics Hospitals 100

EMDocs

FEBRUARY 7, 2024

3 Increasing Strikes and Unions Labor actions in healthcare can disrupt normal hospital operations, potentially impacting costs and threatening patient quality of care. One study from the National Bureau of Economic Research on nursing strikes in New York State from 1984 to 2004 found that hospital mortality increased by 19.4%

Hospitals 77

Hospitals Research Patient Safety Wellness 77

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. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

EMDocs

DECEMBER 14, 2023

A lawsuit is filed against the hospital (including the ED physician) the surgeon, his surgical group, the hospital ’ s trauma service director, and the hospital ’ s chief medical officer. Takeaways : Be certain that your emergency call schedule responsibilities are clearly defined in hospital policy.

Hospitals 73

Hospitals Patient Safety Operations Wellness 73

Don't Forget the Bubbles

JUNE 19, 2024

Well-designed multicentre large studies in children were warranted; cue Leonard et al. Children in the validation cohort were admitted to the intensive care unit or operating room less frequently than those in the derivation cohort. This may limit the generalisability of the results in regional/community hospital settings.

CPR 124

CPR Research Outcomes Documentation/Coding 124

Sensible Medicine

SEPTEMBER 1, 2024

In practice, whether it be in emergency room bays or patient hospital rooms or operating suites, competent physicians know what to do next—whether that is conversation, examination, technical intervention, or prescription. The demands of the work are exacting and the work done well is the professional task.

Academics 118

Academics Operations Hospitals Wellness 118

ACEP Now

SEPTEMBER 5, 2024

With elimination of CME funding in many of our hospitals and groups, it is crucial to continue to add value and communicate that value to residents before graduation. While some issues are handled locally, many issues cannot be solved in our emergency department or hospital. More members translate to more resources.

Leadership 98

Leadership PPE EMS Wellness 98

Don't Forget the Bubbles

MAY 22, 2023

Robin is an LTV patient and will likely need some extra planning should he need to be admitted to hospital. 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. You go to see Robin.

Radiology 98

Radiology Radiology Hospitals Wellness 98

Medagadget

AUGUST 4, 2023

Some of the people poised to gain most from this revolution in miniaturization live in low-resource areas, with no easy access to hospitals and clinics. “Most microfluidic devices need more than just capillary forces to operate,” said Ashutosh Chilkoti, another researcher involved in the study.

Point-of-Care Testing 75

Point-of-Care Testing Research Operations Hospitals 75

Sensible Medicine

MAY 31, 2024

Second guessing, also called post-call quarterbacking, is alive and well in medicine and, when done thoughtfully, can be a great way to teach and learn. percent of ER visits and 6% of hospital admissions in the US. ” When things run well, the person with the power has it for a reason. The patient did well.

Operations 66

Operations Wellness Academics Ultrasounds 66

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. As all radiologists are ostensible experts, this reads more like an endorsement of POCUS in the ICU for intensivists well-trained and experienced in the technique.

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

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

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. However, patients in the 1:1 group had the lowest 24-hour mortality ( 14% vs 18% vs 22% vs 24% ; p = 0.01), and in-hospital mortality ( 32% vs 36% vs 40% vs 44% ; p = 0.01). These procedures require an experienced operator. You are not sure.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Operations 67

Operations Radiology Radiology Fluid Resuscitation 67

ACEP Now

MARCH 13, 2024

Consequences of this are well documented and include delayed treatment, exposure to error, increased length of stay, and increased mortality. 1 Hospital boarding is the main driver of ED crowding, with patients nearly always awaiting transfer to inpatient beds and now more commonly, to other hospitals.

Ethical Issues 52

Ethical Issues Emergency Department Operations Hospitals 52

EMDocs

MAY 25, 2024

recent hospitalization, residence in a long-term care facility, HIV infection, previous antibiotic use, hemodialysis), then vancomycin , linezolid , or daptomycin should be added. If patients have risk factors for methicillin-resistant Staphylococcus aureus infection (e.g.,

EMS 80

EMS Dehydration Operations Hospitals 80

RebelEM

AUGUST 22, 2024

1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Patients whose last known well (LKW) time was within 24 hours of presentation. Paper: Lema GMC, De Leacy R, Fara MG, et al.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Sensible Medicine

MARCH 14, 2024

I’ve heard arguments that frame this discussion in terms of trainee wellness, physician burnout, social contract, and patient outcomes. In short, it’s a mistake to picture medical students on their wellness days off just “kicking their feet up.” The result?

Hospitals 85

Hospitals Wellness Academics Fractures 85

RebelEM

JUNE 19, 2023

Primary Results Patients enrolled from 15 emergency medical services at 21 hospitals across 3 countries over 7 years. Demographics were well balanced in the two groups. The study is relatively small (CRASH2 enrolled > 20,000 patients); just 1300 patients from 21 hospitals over 7 years. Protocol violations occurred in 32.7%

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

RebelEM

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability.

Outcomes 81

Outcomes Hospitals Operations Shock 81