Taming the SRU

JUNE 11, 2023

End-tidal carbon dioxide measured at emergency department triage outperforms standard triage vital signs in predicting in-hospital mortality and intensive care unit admission. It’s reflection of underlying metabolism, circulation and ventilation may serve well to identify patients with early dysfunction of physiologic functions.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Operative management is necessary for signs of peritonitis, evidence of perforation, extensive bowel involvement >40cm, or after failed medical management. If using laxatives, osmotic and stimulant laxatives are first line (polyethylene glycol and senna).

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

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

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 105

Psychiatric Operations Hospitals Wellness 105

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

Don't Forget the Bubbles

JANUARY 31, 2024

As a Trauma Unit within the Thames Valley Trauma Network, Wexham Park Hospital hosts trainees from across the spectrum of acute specialties. Two really important patient groups were excluded – those who were admitted to hospital and families who were not fluent in English. How sick the child was did not appear to play a role.

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

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 97

Operations Hospitals Best Practices Wellness 97

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

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 97

Hospitals Patient Safety Operations Wellness 97

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

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 95

Operations Radiology Radiology Fluid Resuscitation 95

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 96

Hospice Operations Hospitals Sepsis 96

ALiEM

OCTOBER 30, 2024

The Wounds Common among patients who use xylazine, the necrotic and exudative wounds are still not fully understood [5-8], but are likely due in part to direct cytotoxic effects of the drug and its impurities, as well as possible nutritional deficiencies common in those with dependence. J Am Psychiatr Nurses Assoc. 2023;29(6):470-476.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

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

EMDocs

DECEMBER 6, 2024

5 Orogastric lavage may also be considered for GI decontamination but likely to be limited by location, size of tablets, and operator familiarity. Iron Ingestion: an Evidence-Based Consensus Guideline for Out-of-Hospital Management. 9 Typical dose: Polyethylene glycol (Go-Lytely ) 25 mL/kg/hr in small children and 1.5-2 Manoguerra, A.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

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 98

Hospitals Research Patient Safety Wellness 98

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

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

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

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 98

EMS Dehydration Operations Hospitals 98

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 76

Operations Wellness Academics Ultrasounds 76

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 98

Ultrasounds Emergency Department Wellness Operations 98

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

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

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

Sensible Medicine

SEPTEMBER 26, 2024

Employers will not hesitate to hire an applicant they discover has been hospitalized for 2 weeks with community acquired pneumonia or after a suicide attempt. Doctors need to be upfront about issues with their doctors and some well-chosen friends and colleagues. Maybe this is not how the world should be, but it is how the world is.

Psychiatric 97

Psychiatric Research Operations Hospitals 97

EMDocs

AUGUST 10, 2023

Study design: Multicenter open label randomized control trial Enrolled patients from 41 tertiary care hospitals in China Assessing for statistically significant difference in modified Rankin score at 90 days PICO: Population: 206 patients were enrolled with 107 in the intervention group and 99 in the control. N Engl J Med.

Stroke 95

Stroke Outcomes Operations Hospitals 95

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 Documentation/Coding Outcomes 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 119

Academics Operations Hospitals Wellness 119

RebelEM

FEBRUARY 1, 2024

But, if a thrombolytic agent is to be given, tenecteplase would be a reasonable alternative to alteplase with similar efficacy, safety profile, and improved operational logistics. mg/kg, max 25mg) vs. intravenous alteplase (0.09 mg/kg followed by 0.81 vs Alteplase 34.8% Unadjusted risk difference 2.1% [ 95% CI -2.6 mg/kg followed by 0.81

Stroke 135

Stroke Blood Transfusions Outcomes EMS 135

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

American Medical Compliance

AUGUST 7, 2024

Moreover, compliance with HIPAA helps healthcare providers avoid substantial fines and legal penalties associated with data breaches, thereby maintaining compliance with federal standards and ensuring the smooth operation of their practices. It protects the health and well-being of staff.

Hazardous Materials 105

Hazardous Materials Documentation/Coding Legal Issues Infectious Diseases 105

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