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. If the patient can be stabilized to some degree, interventional radiology can be very helpful. As I continue to preach, going anywhere but the OR is dangerous for the patient.

Fractures 147

Fractures Head Injuries Radiology Radiology 147

EMDocs

OCTOBER 30, 2023

1 The shortage in supply posed difficulties for hospitals that significantly depend on GE Healthcare as their supplier, which encompassed approximately 50% of hospitals in the United States (US). Preparation 9 Hospitals had to prepare for the impending contrast shortage as soon as potential shortage news occurred. 11 Table 1.

Radiology 92

Radiology Radiology Emergency Department Hospitals 92

The Trauma Pro

MAY 3, 2024

Various hospital outcomes were tabulated, including hospital charges, mortality, and discharge location. If there is concern that there could be ongoing bleeding, PPP can be followed by a trip to the interventional radiology suite. Bottom line: This is the largest comparison of AE and PPP to date. This is a common practice.

Fractures 113

Fractures Radiology Radiology Documentation/Coding 113

The Trauma Pro

DECEMBER 12, 2023

This necessitates an inter-hospital transfer that is subject to scrutiny by the trauma performance improvement program of both trauma centers. The work-up from the referring hospital can be re-evaluated. In some hospitals, orthopedics may choose to place a traction pin to provide initial fracture management.

Emergency Department 124

Emergency Department Operations Hospitals Radiology 124

The Skeptics' Guide to EM

OCTOBER 21, 2023

Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Implementation of a Clinical Management Tool for Spinal Epidural Abscess Early Diagnosis. AEM October 2023.

Emergency Department 128

Emergency Department Radiology Radiology Hospitals 128

EM Literature of Note

OCTOBER 9, 2024

and GPT-4T – is asked: Should this patient be admitted to the hospital? Does this patient require radiologic investigations? Effectively, what ought to have been asked of the LLMs – and the clinician reviewers – was “ did this patient get admitted to the hospital?” Specifically, the LLM – here GPT-3.5T

Radiology 86

Radiology Radiology Emergency Department Documentation/Coding 86

ACEP Now

JANUARY 4, 2025

1 Just one year prior, Dr. Clarke had begun an emergency medicine residency at what was then known as LA CountyUSC Hospital, Los Angeles. Firsthand Account An ambulance bay at the LA County-USC Hospital in 1978. Dr. Clarke was then hired as assistant director in the emergency department (ED) at Pomona Valley Hospital, Pomona, Calif.

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

EMDocs

MAY 24, 2023

A lawsuit is filed against the emergency physician, radiologists, PCP, and hospital. Plaintiff : You (the hospital) had no system in place regarding non-congruent over-reads by “nighthawk” radiologists. Give the patient a copy of the radiology report and provide follow-up information in writing. Mueller DK.

Radiology 82

Radiology Radiology EKG/ECG Patient Safety 82

The Trauma Pro

APRIL 30, 2024

Angioembolization requires the presence of a special interventional radiology team and a reasonably stable patient. They performed a systematic search of the literature, analyzing the impact of each procedure on in-hospital mortality. The use of both is becoming more widespread, and each has its pros and cons.

Radiology 113

Radiology Radiology Research Fractures 113

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 3, 4 It is the most common nosocomial infection in patients on mechanical ventilation, and one of the leading causes of nosocomial infection among all patients in the ICU. 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 111

CDC Radiology Radiology Head Injuries 111

Sensible Medicine

FEBRUARY 27, 2025

” The Circulation authors also noted this trend, writing, “In the absence of insurance coverage, some hospitals and medical centers have markedly lowered their charges for CAC scans to the $50 to $100 range.”

Radiology 68

Radiology Radiology EKG/ECG Hospitals 68

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 Emergency Department 113

Sensible Medicine

APRIL 12, 2024

Most of my undergraduate medical education took place at New York Hospital, where a medical error occasioned the first calls for duty hour reform. I was responsible for staying at the bedside of (or at least in the hospital with) my patients until they were stable. PR was admitted to my service at a hospital where I briefly attended.

Radiology 83

Radiology Radiology Hospitals Documentation/Coding 83

Emergency Medicine Ireland

JUNE 14, 2021

There is an image of this in the show notes but to run through it verbally, remembering that these are all meant to be performed pre hospital. this is likely to remove 80% of decontamination * early toxidrome recognition eg if its organophopshates * early antidotes * extensive decontamination * transport to hospital.

Radiology 52

Radiology Radiology Hospitals Wellness 52

EMDocs

DECEMBER 6, 2024

Radiology in the management of acute iron poisoning. Iron Ingestion: an Evidence-Based Consensus Guideline for Out-of-Hospital Management. Iron Poisoning: A Literature-Based Review of Epidemiology, Diagnosis, and Management. Pediatric Emergency Care, 27 (10), 978-985. doi: 10.1097/PEC.0b013e3182302604. 0b013e3182302604. Hosking CS.

Poisoning 94

Poisoning Fluid Resuscitation Seizures Resuscitation 94

Sensible Medicine

NOVEMBER 30, 2023

At 50% of GDP on health care, we will give everyone a weekly pass to get unlimited, unnecessary radiologic imaging, and if two doctors on Twitter think you should get a solid organ transplant, insurers have to pay. They say that when Rome fell half the days in the capital were holidays.

Research 145

Research Radiology Radiology Administration 145

RebelEM

APRIL 17, 2023

33 studies selected for full review Of those 33 studies, 17 of those met criteria for inclusion Of the 18 studies, 1 was an RCT, 14 were prospective cohort studies, and 3 were retrospective cohort studies Total of 812 patients of whom 541 had PTA from 17 studies.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

Don't Forget the Bubbles

FEBRUARY 5, 2025

All hospitals will have different makeups of trauma teams and possibly different levels of activation) Do I need any additional expertise outside of who would typically be in the trauma team? E.g. burns, neurosurgery, interventional radiology. Clinical Radiology: Major paediatric trauma radiology guidance.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

RebelEM

MAY 25, 2023

Lancet 2010 [10] >20,000 adult trauma patients with SBP <90mmHg Patients randomized to TXA 1g over 10 min + 1g IV over 8hrs vs Placebo given within 8hrs of injury In-hospital mortality by 28d reduced (14.5% NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

ACEP Now

DECEMBER 7, 2024

In addition to the reduced risk for major bleeding, use of mechanical thrombectomy techniques has been shown to decrease hospital costs by reducing the need for post-procedural critical care following intervention.

Ultrasounds 52

Ultrasounds Radiology Radiology EKG/ECG 52

The Skeptics' Guide to EM

FEBRUARY 3, 2024

March 2023 Date: January 30, 2024 Guest Skeptic: Dr. Alexandra (Ali) Espinel is an Associate professor of pediatrics and otolaryngology at Children’s National Hospital and George Washington University. She is also the director of the Pediatric Otolaryngology Fellowship at Children’s National Hospital. Laryngoscope. I’m the Problem.

Pediatrics 68

Pediatrics Radiology Radiology Head Injuries 68

ALiEM

FEBRUARY 16, 2024

This patient was admitted to the hospital’s general surgical service and treated with IV broad-spectrum antibiotics and a percutaneous cholecystostomy tube placed by interventional radiology. doi: 10.1148/radiology.148.1.6856839. Hole sign” of the gallbladder. Indian J Gastroenterol 36, 66–67 (2017). 148.1.6856839.

Radiology 64

Radiology Radiology Ultrasounds COPD 64

EMDocs

NOVEMBER 20, 2023

Key Concept: For patients with LGIB on cardiac aspirin for secondary prevention, aspirin should be continued during hospitalization if possible. Resumption of antiplatelet medications and risk of recurrence Recommendation: We recommend discontinuing nonaspirin NSAIDs after hospitalization for diverticular hemorrhage.

Resuscitation 99

Resuscitation Fluid Resuscitation Hospitals Research 99

EMDocs

OCTOBER 10, 2024

Hospital Inpatient : R thigh is indurated and blistered but abdomen is all but ignored. On the 2nd hospital day, she becomes obtunded and is intubated. She only gets worse, and by the 4th hospital day she is unresponsive. High level amputation is considered, but she dies of sepsis and multiorgan failure on hospital day 7.

Documentation/Coding 93

Documentation/Coding Hospitals Sepsis Infectious Diseases 93

Don't Forget the Bubbles

SEPTEMBER 13, 2023

The American College of Radiology guidelines provide further detail on imaging recommendations based on different age and seizure type variants. 2006;67(9):1542-1550 Royal Children’s Hospital Melbourne. What is the evidence for avoiding laboratory testing? Afebrile Seizures. Accessed online at [link] Sawires R, Buttery J, Fahey M.

Seizures 131

Seizures Pediatrics Emergency Department Radiology 131

Sensible Medicine

APRIL 16, 2024

The idea was that the software would examine patients’ medical records – the entire medical record: clinical notes; labs; radiology; and their admission histories – and learn to stratify people in terms of their risk for readmission. The idea was that interventions could then be tested in the high-risk groups.

Radiology 97

Radiology Radiology Stroke Hospitals 97

The Trauma Pro

MAY 10, 2024

It also standardizes comparisons between hospitals that use STAT. Once again, let’s look at over- and undertriage experience in the paper: Undertriage: 9.1% undertriage (Cribari) reduced to 3.3% This may be helpful for future triage-related research. What Does It All Mean?

Blood Transfusions 113

Blood Transfusions Radiology Radiology Documentation/Coding 113

Advanced Medical Reviews

APRIL 17, 2019

percent rise in hospital spending and a growth of 5.4 Protect the nation from the health effects of emerging and pandemic infectious diseases and chemical, biological, radiological and nuclear (CBRN) threats. In addition, higher fee-for-service payment updates are expected to result in faster Medicare spending growth.

Infectious Diseases 66

Infectious Diseases Radiology Radiology Administration 66

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 86

Operations Radiology Radiology Fluid Resuscitation 86

The Skeptics' Guide to EM

JUNE 4, 2017

However, when we assess major trauma that includes chest, abdominal and pelvic trauma, the initial radiologic evaluation is left to the treating physician’s judgement. Many studies (most retrospective) have assessed the use of pan scanning as an initial radiologic evaluation.

Radiology 52

Radiology Radiology CPR Hospitals 52

EMDocs

FEBRUARY 12, 2025

The patient also reported significant pain and had a Hospital Anxiety and Depression Scale (HADS) score indicating severe anxiety and depression. She had previously undergone carbon ion radiotherapy, receiving a cumulative dose of 75 GyE in 20 fractions over two courses from December 2020 to January 2021.

Best Practices 54

Best Practices Documentation/Coding Radiology Radiology 54

SheMD

JUNE 8, 2023

July 1st is almost here and hospitals around the country will welcome in their new interns. The transition from internal medicine or surgery intern to Radiology resident (or any other residency) feels daunting to most. Advocate · As a woman in radiology (and most fields in medicine), you are a minority. You CAN do this!

Radiology 52

Radiology Radiology Outcomes Hospitals 52

Sensible Medicine

SEPTEMBER 27, 2024

We are lucky to work at a time when a review of a discharge summary, lab findings, and radiology results can usually give you a pretty perfect sense of what has happened and what remains necessary. There are cases when it is necessary to pore through old records, but the EMR and diagnostic technology has undermined this claim.

Radiology 118

Radiology Radiology Wellness Hospitals 118

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. Gemma responds, ‘Ask the hospital physio to come and see him?’ Robin’s emergency care plan/RESPECT form and ventilator settings should be reviewed and updated while he is in hospital too. You think fast.

Radiology 98

Radiology Radiology Hospitals Wellness 98

Emergency Medicine Journal

NOVEMBER 28, 2023

Method and Design The ED and radiology departments collaborated to develop an MRI direct to scan (DTS) pathway bypassing radiology discussions. All DTS scans had documented senior review at radiology request to ensure governance. The number of hospital admissions and inter-hospital transfers has reduced by 50%.

Radiology 40

Radiology Radiology Documentation/Coding Hospitals 40

SheMD

APRIL 24, 2023

A colleague met me at the hospital and performed an ultrasound once more to confirm. My husband left the fire station and rushed to the hospital to be with me. I got wheeled through the hospital corridors to radiology, in a patient gown, past residents, past firefighters, past a lot of puzzled faces.

Ultrasounds 83

Ultrasounds Radiology Radiology Emergency Department 83

EMDocs

JUNE 22, 2023

As usual, I was the only physician staffing this rural critical access hospital with limited resources which sits 61 miles away from our state’s only Level 1 trauma center. The radiology tech has his hand on a weak femoral pulse. Did I mention that we only had one unit of blood in the hospital for emergent release?

Resuscitation 98

Resuscitation Ultrasounds Critical Access Radiology 98