RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. A comparison between pre-operative ultrasonography and surgical findings. This post will cover some of the most common and important injuries, but is not comprehensive.

Fractures 76

Fractures Dislocations Operations Radiology 76

Pediatric Education

AUGUST 4, 2024

Recurrence can occur and also presentations on the contralateral side after operation have also been noted. What are common neonatal brachial plexus injuries and what are their outcomes? Questions for Further Discussion 1. What is Raynaud’s phenomenon and how is it diagnosed?

Pediatrics 52

Pediatrics Radiology Radiology Operations 52

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. Reference: Sierink et al.

Radiology 52

Radiology Radiology CPR Hospitals 52

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. Radiology Business. Heartland-Charleston of Hanahan SC LLC et al. Stempniak M.

Hospitals 69

Hospitals Radiology Radiology Administration 69

EMDocs

JUNE 3, 2023

4 This is the framework the ED resuscitationist should be operating under, as hemodynamically unstable pelvic trauma patients require a different approach compared to stable patients who will undergo CT, routine pelvic fixation, and definitive surgical repair. Note placement over the greater trochanters.

Fractures 54

Fractures Resuscitation Operations EMS 54

ACEP Now

MARCH 14, 2024

18 The finger is inserted through the stoma alongside the endotracheal tube and, while 90 percent success rate has been reported with this method in controlling bleeding, the pressure must be maintained until the patient is transferred to the operating room. Operative technique for trachea-innominate artery fistula repair. J Vasc Surg.

Operations 52

Operations Pediatrics Radiology Radiology 52

EMDocs

NOVEMBER 16, 2024

4 Pain is the most common reason for presentation in the early post operative period. 5 Highest risk of dislocation early in the post operative course due to laxity of the soft tissue after surgery. 6 Hip flexion or adduction in the early post-operative period can cause atraumatic dislocations (typically avoided for 6 weeks post-op).

EMS 75

EMS Dislocations Fractures Operations 75

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EB Medicine

JULY 8, 2019

Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. These patients often require emergent operative intervention. J Gastrointest Surg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

ACEP Now

JULY 7, 2023

Will this be enough for the general surgeon, or will they want an US performed by the radiology department to make their surgical decision? Clinical Question What is the value of radiology-performed US (RUS) compared to BUSED in terms of the surgical decision-making in acute biliary disease? Click to enlarge. Reference: Hilsden, et al.

Ultrasounds 52

Ultrasounds Radiology Radiology Emergency Department 52

RebelEM

SEPTEMBER 11, 2023

Outcomes: Primary: Percent change in management decisions after introducing the Radiology Department RUQ US. A change in clinical course resulting from a discrepancy between POCUS and radiology department imaging only occurred in 2% of patients (not 10%).

Ultrasounds 69

Ultrasounds Radiology Radiology Emergency Department 69

EMDocs

OCTOBER 17, 2023

In patients with suspected ALCD, we suggest a complete assessment of the patients using clinical history, signs, laboratorial inflammation markers, and radiological findings (weak recommendation based on very low-quality evidence, 2D).” “In American College of Radiology ACR Appropriateness Criteria (2023) Left lower quadrant pain.

Radiology 67

Radiology Radiology Operations Best Practices 67

Don't Forget the Bubbles

FEBRUARY 7, 2024

This week, NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) produced a much-anticipated report on how we manage acute testicular torsion in young people. One systematic review of 1283 patients showed that if you got to the operating room within 6 hours, you had a 97% chance of saving the testicle. Bandarkar, A.N.

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

Don't Forget the Bubbles

MARCH 4, 2024

This was a secondary outcome embedded in the Travel Fever study – a multi-centre, retrospective diagnostic accuracy study for imported malaria. Safety and efficacy of a nitrous oxide procedural sedation programme in a paediatric emergency department: a decade of outcomes. Emerg Med J. 2024 Jan 22;41(2):76-82. PMID: 38123983.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

Don't Forget the Bubbles

OCTOBER 28, 2024

As this is being given and definitive treatment is planned (either surgery or interventional radiology), you consider what adjunctive treatments are needed. In adults, TXA has been shown to reduce transfusion requirements and improve outcomes. Rhaenyra continues to receive blood products in a 1:1:1 ratio.

Blood Transfusions 72

Blood Transfusions Hyperthermia / Hypothermia Shock Pediatrics 72

Don't Forget the Bubbles

SEPTEMBER 23, 2024

suprapubic catheters, gastrostomy tubes, haemodialysis or peritoneal dialysis lines – may have been left in situ in the initial post-operative period), and central vascular catheters. Look for scars indicating previous central lines, peritoneal dialysis catheters or operations. If in doubt, ask. CAKUT, catheterization requirement).

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

EMDocs

JUNE 21, 2023

Functional outcomes Severe soft tissue injuries and damage to the bony structures => poor functional outcomes. If thinking TA, share your concern with radiology, which improves sensitivity. Common operator errors Failing to enter joint capsule before injecting STS. Not injecting enough STS into the joint.

Soft Tissue Injuries 68

Soft Tissue Injuries Fractures Dislocations Radiology 68

Don't Forget the Bubbles

AUGUST 10, 2023

Non-operative approaches There is ongoing controversy regarding the best treatment of fingertip amputations, More extensive wounds are treated surgically. Operative approaches (from orthoinfo & the plasticsfella) More extensive wounds (often zone 2 & 3) are treated surgically. They do not improve outcomes.

Fractures 52

Fractures Soft Tissue Injuries Emergency Department Operations 52

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. demonstrating that functional outcome at 3 months did not differ between the CTA and MRI groups (38.5% vs. 38.1%) with a good functional outcome.

Stroke 86

Stroke Radiology Radiology Emergency Department 86

EB Medicine

JANUARY 2, 2019

With opportunities to improve outcomes for both the fetus and the mother, I’m confident that this episode will be worth your time. Nachi: For patient who have a threatened miscarriage in the first trimester, there is a 2-fold increased risk of subsequent maternal and fetal adverse outcomes. Jeff: Up first is the urine pregnancy test.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40