ALiEM

MARCH 11, 2024

In July 2022, a 32-year-old male with a past medical history of HIV (on antiretroviral therapy, CD4 390, viral load undetectable) presented to the emergency department with constitutional symptoms and a rash for 4-5 days. There is limited literature documenting eye involvement and pictographic examples of its presentation.

Emergency Department 141

Emergency Department ALS OR 141

The Skeptics' Guide to EM

MARCH 31, 2023

Date: March 28, 2023 Reference: Fowler et al. Objective assessment of sleep and fatigue risk in emergency medicine physicians. You find her at […] The post SGEM#399: I’m So Tired – Emergency Medicine and Fatigue first appeared on The Skeptics Guide to Emergency Medicine. Date: March 28, 2023 Reference: Fowler et al.

ALS 130

ALS Emergency Department 130

ACEP Now

JUNE 7, 2023

ED leaders worked to develop new physician documentation and coding guidelines that needed to be implemented at the beginning of 2023. The preliminary results of the 2022 Emergency Department Benchmarking Alliance performance measures survey found a significant deterioration in patient processing due to inpatient boarding.

Emergency Department 52

Emergency Department ED EMS Ambulance 52

ACEP Now

MARCH 13, 2024

Emergency departments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. Consequences of this are well documented and include delayed treatment, exposure to error, increased length of stay, and increased mortality. References Morley, Claire, et al.

Emergency Department 52

Emergency Department ED ALS OR 52

REBEL EM

MARCH 27, 2023

Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. Paper: Owyang CG, et al. The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients. REFERENCES: Acute Respiratory Distress Syndrome Network et al.

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

EMDocs

AUGUST 22, 2024

12 How do we address these disparities in the emergency department? 13 Interventions may include: Ascertaining a patient’s preferred language early in the clinical encounter (during registration, for instance), and clearly documenting this preference in a place that is visible to all providers. Lion KC, et al. Pediatrics.

Emergency Department 82

Emergency Department ALS E-9-1-1 ED 82

Pediatric EM Morsels

JULY 5, 2024

We collected data directly from the bedside clinician which enabled us to gather pertinent patient symptoms and physical examination findings that may not be well documented in the medical record, but more accurately identify the child’s injuries.” Pediatr Emerg Care. Baumann F, Ernstberger T, Neumann C, et al. PMID: 27749628.

ALS 161

ALS OR ED Emergency Department 161

The Skeptics' Guide to EM

JANUARY 23, 2021

Westafer serves as the Social Media Editor and research methodology editor for Annals of Emergency Medicine and as an Associate Editor for the NEJM Journal Watch Emergency Medicine. Reference: Pines et al. The American College of Emergency Physicians ( ACEP ) also has a number of documents discussing APPs in the ED.

ED 130

ED ALS Emergency Department OR 130

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. In fact, Kosuge et al. Stein et al. This is a paper worth reading : Marchik et al. Kosuge et al.

E-9-1-1 138

E-9-1-1 ACS Emergency Department Coronary 138

The Skeptics' Guide to EM

APRIL 24, 2021

She is Chair of the Royal College of Emergency Medicine Women in Emergency Medicine group and involved with the RCEM Public Health and Informatics groups. Reference: Martel et al. Randomized Double-blind Trial Intramuscular Droperidol, Ziprasidone and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

The Skeptics' Guide to EM

DECEMBER 18, 2021

Date: December 13th, 2021 Reference: Lee et al. Addressing gender inequities: Creation of a multi-institutional consortium of women physicians in academic emergency medicine. Date: December 13th, 2021 Reference: Lee et al. Women are paid less than men, even after accounting for potential confounders [2, 8-10].

Emergency Department 100

Emergency Department ALS ED OR 100

Critical Care Scenarios

NOVEMBER 15, 2020

A few rapid-fire cases from the emergency department, with Dr. Seth Trueger (@mdaware), emergency physician at Northwestern University and digital media editor for JAMA Network Open. Continue reading "Episode 19: Emergency medicine with Seth Trueger" A few rapid-fire cases from the emergency department, with Dr. .

ICU 100

ICU Life Support Emergency Department ED 100

EMDocs

SEPTEMBER 26, 2024

An unknown EP reviews the report, determines that there is no reason to notify the patient, and documents nothing. It wasn’t, so you weren’t called, nor did the doc need to document anything. This patient’s history was either poorly taken or poorly documented. Baccei SJ et al. Tyler W et al. Volume 80, no.

Emergency Department 75

Emergency Department ED Coronary ALS 75

The Skeptics' Guide to EM

DECEMBER 5, 2020

Date: November 30th, 2020 Reference: Ohle R et al. Can Emergency Physicians Accurately Rule Out a Central Cause of Vertigo Using the HINTS Examination? John’s Riverside Hospital Emergency Medicine Residency in Yonkers, New York. Date: November 30th, 2020 Reference: Ohle R et al. Reference: Ohle R et al.

ALS 100

ALS Emergency Department ED OR 100

REBEL EM

JUNE 8, 2023

Paper: Singer S, et al. Am J Emerg Med. If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist. Clinical Bottom Line: Acute hypotension must be treated emergently in order to decrease morbidity and mortality. 2022 Sep 5.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

EMDocs

JULY 25, 2024

The nurse completes the Columbia-Suicide Severity Rating Scale (C-SSRS) and documents that the patient’s recent thoughts of killing himself and his detailed plan makes him “High Risk” for suicide. There is no documented handoff to the on-coming emergency physician (EP) who assumes care. Ronquillo L et al.

ED 82

ED ALS Emergency Department OR 82

Don't Forget the Bubbles

NOVEMBER 20, 2023

Neck lumps are a common presenting complaint to the paediatric emergency department with many aetiologies, sometimes resulting in a diagnostic conundrum. Document the size, consistency and location in the notes to compare if they represent. References Al-Khateeb T, Al Zoubi F. DOI: 10.1016/j.joms.2006.11.039

ALS 124

ALS Emergency Department OR 124

Dr. Smith's ECG Blog

OCTOBER 18, 2023

If you were working in a busy emergency department, would you like to be interrupted to interpret these ECGs or can these patients safely wait to be seen because of the normal computer interpretation? Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. Am J Emerg Med.

STEMI 120

STEMI Emergency Department Coronary OR 120

ACEP Now

DECEMBER 17, 2024

We deal with difficult and traumatizing situations daily, and nowhere is this more apparent than in the emergency department, where sickness, violence, and death are routine. One of the first documented strikes among house staff officers took place in 1974 at Howard University here in Washington, D.C., died by suicide.

E-9-1-1 105

E-9-1-1 Emergency Department ALS OR 105

EMDocs

JUNE 9, 2023

We’re defining “protocol” here as a written document that provides oversight from the medical director about how to assess and treat patients. Reassessment and Documentation After any type of restraint is instituted, careful assessment, re-assessment, and documentation is required. Was the documentation complete?

Emergency Medical Services 78

Emergency Medical Services EMS Emergency Department Ambulance 78

EMDocs

SEPTEMBER 23, 2023

A 23-year-old man with no significant medical history presents to the emergency department for evaluation of a syncopal episode. Rosh Review Website Link References Antzelevitch C, Brugada P, Borggrefe M, et al. Priori SG, Napolitano C, Gasparini M, et al. Chen Q, Kirsch GE, Zhang D, et al. Circulation.

E-9-1-1 85

E-9-1-1 EMS ALS Defibrillator 85

Don't Forget the Bubbles

JUNE 19, 2024

Well-designed multicentre large studies in children were warranted; cue Leonard et al. PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Lancet Child Adolesc Health. 2024 Jun 3:S2352-4642(24)00104-4.

CPR 124

CPR Operating Room OR Emergency Department 124

EMDocs

DECEMBER 4, 2023

Johnson, MD ( Community EM, Salina Regional Health Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra, MD (Cleveland Clinic Foundation, EM-CCM); Brit Long, MD (@long_brit) Case A 40-year-old woman presents to a rural emergency department (ED) with left leg pain and swelling for the past 5 days.

ALS 71

ALS Emergency Department ED OR 71

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. Commentary on an article by Marc Schnetzke, MD, et al.: “Determination of Elbow Laxity in a Sequential Soft-Tissue Injury Model. Anatomy, Shoulder and Upper Limb, Radial Nerve. 2023 Nov 5. In: StatPearls [Internet].

E-9-1-1 118

E-9-1-1 ACS OR Emergency Department 118

ACEP Now

NOVEMBER 7, 2024

About three percent of emergency department (ED) visits are due to skin and soft tissue infections, but data are lacking on the contribution of chronic wounds to this number. Photographic documentation of the wound is helpful to enhance continuity of care. References Nussbaum SR, Carter MJ, Fife CE, et al.

ED 97

ED OR Emergency Department Ambulance 97

REBEL EM

JULY 3, 2023

Article: Rossi N et al. Impact of intravenous calcium with diltiazem for atrial fibrillation/flutter in the emergency department. Am J Emerg Med. What They Did: Researchers conducted a multicenter, retrospective cohort study in three community hospitals and two freestanding emergency departments.

E-9-1-1 98

E-9-1-1 EMR Emergency Department ED 98

ACEP Now

JUNE 6, 2023

A medical student reports a murmur, not documented by either the emergency physician or the cardiologist. Dr. Dajer was emergency department medical director at NY Presbyterian Lower Manhattan Hospital for 13 years. Dr. Pilcher is a retired emergency physician and ED medical director at EvergreenHealth in Kirkland, WA.

ACS 85

ACS ALS ED OR 85

ACEP Now

JULY 8, 2024

Recently published experiments with LLMs in the emergency department fall into a handful of primary areas of interest. In a similar vein, another study evaluated the ability of an LLM to assess “clinical acuity” in the emergency department. References Jiang LY, Liu XC, Nejatian NP, et al. Am J Emerg Med.

Emergency Department 52

Emergency Department ALS ED OR 52

Don't Forget the Bubbles

JULY 26, 2023

Prioritise listening to the first 30 minutes which given a good overview of aetiology and treatment (53 mins) Basics of cardiac rhythm problems in the ED Palpitations are a common reason for children to present to the emergency department, the majority of these will be benign from a cardiac perspective and instead related to stress or anxiety.

ALS 98

ALS ED OR CPR 98

Don't Forget the Bubbles

MAY 6, 2024

Article 1: Positive urine cultures without pyuria Wang ME, Jones VG, Kane M, et al. of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Reviewed by: Sarah Gentle and Owen Hibberd Article 2: Second attempt success in neonatal intubation Johnson MD, Tingay DG, Perkins EJ et al. Acad Pediatr. 2024;24(1):111-118.

E-9-1-1 75

E-9-1-1 Emergency Department OR ALS 75

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. He had no previously documented medical problems except polysubstance use. Bigger et al. In fact, use of antidyrhythimcs (e.g.,

STEMI 86

STEMI Coronary Heart Attack ACS 86

Don't Forget the Bubbles

OCTOBER 10, 2024

Exploring communication preferences and risk thresholds of clinicians and parents of febrile infants under 90 days presenting to the emergency department: a qualitative study. Wilson K, Umana E, McCleary D, Waterfield T, Woolfall K. Arch Dis Child. 2024 Jul 10:archdischild-2023-326727. doi: 10.1136/archdischild-2023-326727.

ED 75

ED Emergency Department OR ALS 75

REBEL EM

OCTOBER 5, 2023

Paper: Dequin P, Meziani F, Quenot J, et al. While patients received respiratory support, supportive care, and antibiotics at the discretion of the medical team, the specific interventions provided outside the study were not documented, potentially leading to co-intervention bias. Current Events In a recent study by Meduri et al.

Critical Care 94

Critical Care ICU E-9-1-1 ALS 94

ACEP Now

JUNE 14, 2024

1 As fresh challenges of the pandemic and hospital operations changed emergency medicine practice, one of the more challenging areas was the movement of admitted patients out of the first emergency department (ED). emergency departments. Another COVID casualty: The emergency department transfer process.

Emergency Department 52

Emergency Department ED Ambulance OR 52

EMDocs

JUNE 16, 2023

And now we’re here at our destination, the place we know and love, the emergency room to talk about what we should be doing for the growing volume of children with mental health problems boarding in the emergency department. McEnany, Olutosin Ojugbele, Julie R. Doherty, Jennifer L. McLaren, JoAnna K. 10.1542/peds.2020-1174

ED 52

ED Mental Health Services Emergency Department Emergency Medical Services 52

ACEP Now

FEBRUARY 11, 2024

1,2 In the emergency department (ED), the focus of treatment is pain control and immobilization unless there is a clear indication for surgery, such as open fractures, skin tenting, or neurovascular compromise. References Postacchini F, Gumina S, De Santis P, et al. Kihlström C, Möller M, Lönn K, et al. Am J Emerg Med.

E-9-1-1 52

E-9-1-1 ALS ED Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

This was a male in his 50's with a history of hypertension and possible diabetes mellitus who presented to the emergency department with a history of squeezing chest pain, lasting 5 minutes at a time, with several episodes over the past couple of months. Akkerhuis KM, et al. Gottlieb SO, et al. Jernberg T, et al.

Coronary 52

Coronary STEMI ALS Emergency Department 52