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Date: October 28, 2024 Reference: Verma et al. With emergency department (ED) volumes rising, administrators are eager to explore AI-driven solutions to improve patient safety and reduce staff burnout. Reference: Verma et al. Clinical evaluation of a machine learning–based early warning system for patient deterioration.
Reference: Borgundvaag et al. He has been involved in ED-based clinical research examining ways to improve care for patients with alcohol use disorder in the ED for over two decades. Case 1: A patient presents to the ED with nausea, vomiting and some abdominal pain complaining of alcohol withdrawal.
Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. Date: August 30, 2023 Reference: Griffey et al. The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics.
[display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Critical Care Medicine 2017.
fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold
Background: The immediate post intubation period in the ED is a critical time for continued patient stabilization. The reality of ever increasing ED volumes and longer boarding times to the ICU makes it imperative for emergency physicians to learn how to manage these critical patients.
Date: June 12th, 2022 Reference: Finfer et al. He is board certified […] The post SGEM#368: Just A Normal Saline Day in the ICU – The PLUS Study first appeared on The Skeptics Guide to Emergency Medicine. Date: June 12th, 2022 Reference: Finfer et al. Reference: Finfer et al. Early work suggested potential harm from 0.9%
Reference: Knack et al. They were randomized to ceftriaxone 2gm intravenous (IV) in the ambulance or usual cares (fluids and supplementary oxygen) until arrive to the ED. A similar review by Sanders et al 2015 concludes that clinica. The decision aid only outperformed clinical judgement in 10% of papers (or two total trials).
Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Date: April 25, 2024 Guest Skeptic: Missy Carter is a PA working in an ICU in the Tacoma area and an adjunct faculty member with the Tacoma Community College paramedic program.
More than 1/3 of geriatric trauma patients presenting to the ED after a fall return to the ED or die within one year of initial evaluation. 4 Elderly patients, who comprise only 8-12% of total ED major trauma cases, represent a disproportionate 15-30% of trauma mortalities and costs. Perdue &al. Caterino &al.
Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the Emergency Department (ED)? Is phenobarbital safe for the treatment of EtOH withdrawal in the ED? References Rosenson J, Clements C, Simon B, et al. If not, you probably should be. Well not exactly.
Date: September 12, 2024 Reference: Anderson et al. Case: It’s another day, another dollar in the emergency department (ED). You wonder if she could have an allergy challenge dose of ceftriaxone in the ED. Emergency Physicians frequently encounter ED patients with self-reported penicillin allergies. AEM August 2024.
Background: Patients with decreased level of consciousness due to alcohol, drugs, or medications commonly present to the ED. Paper: Freund Y et al. References: Freund Y et al. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits.
REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? Click here for Direct Download of the Podcast Paper: Knack SKS et al. PMID: Clinical Question: Does a single dose of ketamine or etomidate used for rapid sequence intubation (RSI) of critically adults in the ED impact the SOFA score within 3 days of hospitalization?
Reference: Cashen K, Reeder RW, Ahmed T, et al. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Reference: Cashen K, Reeder RW, Ahmed T, et al. Background: We often manage patients in cardiac arrest in the ED or the intensive care unit (ICU).
100% seems too good to be true Morello et al., European Journal of Internal Medicine , [link] You can listen to my 27-minute rant on Youtube here: [link] This multinational trial looked at a three-pronged diagnostic protocol in the ED for adults with suspected acute aortic syndromes. Did they pick a heap of PEs?
Reference: Peters MJ, et al. Dr. Anireddy Reddy Case: A 3-year-old girl presents to the emergency department (ED) with fever and respiratory distress. Your ED team quickly intubates her and places her on a ventilator. Reference: Peters MJ, et al. Her oxygen saturation is 78% on room air.
Date: September 28th, 2021 Reference: Zampieri et al. Date: September 28th, 2021 Reference: Zampieri et al. Some bench work, observational studies, and now two large, unblinded, cluster-randomized single-center trials ( SMART and SALT-ED ) suggested a benefit to using balanced crystalloids (i.e. Reference: Zampieri et al.
Date: April 20, 2023 Reference: Franklin D, et al. Date: April 20, 2023 Reference: Franklin D, et al. Case: A 14-month-old boy presents to the emergency department (ED) with two days of upper respiratory symptoms and respiratory distress. Reference: Franklin D, et al. He has a cough, fever of 38.5°C,
A recent study by Gaborit et al. The ED clinician should inquire about a relevant history of HIV infection, malignancy, high-dose corticosteroid use, chemotherapy, organ transplant, or use of immunosuppressive drugs for other indications. She reports occasional central chest pain exacerbated by coughing. and specificity of 71.4%).
Date: June 2nd, 2020 Reference: Permpikul et al. Date: June 2nd, 2020 Reference: Permpikul et al. Max is then going to Georgetown to be an attending in both EM and ICU. Case: It’s another day in your emergency department (ED). Reference: Permpikul et al. Respir Crit Care Med 2019. Respir Crit Care Med 2019.
Mild to moderate DKA represents a subgroup of patients that often require admission to the ICU due to hospital policies not allowing insulin infusions outside of this clinical setting. Paper: Griffey RT et al. The SQuID Protocol (Subcutaneous Insulin in /diabetic Ketoacidosis): Impacts on ED Operational Metrics. tests/hr (0.8
Available at: HERE Branch KHR et al. The CT FIRST Trial: Should We Pan-CT After ROSC?, REBEL EM Blog, June 1, 2023. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. Resus 2023.
Takeaway lessons Many decisions in the ED are less about what to do, and more about when to do it. Takeaway lessons * Many decisions in the ED are less about what to do, and more about when to do it. Goals of care starts in the ED, and not with lip service. ICU time and ED time are different. JAMA Intern Med.
EBM Update: Steroids in Severe CAP and CT in Post ROSC OHCA #1: Dequin PF, Meziani F, Quenot JP, et al; CRICS-TriGGERSep Network. Question: In adult patients admitted to the ICU with severe CAP, does hydrocortisone compared to placebo reduce 28-day all-cause mortality? Reyes LF, Garcia E, Ibáñez-Prada ED, et al.
Date: July 16th, 2022 Reference: Lamontagne F et al. Date: July 16th, 2022 Reference: Lamontagne F et al. Case: A 59-year-old woman presents to the emergency department (ED) with fever, tachycardia, and hypotension. She is admitted to the intensive care unit (ICU) for septic shock. Reference: Lamontagne F et al.
However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). While RSI should remain the gold standard in the vast majority of patients in the ED, FI presents an additional technique to mitigate anatomic or physiologic risk. To date, ketamine has been the agent of choice (12).
I was about two months into a family practice internship when I went to visit my uncle whose neighbor happened to be an ED resident, Dr. Clarke said. ED attendings Dr. Gerald Whelan and Dr. Shumary Chow supervising a full arrest in C booththe main trauma roomwith an ED tech administering CPR. Click to enlarge.) Click to enlarge.)
Reference: Schuster et al. 2020 Case: A 74-year-old woman who suffered a fall earlier today presents to the emergency department (ED) and is found to have five rib fractures to her right thorax, but no other injury. His team found grip strength was weakly correlated with frailty in older ED patients [6].
Intravenous insulin infusions typically require treatment in highly monitored settings, such as an intensive care unit (ICU) or step-down unit for safety and due to the frequency and intensity of monitoring. ICU and step-down beds are a limited resource and generate higher hospital charges. ElSayed NA, Aleppo G, Aroda VR, et al.
Date: November 6th, 2019 Reference: Lascarrou et al. Date: November 6th, 2019 Reference: Lascarrou et al. Case: A 59-year-old woman comes is brought into your emergency department (ED) by EMS in cardiac arrest. The patient achieved return of spontaneous circulation (ROSC) on arrival to the ED. Reference: Lascarrou et al.
A 65 y/o Female was admitted to the ICU for septic shock. The combination of prolonged QT and deep T wave inversion throughout the precordium is typical of Takotsubo syndrome, or Stress Cardiomyopathy – which can occur in the context of a physiologically distressed ICU patient, further compromising their hemodynamics. Friedman, M.,
This is critical for the EMS provider, or ED clinician, as identification of Grade I ischemia (aka, HATW’s) addresses the culprit lesion at the earliest opportunity with excellent downstream prognosis for the patient. [2] The following ECG was captured upon arrival at the receiving ED. The ED resulted an 8.7 An ECG is recorded.
A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. We’ll keep it short, while you keep that EM brain sharp. She had a precipitous delivery while the ambulance was pulling in. The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. Electronic address, p. link] j.ajog.2016.03.012
Very rarely are the ED team allowed to stand, in silence, with a purpose. Kapoor et al. 2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. It gives us permission to stop, breathe, recognise the enormity of what has happened, and provide a platform for acknowledgement. 112 (9),pp. 2 (57-68).
PMID: 38592662 Bottom line: Would you be happy if you kid follow-ed your footsteps into emergency medicine? For the most part, central lines can be left to the ICU team during day time hours (and a good percentage of patients will never need one). Cook D, Deane A, Lauzier F, et al. Burton C, Mooney C, Sutton L, et al.
The patient was upgraded to the ICU for closer monitoring. In fact, Kosuge et al. Stein et al. This is a paper worth reading : Marchik et al. Kosuge et al. Witting et al. This does not contradict the conclusions of Kosuge et al. studied ECG findings of PE in 6049 patients, 354 of whom had PE.
Bottom Line Up Top: In patients with infectious processes that are stable for discharge home, there is no role for giving a first dose of antibiotics IV in the ED. PMID: 9114201 Siegel RE et al. BMJ (Clinical research ed.). PMID: 17090560 Castro-Guardiola A et al. PMID: 1664833 Addo-Yobo E, et al. Pneumonia 2017.
Paper: Singer S, et al. This study chose a relevant topic to analyze that could influence acute management in the ED and has a fairly larger sample size of patients to do so. References: Singer S, et al. PMID: 36108346 Cole JB, et al. PMID: 31270748 Maheshwari K, et al. PMID: 29872882 Jones AE, et al.
Article: Liu S, Yao C, Xie J, et al. They consecutively enrolled 1,817 ICU patients from 45 sites across China. Population: Inclusion Criteria: Age 18-75 years old SOFA score 2-13 Admitted to the ICU with a diagnosis of sepsis 3.0, “ Life-threatening organ dysfunction caused by a dysregulated host response to infection.”
2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. Paper: Owyang CG, et al. J Crit Care.
He was intubated on arrival at the ED for mental status and airway protection due to vomiting. His temperature was brought back to normal over time in the ICU. Rituparna et al — as well as Chauhan and Brahma ( Int. There is also large T wave inversion and long QT. Initial vitals included heart rate 109 bpm and BP 145/92 mmHg.
Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). His blood sugar was normal en route to the ED, and his initial rhythm on the cardiac monitor was asystole. Carsten L, et al. Forti A, Brugnaro P, Rauch S, et al.
These medications are a vital tool in the care of ED patients, from simple local analgesia for a laceration repair to regional analgesia for painful procedures. Hemodynamics slowly begin to stabilize, and the patient is transferred to the ICU for further post-cardiac arrest care. doi:10.1007/BF03161199 Olson K, Smollin C, eds.
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