The Skeptics' Guide to EM

OCTOBER 1, 2022

Disparities in the emergency department management of pediatric migraine by race, ethnicity, and language preference. Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. AEM September 2022. AEM September 2022.

Emergency Department 130

Emergency Department ALS ED OR 130

The Skeptics' Guide to EM

SEPTEMBER 14, 2024

Full dose challenge of moderate, severe and unknown beta-lactam allergies in the emergency department. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: It’s another day, another dollar in the emergency department (ED). AEM August 2024.

ICU 143

ICU Emergency Department ALS ED 143

ALiEM

JANUARY 22, 2024

A 40-year-old male, tailor by occupation, was brought to the Emergency Department with complaints of high-grade fever for the past 11 days. Fever was documented to be 102°F and was not associated with any chills or rigors.

Emergency Department 161

Emergency Department OR 161

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

JULY 7, 2023

Last month’s article focused on ACEP’s efforts and resources to support EDs and patients with psychiatric emergencies. Emergency departments (EDs) focus on rapid initiation of medical treatment. Mental health evaluation teams can rely on documentation and interviews to understand a patient’s initial agitation level.

Emergency Department 52

Emergency Department ED Naloxone ALS 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. 45:446-458. Taira B, et al.

Emergency Department 104

Emergency Department ALS E-9-1-1 ED 104

Pulsara

APRIL 2, 2024

Welcoming a New Health System Carolina Pines Regional Medical Center is the first in South Carolina to implement Pulsara, greatly improving collaboration between EMS partners and the emergency department, ultimately leading to better patient care and outcomes! Read the full story here.

Emergency Department 105

Emergency Department EMS 105

ACEP Now

NOVEMBER 14, 2023

The emergency department (ED) at UVA was rebuilt in 2019 and the department had not fully optimized its operations when COVID-19 hit. They also developed standard work documents for each role. The post Re-Engineering Flow in an Academic Emergency Department appeared first on ACEP Now.

Emergency Department 52

Emergency Department Operating Room ED 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. The effect of emergency department crowding on lung-protective ventilation utilization for critically ill patients. Unfortunately, its not clear whether the documentation came from RTs or ED providers.

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

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. Too much weight was given to the EKG, CXR, and labs.

Emergency Department 97

Emergency Department ED Coronary ALS 97

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. Academic Emergency Medicine 22.2

Emergency Department 52

Emergency Department ED ALS Critical Care 52

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. ” (See reference #1 below.)

ED 104

ED ALS Emergency Department OR 104

EM Literature of Note

OCTOBER 9, 2024

This exploration of LLMs in the emergency department is a bit unique in its conceptualization. emergency departments are general cesspools of aggressive empiric antibiotic coverage, driven by CMS regulations – so it may in fact be the LLM displaying astute clinical judgement, here. For what its worth, of course, U.S.

Emergency Department 86

Emergency Department OR ED 86

EMDocs

OCTOBER 3, 2023

Emergency Physician and founder of Orman Physician Coaching Host of the Stimulus Podcast Learn more at roborman.com If you want to hear the coaching session where Brit and Rob deconstructed his shift and came up with this strategy, it’s here. Episode 87: Conquering Mid-Shift Overwhelm Mid-shift in an emergency department is a special beast.

EMR 122

EMR EMS OR Emergency Department 122

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

OCTOBER 28, 2017

Stevens and colleagues updated their review in 2016 and concluded “sucrose is effective for reducing procedural pain” and “no serious side effects or harms have been documented with this intervention”. There are certain patient populations who are at risk for in adequate pain management.

ALS 130

ALS Emergency Department OR ED 130

EMDocs

JUNE 13, 2024

We just don’t document it. If we don’t use printed instructions, document our verbal instructions regarding the most common side effects of the drug(s) being prescribed. Documenting our warnings should be standard care. Giving written instructions about a drug is the pharmacist’s job. Vashi A, Rhodes K. EM, April 2011.

Emergency Department 98

Emergency Department ED EMS OR 98

The Skeptics' Guide to EM

APRIL 24, 2021

Randomized Double-blind Trial Intramuscular Droperidol, Ziprasidone and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department. Randomized Double-blind Trial Intramuscular Droperidol, Ziprasidone and Lorazepam for Acute Undifferentiated Agitation in the Emergency Department. Reference: Martel et al.

Emergency Department 100

Emergency Department ALS Ambulance ED 100

The Skeptics' Guide to EM

JANUARY 16, 2021

In the emergency department (ED), tetracaine drops are applied prior to slit lamp examination and the pain is completely resolved. The first documented use of topical ophthalmologic anesthetics was in 1818. His visual acuity is 20/20 bilaterally and he doesn’t wear corrective lenses or contact lenses.

ALS 130

ALS Emergency Department EMS ED 130

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

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 98

Emergency Medical Services EMS Emergency Department Ambulance 98

The Skeptics' Guide to EM

DECEMBER 18, 2021

Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: At the completion of her 1-month elective in your rural emergency department […] The post SGEM#352: Amendment – Addressing Gender Inequities in Academic Emergency Medicine first appeared on The Skeptics Guide to Emergency Medicine.

Emergency Department 100

Emergency Department ALS ED OR 100

The Skeptics' Guide to EM

JANUARY 23, 2021

Emergency Physician and Advanced Practice Provider Diagnostic Testing and Admission Decisions in Chest Pain and Abdominal Pain. AEM January 2021 Case: A 50-year-old male presents to the Emergency Department (ED) with left lower quadrant abdominal pain. The patient is seen by an advanced practice provider (APP).

ED 130

ED ALS Emergency Department OR 130

The Skeptics' Guide to EM

MARCH 31, 2023

Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: You arrive at 7am to relieve your colleague after a night shift. You find her at the desk, asleep with her face on the keyboard, patient documentation half finished.

ALS 130

ALS Emergency Department 130

ACEP Now

DECEMBER 6, 2024

This case report documents the first known instance of using NTG during an emergency department resuscitation to treat a patient in cardiac arrest due to severe coronary artery vasospasm. Cardiac arrest secondary to myocardial ischemia from coronary vasospasm is well documented.

Coronary 98

Coronary Life Support ALS Emergency Department 98

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. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think?

E-9-1-1 139

E-9-1-1 ACS Emergency Department Coronary 139

EM Literature of Note

OCTOBER 1, 2023

” This brief report in Annals describes a retrospective experiment in which 30 written case summaries lifted from the electronic documentation system were fed to either clinician teams or ChatGPT. “ ChatGPT and Generating a Differential Diagnosis Early in an Emergency Department Presentation “ Tweet

Emergency Department 88

Emergency Department OR 88

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 119

STEMI Emergency Department Coronary OR 119

EMDocs

JUNE 2, 2023

Document what you gave and why, as well as the impact. Best Practices for Evaluation and Treatment of Agitated Children and Adolescents (BETA) in the Emergency Department: Consensus Statement of the American Association for Emergency Psychiatry. Erratum in: West J Emerg Med. 2019 Jul;20(4):688-689. Acad Pediatr.

Emergency Department 93

Emergency Department Emergency Medical Services Overdose ED 93

REBEL EM

JUNE 8, 2023

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. J Med Toxicol. Epub 2019 Jul 3. Intensive Care Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. Written by Bobby Nicholson What do you think of this “STEMI”? Blood glucose was not low at 162 mg/dL.

STEMI 116

STEMI Coronary Emergency Department ACS 116

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.” Indian J Orthop. 2018;52(5):489-500. PMID: 30237606. Leonard JC, Harding M, Cook LJ, et al.

ALS 164

ALS OR ED Emergency Department 164

The Skeptics' Guide to EM

SEPTEMBER 15, 2018

Intervention: Malpractice claims involving trainees (residents) in an emergency department setting over a three-year period from 2009-2012. AEM September 2018 * Population: The Comparative Benchmarking System (CBS) database: a large database of malpractice claims covering more than 400 hospitals and more than 165,000 physicians.

ALS 100

ALS Emergency Department OR 100

The Skeptics' Guide to EM

DECEMBER 5, 2020

Case: A 50-year-old female presents to your community emergency department in the middle of the night with new-onset constant but mild vertigo and nausea. Over the past decade, some emergency physicians have adopted this examination into their own bedside clinical assessment and documentation.

ALS 100

ALS Emergency Department ED OR 100

EMDocs

SEPTEMBER 30, 2024

Inhaled Corticosteroids Rarely Prescribed at Emergency Department Discharge Despite Low Rates of Follow-Up Care. J Emerg Med. Among patients with a primary provider documented in the chart, 30-day outpatient follow-up rate was 21.3% (n = 313). Study: Kligler SK, Vargas-Torres C, Abbott EE, Lin MP. 2023 May;64(5):555-563.

ED 105

ED Emergency Department OR 105

EMDocs

FEBRUARY 13, 2024

You can’t control the influx, but you can control how you approach it, how you document, your own internal triage, team communication. What happens in the emergency department impacts your life outside the emergency department. For example, “All of my shifts that I rated as bad were crazy busy.

Emergency Department 97

Emergency Department OR 97

EMDocs

SEPTEMBER 19, 2023

American College of Cardiology released a new consensus statement, “ Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee “. J Am Coll Cardiol. 2022 Nov 15;80(20):1925-1960.

STEMI 98

STEMI Coronary Emergency Department ICU 98