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With emergencydepartment (ED) volumes rising, administrators are eager to explore AI-driven solutions to improve patient safety and reduce staff burnout. By alerting clinicians to potential problems before they become critical, AI-driven systems aim to reduce unplanned ICU transfers and improve survival rates.
Guidelines for Reasonable and Appropriate Care in the EmergencyDepartment (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergencydepartment. He is a Professor of Emergency Medicine and a Clinician Scientist in the Department of Family and Community Medicine at U of T.
A 36-year-old male presents to the emergencydepartment after being found down at home by his spouse. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. Per the mans wife, the patient is a heavy drinker often consuming two to three pints of vodka daily.
Fever in the EmergencyDepartment Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Guest Skeptic: Jesse Spurr works as a Nurse Educator in the EmergencyDepartment at Redcliffe Hospital in Australia. Case: You are working night shift in the emergencydepartment.
The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. She is an Assistant Professor and Director of Research in the Department of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. He is wondering, “Hey doc, do I have to go back to the ICU strapped to an IV pole?”
Historically, it has been used more frequently in the ICU than in EmergencyDepartments, likely due to provider comfort. […] The post Is there a Precedence for Precedex in the ED? It offers a unique profile of sedation without respiratory depression, making it an attractive option in various clinical scenarios.
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. mg/kg 0.01 – 0.1 up to 1.5)
Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the EmergencyDepartment (ED)? Is phenobarbital safe for the treatment of EtOH withdrawal in the ED? The Journal of Emergency Medicine. Open Access Emerg Med. Well not exactly.
Prehospital Emergency Care. 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. When emergencydepartment (ED) staff roll her to remove her clothing her humeral intraosseous (IO) is dislodged.
Full dose challenge of moderate, severe and unknown beta-lactam allergies in the emergencydepartment. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: It’s another day, another dollar in the emergencydepartment (ED). AEM August 2024.
Background: Standard rapid sequence intubation (RSI) in the emergencydepartment involves administration of an induction agent and a neuroblocking agent in quick succession. REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? Click here for Direct Download of the Podcast Paper: Knack SKS et al. Range 5 to 9) Diff -0.2;
Michael Falk is a Pediatric Emergency Medicine attending at Mount Sinai Medical Center and Associate Professor of Emergency Medicine at the Icahn School of Medicine in New York. Case: A 14-month-old boy presents to the emergencydepartment (ED) with two days of upper respiratory symptoms and respiratory distress.
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 emergencydepartment (ED) volumes and lengths of stay. Paper: Owyang CG, et al. J Crit Care. J Crit Care.
Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. 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. Pediatric Crit Care Med.
Anireddy Reddy is a pediatric intensive care attending physician in the Department of Anesthesiology and Critical Care Medicine at Children’s Hospital of Philadelphia. Dr. Anireddy Reddy Case: A 3-year-old girl presents to the emergencydepartment (ED) with fever and respiratory distress.
A few rapid-fire cases from the emergencydepartment, with Dr. Seth Trueger (@mdaware), emergency physician at Northwestern University and digital media editor for JAMA Network Open. Takeaway lessons Many decisions in the ED are less about what to do, and more about when to do it. Emergency staff have limited bandwidth.
. #1: PREOXI RCT – Preoxygenation with Noninvasive Ventilation vs. Non-rebreather Mask Spoon Feed Noninvasive ventilation (NIV) was superior to a standard non-rebreather (NRB) oxygen mask for preoxygenation of critically ill ED or ICU patients requiring intubation, with a NNT of 11 to prevent 1 episode of hypoxemia <85%.
Clarke had begun an emergency medicine residency at what was then known as LA CountyUSC Hospital, Los Angeles. 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 resident Dr. Steve Hui doing a pericardiocentesis on a trauma patient.
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. We don’t want to go backwards!
Max is then going to Georgetown to be an attending in both EM and ICU. Case: It’s another day in your emergencydepartment (ED). The triage nurse places a 61 year-old-man with fever, hypotension, cough into the smallest room in the ED. You scan through the EMR and see the blood pressure is 60/40.
Emergencydepartments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. ED crowding impairs this mission. 2 This article discusses the practical and ethical issues of interhospital transfer of these patients.
Complications of Gluteal AFT The pale, prone patient with multiple surgical drains and a constrictive faja has become a common site in the Jackson Memorial Hospital EmergencyDepartment. Nearly half of all post-AFT patients presenting to our emergencydepartments required admission and six percent required ICU admission.
Case: A 59-year-old woman presents to the emergencydepartment (ED) with fever, tachycardia, and hypotension. She is admitted to the intensive care unit (ICU) for septic shock. The ICU team is considering using Vitamin C therapy for this patient. She is found to have a urinary tract infection.
In most EmergencyDepartments, staff are allotted little of that scarce resource, time, to begin processing what has just occurred. The Pause Jonathon Bartels worked as an Emergency Nurse in America in 2009. After the death of a young person in the EmergencyDepartment, he initiated ‘ The Pause.’ 23 (2), pp.
2020 Case: A 74-year-old woman who suffered a fall earlier today presents to the emergencydepartment (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]. J Trauma Acute Care Surg.
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. Am J Emerg Med. She reports occasional central chest pain exacerbated by coughing. Int J STD AIDS. 2019;30(2):188-193.
Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the EmergencyDepartment (ED). 2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Am J Emerg Med. 2022 Sep 7.
CJEM debate series: #StillTheOne-while more challenging than ever, emergency medicine is still the best career path available for medical students. PMID: 38592662 Bottom line: Would you be happy if you kid follow-ed your footsteps into emergency medicine? As loud as a construction site: Noise levels in the emergencydepartment.
Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the EmergencyDepartment via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. The patient was upgraded to the ICU for closer monitoring. What do you think? ng/mL, BNP 2790, and lactate 3.7.
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. Acad Emerg Med. JAMA Netw Open.
Case: A 59-year-old woman comes is brought into your emergencydepartment (ED) by EMS in cardiac arrest. The patient achieved return of spontaneous circulation (ROSC) on arrival to the ED. She had a witnessed arrest, and CPR was initiated by bystanders.
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. If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergencydepartment pharmacist. Am J Emerg Med.
On ED arrival GCS is 3, there are rapid eye movements to the right but no other apparent seizure activity. Propofol utilized for sedation; patient admitted to ICU for EEG monitoring. Official diagnosis requires EEG, which is not something we can typically obtain in the ED. They administer two doses of 10 mg midazolam IM.
A non-inferiority randomized controlled trial comparing nebulized ketamine to intravenous morphine for older adults in the emergencydepartment with acute musculoskeletal pain. Although I miss performing the procedure, these days I almost always leave the central line until the patient is stabilized and settled into their ICU bed.
This increases applicability or ED care. population at large Enrollment was terminated at an interim analysis due to predefined futility criteria that suggested that there was a 1% chance that carrying the trial to completion would demonstrate a most effect or least effective treatment. Study included children, as well as adults.
1 History and physical examination have been the cornerstone of seizure diagnosis in the emergencydepartment (ED). 2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus).
Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergencydepartment (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Am J Emerg Med. It is unclear how long he was down.
A patient had 3rd degree AV block in the ED. A transvenous pacer was placed in the EmergencyDepartment by the emergency physicians. and the 2021 YouTube Review by ICU Advantage on "Temporary Pacemakers: Modes and Basic Settings".
All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The ODP is caught up leaving theatres and has not yet made it down to ED. They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups.
It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergencydepartment (ED). percent of ED visits resulted in preventable death as result of diagnostic error. Ann Emerg Med. JAMA Intern Med.
A man in his 60s with a history of severe alcohol use disorder and epidural abscess on long-term ciprofloxacin presented to the emergencydepartment after an episode of syncope while standing in line at a grocery store. Written by Sean Trostel MD, peer reviewed by Meyers, Smith, Grauer, etc. He did not have chest pain. As per Drs.
She presented to the emergencydepartment after a couple of days of chest discomfort. The pacing rate was increased without clinical improvement and the patient was transferred to the ICU for closer monitoring/treatment. This patient presented to the ED “after a couple of days of chest discomfort”.
The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. The junior staff member remains silent throughout the debrief and does not attend their shift the following day.
Five-year-old Ginny presents to the EmergencyDepartment with a syncopal episode. You contact ICU, anaesthetics, ENT, and oncology with a plan to attempt more definitive imaging in the prone position (which Ginny tells you is much comfier) What’s the evidence for our emergent management? RadioGraphics.
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