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EM Journal Update: Prehospital Narrow Pulse Pressure Predicts Need for Resuscitative Thoracotomy and Emergent Intervention After Trauma

Core EM

A narrow pulse pressure has been shown to predict the need for hemorrhage control in the ED setting but has not been assessed as a predictor in the prehospital setting. A narrow pulse pressure occurs due to compensatory increased systemic vascular resistance in the setting of decreased cardiac output.

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Threading the Needle: Bougie-First Intubation

REBEL EM

Included patients from out-of-hospital, emergency department, intensive care unit, and operating-room intubations. Intubation performed in all settings (out-of-hospital, emergency department, ICU, and operating room). Randomized controlled trials or comparative non-randomized observational studies.

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Episode 35: When to operate in trauma with Dennis Kim

Critical Care Scenarios

Dennis Kim ( @traumaicurounds ), associate professor of Clinical Surgery at UCLA and medical director of the Harbor-UCLA Medical Center SICU, as well as host of the Trauma ICU Rounds podcast. Traction splinting is usually not done in the ED. Instead of giving TXA as the CRASH dose of 1 g up front plus a 1 g drip, give 2 g upfront.

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Impact of Emergency Department Crowding on Lung Protective Ventilation

REBEL EM

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. The typical nursing to patient ratio is 1:3 with a shared respiratory therapist for the entire ED.

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Data Cafe Insights: 2023 ESO Trauma Index Overview

ESO

of patients with open long bone fractures receive antibiotics within the critical first 60 minutes of ED arrival. Surgical Repair of Hip Fractures: Demonstrating effective care prioritization, 94% of older adults with hip fractures were moved to the operating room within 24 hours.

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EM@3AM: Retroperitoneal Hematoma

EMDocs

A 70-year-old female with a past medical history of hypertension, coronary artery disease s/p 2x drug eluting stent placement one month ago, atrial fibrillation on apixaban presents to the ED with weakness and lightheadedness. F, RR 16, SpO2 97% on room air. Vital signs include BP 90/48, HR 122, T 98.3

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Case Report: EMS Says Flail Chest, But Is It?

ACEP Now

A 58-year-old male with a history of alcohol abuse presented to the emergency department (ED) as a category 2 trauma for a fall with a reported flail chest. On hospital day 2, he was taken to the operating room for surgical rib fixation. Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). Click to enlarge.)

EMS 52