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Encourage your ED to set up an algorithm that you can follow based on your laboratory’s assay. Low-risk patients do not routinely require stress testing in the ED. You (or someone in your department) needs to know which assay your ED has, and use the appropriate values for that assay.
Symptoms started approximately seven hours prior to arrival and progressive, severe pain eventually prompted her visit to the ED. This happened once 10 years ago, requiring reduction in the ED. The patient denied preceding trauma, rubbing her eyes/eye-lids, or any history of thyroid disease. References Kelly, E.W. and Fitch, M.T.
Clinical impact: Rather than arguing with the patient about the likelihood of this phenomenon occurring and whether this is a true allergy, the patient is informed that they do not need to immediately start treatment to receive care in the hospital. Clinical impact: The patient’s DVT ultrasounds were negative.
Case: A 57-year-old Chinese woman presents to the emergency department (ED) with chest pain. Background: Patient experiences of care are associated with health outcomes and may impact perspectives of ED care and the patient recovery process.(1-5) 6-7) We looked at deaf and hard-of-hearing patients in the ED on SGEM#383.
A 10-year-old boy presents to the emergency department (ED) after a high-speed motor vehicle collision. The study enrolled 22,430 children, aged 0–17 years, presenting with blunt trauma across 18 PECARN-affiliated ED in the US. Case Scenario: What would you do? He complains of neck pain and is reluctant to move his head.
We will be using redacted information from different cases where paramedics attempted TCP in the field. Crew notifies the received ED of an incoming post-arrest patient and notes a sinus bradycardia on their monitor, as seen in Figure 2. Pacing was continued in the ED, with identical settings. Several learning points here.
Author information Maureen Nsofor, MD Pediatric Emergency Medicine Fellow Atrium Health’s Carolinas Medical Center | The post ACMT Toxicology Visual Pearl – Apricot Kernels: Eat or pass? The amount of hydrogen cyanide in each kernel varies and ranges from 540 to 2,000 mg/kg [2]. Grinding or chewing the kernel increases toxicity [4].
Background: Non-invasive positive pressure ventilation (NIPPV) is an effective treatment modality for patients with both hypoxemic or hypercapnic respiratory failure and has been shown to decrease the need for intubation [2]. AVAPS: 0.07 P = 0.015 PaCO2 Excretion in 1 st Hour BPAP S/T: 4.75 AVAPS: 10.20 AVAPS: 0.07 AVAPS: 10.20 AVAPS: 0.07
A 26-year-old male with no significant past medical history presented to the ED after slipping on wet pavement and hitting his head on the ground three hours prior. He endorsed a constant, achy 7/10 headache accompanied by nausea and photophobia. He denied vomiting, dizziness, diplopia, loss of consciousness, or seizures.
Clinical Question: Does simultaneously performing the modified valsalva maneuver and administering intravenous adenosine, compared to either treatment alone, have greater success in achieving normal sinus rhythm in patients presenting to the ED with PSVT? This absence of detail leaves the study open to bias.
A total of eleven intensive care units (ten PICUs and one non-maternity NICU) and four emergency departments (EDs) took part in the study. Given the emergency setting, the trial used a research without prior consent model, with delayed consent-to-continue obtained from the childs legal guardian as soon as practical.
Case: A 24-year-old manual labourer presents to the emergency department (ED) after drinking a few too many beers, having a disagreement with another beer drinker and gets knocked down. Background: Fractures of the scaphoid are the most common carpal fractures presenting to the ED. However, the x-rays read as “normal” by radiology.
Highlighted Quality Posts: Procedures Site Article Author Date Label Rebel EM Intra Articular Lidocaine vs Sedation in Shoulder Reductions Nordia Matthews, MD 30 Jan 2023 AIR EM Docs Video Laryngoscopy in the ED Cameron Jones, MD 8 Aug 2022 AIR First 10 EM Lacerations: Does closure technique matter? Please go to the above link.
He arrived to the ED by helicopter at 1507, about three hours after the start of his chest pain while chopping wood around noon. He arrived to the ED by ambulance at 1529, only a half hour after the start of his chest pain around 1500 while eating. Patient 2 , EKG 1: What do you think? The patient had none of these conditions.
Heres another case from Medical Malpractice Insights Learning from Lawsuits , a monthly email newsletter for ED physicians. Facts : A 28-year-old female is seen in the ED of Hospital A for recurrent bouts of severe, intermittent abdominal pain. Doctor shopping at 3 different EDs with the same problem doesnt help.
A 30-year-old female with a past medical history of Crohn’s Disease presented to the ED for evaluation of an acutely bruised right 4th finger. Author information Cassandra Bradby, MD Residency Program Director East Carolina University | The post SAEM Clinical Images Series: Purple Finger appeared first on ALiEM.
In: Fleisher and Ludwig’s Textbook of Pediatric Emergency Medicine, 7th ed, Shaw K, Bachur RG (Eds), Lippincott Williams & Wilkins, Philadelphia 2015. Author information Meraj Fatima, MBBS Resident Emergency Medicine Aga Khan University | The post Trick of Trade: Removal of Entrapped Metal Zipper appeared first on ALiEM.
Here’s another case from Medical Malpractice Insights – Learning from Lawsuits , a monthly email newsletter for ED physicians. Chuck Pilcher, MD, FACEP Editor, Medical Malpractice Insights Editor, Med Mal Insights The challenge of suicide evaluation in the ED “I’ve changed my mind. If you have a story to share click here.
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. Short acting. mg/kg IV followed by 0.05 – 0.4
In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.
A 10-year-old male with no past medical history presents to the Emergency Department (ED) by EMS for evaluation of an injury sustained while playing tackle football. The patient was forcibly hit by another child against a tree. The patient is reluctant to abduct the right arm secondary to pain.
References Iverson C, ed. Clinical photograph for: Ludwig Angina. CorePendium. For Media Without an Associated Publication: This type of citation may be helpful if the image is used in multiple places within a publication, or if it is not tied to a particular publication. Last Name First Initial. Media title. Date Published. July 27, 2022.
PMID 12801736 Author information Sheila Goertemoeller, PharmD, DABAT, ICPS Clinical Toxicologist and Educator Drug and Poison Information Center Cincinnati Children's Hospital Medical Center | The post ACMT Toxicology Visual Pearl: The Heart Won’t Go On and On appeared first on ALiEM. ouabain, poison rope) Asclepias spp.
Case: A 27-year-old right hand dominant patient presents to the emergency department (ED) with a 2.5 EDs are an important touch point for individuals with opioid use disorder (OUD), given the number of encounters for overdose and complications associated with drug use. cm left forearm abscess. Reference: Reed et 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? If not, you probably should be. Another old drug for a new indication, right? Well not exactly. In short, yes.
Neurodivergence refers to the unique way in which an individual’s brain processes and responds to certain information, differing from the typical or average brain. One common myth is that neurodivergent individuals are intellectually disabled or incapable of understanding complex information.
We will be using redacted information from different cases where paramedics attempted TCP in the field. On ED arrival ROSC is achieved. Details are edited and redacted to preserve patient anonymity. They are unable to feel a pulse and resume CPR. The patient was ultimately discharged with a poor neurologic outcome.
Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3% mg IF requiring IM Epi >3x, switch to IV Epi, 0.05-0.1
A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. This is Bob’s eleventh visit […] The post SGEM#291: Who’s Gonna Drive you to…the ED – with Lights & Sirens? A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. Annals of Emergency Medicine. Annals of Emergency Medicine.
Annie: I developed an interest in EM while working as a scribe in the ED during college. In addition to what Charlotte and Nick said, I can envision myself staying calm in the stressful situations that come up in the ED. Nick: Triaging your time and priorities as an ED doc on shift is so challenging.
Annie: I developed an interest in EM while working as a scribe in the ED during college. In addition to what Charlotte and Nick said, I can envision myself staying calm in the stressful situations that come up in the ED. Nick: Triaging your time and priorities as an ED doc on shift is so challenging.
REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? 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? Click here for Direct Download of the Podcast Paper: Knack SKS et al.
2023.02.011 , PMID 36967275 Author information Chris Belcher, MD Editor, ALiEM AIR Series Assistant Professor and Assistant Program Director Department of Emergency Medicine University of Kentucky College of Medicine | Twitter | The post ALiEM AIR Series | Toxicology Module appeared first on ALiEM. Please go to the above link.
His roommate found an empty pill bottle on the floor next to him. Second-generation antipsychotics (see Table 1 below) improve both positive and negative symptoms of schizophrenia and are less likely to be associated with EPS. 1,2 Most second-generation antipsychotics act as D 2 antagonists and inhibit the 5-HT 2A receptor.
Every shift we use limited information in a busy, chaotic environment to make decisions. The authors start by discussing diagnostic testing in the emergency department (ED). The third edition covers dozens of common and deadly conditions clinicians are faced with in the ED. There are all wonderful additions to the book.
Background Information: Opioid overdose deaths have been increasing in the past twenty years. These statistics make the ED a crucial treatment initiation point to prevent further morbidity and mortality from opioid overdoses. The national number of overdose deaths from any opioid has increased 62.5% PMID 33392580.
A 24-year-old female with no pertinent PMHx presents to the ED with a chief complaint of eye pain. Her mom convinced her to go to the ED and she first went to an outside hospital, but was referred to come to our institution. She reported a 10-day history of worsening right eye pain following being punched in that eye. Neuro : Alert.
A 5-year-old female presented to the emergency department (ED) with a one-year history of gradually increasing anterior neck swelling. She was discharged from the ED on levothyroxine 25 mcg daily with endocrinology outpatient follow-up. The patient had no significant past medical history. Abdominal : Soft. No distention or tenderness.
Introduction Law enforcement officers frequently accompany emergency department (ED) trauma patients or patients who are under arrest or require assistance. At times, law enforcement officers may request assistance from ED staff to gather information or evidence. What is your role as the emergency physician?
Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. 2 Despite these recommendations there are no randomized clinical trials to help guide practice until now.
A 61-year-old female with a past medical history of hypertension, hyperlipidemia, type 2 diabetes, and normal pressure hydrocephalus s/p VP shunt (last revision nine months ago) presented to the Emergency Department (ED) for evaluation after noticing a “string” coming out of her anus today. No peritoneal signs. Non-tender rectal exam.
A 5-year-old generally healthy fully immunized boy presented to the ED with worsening left ear redness, swelling, and tenderness that his family noticed the day before presentation. His family had also recently noticed an abrasion over that ear. This is a case of perichondritis of the auricle, or a bacterial infection of the ear’s cartilage.
This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. BMJ Paediatr Open.
Background As Electronic Health Information (EHI) has increased in prominence, the U.S. The 2015 Edition Cures Act sought to promote “transparency, modern standards, and enhanced health IT capabilities by fostering innovation in the health care technology ecosystem to deliver better information to patients, clinicians, and other users.”
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