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Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Case: A 59-year-old man walks into your community emergency department (ED) complaining of chest pain.
A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. Hemoptysis ED approach and management. Its going to take time to get her to a tertiary center.
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.
In her spare time, Melissa also enjoys being the fellowship director to an amazing group of PEM trainees. Case: Brian is a 14-year-old male who presents to the emergency department (ED) complaining of acute onset testicular pain. He has vomited twice, but there is no history of any fever or trauma. Reference: Frohlich LC, et al.
Takeaway lessons * Trauma patients who are hypotensive or otherwise unstable should be assumed to be bleeding, bleeding, bleeding until proven otherwise, and should have a very low threshold to proceed directly to the operatingroom for exploration.* Traction splinting is usually not done in the ED.
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
Children in the validation cohort were admitted to the intensive care unit or operatingroom less frequently than those in the derivation cohort. A proportion of participants were missed because the ED provider refused enrollment or said “Other,” but this is not well described.
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 operatingroom within 24 hours.
The standard care in North America for post-traumatic EDH involves decompressive craniotomy or trepanation via a burr hole, typically performed in an operatingroom by neurosurgery teams. Initially refusing emergency medical services, she was brought to the ED via a private vehicle. What are the key takeaways? (1)
IPPS Proposed Rule by the Centers for Medicare & Medicaid Services The Age-Friendly Hospital measure assesses hospital commitment to improving care for patients 65 years or older receiving services in the hospital, operatingroom, or emergency department (pg. This is a proposed measure, not to be set in place until Fall 2024.
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. The impact of push-dose phenylephrine use on subsequent preload expansion in the ED setting. 2015;10(3):e0119331. PMID: 25789927 Schwartz MB, et al. Am J Emerg Med.
In 1901, UVA opened its first hospital with 25 beds and three operatingrooms. The emergency department (ED) at UVA was rebuilt in 2019 and the department had not fully optimized its operations when COVID-19 hit. Following the pandemic, the ED saw a surge in its volume as it raced through 60,000 to 80,000 visits per year.
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 operatingroom for surgical rib fixation. Case FIGURE 1: Chest X-ray of multiple rib fractures (arrows). Click to enlarge.)
A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. In the operatingroom, there was minimal urinary output and the bladder pressures were 35 mmHg under sedation and analgesia.
Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. The result of this ED capacity strain and less than ideal patient to staff ratios has led to delays in interventions, treatments and care adjustments. Paper: Owyang CG, et al. J Crit Care.
A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operatingroom videos, recovery tips, and patients praising their plastic surgeon. The data that are available come largely based on voluntary reporting, physician surveys, or autopsies.
1-3 Despite its commonality it retains a relatively high rate of complications overall and patients frequently present to the ED for evaluation. 10% of patient’s have an ED visit within 30 or 90 days following THA. 4 Pain is the most common reason for presentation in the early post operative period. 10% of patients.
and is poorly tolerated by patients with obstruction, it should not be a routine part of the ED evaluation for LBO unless it is critical for another diagnosis on the differential. Bowel Perforation: ED Presentations, evaluation and management. He reports distension and the sensation of fullness. Adv Cancer Res. 2021;151:1-37.
C, respiratory rate 20 breaths per minute, and oxygen saturation 95% on room air. The nuances of fracture patterns and delineating mechanically unstable pelvic fractures from stable ones is less important to the ED. 12 An AP x-ray of the pelvis should be obtained in the ED for unstable patients.
One systematic review of 1283 patients showed that if you got to the operatingroom within 6 hours, you had a 97% chance of saving the testicle. Clinical predictors for testicular torsion as seen in the pediatric ED. This dropped to 79.3% The Journal of Urology , 189 (5), pp.1859-1864. Beni-Israel, T., Goldman, M., Chaim, S.B.
Case A 40-year-old female at 11 weeks, five days gestation presented to the emergency department (ED) with concern for lower abdominal pressure and inability to fully empty her bladder. The patient was admitted to the obstetrics service and underwent spinal anesthesia in the operatingroom to manually reduce the uterus.
3 The majority of those who arrive to the emergency department (ED) live for 2 hours or more, leaving a small window for surgical intervention. Other exceptions are patient refusal, patient death or immediate transfer to the operatingroom. Bailey & Love’s short practice of surgery, 26th ed. Br J Surg 2012;99:655-665.
The sensitivity of these scores range, but they cannot exclude FG diagnosis and may have lower sensitivity when used for prediction in ED patient populations. A thorough physical exam, imaging, and laboratory studies can assist, but definitive diagnosis can only be made in the operatingroom.
Join Justin and I for a sold 80 minutes of nerdy evidence-based ED care. Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the OperatingRoom: A Cluster Randomized Clinical Trial. Join Justin and I for a sold 80 minutes of nerdy evidence-based ED care. 2024 Mar 18:e240762. doi: 10.1001/jama.2024.0762.
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 operatingroom). Randomized controlled trials or comparative non-randomized observational studies. in another study).
Rosens Emergency Medicine: Concepts and Clinical Practice, 7 ed. In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. Louis, Mosby, Inc., 2010, (Ch) 70: p 895-909. GorchynskiJ et al. The “syringe” technique: a hands-free approach for the reduction of acute nontraumatictemporomandibulardislocations in the emergency department.
While this guide isnt exhaustive, its designed by residents, for residents, to provide practical tips and foundational knowledge thats crucial in the fast-paced, high-stakes environment of the ED. Introduction Airway management is a critical ED skill to master. So the actual benefit for most ED patients is unclear.
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