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Case: The Chief of Emergency Medicine (EM) at a large urban hospital recently approached the AI Committee at Unity Health, intrigued by the CMAJ article describing the apparent success of CHARTWatch in detecting early signs of patient deterioration. Reference: Verma et al.
On a busy day shift in the emergencydepartment, our seasoned triage nurse comes to me after I finish caring for a hallway patient, “Hey, can you come see this guy in the triage room? This is the essence of emergency medicine. His vitals are fine…”. In the age of big data, more information sounds like a boon.
You are the Paediatric doctor on call and receive a call for an incoming patient to the emergencydepartment. Tragically, several attempts at resuscitation upon arrival at the emergencydepartment were unsuccessful. Intubated, awake, and paralysed: a never event. His name is Ben. Ben was awake but paralysed.
Bupe Allergy Buprenorphine induction has been the mainstay of emergencydepartment treatment of opioid use disorder for more than a decade [11, 12]. The biggest change has been the gradual replacement of diacetylmorphine (heroin) by fentanyl and other synthetic opioids.
A total of eleven intensive care units (ten PICUs and one non-maternity NICU) and four emergencydepartments (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.
Prospective Validation of Clinical Criteria to Identify EmergencyDepartment Patients at High Risk for Adverse Drug Events. Guest Skeptic: Dr. Chris Bond is an emergency physician and clinical lecturer at the University of Calgary. [display_podcast] Date: August 16th, 2018 Reference: Hohl C et al. AEM Aug 2018.
This time we have our first group of colleagues from Birmingham Children’s Hospital EmergencyDepartment. Intranasal fentanyl and discharge from the emergencydepartment among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Am J Hematol.
The emergencydepartment (ED) evaluation reveals an unremarkable chemistry panel with normal renal function and a white blood cell count of 10,000. Conflicts in the ED often stem from clinical decision-making and actions, leading to potential adverse patient events and exacerbating access block issues.
Intimate partner violence (IPV) in the EmergencyDepartment (ED). 2022 Nov Guest Skeptics: Dr. Nour Khatib is an emergency physician in Toronto working in community sites Markham Stouffville Hospital and Lakeridge health. Intimate partner violence (IPV) in the EmergencyDepartment (ED).
If bleeding has completely stopped, most of these children still come into the hospital for observation so access will likely be necessary and helpful should patient have rebleed event. If bleeding, the only lab that is needed in the EmergencyDepartment is a type and cross. Set up suction x2 in the room! Get IV access!
You’re in the paediatric emergencydepartment, typing some notes for the child you’ve just discharged. They lead to increased team cohesion and are often best led by people involved in the event. They are a judgement-free session focussing on events that occurred. You’re just about aware of the tannoy in the background.
Consider these medications if there are signs of end-organ dysfunction, there is a considerable delta in baseline BP, systolic is less than 90 and/or MAP is less than 65 Norepinephrine is a good pressor for a lot of the situations that we encounter in the emergencydepartment, such as septic shock, undifferentiated shock and hypovolemic shock.
In this issue, we collaborated with the CJEM team to present “Hypotension and respiratory events related to electrical cardioversion for atrial fibrillation or atrial flutter in the emergencydepartment” in a visual abstract format1.
A 32-year-old male with no significant past medical history presented to the emergencydepartment (ED) from an outside hospital for further management of right eye pain and vision loss sustained after he was struck by a metal wire while at work. An emergent ophthalmology consult is needed to plan for operative repair.
Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk EmergencyDepartment Patients: The PROPER Randomized Clinical Trial. Case: A 47-year-old woman presents to the emergencydepartment with a 24-hour history of chest pain and shortness of breath. JAMA February 2018.
IF YOU OR A LOVED ONE NEEDS HELP, CALL 988 OR SEEK CARE AT A LOCAL EMERGENCYDEPARTMENT. TRIGGER WARNING: TOPICS OF SUICIDE MAY BE HARD FOR SOME PEOPLE TO READ ABOUT. THIS ARTICLE IS COVERING THE MEDICAL ASPECTS OF CHEMICAL SUICIDES. REMEMBER, IF YOU ARE TREATING A SUICIDE ATTEMPT SURVIVOR, DO NOT PASS JUDGMENT.
Major adverse cardiac events 40 minutes after giving the antiarrhythmic. Major adverse cardiac events 40 minutes after giving the antiarrhythmic. The following table shows their results, take a look: Note that procainamide leads with less adverse cardiac events. This was based on 11, thats not a typo, ELEVEN patients.
Effectiveness of intravenous lidocaine versus intravenous morphine for patients with renal colic in the emergencydepartment. Urology 2012 Guest Skeptics: Dr. Tony Seupaul is the Chairman of the Department of Emergency Medicine at the University of Arkansas. Of course we were skeptical and wanted to review the evidence.
Sergey Motov is an Emergency Physician in the Department of Emergency Medicine, Maimonides Medical Center in New York City. He is also one of the world’s leading researchers on pain management in the emergencydepartment, specifically the use of ketamine. His twitter handle is @PainFreeED.
Take-Pause: Efficacy of mindfulness-based virtual reality as an intervention in the pediatric emergencydepartment. AEM March 2022 Guest Skeptic: Dr. Lauren Westafer is an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. Reference: Butt et al.
A 68-year-old man presents to the emergencydepartment (ED) with altered mental status and fever. Vital signs on arrival are: Temperature: 38.8 degrees Celsius Heart rate:128 Blood pressure: 74 over 48 Respiratory rate: 10 Oxygen saturation: 77 percent Physical examination was notable for lethargy and confusion.
Case: A 34-year-old male presents to the emergencydepartment with burning epigastric pain after eating two hours ago. Background: Patients presenting to emergencydepartments (EDs) with epigastric pain are typically treated with an antacid, either alone or combined with other medications. AEM Sept 2020. AEM Sept 2020.
Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial. first appeared on The Skeptics Guide to Emergency Medicine. Date: October 14th, 2019 Reference: CRASH-3 Trial Collaborators.
He is a GP by training but works in EmergencyDepartment, Anaesthesia, Internal Medicine and Paediatrics. He has a wonderful #FOAMed blog and podcast called Broomedocs and also work […] The post SGEM#326: The SALSA Study: Hypertonic Saline to Treat Hyponatremia first appeared on The Skeptics Guide to Emergency Medicine.
Background: Patients present commonly to their primary care providers (PCPs) and to the emergencydepartment (ED) with complaints of a sore throat. The ibuprofen did not help and he is requesting antibiotics so he can get back to work sooner. In the US, adults accounted for 6.6 million visits annually to PCPs and EDs for sore throat.
Cuffed Endotracheal Tubes show no difference in immediate post-extubation adverse events (i.e Differences in intubation outcomes for pediatric patients between pediatric and general EmergencyDepartments. Acad Emerg Med. In a systematic review of 10 RCTs comparing cuffed vs. uncuffed ETTs. 1.70) and 0.78 (0.46–1.35),
The parents of 9-month-old Josie bring her into the EmergencyDepartment with coryzal symptoms and difficulty breathing. A secondary analysis of a nationwide study of EmergencyDepartment attendance in America from 2006 to 2008 found that CXRs increase the average length of stay by 27 minutes.
In the emergencydepartment, a lack of awareness about Addison’s disease led to delayed steroid administration. In the emergencydepartment, the patient was evaluated and safely discharged. These cases highlight the impact of adrenal insufficiency on patients, especially during encounters with emergency care systems.
Date: October 2nd, 2020 Guest Skeptic: Dr.Barbra Backus is an emergency physician at the EmergencyDepartment of the Erasmus University Medical Center in Rotterdam, the Netherlands. She is the creator of the HEART Score and an enthusiastic researcher. Reference: Claiborne Johnston S et al. Reference: Claiborne Johnston S et al.
EmergencyDepartment Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial [published online ahead of print, 2023 Oct 12]. Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. 2023;e2320850.
However, ketamine may be associated with adverse clinical events including a higher intubation rate. The primary endpoint was incidence of endotracheal intubation occurring during transportation and within one hour after arrival to the emergencydepartment (ED). versus 2.9%, respectively; p = 0.383).
Physicians, nurses, and staff in emergencydepartments (EDs) across the country have encountered workplace violence for years. 1,2 In a 2018 study by ACEP, nearly half of emergency physicians polled reported a physical assault while at work. Click to enlarge.) are caused by a behavioral crisis. Click to enlarge.)
1: Hypertensive Crisis Averted…New AHA Statement on Asymptomatic Hypertension Spoon Feed This article emphasizes the difference between hypertensive emergency and asymptomatic elevated blood pressure (BP); while hypertensive emergency requires prompt treatment to lower BP, treatment of asymptomatic elevated BP in acute care settings may be harmful.
AEM October 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com Case: A 19-year-old man presents to the emergency […] The post SGEM#381: Put Your Hand on My Shoulder and Reduce It first appeared on The Skeptics Guide to Emergency Medicine.
Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia.
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.’ & Liska, H.
The Learners The target learners were EM residents and physicians practicing in the emergencydepartment. In order to avoid connectivity issues with Wifi, the event administrators broadcasted from an ethernet-connected computer. Internet connection: A stable internet connection is a must. Read more publications from the series.
[display_podcast] Date: November 24th, 2018 As you may know, I was invited to give a keynote address on burnout at the Australasia College of Emergency Medicine 2018 Annual Scientific Meeting (#ACEM18) in Perth, Australia. This turned out to be a very meta event. This turned out to be a very meta event. got seriously ill.
Epinephrine – 10ug/mL, 10mL syringe Phenylephrine – 100ug/mL, 10mL syringe Phenylephrine bolus doses from 100-200ug and epinephrine 10-20ug administered every 2-5 minutes pursuant to provider order Inclusion Criteria: Adults age >18 years old Received at least one bolus dose of phenylephrine or epinephrine pre-filled syringes Exclusion (..)
As hospital boarding, increased emergencydepartment (ED) volumes, and complexity of patients have increased, so have wait times. Some physicians now coin themselves waiting room medicine specialists as departments schedule a physician in triage or attempt to evaluate patients in whatever spaces might be available.
Case: You are working in the emergencydepartment (ED) and have just been involved in a difficult case in the resuscitation room. During the resuscitation, a relative of the patient you have been treating named Rudy makes a derogatory/rude comment about Emergency Medicine (EM) staff.
Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Audrey’s academic interests include trauma and resuscitation. Outside of medicine, Audrey likes to play rugby and run.
A 41-year-old male who presents to the emergencydepartment with chest pain. I do not think it is possible for a 2nd trop to remain undetectable in a patient then goes on to rule in for acute MI, unless there is a 2nd event. I know of no data on unstable angina/30-day adverse events/acute MI after 2 serial undetectable trops.
Interrater reliability of Glasgow Coma Scale scores in the emergencydepartment. Ann Emerg Med. We use the GCS score in both trauma and medical patients, but where did this score come from? When is it useful and what does it tell us? Let’s wrap our heads around the Glasgow Coma Scale in children. May have shouts or exclamations.
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