The Skeptics' Guide to EM

FEBRUARY 2, 2018

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.

Operating Room 100

Operating Room Emergency Department ALS ED 100

Don't Forget the Bubbles

JUNE 19, 2024

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study. Children in the validation cohort were admitted to the intensive care unit or operating room less frequently than those in the derivation cohort.

CPR 124

CPR Operating Room OR Emergency Department 124

GEDC

APRIL 12, 2024

Thanks to the American College of Surgeons and the Institute for Healthcare Improvement, who, along with the American College of Emergency Physicians (ACEP), spearheaded the rule development, the new measure will encourage hospital systems to change the way they approach care for older patients.

Operating Room 52

Operating Room Emergency Department ED OR 52

REBEL EM

JUNE 8, 2023

If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergency department pharmacist. Clinical Bottom Line: Acute hypotension must be treated emergently in order to decrease morbidity and mortality. J Med Toxicol. Epub 2019 Jul 3. Intensive Care Med.

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

Handtevy

SEPTEMBER 20, 2022

The standard care in North America for post-traumatic EDH involves decompressive craniotomy or trepanation via a burr hole, typically performed in an operating room by neurosurgery teams. Initially refusing emergency medical services, she was brought to the ED via a private vehicle.

Operating Room 52

Operating Room Emergency Medical Services ED Emergency Department 52

ACEP Now

MARCH 14, 2024

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 operating room, there was minimal urinary output and the bladder pressures were 35 mmHg under sedation and analgesia.

Operating Room 52

Operating Room ACS Critical Care Coronary 52

ACEP Now

MAY 4, 2023

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

EMS Operating Room ICU Emergency Department 52

FOAMfrat

DECEMBER 28, 2023

During Orientations, new crew members must do a minimum of 10 live intubations in the operating room before being cleared to intubate in the field. From experience, some emergency departments would not even allow the nurse to administer a paralytic. The conclusion of this article…drum roll….

Paramedic 52

Paramedic Emergency Medical Services Operating Room OR 52

EMDocs

JUNE 3, 2023

C, respiratory rate 20 breaths per minute, and oxygen saturation 95% on room air. This is less critical in ED management of the unstable pelvic fracture, as the optimal site for identification of rectal or vaginal tears is the operating room. An x-ray in the trauma bay demonstrated an AP grade III fracture.

ED 54

ED Operating Room ALS Frozen Plasma 54

EMDocs

JULY 17, 2023

In these cases, CT may not be feasible and a plain radiograph showing free air or bedside US showing free fluid may be useful to confirm serious abdominal pathology prior to transfer to the operating room. He describes the pain as a gradually worsening pressure-like discomfort distributed across his entire abdomen.

E-9-1-1 77

E-9-1-1 ED ALS Operating Room 77

ACEP Now

MARCH 14, 2024

A 24-year-old male with history of quadriplegia and traumatic brain injury presents to the emergency department with hemorrhage in his oral cavity and blood from his tracheostomy tube. He has had a tracheostomy for approximately 15 months since his injury. Blood is spurting from the orifice of the tube.

E-9-1-1 52

E-9-1-1 ALS Operating Room OR 52

EMDocs

NOVEMBER 16, 2024

Operative management is required in majority of cases. 9,23 Disposition: Dislocation : If successfully reduced in the emergency department may discharge with strict mobility restrictions and Orthopedic follow up. 6 Periprosthetic fracture : Admission for operative management. The American Journal of Emergency Medicine.

EMS 76

EMS E-9-1-1 Operating Room Emergency Department 76

AAEM RSA

DECEMBER 3, 2020

A thorough physical exam, imaging, and laboratory studies can assist, but definitive diagnosis can only be made in the operating room. West J Emerg Med. Inadequate Sensitivity of Laboratory Risk Indicator to Rule Out Necrotizing Fasciitis in the Emergency Department. West J Emerg Med. 2014;15(1):111-113.

Emergency Department 52

Emergency Department E-9-1-1 ALS EMT 52

Don't Forget the Bubbles

FEBRUARY 7, 2024

My first real encounter with the healthcare system took place when I was about seven years old and had to go into hospital for an orchidopexy, so I can empathize with all the young people who come through our emergency department with acute testicular pain. This dropped to 79.3%

Operating Room 111

Operating Room Emergency Department ALS OR 111

ACEP Now

JANUARY 12, 2024

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 operating room to manually reduce the uterus.

Operating Room 52

Operating Room Emergency Department OR ED 52

ACEP Now

APRIL 4, 2024

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 operating room. About 35 percent of individuals with rAAA will die at home.

Operating Room 40

Operating Room ALS ED Emergency Department 40

ALiEM

FEBRUARY 12, 2024

A 28-year-old female G3P2002 presented to the emergency department for one month of vaginal bleeding. The patient was seen in the emergency department one month earlier for vaginal bleeding in the first trimester of pregnancy. Her estimated gestational age was six weeks by last menstrual period.

Operating Room 161

Operating Room Emergency Department ALS OR 161

REBEL EM

DECEMBER 18, 2024

The “syringe” technique: a hands-free approach for the reduction of acute nontraumatictemporomandibulardislocations in the emergency department. J Emerg Med. Rosens Emergency Medicine: Concepts and Clinical Practice, 7 ed. Louis, Mosby, Inc., 2010, (Ch) 70: p 895-909. GorchynskiJ et al. 2014; 47(6):676-81.

Operating Room 52

Operating Room ALS ED Emergency Department 52

FOAMfrat

NOVEMBER 25, 2024

For patients suffering from intrapartum cardiac arrest, I would encourage you to transport the patient as expeditiously, but safely, as possible to the closest emergency department. Like I said, any emergency physician, as much as they may not love it, can perform a perimortem cesarian section.

Epinephrine 106

Epinephrine CPR Operating Room Plasma 106