The Skeptics' Guide to EM

FEBRUARY 2, 2018

Might his examination be enough to convince the urologists to take him straight to the operating room without a preceding diagnostic ultrasound? On examination, you find a firm, swollen right testicle, and the cremasteric reflex is notably absent on that side. Your index of suspicion for testicular torsion is high.

Operating Room 100

Operating Room Emergency Department ALS ED 100

EMDocs

SEPTEMBER 7, 2024

In this patient with a penetrating posterior flank injury, trace-free fluid in the pelvis on eFAST, and ongoing signs of hemorrhagic shock despite fluid and blood product administration, transferring to the operating room for exploration is indicated, especially with high probability of zone III injury-related retroperitoneal bleeding.

EMS 97

EMS E-9-1-1 Operating Room OR 97

Critical Care Scenarios

JULY 11, 2021

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 operating room for exploration.*

Operating Room 100

Operating Room ICU ED OR 100

ESO

MARCH 7, 2024

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. This rapid intervention reduced complications and highlights the need for maintaining and improving such protocols.

Operating Room 105

Operating Room ICU OR ED 105

Don't Forget the Bubbles

JUNE 19, 2024

Children in the validation cohort were admitted to the intensive care unit or operating room less frequently than those in the derivation cohort. They recruited 22,430 children with suspected or known blunt trauma (11,857 children in the derivation cohort and 10,573 in the validation cohort).

CPR 124

CPR Operating Room OR Emergency Department 124

Don't Forget the Bubbles

NOVEMBER 22, 2023

They concluded that propofol is safe, particularly in short-term sedation, but should be used with caution outside of the operating room, given some of the potentially severe adverse events (including PRIS) seen. Only one of these studies was undertaken in an intensive care setting, and it did not report any cases of PRIS.

E-9-1-1 126

E-9-1-1 Critical Care Operating Room ALS 126

GEDC

APRIL 12, 2024

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, operating room, or emergency department (pg.

Operating Room 52

Operating Room Emergency Department ED OR 52

ACEP Now

MAY 4, 2023

On hospital day 2, he was taken to the operating room for surgical rib fixation. The trauma team placed a pigtail catheter in the right chest cavity to decompress the pneumothorax and the patient was admitted to the surgical intensive care unit. The patient continued to have an oxygen requirement and significant pain.

EMS 52

EMS Operating Room ICU Emergency Department 52

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. EDH accompanies up to 4% of adult head injuries, leading to 10% mortality in adults and 5% mortality in children.

Operating Room 52

Operating Room Emergency Medical Services ED Emergency Department 52

ACEP Now

MARCH 14, 2024

In our case, the patient had a CT of the head, cervical spine, and chest, abdomen, and pelvis with intravenous contrast demonstrated a C2, C7 compression fracture with significant bowel edema (Figure 4), and was taken to the operating room for left arm disarticulation, left below knee amputation and right above knee amputation.

Operating Room 52

Operating Room ACS Critical Care Coronary 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. This flight service noted during orientations that new crew members are required to do a minimum of 10 live intubations in the operating room before being cleared to intubate in the field.

Paramedic 52

Paramedic Emergency Medical Services Operating Room OR 52

REBEL EM

JUNE 8, 2023

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 (..)

Epinephrine 98

Epinephrine Emergency Department ALS Critical Care 98

REBEL EM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

ICU 81

ICU Operating Room Critical Care ALS 81

ACEP Now

NOVEMBER 14, 2023

In 1901, UVA opened its first hospital with 25 beds and three operating rooms. The University of Virginia (UVA) School of Medicine was founded in 1819 by Thomas Jefferson and is one of the oldest medical schools in the United States.

Emergency Department 52

Emergency Department Operating Room ED OR 52

Emergency Medicine Ireland

APRIL 26, 2021

This is certainly outside the realm of intensive care but remains a somewhat magical act that my surgical and anaesthetistic colleagues perform in the operating room. Post op is where intensive care is subbed onto the field to take over the physiology of the fairly roughed up transplant patient.

Critical Care 40

Critical Care Operating Room OR 40

ACEP Now

MAY 9, 2024

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon.

Emergency Department 52

Emergency Department Operating Room Critical Care ICU 52

REBEL EM

MARCH 27, 2023

Inclusion Criteria: Adult emergency department patients 18 years or older Intubated by EMS in the field or ED providers Requiring continuous mechanical ventilation Exclusion Criteria: Intubated in the inpatient service Intubated for a procedure or in the operating room Patients on chronic mechanical ventilation Expired prior to ICU admission Those (..)

Emergency Department 52

Emergency Department ICU Critical Care EMR 52

ACEP Now

MARCH 14, 2024

18 The finger is inserted through the stoma alongside the endotracheal tube and, while 90 percent success rate has been reported with this method in controlling bleeding, the pressure must be maintained until the patient is transferred to the operating room.

E-9-1-1 52

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

Paramedic Training Spot

JANUARY 20, 2022

Students must complete a minimum of 250 hours of clinical experience in the hospital setting including the emergency room, operating room, and labor and delivery. This is followed by 250 hours of clinical externship, also called “ride time”, on an ambulance under the supervision of a licensed paramedic.

Paramedic 52

Paramedic Emergency Medical Technician Emergency Medical Services EMT 52

EMDocs

NOVEMBER 16, 2024

Open reduction in the operating room may be required if closed reduction is unsuccessful. Overview of Operating Room Procedures During Inpatient Stays in U.S. Flexion , abduction , and external rotation (C) should not lead to dislocation, and a fall in this manner may lead to a fracture. Hospitals, 2018. 2021 Aug 31.

EMS 97

EMS E-9-1-1 Operating Room Emergency Department 97

EMDocs

JUNE 3, 2023

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. Preperitoneal Packing While most often done in the operating room, PPP may be done in the trauma bay in rare instances depending on the institution.

ED 64

ED Operating Room ALS Frozen Plasma 64

Don't Forget the Bubbles

FEBRUARY 7, 2024

One systematic review of 1283 patients showed that if you got to the operating room within 6 hours, you had a 97% chance of saving the testicle. Time is testicle , reminding us that the sooner we get a definitive diagnosis and treatment, the more likely we are to save future generations. This dropped to 79.3%

Operating Room 111

Operating Room Emergency Department ALS OR 111

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. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome.

E-9-1-1 98

E-9-1-1 ED Operating Room ALS 98

ACEP Now

JANUARY 12, 2024

The patient was admitted to the obstetrics service and underwent spinal anesthesia in the operating room to manually reduce the uterus. A pessary was inserted during that procedure. On the next day, the Foley catheter was removed and the patient was able to spontaneously void.

Operating Room 52

Operating Room Emergency Department OR ED 52

ACEP Now

APRIL 4, 2024

Other exceptions are patient refusal, patient death or immediate transfer to the operating room. It is hoped that more emergency physicians will use point of care bedside US, which can be performed more rapidly than a CT.

Operating Room 40

Operating Room ALS ED Emergency Department 40

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. Conclusion: Positive outcomes in diagnosis and management of FG rely on rapid intervention as soon as it is suspected.

Emergency Department 52

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

FOAMfrat

MARCH 11, 2024

However, we may need to temporize the patient before they can get to an operating room. The only real fix for placenta previa is cesarean delivery and possible hysterectomy if the patient has PAS. This is where intrauterine resuscitation comes into play.

Operating Room 64

Operating Room ALS OR Ambulance 64

ALiEM

FEBRUARY 12, 2024

The patient was taken to the operating room for dilation and curettage and was discharged the following day. These images, taken by point of care ultrasound, show a heterogenic mass with mixed echogenicities within the uterine cavity consistent with gestational trophoblastic disease or molar pregnancy.

Operating Room 161

Operating Room Emergency Department ALS OR 161

Broome Docs

APRIL 30, 2024

Video Laryngoscopy vs Direct Laryngoscopy for Endotracheal Intubation in the Operating Room: A Cluster Randomized Clinical Trial. PMID: 36895888 Yeah, we get it, video is better Ruetzler K, Bustamante S, Schmidt MT, Almonacid-Cardenas F, Duncan A, Bauer A, Turan A, Skubas NJ, Sessler DI; Collaborative VLS Trial Group.

Operating Room 69

Operating Room Critical Care ED OR 69

REBEL EM

NOVEMBER 25, 2024

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.

Operating Room 97

Operating Room Emergency Department ICU ALS 97

REBEL EM

DECEMBER 18, 2024

Take Home points : Atraumatic TMJ dislocations are typically anterior in nature and can be reduced by a variety of techniques in the ED Traumatic TMJ dislocations often involve mandible fractures and typically require open reduction and fixation in the operating room Consider using the syringe, gag and extraoral reduction techniques first line as they (..)

Operating Room 52

Operating Room ALS ED Emergency Department 52

FOAMfrat

NOVEMBER 25, 2024

Oppositely, if the patient is not suffering from cardiac arrest, I would still encourage you to move with haste but try to transport the patient to a hospital with an in-house obstetrician and operating room capabilities, while notifying the hospital as early as possible.

Epinephrine 105

Epinephrine CPR Operating Room Plasma 105

Core EM

JANUARY 16, 2025

Only about 50% sensitive for detecting an esophageal intubation (Grmec 2004) and about 65% sensitive for detecting a main-stem intubation in the operating room where everything is much quieter than in the ED (Sitzwohl 2010). Auscultation. Observation of chest rise. Even worse.

E-9-1-1 130

E-9-1-1 EMS ALS OR 130