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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. 2013) Recurrent Spontaneous Globe Subluxation: A Case Report and Review of Manual Reduction Techniques. References Kelly, E.W.
saline (NS) solutions are both isotonic crystalloids widely used for intravenous fluid resuscitation across many contexts and disease states ( Myburgh 2013 ). To assess the clinical impact and relevance of these concerns, Alwang et al. Lactated Ringer (LR) and 0.9% performed the retrospective cohort study below ( Alwang 2024 ).
A 75-year-old woman who is bedridden after a stroke presents to the ED from a nursing facility with abdominal pain and constipation. Therefore, discharging the patient on lactulose (C) would not be recommended without additional treatment in the ED. Ahmad H, Jannat H, Khan U, et al. Al-Maharmeh, Q., Stercoral Colitis.
Gortney J, Raub J, Patel P, et al. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold Management of drug and alcohol withdrawal. N Engl JMed. 2003; 348:1786-1795.
Major takeaway: Consider SBP in any patient who comes into the ED with ascites. A 2013 meta-analysis found IV albumin was associated with 22.3% Biggins SW, Angeli P, Garcia-Tsao G, et al. Mattos AA, Wiltgen D, Jotz RF, et al. Aithal GP, Palaniyappan N, China L, et al. Angeli P, Bernardi M, Villanueva C, et al.
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. Available from: [link] Maradit Kremers H, Larson DR, Crowson CS, et al. 2013 Dec;6(4):350-6.
However, these figures fail to account for downstream costs due to misdiagnosis, delayed care, or subsequent ED visits. 27-30 Ambiguity in Defining “Nonemergent” Cases In a 2013 Health Affairs study, the authors label 12.9% Peer-reviewed studies have shown that short-term savings often obscure long-term costs.
This leads to delay or misdiagnosis in the ED, which may lead to missed measles cases. 2014;142(4):685-94 Crowcroft NS, Booy R, Harrison T et al. Prenatal pertussis vaccination coverage in England from January to March 2024 and annual coverage for 2023 to 2024 [Internet] [Accessed 14 Oct 24] Moore K, Marra F, Nussbaum A, et al.
Al Badawi, A. MAML, NRP, WP-C 12 min read Share To: The annual ranking of the top-selling prescription drugs in the United States provides a window into the nation’s health, revealing trends in chronic disease and the rapid rise of breakthrough therapies steering patient care. Adapted from J. 2010 , 87 , 1348. Moloney, C., Sharples, R.,
ACEP level C recommendation that while there is no specific timing for diuretic therapy, physicians can consider earlier administration of diuretics in ED patients with HF (ACEP). In ED population, diuretics have not demonstrated clear benefit in mortality. Heidenreich PA, Bozkurt B, Aguilar D, et al. Am J Emerg Med.
Historically, those battling addiction are treated poorly by healthcare professionals, which directly inhibits them from seeking or complying with care (Van Boekel et al., In: Chabner BA, Knollmann BC, eds. Accessed November 7, 2013. Available from: [link] Mihic SJ, Harris RA. Chapter 17. Hypnotics and Sedatives. Brouwers, E.
You need not be sad regarding the lack of Swan Ganz catheters in your ED. Jan 2015; PMID: 25559473 Airapetian N, et al. Di Nicol P, et al. Mar 2023; PMID: 36983218 Feissel M, et al. Sep 2004; PMID: 15045170 Luecke T, et al “PEEP and cardiac output.” Rudski LG, et al. So, what is in your grab bag?
Because of their worsening respiratory acidosis, they were intubated in the ED, The initial chest-x ray shows a right-sided consolidation, in keeping with bronchopneumonia. In a prospective multi-centre study, Berger et al. Rowlands et al. Hodder et al. Namachivayam et al. 2007;8:207211 Garoudet et al.
The syphilis and trichomonas tests come back negative in the ED, but his rapid HIV test is positive. How should clinicians approach the diagnosis and management of HIV in the ED? 11 These cardiovascular complications have further increased ED visits by HIV-positive patients by three times compared to individuals without HIV.
2013 Mar;40(2):144-57. Callen AL, Timpone VM, Schwertner A, Zander D, Grassia F, Lennarson P, Seinfeld J, Lillehei KO, Birlea M, Thaker AA. He has significant facial trauma, and blood and serous fluid are leaking out of his left ear. His left face and eye have severe contusions. Amoozegar F, Guglielmin D, Hu W, Chan D, Becker WJ.
PMID: 25701296 The SGEM: Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol) ALiEM: Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers. ALiEM: Beta Blockers Vs. Calcium Channel Blockers for Atrial Fibrillation Rate Control: Thinking Beyond the ED. PMID: 10092714 Stiell IG et al.
When I was an inpatient pharmacy manager in 2013, my hospital was visited by the California Department of Public Health (CDPH), concerned about droperidol and ECG monitoring, or rather, lack thereof. Fast forward to now, and it seems droperidol is still a favorite punching bag for CDPH. Despite all the buzzwords (Evidence-based medicine!
Rosh Review Website Link Further Reading: Further FOAMed: [link] [link] [link] References: Fakhoury M, Negrulj R, Mooranian A, Al-Salami H. 2013.05.050 Gajendran M, Loganathan P, Jimenez G, et al. 2023.102173 Segal JP, LeBlanc JF, Hart AL. Inflammatory bowel disease: clinical aspects and treatments. J Inflamm Res. Prev Med Rep.
Reference: Snelling et al. Reference: Snelling et al. Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth. Case: It is a steady Saturday afternoon in your rural emergency department (ED).
Reference: Remick KE, et al. Reference: Remick KE, et al. Case: After your shift in the emergency department (ED) one day, the medical director pulls you aside. Two previous studies conducted assessing the state of nationwide pediatric readiness were conducted in 2003 and 2013. Reference: Remick KE, et al.
A quick primer on hypocalcemia in the ED. J Intensive Care Med 2013; 28:166. Pfenning CL, Slovis CM: Electrolyte Disorders; in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. link] Kelly A, Levine MA. Hypocalcemia in the critically ill patient.
Date: July 6, 2023 Reference: Hanula R et al. Date: July 6, 2023 Reference: Hanula R et al. Case: A 57-year-old woman with hypertension, hyperlipidemia and type-2 diabetes mellitus presents to the emergency department (ED) with fever, cough, myalgias, headache and congestion. JAMA Int Med 2023. JAMA Int Med 2023.
Date: August 27th, 2021 Reference: Gagnon et al. Case: A forty-year-old woman presents to the emergency department […] The post SGEM#342: Should We Get Physical, Therapy for Minor Musculoskeletal Disorders in the ED? Date: August 27th, 2021 Reference: Gagnon et al. first appeared on The Skeptics Guide to Emergency Medicine.
Date: February 17, 2023 Reference: Gettel et al. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. Date: February 17, 2023 Reference: Gettel et al. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019.
Yoo, MD (Assistant Professor/Core Faculty, San Antonio, TX) // Reviewed by Brit Long, MD (@long_brit) Case An 18-year-old man with a history of asthma and medication noncompliance presents to the emergency department (ED) with acute onset shortness of breath. He states that he recently moved to Texas from Colorado. Which one do you select?
Date: May 13th, 2022 Reference: Abril et al. Date: May 13th, 2022 Reference: Abril et al. Case: A 45-year-old man without a significant past medical history presents to your emergency department (ED) with two days of severe lower back pain after shoveling some dirt. EDs annually (1). His twitter handle is @PainFreeED.
Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. link] Lubitz DS, Seidel JS, Chameides L, Luten RC, Zaritsky AL, Campbell FW. 2012.05.028 Silvagni D, Baggio L, Mazzi C, et al. and Seaver, M.
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. Article: Arvig MD, Lassen AT, Gæde PH, et al. US, compared with CXR and CT, offers the absence of ionizing radiation and high reproducibility. Emerg Med J. 2023;40(10):700-707.
Transvere ultrasound views of the bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.) Sagittal view of bladder: Left – Uterus identified posteriorly in girl; Right – Prostate identified posteriorly in boy (Images courtesy of Dinh et al.)
[display_podcast] Date: October 24th, 2017 Reference: Harrison et al. display_podcast] Date: October 24th, 2017 Reference: Harrison et al. That rant relied upon a Cochrane SRMA by Stevens B et al2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015. Reference: Harrison et al.
Reference: Martel et al. Way back in 2013 we looked at haloperidol for agitation due to psychosis ( SGEM#45 ) and concluded that it was an effective treatment but had common side effects. Reference: Martel et al. Kirsty is also the creator of the wonderful infographics called #PaperinaPic.
Read More EMCrit: Podcast 145 – Awake Intubation Lecture from SMACC ERCast: Angioedema References: Baş M et al. PMID 25629740 Hassen GW et al. J Emerg Med 2013; 44 (4): 764-772. PMID 23062323 Kostis JB et al. PMID 16043683 McCormick M et al. PMID 20954277 Sinnert R et al. Zuraw et al.
It is often difficult to do this in an ED setting. Image adapted by Holland JA et al. Image adapted by Holland JA et al. 2013 Sep 24;81(13):1159-65. Epub 2013 Aug 21. Strabismus alone is a rare sign of a brain tumour in this age group; however, the associated papilloedema is concerning. Manometer three-way tap.
6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. 6 24% more likely to return to the ED within 72 hours of their initial visit in an urban ED with >50,000 annual visits. One cohort study in a public ED found that 84.5%
Reference: Post et al. Reference: Post et al. Lancet 2021 Case: You’re working a busy evening shift in your community emergency department (ED) when a 58 year old female presents with a rapid onset terrible intensity headache. Robert Edmonds is an emergency physician in the US Air Force in Ohio.
In ED, repeat potassium level was 2.6 Permanent weakness usually affects the proximal lower extremities, happens in older patients, and develops late. Diagnosis: Can be made in the ED based on history, exam, lab testing. Consult neurology in the ED. ED workup should exclude alternate causes of symptoms. Muscle Nerve.
A 43-year-old male, with no significant medical history, presents to the ED for right eye pain. 2013; 7362. In: Tintinalli JE, Ma OJ, Yealy DM, et al., In: Knoop KJ, Stack LB, Storrow AB, Thurman RJ, eds. In: Tintinalli JE, Ma OJ, Yealy DM, et al., Wakai A, Lawrenson JG, Lawrenson AL, et al.
In the UK, as in most developed countries, more patients are presenting to Emergency Departments (EDs) with minor illnesses or injuries. Simpson et al. Patients who Did Not Wait are a feature of most EDs worldwide. A 2011-2012 Australian study by Blake et al. of those children later returned to the ED.
5 Paper: Lebin J et al. Authors assessed how many of the 470 had return ED visits (for any reason) within 3 days of discharge, within 3-7 days, and after 7 days of discharge. 1, 2 Phenobarbital has been studied as an alternative or adjunct to benzodiazepines with encouraging results, but primarily among inpatient services.
The controversy around what is ‘normal’ in infants’ and children’s vitals was demonstrated in a 2011 systematic review by Fleming et al. and two cohort studies, one performed in Australia by O’Leary et al. and one in the US by Bonafide et al. Brennan et al. Our study supports previous work by Nijman et al.
mmol/L) with acute illness between 2013 and 2018. Younger age, higher bicarbonate levels and lower ketones in children with acute illness and hypoglycaemia on presentation to ED are potential predictors of establishing a hypoglycaemia diagnosis. Selman C, Mainzer R, Lee K, et al. Yu Z, Merid SK, Bellander T, et al.
If they are not already there, get ALS-level care to the patient as soon as possible. I personally know of 2 ALS providers who were exposed to chlorine gas in a pool incident on the job and both ended up retiring from their service and still have lifelong breathing problems as a result. Thomas, Eds.) 2013, 9 9).
A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al.
Introduction: Neurologic emergencies are common in the Emergency Department (ED), and blood pressure management is critical to immediate management. References: Powers WJ, Rabinstein AA, Ackerson T, et al. Leonardi-Bee J, et al; IST Collaborative Group. Okumura K, et al. Oliveira-Filho J, et al. Vlcek M, et al.
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