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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 ). Applicability to Emergency Medicine: For emergency medicine providers, the greatest challenge with this study is that it did not include or account for ED care.
On January 22, 2025, the ACEP Board of Directors approved a clinical policy developed by the ACEP Clinical Policies Committee on the outpatient management of adult patients presenting to the emergencydepartment (ED) with asymptomatic elevated blood pressure. Responses received were used to refine and enhance the final policy.
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. Stercoral colitis in the emergencydepartment: a review of the literature.
A 36-year-old male presents to the emergencydepartment after being found down at home by his spouse. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. Per the mans wife, the patient is a heavy drinker often consuming two to three pints of vodka daily.
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. Emergencydepartment visits following total joint arthroplasty: do revisions present a higher burden?
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. Clear history taking In the EmergencyDepartment, healthcare professionals should prioritise thorough history-taking when assessing potential suspected cases. Epidemiol Infect. 2014;142(4):685-94 Crowcroft NS, Booy R, Harrison T et al.
Patients who use emergency medical services have greater severity of illness or injury compared to those who present to the emergencydepartment via other means: A retrospective cohort study. Canadian Journal of Emergency Medicine , 23, 828–836. Prehospital Emergency Care, 27 (5), 669–686. Adapted from J.
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. Ann Emerg Med. J Am Coll Cardiol 2013; 62(16):e147–239.
RESUS SCENARIO Picture this: you just arrived at your shift at the local emergencydepartment. You need not be sad regarding the lack of Swan Ganz catheters in your ED. Oct 2013; PMID: 24079262 Gohar E, et al. For more than just the correctness of terminology, the distensibility index should then be calculated.
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.
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. Emerg Med J 2005;22:411–4.
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. Guideline directed!) .”
Starting antibiotics (D) in the emergencydepartment is not routinely recommended in the nonoperative management of small bowel obstructions. Published online May 2013:1. Utility of EmergencyDepartment Use of Abdominal Pelvic Computed Tomography in the Management of Crohns Disease. doi:10.1097/MIB.0b013e31828a661e
National Assessment of Pediatric Readiness of US EmergencyDepartments during the Covid-19 Pandemic. July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC. Are general emergencydepartments ready to care for children?
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 emergencydepartment (ED). He has been a guest skeptic on the SGEM multiple times.
Direct-access physiotherapy to help manage patients with musculoskeletal disorders in an emergencydepartment: Results of a randomized controlled trial. Case: A forty-year-old woman presents to the emergencydepartment […] The post SGEM#342: Should We Get Physical, Therapy for Minor Musculoskeletal Disorders in the ED?
Case: A 57-year-old woman with hypertension, hyperlipidemia and type-2 diabetes mellitus presents to the emergencydepartment (ED) with fever, cough, myalgias, headache and congestion. Managing editor of EM:RAP and Associate Editor at REBEL EM. It’s flu season and you’ve already seen 15 people with the same symptoms.
Background: The emergencydepartment is frequently visited by patients suffering from symptomatic alcohol withdrawal, and the traditional management has been dominated by repeated doses of benzodiazepines. Return Encounters in EmergencyDepartment Patients Treated with Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal.
Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. AEM Feb 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and Assistant Professor at the University of Calgary. The SGEM has done two previous podcasts on APPs in the ED.
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 emergencydepartment (ED) with acute onset shortness of breath. He states that he recently moved to Texas from Colorado.
A 5-year-old female presented to the emergencydepartment (ED) with a one-year history of gradually increasing anterior neck swelling. She was discharged from the ED on levothyroxine 25 mcg daily with endocrinology outpatient follow-up. 2013 Mar;34(3):115-24; quiz 125. Pediatric neck masses. Pediatr Rev.
In many emergencydepartments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergencydepartments in Denmark Duration: October 9, 2019 to May 26, 2021.
Lacerations are a common presenting complaint to emergencydepartment. In 2013, in the United States there were 7 million visits to the emergencydepartment (ED) for lacerations making up a total of 5.2% of ED visits(1).
The EmergencyDepartment Benchmarking Alliance (EDBA) is a membership organization composed of high-performance emergencydepartments (EDs) that share a commitment to quality. Thus, the survey included data for about one-third of all patients seen in US ED’s in 2022.
He is also one of the world’s leading researchers on pain management in the emergencydepartment and specifically the use of ketamine. Case: A 45-year-old man without a significant past medical history presents to your emergencydepartment (ED) with two days of severe lower back pain after shoveling some dirt.
Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Emergency Medical Services for Children] “Red to Head.” One end of the tape is red with an arrow. PAWPER [Wells 2013, Silvagni 2022] Takes into account body habitus. Int J Emerg Med. J Emerg Med.
Facts and Literature Review Bladder volume estimation Measuring bladder volume via POCUS in pediatric patients has been studied, demonstrating a benefit on EmergencyDepartment workflow and length of stay (Table 1). The pain is intermittent, sharp, severe, and associated with 2 episodes of nonbloody, nonbilious emesis. Chen et al.,
Randomized Double-blind Trial Intramuscular Droperidol, Ziprasidone and Lorazepam for Acute Undifferentiated Agitation in the EmergencyDepartment. 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.
That rant relied upon a Cochrane SRMA by Stevens B et al 2013 and a randomized clinical trail published in Pediatrics by Gray L et al 2015. There are certain patient populations who are at risk for in adequate pain management. One medication that should not be use in children under 12 years of age is codeine.
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%
In the UK, as in most developed countries, more patients are presenting to EmergencyDepartments (EDs) with minor illnesses or injuries. examined 977,907 first-time ED presentations by children aged 0-15 across thirteen acute hospital trusts (between April 2014 and March 2017), trying to figure out how many were non-urgent.
patients that take ACE inhibitors (but 20-30% of all angioedema presentations to the EmergencyDepartment) 3 times more common in Black Americans ( Kostis 2005 ) 0.01 J Emerg Med 2013; 44 (4): 764-772. Optimizing Emergent Surgical Cricothyrotomy for Austere Environments. Emergency Medicine Practice.
Lancet 2021 Case: You’re working a busy evening shift in your community emergencydepartment (ED) when a 58 year old female presents with a rapid onset terrible intensity headache. Jeff was actually on the SGEM as the guest skeptic discussing this clinical decision instrument way back in 2013 ( SGEM#48 ).
The parents of two-year-old, previously healthy, Jamie bring him to the EmergencyDepartment with coryzal symptoms, wheezing and difficulty breathing. Jamie is admitted to the Paediatric Ward, and the paediatric trainee calls the ED to ask if a viral respiratory panel was obtained. 2013 Feb;18(1):5-10. SpO2 is 88%.
How does that apply to the role of the board certified emergency physician? Fundamentally, I believe every patient coming to an emergencydepartment is best served by care delivered by board certified emergency physicians. When those same fundamentals done right achieve great success, they aren’t little at all.
A 43-year-old male, with no significant medical history, presents to the ED for right eye pain. 2013; 7362. Eye Emergencies. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. In: Knoop KJ, Stack LB, Storrow AB, Thurman RJ, eds.
Belcher, MD (EM Attending Physician, University of Kentucky, Department of Emergency Medicine) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine); Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) “What do you call an IV contrast shortage? Alternative contrast agents.
Clinicians may under or over-estimate paediatric patients presenting to the ED as being at high-risk for sepsis if there do not have evidence-based heart and respiratory rate ranges, Brennan et al set out to add to our understanding of what is ‘normal ’ in paediatric vital signs. 2013 Apr 1;131(4):e1150–7. Acad Emerg Med.
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. There is a lack of data to indicate whether these children require endocrine evaluation.
He presented to the emergencydepartment because he is having numbness distal to the site of injury, as well as constant bleeding and some difficulty with flexing his finger. The Atlas of Emergency Medicine, 5e. April 9, 2013. Ann Emerg Med. Emergency Medicine Residents’ Association; 2022:10-11. J Ultrason.
Fletcher, MD, FACEP and Nicholas Slattery, MD Background: Diverticulitis is a common finding amongst EmergencyDepartment patients, accounting for more than 360,000 visits in 2013 alone 1. Once appropriate symptom control was achieved, patients were discharged home with medical treatment and diet recommendations.
Schreyer, MD CMQ FAAE Originally published: Common Sense January/February 2021 The advent and broad availability of ridesharing services, such as Lyft and Uber, are changing the way patients access medical services, and emergencydepartments (EDs) are taking notice. 5 The cost of transport is also an issue.
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