This site uses cookies to improve your experience. To help us insure we adhere to various privacy regulations, please select your country/region of residence. If you do not select a country, we will assume you are from the United States. Select your Cookie Settings or view our Privacy Policy and Terms of Use.
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Used for the proper function of the website
Used for monitoring website traffic and interactions
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Strictly Necessary: Used for the proper function of the website
Performance/Analytics: Used for monitoring website traffic and interactions
Date: October 29, 2024 Reference: Galili et al. Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. Case: You are hitting the zone in your shift, a veritable disposition machine meeting the constant flow of patients through the emergency department (ED). AEM Oct 2024.
A young woman, 13 days post-tonsillectomy, comes into your rural emergency department (ED) coughing up blood. Managing post-tonsillectomy hemorrhage in the ED can be challenging, especially in rural or resource-limited settings. References Grasl S, Mekhail P, Janik S, et al. Dharmawardana N, Chandran D, Elias A, et al.
Date: December 26, 2024 Reference: Steinhauser S et al. Emergency departments (EDs) are often the first point of contact for patients experiencing opioid-related crises, ranging from overdose to withdrawal. Despite this, patients with OUD frequently encounter stigma in healthcare settings, including the ED. Suchismita Datta.
Our experience: Traditionally, ED physicians do not like ordering urine drug screens (UDS). In our study, we used COWS alone in the ED, which does utilize restlessness, anxiety, and tachycardia as part of the formula, as the sole evaluation tool for tranq dope withdrawal. Some patients require re-dosing in the ED.
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. A 55-year-old female presented with the complaint of my right eye popped out. She endorsed right eye blurred vision and severe pain.
Reference: Arnold CG, et al. Case: A ten-year-old boy presents to your emergency department (ED) after being involved in a motor vehicle collision at high speed. His parents were also in the vehicle and are currently being brought to the ED as well. Acad Emerg Med.
Date: October 28, 2024 Reference: Verma et al. With emergency department (ED) volumes rising, administrators are eager to explore AI-driven solutions to improve patient safety and reduce staff burnout. Reference: Verma et al. Clinical evaluation of a machine learning–based early warning system for patient deterioration.
Clinical Application in the ED Incorporating VTI into sepsis management requires minimal additional equipment beyond the ultrasound already present in many emergency departments. This assumption expedites the evaluation of a patient’s volume responsiveness and facilitates implementation in the ED setting. F, and SpO₂ 92% on room air.
About three percent of emergency department (ED) visits are due to skin and soft tissue infections, but data are lacking on the contribution of chronic wounds to this number. Wound management in the ED is only a starting point, and appropriate referral and follow-up are key to an improved outcome. Back to the patient.
Effective Communication Strategies to Aid in the ED When working with neurodivergent patients, emergency physicians can use the following communication strategies to create a positive and respectful experience: Active Listening: Take the time to listen to the patient’s concerns and needs. Maenner MJ, Warren Z, Williams AR, et al.
Benger JR, Kirby K, Black S, et al. Wang HE, Schmicker RH, Daya MR, et al. In: Cone DC, Brice JH, Delbridge TR, Myers B, eds. Ramaiah R, Das D, Bhananker SM, et al. Agro F, Frass M, Benumof JL, et al. Shin WJ, Cheong YS, Yang HS, et al. Price P, Laurie A, Plant E, et al. Accessed October 17, 2024.
Remember, from the ED point of view, if you are confronted with a wide complex regular tachydysrhythmia, assume VTach until proven otherwise! Isenhour JL, Craig S, Gibbs M, et al. References Tannenbaum L, Bridwell R, Inman B. EKG Teaching Rounds. EKG Teaching Rounds. Vereckei A. Curr Cardiol Rev. 2014 Aug;10(3):262-76. Academic EM.
To assess the clinical impact and relevance of these concerns, Alwang et al. 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. PMID: 28423290 Kidwell K, Albo C, Pope M, et al. Sickle Cell Disease in the ED.
My goal in this column is to share tips, tricks, and emerging concepts from the intensive care unit (ICU) that you can use on your next shift in the emergency department (ED). For this inaugural column, I wanted to start with a topic near and dear to my heart: push-dose vasopressors in the ED. This column is for you! to one unit once.
A 28-year-old female is brought to the emergency department (ED) by police after a sexual assault. 1 A significant number of patients present to the ED with concerns related to traumatic experiences. 1 A significant number of patients present to the ED with concerns related to traumatic experiences.
Reference: Umana E, et al. Case: A 6-week-old boy is brought by his parents to your emergency department (ED) for fever. Unfortunately, its expensive, and not all EDs have access to it or can receive the results promptly to help with decision making. Reference: Umana E, et al.
Reference: Bourke EM, et al. Case: A 14-year-old girl with no known medical or psychiatric history presents to the emergency department (ED) with her family for aggression. In the ED setting, pediatric agitation presents unique challenges. Annals of Emergency Medicine.
A Simplified Protocol for Intralipid Administration in the ED Ultrasound-guided nerve blocks (UGNBs) are becoming more common in emergency medicine practice. Recently, numerous Emergency Department (ED) groups have demonstrated the efficacy of UGNBs for pain control with a low rate of complications. Click to enlarge.
Acute toxic ingestions are a common reason for presentation to the emergency department (ED) and clinical scenarios range from benign accidental ingestions to large overdoses resulting in hemodynamic instability. 13 The treatment of toxic exposures causing hemodynamic instability can represent a unique clinical challenge in the ED.
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.
Garcia et al. Although the study includes a variety of patient settings, such as CT surgery and cath lab patients, which may not be directly applicable to ED patients, it’s certainly worth a read. Epinephrine and cardiac arrest: what’s the question? How much epinephrine is enough? Link to article
The emergency department (ED) is full with boarding and critical patients, and 25 patients are in the waiting room. 15 Some specific interventions to improve communication in the ED include a seated position, eye contact, reflective listening, and physician self-disclosure. Howick J, Moscrop A, Mebius A, et al. J R Soc Med.
I was about two months into a family practice internship when I went to visit my uncle whose neighbor happened to be an ED resident, Dr. Clarke said. ED attendings Dr. Gerald Whelan and Dr. Shumary Chow supervising a full arrest in C booththe main trauma roomwith an ED tech administering CPR. Click to enlarge.) Click to enlarge.)
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.
On arrival, here is the ED ECG: No significant change. mm (presumably in 2 consecutive leads, but this important study by Wung et al in 2001 is vague on that). Had this patient had atrial fibrillation with rapid ventricular response, cardioversion would have been indicated (hypotension and very recent onset).
Major takeaway: Consider SBP in any patient who comes into the ED with ascites. 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. Arvaniti V, D’Amico G, Fede G, et al. Hepatology. Hepatology.
A follow-up review conducted in 2006 found that ED personnel utilizing non-invasive positive pressure ventilation (NPPV) could decrease the relative risk of mortality by 39% while simultaneously decreasing the need for endotracheal intubation by 57% in patients with similar signs and symptoms (Collins et al.,
Paper: von Hellmann R, Fuhr N, Maia IWA, et al. Duration of intubation: Nine of thirteen studies reported slightly longer intubation times with a bougie, with a maximum average increase of 13 seconds in ED–based studies. References: Driver BE, Prekker ME, Klein LR, et al. PMID: 29800096 Driver BE et al. Ann Emerg Med.
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. Parvizi J, Tan TL, Goswami K, et al.
100% seems too good to be true Morello et al., European Journal of Internal Medicine , [link] You can listen to my 27-minute rant on Youtube here: [link] This multinational trial looked at a three-pronged diagnostic protocol in the ED for adults with suspected acute aortic syndromes. Did they pick a heap of PEs?
Perkins ZB, Greenhalgh R, Avest E, et al. Sutori D, Erdelyi LS, Uri I, et al. Dorsett M, Allen H, Garbacz H, et al. Baker PO, Karim SR, Smith SW, et al. Perkins ZB, Greenhalgh R, Avest E, et al. Sutori D, Erdelyi LS, Uri I, et al. Baker PO, Karim SR, Smith SW, et al. 2025;160:432-440 2. 2025 [link] 4.
It’s a busy day in the paediatric ED. Back to our toddler in the ED. References Brent J, McMartin K, Phillips S, et al. Barceloux DG, Bond GR, Krenzelok EP, et al. Hassanian-Moghaddam H, Pajoumand A, Dadgar SM, et al. The child looks unsettled but otherwise fine—for now. “It N Engl J Med. 2001;344(6):424–429.
Options include feedback on the final diagnosis, inpatient progress, prehospital and ED management, and general paediatric learning points. Feedback quotes from prehospital clinicians: “For me, there was some diagnostic uncertainty in this case so it was very useful to hear what the ED diagnosis was. Thank you so much.”
Evans, et al., Gausche-Hill M, et al. Hair-Grooming Syncope When evaluating these patients with low-risk syncope, how often have you asked: “Were you getting your hair groomed when you passed out?” Hair-grooming syncope is a rare subtype of neurocardiogenic syncope that is precipitated by different acts of hair care or grooming.
The ED staff quickly checks vital signs and a blood glucose, starts an IV, then wheels the patient to the CT scanner, where you perform a brief exam. According to the patient’s wife, his symptoms started suddenly, approximately one hour before they arrived at the ED. 37595 Martin-Schild S, Albright KC, Tanksley J, et al.
However, these figures fail to account for downstream costs due to misdiagnosis, delayed care, or subsequent ED visits. 23 Utilization of terminology, for example, non-emergent, is problematic because field assessment can miss subtleties that ED evaluations catch. ” 31 This term is repeated in the CMS final report on ET3.
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.
Article: Chanderraj R, Admon AJ, He Y, et al. They analyzed the electronic health records of patients presenting to the ED who met modified Center for Disease Control and Prevention (CDC) sepsis surveillance criteria and received empiric treatment with either vancomycin/piperacillin-tazobactam or vancomycin/cefepime. JAMA Intern Med.
ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. Labs Laboratory workup in the ED is notable for a leukocytosis of 41,000/L, hemoglobin of 6.5 She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI. 57 Table 2.
ED Evaluation: Clinical diagnosis in the ED based on history and exam. Other biomarkers available but not helpful in ED setting (Fas ligand, granzyme B, soluble CD40 ligand, granulysin, high mobility group protein B1, RIPK3, galectin 7, CCR-27, and IL-15). link] Sassolas B, Haddad C, Mockenhaupt M, et al. J Burn Care Res.
Authors: Noah Kronk, MS-4 (University of Missouri-Columbia); Jessica Pelletier, DO, MHPE (APD, EM Attending Physician, University of Missouri-Columbia, USA) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case A 30-year-old female presents to the emergency department (ED) with fever, fatigue, and an extensive rash.
Thats exactly what Shane George et al. George S, Williams T, Humphreys S, et al. A total of eleven intensive care units (ten PICUs and one non-maternity NICU) and four emergency departments (EDs) took part in the study. Recruitment took place across ten PICUs, one NICU, and four EDs in Australia, New Zealand, and Switzerland.
We organize all of the trending information in your field so you don't have to. Join 5,000+ users and stay up to date on the latest articles your peers are reading.
You know about us, now we want to get to know you!
Let's personalize your content
Let's get even more personalized
We recognize your account from another site in our network, please click 'Send Email' below to continue with verifying your account and setting a password.
297 
Let's personalize your content