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With emergencydepartment (ED) volumes rising, administrators are eager to explore AI-driven solutions to improve patient safety and reduce staff burnout. By alerting clinicians to potential problems before they become critical, AI-driven systems aim to reduce unplanned ICU transfers and improve survival rates.
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 emergencydepartment (ED). For this inaugural column, I wanted to start with a topic near and dear to my heart: push-dose vasopressors in the ED.
Bupe Allergy Buprenorphine induction has been the mainstay of emergencydepartment treatment of opioid use disorder for more than a decade [11, 12]. Our experience: Traditionally, ED physicians do not like ordering urine drug screens (UDS). Some patients require re-dosing in the ED. Journal of general internal medicine.
In emergencydepartments, determining a septic patient’s fluid responsiveness can be challenging, as both under- and over-resuscitation can lead to poor outcomes. It is an essential metric for estimating cardiac output without the need for invasive procedures within the emergencydepartment. F, and SpO₂ 92% on room air.
Included patients from out-of-hospital, emergencydepartment, intensive care unit, and operating-room intubations. Intubation performed in all settings (out-of-hospital, emergencydepartment, ICU, and operating room). Randomized controlled trials or comparative non-randomized observational studies.
Clarke had begun an emergency medicine residency at what was then known as LA CountyUSC Hospital, Los Angeles. 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 resident Dr. Steve Hui doing a pericardiocentesis on a trauma patient.
The characteristics that were significantly different between the LR and NS exposure groups race, organ dysfunction at presentation, ICU admission, hemoglobin SS genotype, discharge year, and hydroxyurea use were appropriately included as confounders in the TMLE analysis. Sickle Cell Disease in the ED. 2021;16(2):e0247324.
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.
What They Did: Investigators performed a retrospective cohort study in the EmergencyDepartment at the University of Michigan between July 1, 2014 through December 31, 2018. Imbalances Between Treatment Groups : ICU Admissions : Higher in piperacillin-tazobactam (33% vs. 30%). Sex : More males in piperacillin-tazobactam (57.1%
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.
set out to explore in the Kids THRIVE study investigating whether NHF apnoeic oxygenation could improve intubation outcomes in critically unwell children needing emergency airway management. A total of eleven intensive care units (ten PICUs and one non-maternity NICU) and four emergencydepartments (EDs) took part in the study.
Lower intubation, need for BPAP and ICU admission in bolus group (Levy 2007). 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.
This series highlights members of the GEDC community who are clinical champions for older adults in the emergencydepartment. Throughout her career as a pharmacist, Jennifer Esch, PharmD, MBA, BCPS, has worked in a variety of hospital settings from the ICU to the emergencydepartment.
For example, discharge risk stratification tools, such as the emergencydepartment (ED) revisit algorithm or the SHOUT scoring system (see Table 1 ), provide structured approaches to identifying patient risk levels for readmission, follow-up failure, or adverse outcomes. No external validation. No external validation.
normal glucose, and mild acute on chronic renal failure (Creatinine from 140 to 170 umol/L), and the following ECG, and they were sent to the ED. The patient was seen three hours later in the ED, with triage vitals showing BP 50 and BP 106/60. ED labs showed a repeat K of 6.6 Eur J Emerg Med 2020. References 1.
PECARN prediction rule for cervical spine imaging of children presenting to the emergencydepartment with blunt trauma: a multicentre prospective observational study. Lancet Child Adolesc Health. 2024 Jul;8(7):482-490. doi: 10.1016/S2352-4642(24)00104-4. Epub 2024 Jun 4.
Jarcho JA, ed. Myasthenia Gravis and Crisis: Evaluation and Management in the EmergencyDepartment. J Emerg Med. Hazardous Chemical Emergencies and Poisonings. Longo DL, ed. The patient’s caregivers noticed that the patient had become more short of breath over the last 12 hours and seemed confused.
Case: A 62-year-old male presents to the EmergencyDepartment (ED) with fever, confusion, and shortness of breath. This parameter has the advantage of being available very quickly without additional blood draws, which could be helpful in the fast-paced ED setting.
Clinical Scenario: A 62 year old woman with a history of HTN, ESRD on MWF dialysis presents to the EmergencyDepartment with generalized weakness. Similar results were found for 219 paired samples from ICU patients with statistically significant but clinically meaningless differences for sodium and potassium ( Triplett 2016 ).
On arrival to the ED the patient’s initial vital signs are temperature 38.5C, BP 102/48, HR 106, RR 20. 6 Patients who receive deferoxamine, have significant metabolic abnormalities, or hypotension should be admitted to an intensive care unit (ICU). She was initiated on deferoxamine and admitted to the ICU. Tenenbein M.
Intubated patients in the ED should have soft, wrist restraints places without the need for arduous, high-risk documentation or sitters Intubation Checklist EMCrit 176 – Updated EMCrit Rapid Sequence Intubation Checklist Awareness during Paralysis EMCrit 331 – Awareness after Resus RSI and ICU Paralysis – It is Unacceptable!!!
Guidelines for Reasonable and Appropriate Care in the EmergencyDepartment (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergencydepartment. He is a Professor of Emergency Medicine and a Clinician Scientist in the Department of Family and Community Medicine at U of T.
Fever in the EmergencyDepartment Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Guest Skeptic: Jesse Spurr works as a Nurse Educator in the EmergencyDepartment at Redcliffe Hospital in Australia. Case: You are working night shift in the emergencydepartment.
The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. She is an Assistant Professor and Director of Research in the Department of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. He is wondering, “Hey doc, do I have to go back to the ICU strapped to an IV pole?”
Historically, it has been used more frequently in the ICU than in EmergencyDepartments, likely due to provider comfort. […] The post Is there a Precedence for Precedex in the ED? It offers a unique profile of sedation without respiratory depression, making it an attractive option in various clinical scenarios.
Are you using phenobarbital instead of benzodiazepines as the first-line monotherapy for patients in alcohol withdrawal in the EmergencyDepartment (ED)? Is phenobarbital safe for the treatment of EtOH withdrawal in the ED? The Journal of Emergency Medicine. Open Access Emerg Med. Well not exactly.
Prehospital Emergency Care. Date: April 25, 2024 Guest Skeptic: Missy Carter is a PA working in an ICU in the Tacoma area and an adjunct faculty member with the Tacoma Community College paramedic program. When emergencydepartment (ED) staff roll her to remove her clothing her humeral intraosseous (IO) is dislodged.
Full dose challenge of moderate, severe and unknown beta-lactam allergies in the emergencydepartment. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Case: It’s another day, another dollar in the emergencydepartment (ED). AEM August 2024.
Background: Standard rapid sequence intubation (RSI) in the emergencydepartment involves administration of an induction agent and a neuroblocking agent in quick succession. REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? Click here for Direct Download of the Podcast Paper: Knack SKS et al. Range 5 to 9) Diff -0.2;
2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. Over the past few years, there has been an increase in emergencydepartment (ED) volumes and lengths of stay. Paper: Owyang CG, et al. J Crit Care. J Crit Care.
Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Reference: Cashen K, Reeder RW, Ahmed T, et al. Pediatric Crit Care Med.
Max is then going to Georgetown to be an attending in both EM and ICU. Case: It’s another day in your emergencydepartment (ED). The triage nurse places a 61 year-old-man with fever, hypotension, cough into the smallest room in the ED. You scan through the EMR and see the blood pressure is 60/40.
Emergencydepartments (EDs) provide the essential service of evaluating patients with unscheduled, acute, undifferentiated, and decompensated conditions. ED crowding impairs this mission. 2 This article discusses the practical and ethical issues of interhospital transfer of these patients.
. #1: PREOXI RCT – Preoxygenation with Noninvasive Ventilation vs. Non-rebreather Mask Spoon Feed Noninvasive ventilation (NIV) was superior to a standard non-rebreather (NRB) oxygen mask for preoxygenation of critically ill ED or ICU patients requiring intubation, with a NNT of 11 to prevent 1 episode of hypoxemia <85%.
2020 Case: A 74-year-old woman who suffered a fall earlier today presents to the emergencydepartment (ED) and is found to have five rib fractures to her right thorax, but no other injury. His team found grip strength was weakly correlated with frailty in older ED patients [6]. J Trauma Acute Care Surg.
Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the EmergencyDepartment (ED). 2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Am J Emerg Med. 2022 Sep 7.
CJEM debate series: #StillTheOne-while more challenging than ever, emergency medicine is still the best career path available for medical students. PMID: 38592662 Bottom line: Would you be happy if you kid follow-ed your footsteps into emergency medicine? As loud as a construction site: Noise levels in the emergencydepartment.
Intravenous insulin infusions typically require treatment in highly monitored settings, such as an intensive care unit (ICU) or step-down unit for safety and due to the frequency and intensity of monitoring. ICU and step-down beds are a limited resource and generate higher hospital charges. Acad Emerg Med. JAMA Netw Open.
Case: A 59-year-old woman comes is brought into your emergencydepartment (ED) by EMS in cardiac arrest. The patient achieved return of spontaneous circulation (ROSC) on arrival to the ED. She had a witnessed arrest, and CPR was initiated by bystanders.
This study chose a relevant topic to analyze that could influence acute management in the ED and has a fairly larger sample size of patients to do so. If pre-made syringes are not financially feasible then the creation of these medications should be done by a dedicated emergencydepartment pharmacist. Am J Emerg Med.
On ED arrival GCS is 3, there are rapid eye movements to the right but no other apparent seizure activity. Propofol utilized for sedation; patient admitted to ICU for EEG monitoring. Official diagnosis requires EEG, which is not something we can typically obtain in the ED. They administer two doses of 10 mg midazolam IM.
1 History and physical examination have been the cornerstone of seizure diagnosis in the emergencydepartment (ED). 2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus).
A patient had 3rd degree AV block in the ED. A transvenous pacer was placed in the EmergencyDepartment by the emergency physicians. and the 2021 YouTube Review by ICU Advantage on "Temporary Pacemakers: Modes and Basic Settings".
She presented to the emergencydepartment after a couple of days of chest discomfort. The pacing rate was increased without clinical improvement and the patient was transferred to the ICU for closer monitoring/treatment. This patient presented to the ED “after a couple of days of chest discomfort”.
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