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He is the Vice Chair of the EmergencyDepartment and Program Director of the EM residency program at Nassau University Medical Center in East Meadow, NY, the safety net hospital for Nassau County. It has become a favourite medication in emergencydepartments for procedural sedation as well as a useful behavioural takedown medication.
Sandi Angus is a Paediatric and Adult Emergency Medicine Registrar in the Shrewsbury and Telford Hospital NHS Trust. Case: A ten-year-old boy presents to your emergencydepartment (ED) after being involved in a motor vehicle collision at high speed. Emergency Medical Service (EMS) tells you that he was properly restrained.
The Childrens EmergencyDepartment is a busy, challenging, and dynamic environment. Here are eight key leadership lessons inspired by real-life interactions and reflections from Paediatric Emergency Care 1. They involve a mixture of clinical, communication, and leadership traits.
The emergencydepartment is a place of risk and errors. “Implementation of Electronic Triggers to Identify Diagnostic Errors in EmergencyDepartments” [link] Tweet Those who work in the ED are acutely aware of this, and it conjures up tremendous cognitive pressures on staff every shift.
On a busy day shift in the emergencydepartment, our seasoned triage nurse comes to me after I finish caring for a hallway patient, “Hey, can you come see this guy in the triage room? This is the essence of emergency medicine. His vitals are fine…”. In the age of big data, more information sounds like a boon.
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). Known hypotension, as a bridge to a continuous infusion of a pressor. Unanticipated hypotension. Use in the ED has mainly been described in case reports.
Bupe Allergy Buprenorphine induction has been the mainstay of emergencydepartment treatment of opioid use disorder for more than a decade [11, 12]. The biggest change has been the gradual replacement of diacetylmorphine (heroin) by fentanyl and other synthetic opioids.
A 25-year-old female with no pertinent past medical history presented to an emergencydepartment in Massachusetts with four days of generalized malaise, myalgias, congestion, low-grade fever, and a rash behind her left knee. The patient denied cough, shortness of breath, chest pain, abdominal pain, nausea, vomiting, and diarrhea.
The hospitals patient volume has more than doubled in the past couple of years, and the emergencydepartment has expanded from seven beds to include two surge spots with four beds each. The emergencydepartment receives an estimated 13,000 annual visits, with approximately 5,500 of those visits being older adult patients.
First, research suggests a higher number of emergencydepartment visits among individuals with ASD. About 30 percent of children with ASD need treatment in an emergencydepartment, and this number increases to nearly 70 percent for those aged 15–18. But what exactly are neurodivergence and neurodiversity?
The patient was discharged from the emergencydepartment with tobradex ointment and ophthalmology follow-up in one week Case Discussion Take-Home Points Immediate reduction of a luxed globe is paramount. Symptoms started approximately seven hours prior to arrival and progressive, severe pain eventually prompted her visit to the ED.
The emergencydepartment (ED) is full with boarding and critical patients, and 25 patients are in the waiting room. What is the emergency physician’s role? Ann Emerg Med. Let Me Tell You About My…” Provider self-disclosure in the emergencydepartment builds patient rapport. West J Emerg Med.
Emergencydepartment staff compassion is associated with lower fear of enacted stigma among patients with opioid use disorder. She is anAssistant Professor and Director of Research in theDepartment of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. Date: December 26, 2024 Reference: Steinhauser S et al.
A 26-year-old male with a past medical history of eczema presented to the EmergencyDepartment with a rash for two days. The patient stated he first noticed a rash on his right arm that rapidly spread to his face, chest, and left arm. He reported having similar rashes before but never to this extent. He made a full recovery.
Journal of Hepatology Association of central capillary refill time with mortality in adult trauma patients: a secondary analysis of the crash-2 randomised controlled trial data Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Dorsal Digital Nerve Block Versus Ultrasound-Guided Selective Peripheral Nerve Block for Finger Analgesia: (..)
They applied a three-way seal and transported him to the Emergencydepartment. This results in less protection for underlying structures, and more force is transmitted to the underlying organs. A high index of suspicion is essential—even in the absence of bruising, deformity, or wounds. What you don’t see can still be life-threatening.
A young woman, 13 days post-tonsillectomy, comes into your rural emergencydepartment (ED) coughing up blood. On exam, you see bright red blood trickling down her left tonsillar fossa. Her vital signs are normal, except for a heart rate of 115 bpm. Its going to take time to get her to a tertiary center. CREDIT: Dr. P.
Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)
There should be a 2-hour limit before you can give Diltiazem, or rate control, in the EmergencyDepartment. He wants paramedics to ask the same question he asks: Is the rapid A-fib the primary problem or secondary to another critical condition like sepsis, PE, DKA, hypovolemia, etc?
A 3-month-old male with no past medical history was brought to the emergencydepartment for evaluation of newly asymmetric pupils. The infant appeared to be asymptomatic per parents, without any behavior changes or associated symptoms noted. Abdominal : Soft, nontender, nondistended. Neurological : Alert. Normal muscle tone.
Between 2006-2017 the country saw a 60% rise in pediatric emergencydepartment visits that were related to behavioral health. This increase was also reflected in data from 2011-2020 where pediatric emergencydepartment visits for behavioral health increased from 4.8 million in 2011 to 7.5 million in 2020. of visits.
Case: The Chief of Emergency Medicine (EM) at a large urban hospital recently approached the AI Committee at Unity Health, intrigued by the CMAJ article describing the apparent success of CHARTWatch in detecting early signs of patient deterioration. Reference: Verma et al.
EmergencyDepartment Management Resuscitation & ABCs: oxygen, IV fluids, vitals monitoring. Defined by: >20% blasts in peripheral blood or bone marrow. May include extramedullary blast proliferation. Without treatment, median survival is only 36 months. LDH & uric acid: markers of high cell turnover.
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.
Since the county health department program launched in October, Breunig has provided direct medical care or medical case management to more than 110 people. Besides, he and Breunig said, emergencydepartments are not the ideal setting for many of the services these patients need, like renewing a prescription or dressing a wound.
About three percent of emergencydepartment (ED) visits are due to skin and soft tissue infections, but data are lacking on the contribution of chronic wounds to this number. The impact of early-stage wounds, including those at risk of progression, is also poorly studied and may go unnoticed.
These are very commonly encountered in the emergencydepartment, so being able to correctly identify the rhythm is extremely important. Lets dive in! When you are presented with a tachycardic ECG, we want you to focus on two major factors right away. Ask yourself, is the QRS narrow or wide and is the R-R interval regular or irregular?
Owen Hibberd The use and utility of the paediatric oral fluid challenge in a single tertiary paediatric emergencydepartment Why? The paediatric oral fluid challenge (OFC) has been a staple in emergencydepartments for years, helping to determine which children struggling with oral intake truly need IV fluids.
A 28-year-old female is brought to the emergencydepartment (ED) by police after a sexual assault. She is visibly anxious and tearful. The police officer is waiting for the sexual assault evidence kit. What is the trauma-informed approach to care for this patient? These concerns may be a direct result of trauma (e.g.,
These are very commonly encountered in the emergencydepartment, so being able to correctly identify the rhythm is extremely important. Let’s dive in! When you are presented with a tachycardic ECG, we want you to focus on two major factors right away. This is a diagnosis that can be made off of telemetry or a rhythm strip.
A 55-year-old woman with medical history of well-controlled hypertension and renal cell carcinoma, status post-partial nephrectomy, presented to the emergencydepartment (ED) with sudden-onset, 10-out-of-10 chest pain and pressure. She denied back pain and abdominal pain but endorsed mild nausea. She had a normal cardiopulmonary exam.
A 48-year-old male with no significant past medical history presented to the EmergencyDepartment with a left-sided facial rash and associated burning left eye pain that started four days prior. He was seen at an ophthalmology clinic when his symptoms started and given oral valacyclovir which he took for three days without improvement.
Eczema herpeticum: making the diagnosis in the emergencydepartment. J Emerg Med. Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. 2011 Feb;40(2):167-9. doi: 10.1016/j.jemermed.2007.11.049.
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.
Its narrow indication for stable VT means many emergencydepartments may not routinely stock the medication. Naturally you would assume that this was a large, multicenter trial, right? This was based on 11, thats not a typo, ELEVEN patients. Ok, so what did the PROCAMIO trial find? Ok, so what did the PROCAMIO trial find?
In a large emergencydepartment, intubation is a frequent enough event to generate confidence. Finally, it should be noted that EMS’s LTs were converted to ETI at the receiving emergencydepartment 64.4 However, paramedic experience for intubation may entail one to eight attempts per year. percent compared with 11.8
14,15 This suggest VExUS may be utilized as a marker for identifying emergent hemodialysis in patient’s presenting to the emergencydepartment. Frequently, point-of-care ultrasound (POCUS) is utilized to evaluate ejection fraction and for B-lines, but evaluating for these alone does not answer the full question.
Fever in the EmergencyDepartment predicts survival of patients with severe sepsis and septic shock admitted to the ICU. Bottom Line Up Top: There doesnt appear to be a morbidity or mortality benefit to treating fever in sepsis and fever may have a protective effect. Only treat fever if it causes the patient distress. Sat 93% on RA.
Acute toxic ingestions are a common reason for presentation to the emergencydepartment (ED) and clinical scenarios range from benign accidental ingestions to large overdoses resulting in hemodynamic instability. The dose is 25 mg- 100 mg for adults and 0.5 mg/kg-1 mg/kg with maximum dose of 50 mg in children.
Although finding the perfect outfit and keeping it clean, making sure remnants of breakfast aren’t present in the child’s teeth, and getting their hairstyle just right are typical stressors surrounding picture day, most parents do not think about their young student having a potential medical emergency just hours before saying “cheese.”
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). However, in emergencydepartment studies, there were no direct airway injuries related to bougie use.
examined prehospital or initial emergencydepartment ECGs for the presence of these “STEMI equivalents” and found that approximately 4% of patients treated with emergent PCI had one of these three findings (ST elevation in aVR, De Winter T waves, and Wellens Syndrome) 7. Non-occlusive MI would tend to be managed medically.
You are working in the paediatric emergencydepartment overnight, and the resus nurses are checking the emergency drugs during their daily checks. The department is quiet, and one of the newly qualified nurses asks you to explain why there are so many different concentrations of adrenaline and how they work.
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