The Trauma Pro

AUGUST 22, 2023

The patient is doing well but has an unexplained pressure dip. They found that they both worked well with the following results: Shock index > 1 – 68% sensitive 81% specific ABC > 2 – 47% sensitive, 90% specific The study suggests that shock index is more sensitive, and takes less technical skill to calculate. It happens again.

Shock 100

Shock Wellness EMS 100

Pediatric EM Morsels

SEPTEMBER 22, 2023

” Children compensate for blood and volume loss very well… until they don’t. 2018 Oct;14(2):47-54. Epub 2018 Oct 31. As our fearless leader likes to say: “children are not aliens, but they are a special population with unique anatomy and physiology.” Treasure Island (FL): StatPearls Publishing; 2023 Jan-.

Shock 274

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 274

Pediatric EM Morsels

OCTOBER 27, 2023

Taking care of a critically ill child can be nerve-racking to say the least, and downright petrifying for those who don’t do it frequently, even if they are well-trained and brilliant clinicians. Sinha 2012] It is useful in the prehospital setting , correlating well with actual weight and ED Broselow weight. Broselow does not.

Pediatrics 244

Pediatrics Resuscitation Documentation/Coding Wellness 244

Pediatric EM Morsels

AUGUST 18, 2023

Wirth 2018) One study including 4.4 Meesters 2018) Resistance is growing (likely from inappropriate / overuse)! (Jackson 2016) It can also be used in UTIs , but is typically reserved for special cases where the infectious bacteria is found to be multidrug resistant or in complicated UTIs. 451 pediatric patients were included.

Pediatrics 130

Pediatrics Infectious Diseases Hospitals Seizures 130

Pediatric EM Morsels

AUGUST 4, 2023

Ganss, 2018) There are additional associations with scoliosis, burn injuries, and spinal cord injuries. (Oka, Positional changes after intake can also be helpful including the lateral decubitus position as well as knee to chest. Ganss, 2018) At least one case of abdominal compartment syndrome noted in the literature.

Pediatrics 221

Pediatrics Burns Operations Ultrasounds 221

Greater Sydney Area HEMS

FEBRUARY 20, 2024

The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i]. Its use in the prehospital environment is not well known or studied and may be an interesting area for future research. [i] Anesthesiology 2018; 128 : 38–43. [v] Medicine 2018; 97 : e13661. Green et al.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

Pediatric EM Morsels

JULY 7, 2023

Cunningham, 2018 ] Account for less than 1% of all knee injuries. Seen in sports that involved aggressive twisting of the knee (ex, snowboarding, soccer, horse-riding) as well as direct trauma. Epub 2018 Apr 19. The PTF joint is inherently stable with good ligamentous support, especially when the knee is in extension.

Dislocations 141

Dislocations Fractures Pediatrics EMS 141

ALiEM

MAY 13, 2024

They may be well-circumscribed or may have irregular borders. Well-circumscribed abscess with heterogeneous debris C. Larger abscess with well-circumscribed borders D. Superficial abscess with well-circumscribed borders Table 1. 2018 Jan;54(1):96-101. The rim may be echogenic or blend in with surrounding tissue.

Ultrasounds 64

Ultrasounds Pediatrics Emergency Department Wellness 64

Ken Grauer, MD

APRIL 26, 2024

An example of a case in which the diagnosis of acute OMI was made purely by assessment of ST-T wave morphology in a PVC can be found HERE ( See My Comment at the bottom of this page in the October 8, 2018 post in Dr. Smith's ECG Blog ). = A cknowledgment : My appreciation for this case that is anonymously contributed. =

EKG/ECG 348

EKG/ECG Resuscitation EMS Wellness 348

Pediatric EM Morsels

JULY 21, 2023

cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! 2018 Jun;128(6):1612-1620. 2018): 192–200. Fun fact for animal lovers!- Brennan PM, Murray GD, Teasdale GM. Simplifying the use of prognostic information in traumatic brain injury. J Neurosurg.

Head Injuries 231

Head Injuries Pediatrics Outcomes Shock 231

Ken Grauer, MD

APRIL 18, 2023

This blog post reviews the basics for predicting the " C ulprit" A rtery ( as well as reviewing why the term "STEMI" — should replaced by " OMI" = O cclusion-based MI ). For review — Check Out My Comment — at the bottom of the page in the following posts on Dr. Smith's ECG Blog: The June 4, 2018 post ( LA-LL reversal ).

EKG/ECG 195

EKG/ECG Wellness 195

Taming the SRU

MAY 13, 2024

The patient is a well-appearing male who is awake, alert, and oriented. There is also a well-appearing, healed surgical scar. There is also a well-appearing, healed surgical scar. The skin is warm and well perfused with brisk capillary refill. World J Emerg Surg 13, 22 (2018). Notable diagnostics CBC : WBC 19.2,

Ultrasounds 87

Ultrasounds Emergency Department Wellness Operations 87

Ken Grauer, MD

JUNE 6, 2023

That said — lack of a well defined P wave in lead II makes assessment of the PR interval difficult — and — the QRS looks a little wide in lead V3, albeit QRS duration does not appear to exceed 0.10 This explains the marked increased in QRS amplitude in the lateral chest leads — as well as some of the ST-T wave depression in these leads.

EKG/ECG 195

EKG/ECG Hospitals Wellness Resuscitation 195

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Background: Sepsis remains one of the leading causes of morbidity and mortality.

Sepsis 122

Sepsis Hospitals Administration Outcomes 122

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

Dr. Smith's ECG Blog

JULY 26, 2023

But the well-formed Q-wave and the presence of a normal T-wave in inferior leads led me to believe this was Old Inferior MI with persistent ST Elevation, otherwise known as inferior LV aneurysm. To facilitate comparison in Figure-1 — I put this 2018 prior tracing ( = ECG #3 ) — together with ECG #1.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

ALiEM

DECEMBER 8, 2023

Major risk factors for their development include prior abdominal surgeries that weaken the musculature as well as cardiovascular co-morbidities. 2018 Apr;22(2):353-361. Epub 2018 Jan 27. Case Discussion Take-Home Points Abdominal wall hernias are classified by their location: ventral, groin, pelvic, and flank. PMID: 32310432.

Academics 60

Academics Emergency Department Outcomes Wellness 60

ALiEM

MARCH 7, 2024

It is usually large, nodular, well-defined, homogeneous, and slightly hypoechoic (Figure 13) [6]. Acad Emerg Med , 2018 [11] Systematic review & Meta-analysis, Multicenter, 2005 Through April 2016 N=1,773, Adults POCUS has modest diagnostic accuracy in adults for nephrolithiasis. Wong et al.,

Ultrasounds 70

Ultrasounds Pediatrics Emergency Department Radiology 70

The Trauma Pro

SEPTEMBER 14, 2023

” This guideline was implemented in 2018-2019, and patients presenting before implementation were compared to those arriving after. The Medical College of Wisconsin trauma group performed a retrospective review of 391 patient charts to test a new 300cc rule defining when a hemothorax is “too big.”

Resuscitation 162

Resuscitation Hospitals Wellness 162

Don't Forget the Bubbles

AUGUST 23, 2023

Definitive emotional support is critical to our emotional and psychological well-being. 2018) “Benefits of using the pause after death in emergency departments: a Delphi study”. 2018) “Sacred Pause Imitative in the ICU: A survey of ICU physicians and nurses”. Psychological harm occurs. & Liska, H. Journal of Trauma Nursing.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

PEMBlog

MAY 9, 2024

2018 Nov;142(5):e20181009. Epub 2018 Oct 8. Well, they are the most common neurologic disorder of infants and young children, and they happen in about 2 to 4 percent of children between the ages of 6 months and 5 years of age. And interestingly, they’re usually about the same length as well. Pediatrics.

Seizures 59

Seizures Pediatrics Wellness Emergency Department 59

Don't Forget the Bubbles

JANUARY 24, 2024

The first human trials for children with SRSE were conducted in 2014 where 2 patients responded well to the treatment and there have been encouraging results in open label adult trials more recently. 2018 May 17;378(20):1888-1897. 2018 Dec;84(6):940-945. Epub 2018 Nov 30. N Engl J Med. doi: 10.1056/NEJMoa1714631.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

Emergency Medicine Journal

MAY 23, 2023

A modified GBS (mGBS) and CANUKA score have recently been proposed but have not been well studied. Methods A single-centre retrospective study was performed including patients with suspected UGIB visiting the ED of Saint-Antoine hospital (Paris, France) from January 2016 to December 2018.

Emergency Department 40

Emergency Department Blood Transfusions Hospitals Wellness 40

Taming the SRU

MARCH 12, 2024

ED visits per 1000 adults with diabetes based on 2018 data resulting in over 500,000 annual hospital days. as well as patients less than 18 years old were excluded from analysis. DKA accounts for approximately 223,000 ED visits annually or 8.9 This amounts to annual hospital costs of $5.1

Operations 86

Operations Hospitals Wellness Best Practices 86

ACEP Now

NOVEMBER 13, 2023

1,2 In a 2018 study by ACEP, nearly half of emergency physicians polled reported a physical assault while at work. For the safety of staff as well as patients, interventions that interrupt escalations before they blossom into violence deserve further study. “But References Workplace Violence in Healthcare, 2018. Published 2018.

Emergency Department 52

Emergency Department Documentation/Coding Psychiatric Best Practices 52

SheMD

NOVEMBER 9, 2023

One of my favorite quotes from Girl Med Live 2018 was Dr. Suzy Feigofsky ( @DrSuzyFeigofsky ) saying “Every time you say ‘yes’ to something, you are saying ‘no’ to something else.” Being well-rested is a value. What do I want to call my mom and tell her about when it’s going well? Getting paid is a value.

Leadership 52

Leadership Wellness Research 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Background While the role of Extended Focused Assessment with Sonography in Trauma (eFAST) is well defined in the management of severe blunt trauma, its performance in injuries caused by stab wounds has been poorly assessed.

Wellness 40

Wellness 40

The Skeptics' Guide to EM

DECEMBER 23, 2023

Well done CFPC. Well, it is because we are all on Team Patient. million in 2018. Mike Green) apologized and announced they are not implementing an additional year of training. This took a great deal of insight and humility. Now it is time to address some immediate issues with Family Practice. million in March 2020, or up from 1.6

Administration 53

Administration Research Wellness 53

EMDocs

DECEMBER 4, 2023

The Wells’ Criteria for DVT can help risk stratify [2,3]. If the patient’s Wells score is ≤ 0, DVT is nearly clinically excluded and no further immediate lab or ultrasound is necessary. In patients with a Wells’ score of 1-2 (moderate risk), DVT can be ruled out with a negative d-dimer rather than an US. Published 2020 Feb 11.

Ultrasounds 70

Ultrasounds Wellness Documentation/Coding EMS 70

American Medical Compliance

APRIL 10, 2023

This empowers victims to step forward with these allegations as well as show others that they are not alone. Reference Christina Jewett (22 March 2018). The goal is to normalize accountability for those who victimize women in the healthcare field and the organizations that allow it. Visit [link] for more information.

Hospitals 52

Hospitals Wellness 52

EMDocs

DECEMBER 11, 2023

There are multiple criteria systems for diagnostic an acute myocardial infarction in this population, as well as patients with ventricular-paced rhythms. Fourth Universal Definition of Myocardial Infarction (2018). 2018 Oct 30;72(18):2231-2264. J Am Coll Cardiol. Meyers, S.D. Weingart, S.W. The OMI manifesto.

EKG/ECG 109

EKG/ECG Emergency Department Academics Operations 109

Cook County EM Blog

MAY 15, 2023

His EKG suggested a posterior MI as well as other signs of ischemia. Repeat EKGs continued to show ST depression in V2, as well as a new q wave in lead II, and deeper, wider q waves in lead III and aVF. Fourth Universal Definition of Myocardial Infarction (2018). What does this EKG suggest? and eventually doubled to.112.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Heart disease and stroke statistics—2018 update: A report from the American Heart Association.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

RCEM Learning

JANUARY 23, 2024

I had completed the ELECT feasibility study successfully in 2018, with a Pathway to Portfolio grant (only available in Wales). The approvals process was held over TEAMS and I attended with one of my patient representatives, which seemed to be well-received by the ethics committee. We passed that with just minor amendments.

Research 72

Research Wellness Outcomes Documentation/Coding 72

Don't Forget the Bubbles

AUGUST 2, 2023

in 2018, 16% of patients diagnosed with CRPS had comorbid depression, and two-thirds had at least one psychiatric diagnosis, significantly higher than in the general population. As well as nonpharmacological treatments included physiotherapy and psychological therapy, 79% were also prescribed medication, most commonly gabapentin.

Psychiatric 98

Psychiatric Pediatrics Outcomes Academics 98

Dr. Smith's ECG Blog

JANUARY 6, 2024

In the 500+ Comments I have written on Dr. Smith's ECG Blog since becoming an Associate Editor in 2018 — I do not believe we have had a case of RA-LL lead reversal. Even when a low atrial rhythm is present — the P wave will typically be positive in lead I ( as well as in lead aVL ). The July 29, 2018 post ( LA-RA reversal ).

EKG/ECG 79

EKG/ECG Wellness 79

ALiEM

OCTOBER 30, 2023

Well, instead of passively waiting for Godot, you can seize the initiative and bend the arc of your career into alignment with your values, strengths, and passions, and, by extension, toward fulfillment. The most supportive data for coaching in medicine is for physician wellness and mitigating burnout [7]. 2018; 10(2):227-228.

Academics 64

Academics Leadership Wellness Research 64