Mount Sinai EM

AUGUST 23, 2023

Today is a 2 parter: 1) The Supraorbital (+supratrochlear) block for forehead lacs and 2) Comments on decision-making TNF at Ethyl’s 84th and 2nd again, 8 PM TLDR: The Supraorbital block will save you time and make your life easier/patient happier – WATCH THE 3 MIN VID ; We are DECISION MAKERS – make decisions, learn from them, READ THE ATTACHMENT, get amped THE SUPRAORBITAL/TROCHLEAR FOREHEAD BLOCK A must-have in your Elmhurst tool belt.

EMS 187

EMS 187

Don't Forget the Bubbles

AUGUST 23, 2023

Siren and blue lights. Team allocated and primed. Voices command, ears listen, and hands swiftly execute. Monitors beep—loops of communication. As the second hand sweeps, loud voices grow quieter, and pulse checks fall into an unfortunate pattern. Realisation, its time, knowing looks, a shake of the head, a pain, heaviness. Winding down…. “Time of Death 10:43”.

Emergency Department 98

Emergency Department Resuscitation Documentation/Coding Best Practices 98

St. Emlyn

AUGUST 23, 2023

St.Emlyn's - Emergency Medicine #FOAMed Part 1 of an introduction to paediatric ultrasound in the emergency department from Dr Pete Hulme @Dr_Pete_EmMed @stemlyns #FOAMed The post Paediatric Point of care ultrasound: Big Kids playing with toys or the future of Paediatric emergency medicine? Part I appeared first on St.Emlyn's.

Ultrasounds 89

Ultrasounds Emergency Department 89

Emergency Live

AUGUST 23, 2023

Extreme weather is becoming more and more frequent across Europe because of climate changes In recent years, as our world heats up, change has brought irregular weather patterns. Heatwaves, forest fires, droughts, heavy rain falls which lead to shocking destructive flooding and storms have rapidly becoming the new norm of our world. We witness, today, […] The post Changing World And How Project PEERS Can Help appeared first on Emergency Live.

Shock 88

Shock 88

Science Based Medicine

AUGUST 23, 2023

Studies have found large language model AIs to have impressive medical knowledge, but they are not quite there yet. The post Update on Dr. AI first appeared on Science-Based Medicine.

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82

EM Literature of Note

AUGUST 23, 2023

In a world of doors, truck beds, furniture, and other finger-crushing nuisances, emergency department visits for injuries involving the distal digits are common. Injuries range from tuft fractures, to degloving injuries, to all manner of nail and nailbed derangement. Perusing any textbook or online resource will typically advise some manner of repair, including, but not limited to, replacing an avulsed nail back into the proximal nail fold and securing it in place.

Emergency Department 75

Emergency Department Fractures Outcomes 75

Emergency Live

AUGUST 23, 2023

The European Union is mobilising to tackle the devastating wave of fires in the Alexandroupolis-Feres region of Greece Brussels – The European Commission has announced the deployment of two RescEU firefighting aircraft based in Cyprus, together with a team of Romanian firefighters, in a coordinated effort to contain the disaster. A total of 56 firefighters […] The post The European Union in Action against Fires in Greece appeared first on Emergency Live.

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70

Emergency Live

AUGUST 23, 2023

Psoriasis is a chronic and permanent dermatological disorder that predominantly affects immunocompromised individuals and can progress or regress spontaneously, to the point of leaving almost no trace of it The post Psoriasis: causes, symptoms, diagnosis and treatment appeared first on Emergency Live.

52

52

Emergency Medicine Journal

AUGUST 23, 2023

Background The priorities for UK emergency medicine research were defined in 2017 by a priority setting partnership coordinated by the Royal College of Emergency Medicine in collaboration with the James Lind Alliance (JLA). Much has changed in the last 5 years, not least a global infectious disease pandemic and a significant worsening of the crisis in the urgent and emergency care system.

Research 52

Research Infectious Diseases 52

Maria Yang, MD

AUGUST 23, 2023

Related to my ongoing efforts to be a better spouse by learning more about baseball: On August 1, 2023, New York Yankees pitcher Domingo Germán was reportedly intoxicated from alcohol and ended up “ flipping over a couch and smashing a TV ” in the team clubhouse. The New York Post further reported that he was held in a sauna as the team tried to get him to sweat out the alcohol.

Emergency Department 52

Emergency Department 52

Emergency Medicine Journal

AUGUST 23, 2023

Welcome to the September 2023 issue of the Emergency Medicine Journal. This month we have a trio of papers on health services: a qualitative study exploring views of NHS 111 from the perspective of the Emergency Department (ED); a retrospective study looking at the impact scrapping the UK 4 hour process target; and an evaluation of an innovative service to try and avoid ED attendances for older adults.

Emergency Department 52

Emergency Department 52

Core Ultrasound

AUGUST 23, 2023

Knee Aspiration/Injection Elbow Aspiration/Injection Knee Exam The post Wrist Effusion – Identification, Aspiration, Injection (5MS) first appeared on Core Ultrasound.

Ultrasounds 52

Ultrasounds 52

Emergency Medicine Journal

AUGUST 23, 2023

Case presentation A 57-year-old man with a history of recently diagnosed diabetes mellitus presented to the ED with 2 weeks of perineal pain and swelling. He was seen at an urgent care centre approximately 1 week prior to presentation, where he was diagnosed with cellulitis and prescribed trimethoprim-sulfamethoxazole. A few days prior to presentation to the ED, the swelling had increased significantly and was now associated with chills, diaphoresis and purulent drainage.

Urgent Care 40

Urgent Care Ultrasounds 40

Emergency Medicine Journal

AUGUST 23, 2023

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study, as selected by their editors. This edition will feature an abstract from each publication.

Research 40

Research 40

Emergency Medicine Journal

AUGUST 23, 2023

This month’s update is by the University Department of Emergency Medicine in Reading. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. We identified the five most interesting and relevant papers (decided by consensus) and have highlighted the main findings, key limitations and clinical bottom line for each paper.

Outcomes 40

Outcomes 40

Emergency Medicine Journal

AUGUST 23, 2023

Mild traumatic brain injury is a common presentation to the emergency department, with current management often focusing on determining whether a patient requires a CT head scan and/or neurosurgical intervention. There is a growing appreciation that approximately 20%–40% of patients, including those with a negative (normal) CT, will develop ongoing symptoms for months to years, often termed post-concussion syndrome.

Emergency Department 40

Emergency Department Outcomes 40

Emergency Medicine Journal

AUGUST 23, 2023

Background Nausea and vomiting is a common ED chief complaint. However, randomised trials comparing antiemetic agents to placebo have not demonstrated superiority. This systematic review investigates the efficacy of inhaled isopropyl alcohol (IPA) compared with usual care or placebo in adults presenting to the ED with nausea and vomiting. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, other relevant trial registries, journals, and conference proceedings up t

Emergency Department 40

Emergency Department Outcomes 40

Emergency Medicine Journal

AUGUST 23, 2023

Background Combined ED and police department (PD) data have improved violence surveillance in the UK, enabling significantly improved prevention. We sought to determine if the addition of emergency medical service (EMS) data to ED data would contribute meaningful information on violence-related paediatric injuries beyond PD record data in a US city.

EMS 40

EMS 40

Emergency Medicine Journal

AUGUST 23, 2023

Recent evidence has begun to challenge the use of large-bore surgical chest drains in the management of traumatic haemopneumothorax. Large-bore surgical drains are considered those >24F in diameter (requiring blunt dissection for insertion) while smaller drains (using a Seldinger needle over-wire technique) are those varying in size from <14F up to 20F. 1 2 It has been reported that small-bore drains are more likely to be malpositioned and complicated by pneumonia, whereas large-bore dra

40

40

Emergency Medicine Journal

AUGUST 23, 2023

Background Transcutaneous carbon dioxide (Ptcco 2 ) measurement is a non-invasive surrogate marker for arterial carbon dioxide (Paco 2 ), which requires invasive arterial blood sampling. Use of Ptcco 2 has been examined in different clinical settings, however, most existing evidence in the adult emergency department (ED) setting shows insufficient agreement between the measurements.

Emergency Department 40

Emergency Department Hospitals 40

Emergency Medicine Journal

AUGUST 23, 2023

Clinical introduction An 11-year-old boy lying in bed caught his right great toe nail on the blanket as the blanket was pulled away, forcing plantar flexion and traction injury to the toe, resulting in a dorsal transverse laceration just proximal to the proximal nail fold, exposing the proximal end of the nail plate ( figure 1A ). There was no deformity of the great toe.

Fractures 40

Fractures 40

Emergency Medicine Journal

AUGUST 23, 2023

Background Uncertainty is particularly obvious in emergency medicine (EM) due to the characteristics of the patient cohort, time constraints, and busy environment. Periods of transition are thought to add to uncertainty. Managing uncertainty is recognised as a key ability for medical practice, but is often not addressed explicitly. This study explored how new consultants in EM experience uncertainty, with the aim of making explicit what is often hidden and potentially informing support for docto

EMS 40

EMS Emergency Department 40

Emergency Medicine Journal

AUGUST 23, 2023

Most physicians can recall the palpable stresses of entering practice, from the pressures of figuring out new systems, to worries of how others will view their expertise, to experiencing the weight of responsibility for important clinical decisions. Recent work by Collini et al 1 nicely illustrates these experiences among new emergency medicine consultants, framing the transition from training to practice as a liminal period.

40

40

Emergency Medicine Journal

AUGUST 23, 2023

Background Time-based targets are used to improve patient flow and quality of care within EDs. While previous research often highlighted the benefits of these targets, some studies found negative consequences of their implementation. We study the consequences of removing the 4-hour access standard. Methods We conducted a before and after, retrospective, observational study using anonymised, routinely collected, patient-level data from a single English NHS ED between April 2018 and December 2019.

Hospitals 73

Hospitals Research Outcomes 73

Emergency Medicine Journal

AUGUST 23, 2023

Background NHS 111 is a phone and online urgent care triage and assessment system that aims to reduce UK ED demand. In 2020, 111 First was introduced to triage patients before entry to the ED and to offer direct booking for patients needing ED or urgent care into same-day arrival time slots. 111 First continues to be used post pandemic, but concerns about patient safety, delays or inequities in accessing care have been voiced.

Emergency Department 75

Emergency Department Urgent Care Documentation/Coding Patient Safety 75

Emergency Medicine Journal

AUGUST 23, 2023

We recently published a systematic review of the impact of patient positioning in Emergency Medicine Journal. 1 A significant challenge to completing this review and to conducting research to understand this topic is the lack of standardisation of positioning terminology. The 10 studies included in our review used five different terms to denote patient position including ‘head-elevated’, ‘inclined’, ‘non-supine’, ‘ramped’ and ‘upright’

Research 40

Research 40