ACEP Now

OCTOBER 26, 2023

Maryland enacted the first “prudent layperson standard” (PLP) in state law in 1993 (see related timeline). The PLP standard they devised protected a patient’s access to emergency medical services, including on-call services, if the medical condition of the patient manifests itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson could reasonably expect that the absence of immediate medical attention could result in serious jeopardy to the health of t

Documentation/Coding 124

Documentation/Coding Hospitals Administration Emergency Department 124

EMCrit

OCTOBER 26, 2023

Some folks on twitter asked my thoughts on AMIKINHAL trial, so I thought I'd jot them here. AMIKINHAL is a multi-center RCT that evaluated the ability of inhaled amikacin to prevent VAP (ventilator-associated pneumonia) among patients who had been intubated for three days. It's available here at NEJM. It was a positive trial, which is […] EMCrit Project by Josh Farkas.

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122

EM Ottawa

OCTOBER 26, 2023

You are seeing your next patient in urgent care, a 35-year-old female with a wrist injury who has been waiting for 6-hours. After sending her for an x-ray and offering pain control in the ED, she tells you she is 3-months post-partum and is currently nursing. She asks if there are any pumps available in […] The post Lactation – A brief guide for the emergency provider appeared first on EMOttawa Blog.

Urgent Care 115

Urgent Care Pediatrics 115

Emergency Live

OCTOBER 26, 2023

An engineering masterpiece that marked an important turning point in the history of Italian ambulances The Fiat 238 Autoambulanza “Unificata,” known for its refined Fiat/Savio evolution, represents a crucial chapter in the history of ambulances in Italy. This model marked Fiat’s first significant attempt to enter the market for Mobile Resuscitation Units, a sector until […] The post Fiat 238 Autoambulance "Unified" appeared first on Emergency Live.

Resuscitation 98

Resuscitation 98

Medagadget

OCTOBER 26, 2023

Researchers at the University of Massachusetts Amherst have developed a new method of detecting very small amounts of DNA. The breakthrough could allow clinicians to spot genetic markers of disease at the point-of-care, as the approach does not require conventional laboratory analysis, which is usually time-consuming and costly. In fact, the approach has led to a 100-fold increase in DNA detection sensitivity, with no corresponding increase in cost.

Research 91

Research 91

Emergency Live

OCTOBER 26, 2023

Red Cross offers a series of useful tips for parents to ensure the safety of children during Halloween festivities Halloween is fast approaching, and little superheroes, cartoon and TV show characters are about to invade neighborhoods in search of treats. It is a festive time eagerly anticipated by little ones, but it is also an […] The post Red Cross: Tips for Risk-Free Trick-or-Treating appeared first on Emergency Live.

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84

Medagadget

OCTOBER 26, 2023

Researchers at Northwestern University have developed a sophisticated microfluidic system that incorporates tissue from up to eight different organ systems. The technology is unprecedented in allowing researchers to study complex interactions between different organs during disease. Moreover, it also allows for more comprehensive drug testing that investigates the effects of drug candidates on multiple organ systems at once.

Research 90

Research Wellness 90

Sensible Medicine

OCTOBER 26, 2023

Reading Vinay’s article last week called to mind one of my favorite articles. In 1999 I started teaching a course to 4 th year medical students called “Critical Appraisal of the Landmark Medical Literature.” The idea behind the course was simple. By the time a medical student has reached the 4 th year, he or she has learned from textbooks, review articles, and lectures.

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76

Life in the Fast Lane

OCTOBER 26, 2023

Kane Guthrie Impending Doom Cliff Reid starts us off on this series by looking at the patient that presents saying they're 'going to die' - "The Impending Doom Patient".

Resuscitation 75

Resuscitation 75

Emergency Medicine Journal

OCTOBER 26, 2023

Background Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment method for refractory out-of-hospital cardiac arrest (OHCA) requiring a complex chain of care. Methods All cases of OHCA between 1 January 2016 and 31 December 2021 in the Helsinki University Hospital catchment area in which the ECPR protocol was activated were included in the study.

Hospitals 75

Hospitals CPR Resuscitation Outcomes 75

PEMBlog

OCTOBER 26, 2023

Background Meckel diverticulum is a congenital abnormality of the small intestine and is the most common cause of significant lower gastrointestinal bleeding in children. It arises from incomplete involution of the vitelline duct during embryonic development, typically occurring by the 7th week of gestation. It is characterized by a blind-ending true diverticulum that contains all the layers found in the ileum.

Radiology 64

Radiology Radiology Administration Shock 64

Emergency Medicine Journal

OCTOBER 26, 2023

Objective Over 300 000 cases of out-of-hospital cardiac arrests (OHCAs) occur each year in the USA and Europe. Despite decades of investment and research, survival remains disappointingly low. We report the trends in survival after a ventricular fibrillation/pulseless ventricular tachycardia OHCA, over a 13-year period, in a French urban region, and describe the simultaneous evolution of the rescue system.

Resuscitation 75

Resuscitation Basic Life Support Hospitals CPR 75

ALiEM

OCTOBER 26, 2023

The Problem: Emergency Medicine (EM) in Pakistan has moved from developing to developed stage in the last decade [1]. As the specialty evolves in Pakistan and other countries, there is a need to improve and assimilate novel learning methods to elevate education standards. The COVID-19 pandemic catalyzed the routine use of video-conference platforms such as Zoom.

EMS 64

EMS Academics Evidence-Based Practice Emergency Department 64

Emergency Medicine Journal

OCTOBER 26, 2023

Background Blood transfusion for bleeding trauma patients is a promising pre-hospital intervention with potential to improve outcomes. However, it is not yet clear which patients may benefit from pre-hospital transfusions. The aim of this study was to enhance our understanding of how experienced pre-hospital clinicians make decisions regarding patient blood loss and the need for transfusion, and explore the factors that influence clinical decision-making.

Blood Transfusions 52

Blood Transfusions Hospitals Outcomes 52

ACEP Now

OCTOBER 26, 2023

The Case A two-year-old female, seen three days ago at different local emergency department (ED)—Children’s General—presents with fever, headache, and neck pain. Her parents say that when she was previously seen, blood and urine were tested, and some type of X-ray and a spinal tap were performed. They were told she might have a kidney infection and she was prescribed cephalexin (Keflex).

Infectious Diseases 52

Infectious Diseases Hospitals Documentation/Coding Administration 52

Emergency Medicine Journal

OCTOBER 26, 2023

Background Ambulance services need to identify and prioritise patients with sepsis for early hospital assessment. We aimed to determine the accuracy of early warning scores alongside paramedic diagnostic impression to identify sepsis that required urgent treatment. Methods We undertook a retrospective diagnostic cohort study involving adult emergency medical cases transported to Sheffield Teaching Hospitals ED by Yorkshire Ambulance Service in 2019.

Sepsis 52

Sepsis Ambulance Services Operations Hospitals 52

Dr. Smith's ECG Blog

OCTOBER 26, 2023

@RobertHermanMD on Making Waves from Mayo clinic. Artificial Intelligence-Augmented ECG Interpretation Using Smartphone Technology @TheEKGGuy [link] == MY Comment , by K EN G RAUER, MD ( 10/26 /2023 ): == Our THANKS to Drs. Anthony Kashou & Robert Herman for their wonderful ongoing work toward continued evolution and improvement of clinical ECG utilization.

EKG/ECG 52

EKG/ECG Wellness 52

Emergency Medicine Journal

OCTOBER 26, 2023

Background In-hospital alcohol testing provides an opportunity to implement prevention strategies for patients with high risk of experiencing repeated alcohol-related injuries. However, barriers to alcohol testing in emergency settings can prevent patients from being tested. In this study, we aimed to understand potential biases in current data on the completion of blood alcohol tests for major trauma patients at hospitals in Victoria, Australia.

Burns 52

Burns Hospitals 52

PHARM

OCTOBER 26, 2023

Bruce Lehrmann named as man charged with alleged rape of woman in Toowoomba – ABC News Lets hope he is put away this time as folks wont be fooled again — Read on amp.abc.net.

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40

Emergency Medicine Journal

OCTOBER 26, 2023

Welcome to November 2023’s primary survey, where I am going to take you through a whistle stop tour of this month’s papers. Our tour will cover alcohol and major trauma, cardiac arrest management, cauda equina diagnosis and e-scooters. Editor’s choice: Biases in the collection of blood alcohol data for adult major trauma patients in Victoria, Australia Lau et al talk about the importance of in-hospital alcohol testing and how could provide an opportunity to implement preventive

Hospitals 52

Hospitals 52

RebelEM

OCTOBER 26, 2023

Background: There is a shifting paradigm towards shorter durations of antibiotics in pediatric infections. Conflicting international guidelines recommend treatment of urinary tract infection (UTI) with antibiotic courses ranging from just 3 days to 7–14 days. 1–4 Antimicrobial resistance is a global health crisis, underscoring the importance of antibiotic stewardship.

Pediatrics 79

Pediatrics Infectious Diseases Outcomes Research 79

Emergency Medicine Journal

OCTOBER 26, 2023

Kazakhstan is the ninth largest country in the world in terms of area. It is divided into 14 geographical regions and 3 big cities and has a population of 19.1 million people as of January 2021. People that live in cities comprise 58% of the total population. Kazakhstan gained its independence from the Soviet Union in 1991. Having been a part of the Soviet Union in the past, Kazakhstan’s education and science naturally mirrored those of Russia.

40

40

Mount Sinai EM

OCTOBER 26, 2023

Applying the LUCAS with minimal pauses in chest compressions FIRST STEP : LUCAS backboard behind patient’s head SECOND STEP : lift patient forward to slide backboard behind chest THIRD STEP : apply the LUCAS and start GIFs lifted from this video: [link] Whenever my team applies the backboard during a roll, it ends up getting tangled in sheets and clothing and needs additional adjustment to be centered once the patient is rolled back.

202

202

Emergency Medicine Journal

OCTOBER 26, 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

ACEP Now

OCTOBER 26, 2023

“So how long has he been in jail? I mean his core temp is 27.” I think that the only acceptable answer from the corrections officers at that time would have been “20 minutes or less,” but that was not the response. I sighed, wondering if I was the only person who thought that this situation was dubious. After perusing this with residents and colleagues for more than five years, I now think the nature of the possible prisoner-abuse situation would have been clear to anyone, but the next steps ha

Stroke 52

Stroke Resuscitation Hospitals 52

Emergency Medicine Journal

OCTOBER 26, 2023

This month’s update is by the Division of Emergency Medicine, Faculty of Health Sciences, at the University of Cape Town, South Africa. 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 highlighted the main findings, key limitations and clinical bottom line for each paper.

Outcomes 40

Outcomes Hospitals 40

SheMD

OCTOBER 26, 2023

, “You have to be careful in the cath lab, don’t want to be pregnant and have to be pulled out.” Words of advice from a mentor when expressing my desire to go into cardiology. “I just assumed you wouldn’t be having children with your career path.” Discussion with my family regarding my plans for the future. , “You’ll match cardiology because you’re female and pretty.

Leadership 52

Leadership Documentation/Coding Wellness 52

Emergency Medicine Journal

OCTOBER 26, 2023

Clinical introduction A man in his 60s with history of smoking presented to the emergency room 10 days after an epigastric pain and progressive worsening dyspnoea. Vital signs were normal. Examination revealed bibasilar crackles and a murmur in the left sternal border. ECG shows an inferior wall myocardial infarction with Q-waves and T-wave inversion.

EKG/ECG 40

EKG/ECG 40

Emergency Medicine Journal

OCTOBER 26, 2023

Cauda equina syndrome (CES) is a spinal emergency that can be challenging to identify from among the many patients presenting to EDs with low back and/or radicular leg pain. This article presents a practical guide to the assessment and early management of patients with suspected CES as well as an up-to-date review of the most important studies in this area that should inform clinical practice in the ED.

Emergency Department 40

Emergency Department Wellness 40

Emergency Medicine Journal

OCTOBER 26, 2023

E-scooters have emerged as an environmentally friendly mode of inner-city transportation, 1 and e-scooter-associated injuries are a growing area of concern. 2 In the UK, rental e-scooter trial schemes were introduced in 2020; alongside these trials, illegal private e-scooter use in public spaces has also increased. 3 There is little UK data outlining the healthcare impact of e-scooters, although work has examined the impact in Europe. 4 The primary objective was to quantify the prevalence and na

Emergency Department 40

Emergency Department 40

Emergency Medicine Journal

OCTOBER 26, 2023

Clinical introduction An 18-year-old male patient with a history of Hodgkins lymphoma came to emergency department with complaint of breathlessness. His respiratory rate was 26/min, room air saturation was 98%, heart rate 120. On examination, his trachea was shifted towards right side and there was decreased air entry on right lung. Chest X-ray ( figure 1 ) and point of care ultrasound were performed ( figure 2 ).

Ultrasounds 40

Ultrasounds Emergency Department 40

Emergency Medicine Journal

OCTOBER 26, 2023

Clinical introduction A 46-year-old woman presented to the emergency department with right elbow pain after falling down on an outstretched hand while descending the stairs. Physical examination showed right elbow swelling, tenderness and limited motion. The distal limb circulation and neurovascular function were unremarkable. Plain radiographs were obtained ( figure 1 ).

Dislocations 40

Dislocations Fractures Emergency Department 40

Emergency Medicine Journal

OCTOBER 26, 2023

Alcohol use is common among patients admitted to hospital following trauma 1 and is associated with repeated trauma admissions 2 and a higher risk of complications. 3 Alcohol screening for trauma patients may be useful as an opportunity for brief intervention measures that aim to reduce further risk through prevention strategies. Lau and colleagues investigated blood alcohol testing in their observational study of 14 221 major trauma patients from Victoria, Australia, from 2018 to 2021. 4 In the

Hospitals 40

Hospitals 40