Taming the SRU

AUGUST 25, 2023

doxycycline Consider a splint/cast window to allow direct monitoring mainly used for fracture blisters and/or open wounds yet takes away from the strength of the splint/cast Case #3 43yo with FOOSH injury and closed wrist deformity, yet no x-ray machine is available to you Least likely injuries to need an x-ray in a resource-limiting setting?

Seizures 66

Seizures Fractures EKG/ECG Resuscitation 66

RebelEM

JANUARY 24, 2024

Wallace 2011 ) If addressed early and appropriately, most patients have good self-reported long-term outcomes regardless of the treatment modality Links Orthobullets: Achilles Tendon Rupture Resources: Sheth U et al. Bone Joint J. 2017; 99-B(1): 78-86.

Operations 74

Operations Ultrasounds Outcomes Fractures 74

Taming the SRU

NOVEMBER 21, 2023

Workup: CBC with differential Peripheral smear CMP LDH Uric acid Coags Close follow up with bone marrow biopsy (can be done outpatient) Immunophenotyping, cytogenics, and molecular mutation testing will also be performed in clinic and will yield appropriate management Complications of acute leukemia Leukostasis Can be seen in WBC 50-100k.

Pediatrics 80

Pediatrics EKG/ECG Resuscitation Dehydration 80

PEMBlog

AUGUST 30, 2023

Legal implications of a missed diagnosis also play a role in testing decisions, and providers may be pressured to perform these tests due to expectations of outpatient referring physicians or those receiving patients to the hospital from the ED. However, the impact of such resources has not yet been deeply explored.

Pediatrics 52

Pediatrics Best Practices Hospitals Emergency Department 52

Don't Forget the Bubbles

DECEMBER 25, 2023

Additional Resources EBM Masterclass with Ken Milne Don’t Panic EBM is Easy References Chen T, Li C, Qin R, et al. Short- vs standard-course outpatient antibiotic therapy for community-acquired pneumonia in children: the scout-cap randomized clinical trial. He is a tremendous mentor and teacher of evidence-based medicine. JAMA Pediatr.

Research 83

Research Outcomes Fractures Hospitals 83

Cook County EM Blog

MARCH 28, 2023

Posterior dislocations can often be managed in an urgent outpatient basis (1). Authored by Jordyn Cohen, MD Resources: 1: Glickman, Andrew, et al. Anterior lens dislocations often need more emergent surgical intervention because they can cause acute angle-closure glaucoma. What is the management of lens dislocation?

Dislocations 52

Dislocations Ultrasounds Fractures Radiology 52

ACEP Now

NOVEMBER 13, 2023

Evidence from inpatient wards, outpatient facilities, and addiction treatment centers has demonstrated that BERTs are an effective de-escalation solution in a variety of care contexts. 4 Conclusion More implementation studies of this emerging behavioral solution in resource-limited emergency settings are needed.

Emergency Department 52

Emergency Department Documentation/Coding Psychiatric Best Practices 52

Taming the SRU

FEBRUARY 22, 2023

STEP-UP Self Physical and Psycological IM-SAFE Illness Medications Stress Alcohol Fatigue Eating Psychological Cognitive Threat/Challenge appraisal: PERCEIVED demands vs. resources Threat appraisal - stress levels excessive, performance impaired – vapor lock (autonomic arousal, tunnel vision, auditory exclusion, loss of time awareness, impaired memory (..)

Hospice 40

Hospice EKG/ECG Wellness Resuscitation 40

Taming the SRU

OCTOBER 1, 2023

Institutional resources and specialty services may further dictate the management of PTX. May be considered first line in the future however results may be dependent upon provider training and hospital resources [17]. Is additionally helpful to differentiate bullous lung disease from PTX [18].

Fractures 85

Fractures COPD Hospitals Emergency Department 85

Taming the SRU

APRIL 13, 2023

stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

EMDocs

APRIL 27, 2024

Outpatient treatment is reserved for healthy patients with early infection and adequate follow-up. Rosh Review Website Link Additional FOAM Resources: [link] [link] [link] [link] References: Rubin Grandis, J., and Staphylococcus spp. 2 F ungal involvement (usually Aspergillus fumigatus ), especially in immunocompromised patients.

EMS 81

EMS Infectious Diseases Radiology Radiology 81

Taming the SRU

DECEMBER 11, 2023

If a patient is safe for discharge, especially in cases where care is likely to be limited by socioeconomic factors, they should be provided local mental health resources including psychiatric emergency services, nonprofit organizations, and contact information for crisis hotlines.

Psychiatric 86

Psychiatric EMS Emergency Department Poisoning 86

Sensible Medicine

MAY 31, 2023

Her outpatient follow-up appointments were scheduled; we had reviewed her safety plan; she felt well and ready to leave the hospital. The resource strains, time constraints, and lack of staff on both the hospital and legal side can make meaningful involuntary treatment impossible in some places.

Psychiatric 80

Psychiatric Hospitals Wellness Military 80

EMDocs

JUNE 16, 2023

There have been improvements in outpatient care and crisis care. As capacity and resources decrease in the ED, that leads to longer wait times, higher rates of left-without-being-seen patients. Over the past 50 years, mental health has shifted away from hospital-based to community-based care models. This has a downstream effect.

Psychiatric 52

Psychiatric Pediatrics Emergency Department Best Practices 52

Taming the SRU

OCTOBER 20, 2023

Quantifying the significance of this test comes down to the provider's perspective on managing knee injuries and the resources available to them. Suppose prompt outpatient Orthopedic follow-up is available to all of their patients, and all patients with traumatic knee pain receive Orthopedic follow-up.

Fractures 87

Fractures Dislocations Emergency Department 87

RebelEM

JANUARY 19, 2023

If pneumothorax size is >2cm and/or the patient appears breathless → Use 14-16G cannula to aspirate <2.5L → If the pneumothorax is <2cm and breathing improved → Discharge with outpatient pulmonary follow-up in 2-4 weeks. Many outpatient clinicians may not be comfortable managing chest drains.

Outcomes 52

Outcomes Hospitals Research EMS 52

RebelEM

AUGUST 3, 2023

This practice is both resource and time intensive thus limiting the number of people who can actually have their penicillin allergy removed from their chart. Direct Oral Challenging is less resource and time intensive, less expensive, and provides a scalable approach to remove unverified penicillin allergy in multiple practice settings.

Anaphylaxis 52

Anaphylaxis Allergic Reactions Outcomes Infectious Diseases 52

EMDocs

FEBRUARY 26, 2024

5 However, molecular tests are often inaccessible in numerous low-resource clinical settings, particularly where HIV/AIDS significantly contributes to the disease burden. Therefore, it is of critical importance to develop cost-effective methods for early detection to improve the diagnosis of PJP in resource-limited settings.

Radiology 85

Radiology Radiology Outcomes Ultrasounds 85

RebelEM

DECEMBER 28, 2022

Patients were enrolled in the outpatient setting, which also decreases external validity and generalizability. The 10% safety margin seems appropriate for a group of otherwise stable afebrile men who are being treated outpatient. Resources: Tan CW, Chlebicki MP. The study was conducted in the VA system. Singapore Med J.

Outcomes 52

Outcomes Documentation/Coding Hospitals Research 52

EB Medicine

AUGUST 6, 2019

This is also a great place to have institutional policies, which could support this practice and also ensure rapid outpatient follow up. However, despite their outpatient ease of use, it definitely complicates our lives in the ED with no easy way to evaluate their anticoagulant effect and costly reversal options. Jeff: Absolutely.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EB Medicine

MAY 3, 2019

Nachi: Sadly, though outpatient visits for depression and suicide related complaints have decreased over the years, while ED visits remain stable, implying that the ED is a critical entry point for depressed and suicidal patients. These have been developed primarily for the outpatient and primary care settings. Pretty big numbers.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

RebelEM

DECEMBER 19, 2022

The above resource limitation applies in the opposite setting and requires a clinical judgement call to be made. However, until additional evidence presents itself, the use of double defibrillation on a case-by-case basis should be considered based on operational feasibility such as institution/agency policies, and availability of resources.

EMS 52

EMS Shock CPR Resuscitation 52

Pediatric Emergency Playbook

MAY 1, 2017

in the New England Journal of Medicine compared filtered sunlight versus conventional phototherapy for safety and efficacy in a resource-poor environment. A recent randomized control trial by Slusher et al. These were all term babies with clinically significant jaundice in Nigeria.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Taming the SRU

JUNE 6, 2023

mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5

Documentation/Coding 59

Documentation/Coding Seizures Wellness Psychiatric 59

EB Medicine

JANUARY 2, 2019

In addition, providers should consider an early destination consult both to select the correct destination and to begin the process of mobilizing resources early in those patients who really need them, such as those with hemodynamic instability. This approach is preferred in low-resource settings. Jeff: All great advice.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40