Taming the SRU

FEBRUARY 23, 2024

Consider starting more goals of care discussions in the emergency department, not just for patients who are actively dying. The intensity of the care plan while inpatient tends to follow that started in the ED. Advocate for patients who need more urgent follow up or may have more barriers to obtaining follow up.

Pediatrics 68

Pediatrics Ultrasounds Wellness Fractures 68

Sensible Medicine

MAY 22, 2023

A true crisis in humanity goes unnoticed in nearly every US hospital. Routine is the image of people receiving brutal non-beneficial care at the end of their life. Patients who have no chance of meaningful survival get stuck on ventilators and dialysis machines. Inhumane care at the end of the life is the opposite of help.

Documentation/Coding 56

Documentation/Coding Hospitals Shock Outcomes 56

Taming the SRU

SEPTEMBER 27, 2023

Benoit, Ferman, and Freiermuth and Heidi Sucharew, PhD It is important for us to understand which high impact studies have influenced our practice to be what it is today. You must understand the parts to understand the machine. landmark studies in em WITH Drs. Interpret in context… carefully. Practice struggling.

Stroke 52

Stroke EMS Pediatrics Outcomes 52

Stop and Think

JANUARY 10, 2024

The Case of Extracorporeal Life Support or ECLS Extracorporeal membrane oxygenation (ECMO) may be the highest-level supportive care we can offer. It is, basically, a heart-lung machine. It’s used to support the sickest patients. Two trials published this year provided clarity on whether it is useful.

CPR 44

CPR Shock Outcomes Resuscitation 44

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. Circulation. 2011 Mar;123(16):1788-1830.

Ultrasounds 79

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Shock 79

PulmCCM

NOVEMBER 27, 2023

So, authors randomized 126 adults (at 40 UK centers) with septic shock and tachycardia, who were receiving norepinephrine for at least 24 hours, to receive either open-label landiolol (a beta-blocker available in Europe) or not, in addition to usual care. At 90 days, mortality was even worse with landiolol: 44% vs 29% with usual care.

Sepsis 52

Sepsis Shock Administration Outcomes 52

Cook County EM Blog

APRIL 22, 2022

Point of Care Ultrasound is shown below: Clip 1. Instead, ultrasound waves bounce back and forth between the highly reflective diaphragm before returning, leading the delayed echoes to be perceived as deeper structures by the ultrasound machine. VS: T 36.6, Lungs are clear to auscultation bilaterally. Right upper quadrant ultrasound.

Ultrasounds 40

Ultrasounds COPD Emergency Department 40

ETM Course

DECEMBER 13, 2014

It’s a new simplified point of care TEG (thromboelastography) machine that runs with a simple cartridge. So I grabbed the Haemonetics rep Lisa for a quick interview and she runs us through the new machine and how to interpret the results.

Resuscitation 52

Resuscitation 52

Advanced Medical Reviews

MAY 2, 2019

Not only does it increase access to care and reduce travel time—especially for people living in rural areas—but telehealth also decreases the number of hospital stays and can improve communication between clinicians. To learn more about healthcare industry news and upcoming events, connect with us via social media and follow the AMR blog.

Hospitals 88

Hospitals Pediatrics Research 88

Emergency Medicine Ireland

FEBRUARY 1, 2021

Welcome back to the tasty morsels of critical care podcast. A meandering monologue through critical care exam preparation. Not content with producing deafness and killing kidneys they’ve also demanded awkward dosing schedules, Read More » Welcome back to the tasty morsels of critical care podcast.

Sepsis 40

Sepsis Shock Wellness 40

Dr. Smith's ECG Blog

JUNE 11, 2021

Below is the first ED ECG, labeled LBBB by the machine. The patient still had chest pain and the ECG was repeated one hour later, labeled LBBB by the machine. Meyers note: As Dr. McLaren points out, skilled ECG interpretation helps us see prospectively that the LAD was the clear culprit in this case. Learning points 1.

EKG/ECG 52

EKG/ECG Documentation/Coding CPR Shock 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

Arrival at time 0 ECG 7 min Roomed in hallway at 17 min Moved to room with monitor at 37 min The patient was seen briefly by the physician, who then went to get an ultrasound machine. Then the patient would have been taken to the critical care area with a defibrillator at his side while waiting for the cath lab to be ready.

EKG/ECG 120

EKG/ECG Resuscitation CPR Emergency Department 120

Emergency Medicine Ireland

JULY 3, 2023

Welcome back to the tasty morsels of critical care podcast. This might allow us to effectively assess congestion while avoiding the terrors of hypoperfusion from volume removal. This segues relatively nicely into a section of the document on palliative care. Welcome back to the tasty morsels of critical care podcast.

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

American Medical Compliance

FEBRUARY 26, 2023

To become certified, please visit us at American Medical Compliance (AMC). Additionally, HCIRs provide product support for complex instrumentation and sophisticated equipment that is used in the OR. Overall, HCIRs are incredibly useful in the operating room due to their in-depth knowledge regarding medical devices and systems.

Operations 52

Operations Best Practices Administration Hospitals 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. The patient was tremulous and severely hypoglycemic by point-of-care testing. Remember that ECG machines generally have modifiable gain. Written by Colin Jenkins.

EKG/ECG 61

EKG/ECG Wellness Point-of-Care Testing Shock 61

Don't Forget the Bubbles

DECEMBER 6, 2023

They concluded that, in low-risk, febrile infants, the language used for medical care was associated with the use of at least one non-indicated intervention, whereas race and ethnicity were not. Differences in language may create communication barriers, fostering disparities in medical care. Jankiewicz M et al.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Research Hospitals 52

Thinking Critical Care

MAY 18, 2023

The Boss was Professor Iain McAllister Ledingham, Editor of the book series Recent Advances in Critical Care Medicine, a founder of The European Society of Intensive Care Medicine and one of its first Presidents. As an American visitor to the Unit observed, this was surely the best Intensive Care service in England (sic) [2].

Shock 40

Shock Research Sepsis Resuscitation 40

Dr. Smith's ECG Blog

MARCH 31, 2023

Finally, no matter what, it pays to record frequent serial ECGs, though using the bot will get the answer faster. = My Comment by K EN G RAUER, MD ( 3/31 /2023 ): = Computers are amazing machines. Grauer K, Kravitz L, Curry RW, Ariet M: Computerized Electrocardiogram Interpretations: Are They Useful for the Family Physician?

EKG/ECG 52

EKG/ECG Academics Wellness Documentation/Coding 52

Dr. Smith's ECG Blog

OCTOBER 18, 2023

1-3] But these studies were very short duration and used cardiology interpretation of ECGs or emergent angiography rather than patient outcomes. Posterior leads showed mild posterior ST elevation, labeled ‘nonspecific’ by machine but STEMI on final interpretation: Cath lab was activated and found 100% ramus intermedius occlusion.

EKG/ECG 111

EKG/ECG Documentation/Coding Emergency Department Outcomes 111

Emergency Medicine Ireland

SEPTEMBER 18, 2023

Welcome back to the tasty morsels of critical care podcast. TIPS has been described to be helpful in improving renal function in HRS but only on a very limited basis so probably worth a discussion with your local liver experts but not something you can use evidence to make a compelling argument for.

Wellness 52

Wellness Hospitals Outcomes 52

Dr. Smith's ECG Blog

APRIL 21, 2023

Smith comment: Cardiologists, like all health care professionals who interpret ECGs, are a very heterogeneous group when it comes to ECG interpretation. ECGs labeled as ‘normal’ by conventional machines (and confirmed by over-reads) can still be diagnostic of OMI, and identified by OMI experts and the AI they train 2.

EKG/ECG 52

EKG/ECG Outcomes Research Hospitals 52

EM Curious

JULY 24, 2015

One of our beloved colleagues from the community has recently declared to us his love of ultrasound guided nerve blocks--a skill that is established in the anesthesia world but is quickly gaining traction in our realm. These nerve blocks have the potential to be huge for us as emergentologists, but don't take our word for it.

Fractures 52

Fractures Ultrasounds Emergency Department Dislocations 52

Mind The Bleep

DECEMBER 31, 2023

Renal nurses know what they’re doing Renal patients in hospitals also tend to be cared for by more experienced nurses, including dialysis nurses, renal nurses and ICU-trained nurses. If they’re still hooked up to their dialysis machine, give the fluid through this. Too much fluid may have been taken off in dialysis.

Fluid Resuscitation 52

Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

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

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Review of the Wellcome Library movies on YouTube (1945) [ links below in references ] is instructive as to resuscitative methods of the 1930s and 1940s: Manual methods; gas bag or bellows operated by hand or machine; an anesthesia gas machine; or iron lung. Anaesthesia and intensive care, 38, 10-15. Mitchell, H.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

Dr. Smith's ECG Blog

JUNE 20, 2018

Clinician and EKG machine read of acute pericarditis. Normal 0 false false false EN-US JA X-NONE --> --Walsh B. That seems to be what's happening - the shiny fun diagnosis of pericarditis is distracting us from the actual emergencies. -- Comment by KEN GRAUER, MD ( 6/20/2018 ): -- Great case & supporting comments by Drs.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness Ultrasounds 52

Sensible Medicine

MARCH 14, 2024

These suspicions are not baseless as a 2023 Elsevier survey suggests a majority of trainees are struggling to imagine themselves shouldering a career in direct patient care. The analogy of a physical hospital expanding from its original isolated ward to become an interconnected quaternary care center may help.

Hospitals 81

Hospitals Wellness Academics Fractures 81

RebelEM

JANUARY 25, 2024

Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. Emerg Med J. 2023;40(10):700-707.

Ultrasounds 110

Ultrasounds Outcomes COPD Hospitals 110

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Note that the machine read is "normal sinus rhythm, normal ECG." However, it does give us some context for thinking about benign causes of ST elevation. Normal" machine read does not rule out OMI. The "onus of proof" remains on us as medical providers to objectively rule out ACS. The following ECG was obtained.

EKG/ECG 105

EKG/ECG Documentation/Coding Wellness Emergency Department 105

SheMD

JUNE 25, 2023

Every year, a new generation of sparkling new interns will join us. From intern to intern, here’s my tips: The Hospital is a Machine. But the importance of our presence is to learn, to grow as physicians, and care for our patients. But at the end of the day, you will have made a difference in patient care. Be the cog.

Academics 52

Academics Hospitals EMS Wellness 52

33 Charts

OCTOBER 2, 2021

This change has been driven by health systems actively promoting portal use. COVID has clearly driven remote care. The challenge has been that the workflows of health professionals have not been adjusted to reflect this change in care patterns. Without thinking this through we wind up with pajama time.

Leadership 73

Leadership Hospitals Operations Administration 73

Sensible Medicine

MARCH 11, 2024

JMM Subscribe now Authors: James McCormack, BSc (Pharm), PharmD and Marc Levine PhD, Professor Emeritus, Faculty of Pharmaceutical Sciences, UBC Most of us likely understand descriptive statistics (average, median, etc). That is literally all a margin of error tells us. Inferential statistics don’t give us a probability.

Outcomes 103

Outcomes Research Stroke COPD 103

Don't Forget the Bubbles

OCTOBER 11, 2023

Most toys have warnings, reminding us to keep magnets and small parts away from children and infants. Powerful rare earth magnets are often found in: cordless tools hybrid electric cars cell phones MRI machines hard drives, and speakers Does the number of magnets ingested matter? She tolerated eating and drinking normally.

Pediatrics 116

Pediatrics Operations Radiology Radiology 116

Taming the SRU

JANUARY 1, 2024

unported license [link] Ultrasound allows us to visualize deeper, typically larger veins in the forearm and upper arm. The basilic and cephalic veins are common targets, though the deep brachial vein can also be used. Place ultrasound machine on the opposite side of the bed to minimize neck strain. J Trauma Acute Care Surg.

Emergency Department 80

Emergency Department Ultrasounds Administration Burns 80

Dr. Smith's ECG Blog

JUNE 2, 2023

Despite otherwise normal vital signs, she was appropriately triaged to the critical care area of the ED. I admitted her to cardiology with these concerns, and we agreed that cardiac MRI may help us confirm possible ARVC. This leaves us with the strong likelihood that ECG #1 is some form of VT.

EKG/ECG 72

EKG/ECG Wellness Ultrasounds EMS 72

EB Medicine

MAY 3, 2019

Jeff: And finally, how many of you wish there was a clearly outlined evidence-based approach to managing such patients to improve care and outcomes? billion per year in the US. Jeff: In terms specific risk factors for suicide and suicide related complaints - white men over 80 have the highest rate of suicide death in the US, with 51.6

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

Dr. Smith's ECG Blog

OCTOBER 9, 2018

I will briefly review the guidelines here and now: One should never use charges to calculate cost. In our ED, a health care assistant (HCA) records all ECGs, in triage and elsewhere. One must add in the cost of paper, and the system, and the ECG machine, all of which are negligible per ECG. Is that $125.00

EKG/ECG 52

EKG/ECG Hospitals 52