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ER Techniques

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253 papers 500 to 1000 followers ER Techniques
By David Rhine MD FRCPC. Emergency medicine. Special interest in concussion management.
Alejandra Vasquez, Marina Gaínza-Lein, Iván Sánchez Fernández, Nicholas S Abend, Anne Anderson, J Nicholas Brenton, Jessica L Carpenter, Kevin Chapman, Justice Clark, William D Gaillard, Tracy Glauser, Joshua Goldstein, Howard P Goodkin, Yi-Chen Lai, Tobias Loddenkemper, Tiffani L McDonough, Mohamad A Mikati, Anuranjita Nayak, Eric Payne, James Riviello, Dmitry Tchapyjnikov, Alexis A Topjian, Mark S Wainwright, Robert C Tasker
OBJECTIVE: We aimed to evaluate and compare the status epilepticus treatment pathways used by pediatric status epilepticus research group (pSERG) hospitals in the United States and the American Epilepsy Society (AES) status epilepticus guideline. METHODS: We undertook a descriptive analysis of recommended timing, dosing, and medication choices in 10 pSERG hospitals' status epilepticus treatment pathways. RESULTS: One pathway matched the timeline in the AES guideline; nine pathways described more rapid timings...
July 11, 2018: Pediatric Neurology
Anne Kristine Servais Iversen, Michael Kristensen, Rebecca Monett Østervig, Lars Køber, György Sölétormos, Jakob Lundager Forberg, Jesper Eugen-Olsen, Lars Simon Rasmussen, Morten Schou, Kasper Karmark Iversen
OBJECTIVE: To compare the Danish Emergency Process Triage (DEPT) with a quick clinical assessment (Eyeball triage) as predictors of short-term mortality in patients in the emergency department (ED). METHODS: The investigation was designed as a prospective cohort study conducted at North Zealand University Hospital. All patient visits to the ED from September 2013 to December 2013 except minor injuries were included. DEPT was performed by nurses. Eyeball triage was a quick non-systematic clinical assessment based on patient appearance performed by phlebotomists...
October 16, 2018: Emergency Medicine Journal: EMJ
Catherine M Lunter, Ellen L Carroll, Charlotte Housden, Joanne Outtrim, Faye Forsyth, Annie Rivera, Chris Maimaris, Adrian Boyle, Barbara J Sahakian, David K Menon, Virginia Fj Newcombe
OBJECTIVE: Despite mild traumatic brain injury (mTBI) accounting for 80% of head injury diagnoses, recognition of individuals at risk of cognitive dysfunction remains a challenge in the acute setting. The objective of this study was to evaluate the feasibility and potential role for computerised cognitive testing as part of a complete ED head injury assessment. METHODS: mTBI patients (n = 36) who incurred a head injury within 24 h of presentation to the ED were compared to trauma controls (n = 20) and healthy controls (n = 20) on tests assessing reaction time, speed and attention, episodic memory, working memory and executive functioning...
September 3, 2018: Emergency Medicine Australasia: EMA
Abdullah Bakhsh, Michael Ritchie
Tracheal intubation is a critical step in securing the patient's airway in a variety of emergent and non-emergent settings. Difficulties and complications may arise with this procedure, and alternative laryngoscopes that use video technology have been designed to improve visibility when airway difficulty is predicted or encountered. These devices may be flexible or rigid in design for the purpose of assisting in intubations, especially expected difficult intubations. Video laryngoscopes have been advertised as being able to reduce difficulty, failure, trauma and other complications compared with direct laryngoscopy...
October 15, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
K Hawrylyshyn, S L McLeod, J Thomas, Catherine Varner
CLINICIAN'S CAPSULE What is known about the topic? Methotrexate is widely accepted as first-line treatment of non-ruptured ectopic pregnancy and may be considered for women with a suspected ectopic pregnancy. What did this study ask? What are the outcomes of pregnant women with suspected ectopic pregnancy who received methotrexate as first-line treatment? What did this study find? Of patients treated with methotrexate, 18% went on to require surgical management, with 11.2% having ruptured on surgical evaluation...
October 8, 2018: CJEM
Daniel J Corwin, Kathleen J Propert, Joseph J Zorc, Mark R Zonfrillo, Douglas J Wiebe
BACKGROUND: Concussion guidelines recommend a vestibular and oculomotor (VOM) examination be performed for all patients with concern for concussion, however the feasibility of performing testing is unknown. We aimed to measure rates of exam performance after implementation of training and support tools in a pediatric emergency department. METHODS: We conducted a retrospective study of patients age 6 to 18 years old presenting over a 12-month period. Charts were obtained via natural language processing, where concussion was suggested as a diagnosis in the electronic health record, and then manually reviewed to record patient and provider factors...
September 5, 2018: American Journal of Emergency Medicine
Peter S Graves, Stephen R Graves, Tanvir Minhas, Rebecca E Lewinson, Isabelle A Vallerand, Ryan T Lewinson
BACKGROUND: Emergency department efficiency is a priority across Canada. In the United States, scribes may increase the number of patients seen per hour per physician; however, Canadian data are lacking. We sought to implement scribes in a Canadian emergency department with the hypothesis that scribes would increase the number of patients seen per hour per physician. METHODS: We conducted a 4-month quality improvement pilot study in a community emergency department in Ottawa, Ontario...
July 2018: CMAJ Open
Roberto C Portela, Andrew C Miller
Idiopathic facial paralysis (aka Bell's Palsy) is the most common cause of unilateral facial paralysis.1 Maximal disability occurs within 48-72 hours, with symptoms involving both the upper and lower face.1 Patients may exhibit flattening of the forehead and nasolabial fold on the affected side, with the forehead remaining flat on the affected side when the patient raises his/her eyebrows. Additional symptoms may include poor eyelid closure, eye pain, blurred vision, posterior auricular pain, otalgia, hyperacusis, and taste disturbances...
September 4, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Romolo J Gaspari, Alexandra Sanseverino, Timothy Gleeson
STUDY OBJECTIVE: We hypothesize that clinical failure rates will be lower in patients treated with point-of-care ultrasonography and incision and drainage compared with those who undergo incision and drainage after physical examination alone. METHODS: We performed a prospective randomized clinical trial of patients presenting with a soft tissue abscess at a large, academic emergency department. Patients presenting with an uncomplicated soft tissue abscess requiring incision and drainage were eligible for enrollment and randomized to treatment with or without point-of-care ultrasonography...
August 17, 2018: Annals of Emergency Medicine
Michael Gottlieb, Dallas Holladay, Gary D Peksa
STUDY OBJECTIVE: Intubation is routinely performed in the emergency department, and rapid, accurate confirmation is essential to avoid potentially serious adverse outcomes. The number of studies assessing ultrasonography for the verification of endotracheal tube placement has expanded rapidly in recent years. We performed this systematic review and meta-analysis to determine the sensitivity and specificity of transtracheal ultrasonography for the verification of endotracheal tube location...
August 14, 2018: Annals of Emergency Medicine
Manu L N G Malbrain, Niels Van Regenmortel, Bernd Saugel, Brecht De Tavernier, Pieter-Jan Van Gaal, Olivier Joannes-Boyau, Jean-Louis Teboul, Todd W Rice, Monty Mythen, Xavier Monnet
In patients with septic shock, the administration of fluids during initial hemodynamic resuscitation remains a major therapeutic challenge. We are faced with many open questions regarding the type, dose and timing of intravenous fluid administration. There are only four major indications for intravenous fluid administration: aside from resuscitation, intravenous fluids have many other uses including maintenance and replacement of total body water and electrolytes, as carriers for medications and for parenteral nutrition...
May 22, 2018: Annals of Intensive Care
Alia Dharamsi, Sara Gray, Christopher Hicks, Jonathan Sherbino, Melissa McGowan, Andrew Petrosoniak
CLINICIAN'S CAPSULE What is known about the topic? The steps for performing a bougie-assisted cricothyroidotomy (BAC) have not been systematically developed, leading to instructional and performance variability. What did this study ask? Can the modified Delphi process be used to establish the essential steps required for BAC instruction? What did this study find? Using a modified Delphi methodology, we developed a 17-item BAC checklist to guide instruction for novice learners. Why does this study matter to clinicians? This checklist, developed by expert consensus, can be used to improve consistency in training for this life-saving procedure...
June 28, 2018: CJEM
Youn-Jung Kim, Chang Hwan Sohn, Dong Woo Seo, Bum Jin Oh, Kyoung Soo Lim, Won Young Kim
OBJECTIVES: Objective screening tool for patients at a high risk of developing acute brain injury (ABI) is necessary for the proper treatment of carbon monoxide (CO) poisoning patients. The aim of this study is to identify clinical factors that could predict ABI due to CO poisoning in patients with an altered mental status. METHODS: A prospectively collected CO poisoning registry at a single academic medical center was retrospectively analyzed. CO poisoning patients with an altered mental status at the emergency department, defined as unalert on the alert/responsive to voice/responsive to pain/unresponsive scale and underwent diffusion-weighted magnetic resonance imaging (DW-MRI) between January 1, 2013, and December 31, 2015, were included...
June 28, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Kai Li, Patil Armenian, Jessica Mason, Andrew Grock
No abstract text is available yet for this article.
July 2018: Annals of Emergency Medicine
Dawn Dalen, Amy Fry, Samuel G Campbell, Jeffrey Eppler, Peter J Zed
OBJECTIVE: The purpose of our study was to determine if cephalexin 500 mg orally four times daily was non-inferior to cefazolin 2 g intravenously daily plus probenecid 1 g orally daily in the management of patients with uncomplicated mild-moderate skin and soft tissue infection (SSTI) presenting to the ED. METHODS: This was a prospective, multicentre, double dummy-blind, randomised controlled non-inferiority trial conducted at two tertiary care teaching hospitals in Canada...
August 2018: Emergency Medicine Journal: EMJ
Howard S Kim, Kyle J Strickland, Katie A Mullen, Michael T Lebec
Emergency department-initiated physical therapy (ED PT) is an emerging resource in the United States, with the number of ED PT programs in the United States growing rapidly over the last decade. In this collaborative model of care, physical therapists are consulted by the treating ED physician to assist in the evaluation and treatment of a number of movement and functional disorders, such as low back pain, peripheral vertigo, and various gait disturbances. Patients receiving ED PT benefit from the physical therapist's expertise in musculoskeletal and vestibular conditions and from the individualized attention provided in a typical bedside evaluation and treatment session, which includes education on expected symptom trajectory, recommendations for activity modulation, and facilitated outpatient follow-up...
August 2018: American Journal of Emergency Medicine
Bryan J Harvell, Stephen D Helmer, Jeanette G Ward, Elizabeth Ablah, Raymond Grundmeyer, James M Haan
Introduction: Recent studies have provided guidelines on the use of head computed tomography (CT) scans in pediatric trauma patients. The purpose of this study was to identify the prevalence of these guidelines among concussed pediatric patients. Methods: A retrospective review was conducted of patients four years or younger with a concussion from blunt trauma. Demographics, head injury characteristics, clinical indicators for head CT scan (severe mechanism, physical exam findings of basilar skull fracture, non-frontal scalp hematoma, Glasgow Coma Scale score, loss of consciousness, neurologic deficit, altered mental status, vomiting, headache, amnesia, irritability, behavioral changes, seizures, lethargy), CT results, and hospital course were collected...
May 2018: Kansas journal of medicine
Tim Harris, Timothy J Coats, Mohammed H Elwan
Intravenous fluid therapy is one of the most common therapeutic interventions performed in the ED and is a long-established treatment. The potential benefits of fluid therapy were initially described by Dr W B O'Shaughnessy in 1831 and first administered to an elderly woman with cholera by Dr Thomas Latta in 1832, with a marked initial clinical response. However, it was not until the end of the 19th century that medicine had gained understanding of infection risk that practice became safer and that the practice gained acceptance...
August 2018: Emergency Medicine Journal: EMJ
Samantha Calder-Sprackman, Thara Kumar, Caroline Gerin-Lajoie, Megan Kilvert, Kari Sampsel
Introduction/Innovation ConceptEmergency medicine (EM) requires physicians to deal with acutely ill patients in a fast-paced and dynamic environment, which creates a barrier to debriefing after critical events. These unique challenges can negatively impact wellness. We sought to adapt and implement a peer-support wellness program called 'Ice Cream Rounds' in an EM residency setting. METHODS: A needs assessment survey was conducted among EM residents at The University of Ottawa to gauge interest and obtain resident input regarding program design...
September 2018: CJEM
Maala Bhatt, David W Johnson, Monica Taljaard, Jason Chan, Nick Barrowman, Ken J Farion, Samina Ali, Suzanne Beno, Andrew Dixon, C Michelle McTimoney, Alexander Sasha Dubrovsky, Mark G Roback
Importance: It is not clear whether adherence to preprocedural fasting guidelines prevent pulmonary aspiration and associated adverse outcomes during emergency department (ED) sedation of children. Objective: To examine the association between preprocedural fasting duration and the incidence of sedation-related adverse outcomes in a large sample of children. Design, Setting, and Participants: We conducted a planned secondary analysis of a multicenter prospective cohort study of children aged 0 to 18 years who received procedural sedation for a painful procedure in 6 Canadian pediatric EDs from July 2010 to February 2015...
July 1, 2018: JAMA Pediatrics
2018-05-30 13:49:44
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