Emergency
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Hospitals Work to Improve Procedures Designed to Protect Staff and Patients From Harm
Hospitals are looking for new and better ways to protect staff and patients, both from intruders who mean harm, and patients or family members who become aggressive and agitated. However, defending against active assailants presents the greatest challenge, as hospitals and EDs strive to remain open and welcoming to the communities they serve.
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Suicide Assessment and Disposition
During the past 20 years, suicide has become recognized as a major public health concern. Focused medical assessment and suicide risk assessment in the emergency department can help determine whether a mental health consultation is required and whether patients need hospitalization.
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Early Rehospitalization Among ICU Survivors: How Can We Do Better?
Based on inductive analysis of a large sample of patients and caregivers, this study provides an organizational framework on which to focus efforts to develop complex healthcare interventions aimed at reducing readmission after critical illness.
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Diagnosis Sepsis: Is Newer Better?
Sepsis-3 criteria may be the favored method for prognostication, whereas SIRS-based criteria may be the preferred method to screen patients for consideration of ICU admission. Future studies are necessary to continue to explore the benefits of qSOFA and potentially reveal a more precise and reliable screening tool. Most importantly, it is paramount to remember that neither set of criteria is diagnostic. Using clinical judgment along with these guides remains the ideal approach.
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A Combination of Commonly Measured Clinical Variables May Predict Prolonged Mechanical Ventilation
The results of this study validate a clinical tool using common ICU variables for predicting prolonged mechanical ventilation. However, one must consider both the implications and strength of any predictive model for clinical decision-making.
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Antipsychotics Do Not Shorten the Duration of ICU Delirium
These results support minimizing the use of haloperidol and ziprasidone in delirious patients who are not agitated. Current best practice is to adhere to the ABCDE bundle, remove causative agents when possible, and continue antipsychotics (only if they appear effective and for the minimum time necessary). The jury is still out regarding how to manage agitated delirium.
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Pediatric Cardiothoracic Point-of-Care Ultrasound: Part I
Ultrasound has emerged as a critical tool for use at the bedside to guide not only diagnosis but treatment strategies as well. The first part of this article focuses on the uses and limitations of cardiac ultrasound in the acute setting. Part II will include discussion of cardiac arrest, congenital abnormalities, pneumothorax, pleural effusion, and pneumonia.
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High Altitude Medicine: A Review for the Practicing Emergency Physician
The recognition and treatment of high altitude illness is within the core content of emergency medicine practice. High altitude illness represents a spectrum of clinical entities, ranging from common and benign acute mountain sickness to life-threatening high altitude pulmonary edema and rare but potentially lethal high altitude cerebral edema.
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Patients Link Errors to Negative Physician Interactions: Important Risk Implications for EDs
In a recent study, researchers analyzed a largely unexplored data source: What patients and families had to say about errors. Diagnostic error literature has, so far, focused mainly on clinician decision-making and healthcare system design.
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Many EPs Lack Due Process Rights; Legislation Offers Possible Protection
Without due process rights, EPs lose the ability to advocate for patients without fear of termination. Typically, contract holders form arrangements with hospitals to staff EDs; the contract holder hires EPs to perform the actual work. The hospital tells the contract holder what it wants from the EPs. Those EPs who do not comply can be fired without recourse since due process rights are waived routinely as a condition of employment.