Emergency
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ECG Overload? EP Might Miss Subtle STEMI
It’s not uncommon for EPs to be presented with dozens of ECGs during a shift. The large number of ECGs performed at triage could lead to an unintended legal consequence: increasing the possibility of missed ST-elevation myocardial infarction (STEMI), especially those that are subtle or atypical presentations.
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Surprising New Data on Missed Acute Coronary Syndrome in EDs
Lack of “typical” symptoms cannot rule out acute coronary syndrome, and “atypical” symptoms should raise the EP’s index of suspicion, according to a recent review of the literature.
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Did ED Prescription Spark Opioid Addiction? Causation Tough to Prove
Plaintiff attorneys may try to link a patient’s addiction to an ED prescription, but linking causation to one specific EP is difficult. EPs can reduce legal risks by checking available registries to identify high-risk patients, posting clear guidelines on prescribing practices in ED waiting rooms, and using caution about referring screening to social workers or behavioral health specialists.
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ED Claims Involving High-dose Analgesics Carry Jury Appeal
Recent successful ED claims involving high-dose analgesics focused on failure to monitor patients and improper discharge. The malpractice lawsuits alleged that a patient was seriously injured because he or she was allowed to leave the ED while sedated, a patient went into respiratory arrest because of unsafe discharge, and the ED failed to monitor a patient adequately, resulting in the patient’s death.
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Revised Standards on Pain Assessment and Management Reflect Concerns About Opioid Epidemic
As of Jan. 1, 2018, The Joint Commission will judge accredited hospitals according to newly revised standards for pain assessment and management. The standards are intended to address some of the unintended consequences of a nationwide focus on the under-treatment of pain, reflected in earlier versions. The revised standards push practitioners to offer alternatives to opioids when appropriate, and to engage patients in treatment planning for their pain so that realistic expectations are established.
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Two-stage Screening Tool Improves Identification of Young Sepsis Patients in ED
Investigators at Children’s Hospital of Philadelphia have developed a two-stage process to better identify children with sepsis while also minimizing alert fatigue. The approach includes an electronic alert tool that flags children with abnormal vital signs, but includes screening questions that enable clinicians to eliminate patients with no sign of infection. This approach is paired with a sepsis huddle to bring clinician judgment into the equation.
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Electronic Tool, Clinical Judgment Replace Electronic Severity Index Triage System
Johns Hopkins Hospital in Baltimore has replaced a widely used triage system with a new decision-support tool that enables nurses at triage in the ED to better differentiate patients based on acuity level. The electronic tool, dubbed e-triage, is able to quickly factor in a patient’s medical history, vital signs, and chief complaint, and compare this information to thousands of other patients.
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How Las Vegas Hospitals Responded to Nation’s Deadliest Mass Shooting
Las Vegas medical professionals describe their experience responding to the nation's deadliest mass shooting that occurred in October. These providers also emphasize the importance of developing a versatile emergency response process that can be deployed in any type of mass casualty event.
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Emerging Infectious Disease and Emergency Medicine
There are many emerging infections for which the emergency physician must remain clinically vigilant. Although many infections may not represent true emergencies, it is important for ED providers to understand the epidemiology, presentation, and treatment of some of today’s common and life-threatening infections.
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Tachycardia
The recognition, diagnosis, and treatment of tachycardia is a cornerstone of emergency medicine practice. This article will cover the most commonly seen supraventricular and ventricular tachycardias encountered in the ED, with a focus on their electrocardiographic diagnoses and treatment options.