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A new peer review and quality improvement process at the University of Michigan Hospital and Health Systems in Ann Arbor methodically samples patient safety indicators in the emergency department (ED) to spot trends that signal problems.
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If a nurse asks the emergency physician (EP) whether an arterial blood gas (ABG) is needed because a boarded patients pulse oximetry is dropping, a busy EPs response might be to tell the nurse to order the test and let the admitting physician know about it.
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Does a malpractice suit filed by a boarded ED patient allege he or she was being monitored differently in the ED than would have occurred in the intensive care unit (ICU)? In one claim that included this allegation, the ED nurses notes clearly showed that the same standard was followed in the ED.
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Were you called by the intensive care unit (ICU) because a patient needs emergent intubation due to a dislodged tube or deterioration of the patients status?
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CAP is a commonly encountered disease process in the emergency department. Early recognition and appropriate management can minimize morbidity and mortality. In addition, the early recognition of complications may facilitate timely intervention.
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To some, the term genital emergencies recalls junior high school with the typical adolescent male humor of the time. But to a physician, this term describes a collection of disorders with potential implications to reproductive, sexual, and urologic function. Since many of these disorders are progressive, with the potential to cause increasing injury with the passage of time, early recognition and treatment are important in minimizing damage. In this two-part series, the author discusses the current literature and makes treatment recommendations for both the common and rare emergent conditions that can affect the male genitalia.
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Traumatic injury remains one of the most important and persistent causes for morbidity and mortality in the United States. The establishment of a trauma team that is available to evaluate and manage trauma quickly and efficiently during the very critical first minutes after the injured patient arrives at the hospital has significantly improved survival and dramatically reduced sequelae from these injuries. An important component of this expedited evaluation has been the recognition of the utility of ultrasound to augment the imaging and triage of the injured patient. In this well-researched monograph, the authors describe this rapidly growing modality and its many applications. All members of the trauma team should be familiar with the indications and limitations of this important trauma tool.
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High-sensitivity cardiac troponin (hs-cTn) assays have higher sensitivity for myocardial ischemic injury and necrosis than conventional assays, but with reduced specificity.
An hs-cTn level below the detectable limit is very accurate at excluding AMI in an ED patient with chest pain.
The precision of hs-cTn assays enables serial sampling of cardiac biomarkers to exclude AMI to be done over 1-2 hours as opposed to 3-9 hours for conventional cTn assays.
A normal coronary CT angiography (CCTA) (< 50% stenosis in any epicardial coronary artery) performed in an ED patient with chest pain is associated with a good 30-day outcome.
Use of CCTA in ED patients with chest pain is associated with reduced length of stay, admissions, and overall costs compared to typical care that often involves myocardial perfusion imaging.
CCTA is associated with a small but consistent increase in invasive coronary angiograms and reperfusion procedures compared to typical care that often involved myocardial perfusion imaging.
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It is entirely understandable for emergency providers to question any new task or responsibility handed down by regulators or administrators. Busy providers are already stressed with burgeoning patient volumes and all the pressures associated with handling acute care crises.
