Browse Emergency Articles by Topic

‘Purposeful Rounding’ Mixes Security, Clinical Teams to Help De-Escalate Tense Situations

Concerned about upticks in workplace violence in healthcare settings across the country, SSM Health has implemented “purposeful rounding,” a concept designed to strengthen communications and feedback between security personnel and clinicians on hospital units. Administrators describe the approach as a culture change but one that is well-received by clinicians in some of the most vulnerable units such as the ED, neonatal ICU, and behavioral health.

Measles Outbreaks Put EDs, Other Frontline Providers on Heightened Alert

Measles was declared all but finished as recently as 2000. However, the disease has re-emerged in the wake of declines in the number of people receiving vaccinations against it. With hundreds of reported cases in more than a dozen states, the disease is a significant concern for EDs because of the highly contagious nature of measles.

Managing Complications of New-Age Cancer Therapy

Cancer patients undergoing treatment are immunocompromised and at high risk for developing early complications leading to critical illness. Compared to complications encountered with conventional chemotherapy, new-generation immunotherapies pose unique diagnostic challenges because their presentation can be vague and nonspecific or can mimic autoimmune diseases.

Corticosteroid Administration in Sepsis May Be Associated With Lower 28-Day Mortality

In this systematic review and meta-analysis of randomized, controlled trials comparing administration of corticosteroids with placebo or standard supportive care in sepsis, corticosteroids were associated with reduced 28-day mortality.

Using Ketamine in the Critically Ill: A Clinical Review

This is a guideline for ketamine use in the appropriate clinical setting from the practicing intensivist’s perspective.

Acute Treatment of Pediatric Migraine

Migraines occur in young children, but may be challenging to diagnose. Migraines can have a great impact on pediatric patients’ quality of life with school absence and limitations on extracurricular activities. Treatment of pediatric migraines or possible migraines is difficult secondary to the lack of evidence for effective therapies in pediatric patients. Treatment includes traditional therapy with dopamine receptor antagonists (DRAs), nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, and combination therapies. Newer therapies include magnesium, valproic acid (VPA), and peripheral nerve blocks. The authors review the clinical presentation of migraines in children, guidelines for diagnosis, and therapeutic options.

EPs, Hospitals Face Liability for ED Nurse Practitioners’ Negligence

If an ED nurse practitioner is sued for malpractice, the hospital will “almost always” be named, says one attorney. However, the hospital may not rally behind the care given by the nurse defendant. For this reason, nurse practitioners should carry their own malpractice insurance.

Vague Symptoms Trigger Sepsis Care Delays and Lawsuits

More than one-third of ED patients with septic shock reported only vague symptoms at presentation, according to the authors of a recent study of septic shock patients discharged from a large urban ED. These patients had delayed antibiotic administration and were at a higher risk of mortality compared to patients with explicit infection symptoms. Another recent analysis revealed that a faster completion of a three-hour bundle of sepsis care and quick administration of antibiotics — but not rapid completion of an initial bolus of IV fluids — were associated with lower risk-adjusted, in-hospital mortality rates.

High Policy Limits Make EP a ‘Deep Pocket’ for Plaintiff

One insider recommends emergency physicians spend money ensuring their assets are protected from third parties rather than on "higher premiums for larger limits."

Was ED Unprepared for Critically Ill Child? Guidelines Could Help Prove It

The risk of a poor outcome for a critically ill child is high when a system is not ready to meet the emergency needs of that child. New guidelines from the National Pediatric Readiness Project can be used to prove that an ED fell short in this regard.