Browse Emergency Articles by Topic

Creating a Standard of Care for Identifying, Managing Patients With Uncontrolled BP

Given the high prevalence of undiagnosed hypertension, investigators are looking at how emergency providers can play a role in identifying and intervening with patients who present to the ED with high blood pressure readings. The idea is to catch the condition at an earlier stage so that patients do not end up returning to the ED with strokes, heart attacks, and other serious cardiovascular consequences from uncontrolled hypertension.

Innovative Staffing Model Reduces Handoffs, Boosts Provider Satisfaction

To address the patient safety risks associated with provider handoffs, Seattle Children’s Hospital designed a new staffing model that is built around waterfall-style shifts, in which a new attending physician arrives every three to five hours. The approach has significantly reduced the number of handoffs that occur without increasing attending physician hours. Further, it has won the approval of both providers and charge nurses.

Frontline Providers Look for Answers Regarding Return of Acute Flaccid Myelitis

Confirmed cases of acute flaccid myelitis (AFM) in 2018 reached 90 by the end of October, according to the CDC. While the CDC has yet to confirm what is causing AFM, experts strongly suspect that the disease stems from common viral infections. Still, it is not yet clear why just a small number of patients go on to experience paralysis in one or more limbs, a characteristic disease feature.

The Influenza Virus: Winter Is Coming

Influenza is an acute respiratory illness responsible for significant seasonal epidemics each year. Despite commonly being a self-limited illness, the virus causes significant morbidity and mortality. During the winter months, emergency physicians should maintain a high suspicion for influenza in patients presenting with an acute febrile respiratory illness.

Finding a Consensus on ARDS Diagnostics and Determining a Relationship to Hospital Mortality

Critical care physicians reviewed more than 700 mechanically ventilated patients with acute hypoxemia and reached a consensus on the presence of acute respiratory distress syndrome (ARDS) in 15% of patients and nonconsensus on the presence of ARDS in an additional 14% of cases. Hospital mortality was not different between these cohorts (37% and 35%, respectively).

Preventive Tactics and Management of Acute Kidney Injury in the ICU

Acute kidney injury (AKI) is a sudden decline in renal function due to nephron dysfunction and/or damage that results in nitrogenous waste product accumulation and acid-base, electrolyte, and fluid disturbances. It is estimated to occur in 16-67% of critically ill patients admitted to the ICU. Common inciting causes include major surgery, iatrogenic interventions, and sepsis. Advanced age and comorbidities increase kidney susceptibility to various exposures and insults. Severe AKI requiring renal replacement therapy (RRT) is associated with a 10-fold increase in mortality and increases length of stay an average of 5.7 days. Preventive tactics and RRT remain the cornerstones of AKI management in critically ill patients.

Pediatric Ocular Trauma: A Clinical Perspective

Eye trauma can be devastating to a child and challenging to the clinician. These authors review common traumatic eye injuries and provide tips for the clinical evaluation of our youngest patients.

Limb Ischemia and Gangrene

Although many cases of extremity pain are the result of mild, self-limited issues, ischemia and gangrene are catastrophic causes of pain that initially can present with nondescript findings. To limit tissue loss and optimize patient outcomes, emergency physicians must be able to distinguish benign limb pain from the earliest stages of high-risk, life- and limb-threatening disease.

Claims Allege Life-saving Information Was Hiding in Plain Sight

The patient history, labs, and radiology — that was the extent of the information available to EPs historically. EPs argue they do not have time to hunt for every possible piece of information that could have prevented a bad outcome. But that is beside the point when lawyers get involved. Critical information might be hiding in plain sight. Modules used by pathology or radiology are not always easily accessible, but ED providers should not expect a jury to be too sympathetic to this dilemma.

Poor Nurse-EP Communication Pits Hospital Against EP

Conflicting deposition testimony bolsters any medical malpractice case. Communication gaps between EPs and ED nurses often become a central issue during malpractice litigation. Conflict over what, if anything, nurses communicated to the EP works to the plaintiff’s benefit.