Browse Emergency Articles by Topic

New Concepts of Ultrasound in the Emergency Department: Focused Cardiac Ultrasound in Cardiac Arrest

Ultrasound is an integral aspect of caring for patients in the emergency department, and real-time use of this imaging modality at the bedside allows practitioners a hands-on approach to the clinical evaluation of patients. Point-of-care ultrasound (POCUS) has particular benefit in the critically ill patient for whom rapid information for decision-making is essential. Given this benefit, there is clear application for POCUS in the patient in cardiac arrest.

The Evaluation of the Dizzy Patient

Dizziness is a common complaint among emergency department patients. Emergency providers need to differentiate benign from serious causes.

Does This Older Patient Have a Spinal Fracture? Evaluation and Management of Spinal Fractures in Older Adults

Older adults present unique challenges for the clinician. Missing a spinal fracture can have devastating consequences for this more fragile population. The authors review the clinical presentation, injury patterns, and unique considerations for imaging and management of spinal fractures in older adults.

An International Survey of Ventilator Weaning Practices

A cross-sectional, multinational survey of adult intensivists revealed significant regional variation in several weaning practices, including screening, weaning modes, techniques to conduct spontaneous breathing trials, the use of written directives, and use of non-invasive ventilation in the peri-extubation period.

ICU Bed Availability: Does It Make a Difference?

Nationwide, the volume of ICU admissions from the ED has increased significantly over recent years (by 50% from 2001 to 2009). When demand exceeds bed availability, complex decisions regarding ICU must be made. Does bed availability affect triage decisions? If many beds are available, patients who are too ill or too well to benefit from the ICU may be admitted. Conversely, if too few beds are available, ICU admission may be denied to patients who may benefit. In prior studies, ICU denial has been associated with increased hospital mortality.

Is There a Role for Steroids in ARDS Management?

Mortality rates from acute respiratory distress syndrome (ARDS) remain high, even as therapy has improved over the last decade. Recent guidelines for management center on mechanical ventilation, with initial therapy beginning upon identification and treatment of the underlying cause of the ARDS. There is reasonable consensus regarding the use of lung-protective strategies, such as low tidal volume ventilation, prone positioning for those meeting criteria for severe ARDS, and restrictive fluid management after the initial resuscitation. However, for patients with the most severe disease, these treatments often are not completely effective, and we look for other therapies that might help.

Cervical Spinal Injury

Although spinal injuries are uncommon, they should be considered when children have sustained head or neck trauma or multiple severe injuries. Children with severe or multisystem trauma are more likely to suffer a spinal injury. Thus, emergency department providers should have a lower threshold to immobilize and image such patients to prevent morbidity and mortality. This article reviews the most common pediatric spinal fractures and injuries and optimal management practices.

Undetected Medical Conditions in ‘Psych’ Patients Are Legal Landmine

Once EPs conclude that a patient’s behavior is psychiatric, they may miss underlying medical conditions that are the real cause of the symptoms. This is less likely if a patient is behaving bizarrely, presents with a psychiatric history, and is taking psychiatric medications. Experts recommend obtaining a good history before deciding a patient is psychiatric.

Good Documentation of ED Consult Makes It Clear EP Met Standard of Care

To avoid needless legal entanglements, experts say EPs should know when they’re in over their heads and remain firm about what they need from a consultant. Invariably, specialists testify that while the EP asked for their opinion, the EP never asked or insisted that the specialist come in — and that had the severity of the situation been explained, the specialist certainly would have come to the ED.

Legal Exposure for ED and Hospital if Patients Refuse Discharge

Some patients may choose to remain in the ED against medical advice for several social reasons, including the fact the patient has no home, or views a hospital room as safer, more comfortable, or less lonely than going home.