scholarly journals Emergency Physicians Take to the Airwaves During COVID-19

2021 ◽  
Vol 78 (1) ◽  
pp. A18-A21
Author(s):  
Soo Youn
Keyword(s):  
Emergency Physicians

Successful Control of Massive Vaginal Bleeding with Resuscitative Endovascular Balloon Occlusion of the Aorta and Pelvic Packing

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Emre Özlüer ◽  
Çagaç Yetis ◽  
Evrim Sayin ◽  
Mücahit Avcil
Keyword(s):  
Vaginal Bleeding ◽  
Balloon Occlusion ◽  
Emergency Physicians ◽  
Pelvic Packing ◽  
Gynecological Malignancies ◽  
Life Threatening ◽  
Successful Control ◽  
Endovascular Balloon Occlusion

Gynecological malignancies may present as life-threatening vaginal bleeding. Pelvic packing and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be useful along with conventional vaginal packing when in terms of control of the hemorrhage. Emergency physicians should be able to perform these interventions promptly in order to save their patients from exsanguination.

scholarly journals Management of sepsis and septic shock in the emergency department

2021 ◽  
Author(s):  
Francesco Gavelli ◽  
Luigi Mario Castello ◽  
Gian Carlo Avanzi
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Patient Management ◽  
Emergency Physicians ◽  
Surviving Sepsis Campaign ◽  
Sepsis Management ◽  
Early Management ◽  
New Information ◽  
Sepsis And Septic Shock ◽  
Early Phases

AbstractEarly management of sepsis and septic shock is crucial for patients’ prognosis. As the Emergency Department (ED) is the place where the first medical contact for septic patients is likely to occur, emergency physicians play an essential role in the early phases of patient management, which consists of accurate initial diagnosis, resuscitation, and early antibiotic treatment. Since the issuing of the Surviving Sepsis Campaign guidelines in 2016, several studies have been published on different aspects of sepsis management, adding a substantial amount of new information on the pathophysiology and treatment of sepsis and septic shock. In light of this emerging evidence, the present narrative review provides a comprehensive account of the recent advances in septic patient management in the ED.

scholarly journals Accuracy of emergency physicians’ self-estimates of CT scan utilization and its potential effect on an audit and feedback intervention: a randomized trial

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Celine Larkin ◽  
Alexandra M. Sanseverino ◽  
James Joseph ◽  
Lauren Eisenhauer ◽  
Martin A. Reznek
Keyword(s):  
Randomized Trial ◽  
Repeated Measures ◽  
Intervention Group ◽  
Potential Effect ◽  
Audit And Feedback ◽  
Emergency Physicians ◽  
Feedback Intervention ◽  
Experimental Conditions ◽  
Actual Performance ◽  
Ct Utilization

Abstract Background Audit and feedback (A&F) has been used as a strategy to modify clinician behavior with moderate success. Although A&F is theorized to work by improving the accuracy of clinicians’ estimates of their own behavior, few interventions have included assessment of clinicians’ estimates at baseline to examine whether they account for intervention success or failure. We tested an A&F intervention to reduce computed tomography (CT) ordering by emergency physicians, while also examining the physicians’ baseline estimates of their own behavior compared to peers. Methods Our study was a prospective, multi-site, 20-month, randomized trial to examine the effect of an A&F intervention on CT ordering rates, overall and by test subtype. From the electronic health record, we obtained 12 months of baseline CT ordering per 100 patients treated for every physician from four emergency departments. Those who were randomized to receive A&F were shown a de-identified graph of the group’s baseline CT utilization, asked to estimate wherein the distribution of their own CT order practices fell, and then shown their actual performance. All participants also received a brief educational intervention. CT ordering rates were collected for all physicians for 6 months after the intervention. Pre-post ordering rates were compared using independent and repeated measures t tests. Results Fifty-one of 52 eligible physicians participated. The mean CT ordering rate increased significantly in both experimental conditions after the intervention (intervention pre = 35.7, post = 40.3, t = 4.13, p < 0.001; control pre = 33.9, post = 38.9, t = 3.94, p = 0.001), with no significant between-group difference observed at follow-up (t = 0.43, p = 0.67). Within the intervention group, physicians had poor accuracy in estimating their own ordering behavior at baseline: most overestimated and all guessed that they were in the upper half of the distribution of their peers. CT ordering increased regardless of self-estimate accuracy. Conclusions Our A&F intervention failed to reduce physician CT ordering: our feedback to the physicians showed most of them that they had overestimated their CT ordering behavior, and they were therefore unlikely to reduce it as a result. After “audit,” it may be prudent to assess baseline clinician awareness of behavior before moving toward a feedback intervention.

scholarly journals What are Canadian emergency physicians’ attitudes and self-perceived competence toward patients who present with suicidal ideation?

CJEM ◽  
2021 ◽  
Author(s):  
Justin Fernandes ◽  
Frank X. Scheuermeyer ◽  
Apu T. Chakraborty ◽  
William G. Honer ◽  
David Barbic
Keyword(s):  
Suicidal Ideation ◽  
Perceived Competence ◽  
Emergency Physicians

scholarly journals Unusual Presentation of Kratom Overdose With Rhabdomyolysis, Transient Hearing Loss, and Heart Failure

2021 ◽  
Vol 9 ◽  
pp. 232470962110050
Author(s):  
Vikram Sangani ◽  
Naseem Sunnoqrot ◽  
Kurdistan Gargis ◽  
Akshay Ranabhotu ◽  
Abbas Mubasher ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hearing Loss ◽  
Cardiac Death ◽  
Multidisciplinary Approach ◽  
Kidney Injury ◽  
Lethal Effect ◽  
Limited Information ◽  
Emergency Physicians ◽  
Behavioral Impairment ◽  
Elevated Creatinine

Kratom mainly grows in Southeast Asia. It is widely used for pain management and opioid withdrawal, which is available online for cheaper prices. Alkaloids extracted from kratom such as mitragynine and 7-hydroxy mitragynine exhibit analgesic properties by acting through µ receptors. Commonly reported side effects of kratom include hypertension, tachycardia, agitation, dry mouth, hallucinations, cognitive and behavioral impairment, cardiotoxicity, renal failure, cholestasis, seizures, respiratory depression, coma, and sudden cardiac death from cardiac arrest. Rhabdomyolysis is a less commonly reported lethal effect of kratom. Limited information is available in the literature. In this article, we present a case of a 45-year-old female who is overdosed with kratom and presented with lethargy, confusion, transient hearing loss, and right lower extremity swelling and pain associated with weakness who was found to have elevated creatinine phosphokinase. She was diagnosed with rhabdomyolysis, compartment syndrome, multiorgan dysfunction including acute kidney injury, liver dysfunction, and cardiomyopathy. She underwent emergent fasciotomy and required hemodialysis. Her renal and liver function subsequently improved. We described the case and discussed pharmacology and adverse effects of kratom toxicity with a proposed mechanism and management. We conclude that it is essential for emergency physicians, internists, intensivists, cardiologists, and nephrologists to be aware of these rare manifestations of kratom and consider a multidisciplinary approach.

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