Lung ultrasound: a useful tool in the assessment of the dyspnoeic patient in the emergency department. Fact or fiction?

Patients with respiratory distress present a frequent and challenging dilemma for emergency physicians (EPs). The accurate diagnosis and treatment of the underlying pathology is vitally important in these sick patients to ensure the best outcome and minimise harm from unnecessary treatments. Within the last decade, studies have shown lung ultrasonography (LU) to be valuable in the accurate diagnosis of a variety of lung pathologies, including cardiogenic pulmonary oedema, pleural effusion, pneumothorax, haemothorax and pneumonia. However, despite advances in techniques and the evidence for the use of LU in the diagnosis of respiratory pathology, it remains poorly understood and rarely used by EPs. This clinical review article provides an overview of LU and its relevance as a diagnostic aid to the detection of respiratory pathology in the Emergency Department (ED).

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An Acute Severe Headache

Acute Medicine Journal ◽

10.52964/amja.0618 ◽

2016 ◽

Vol 15 (2) ◽

pp. 104-106

Author(s):

Adnan Azim ◽

◽

C Spake ◽

T Raza ◽

◽

...

Keyword(s):

Emergency Department ◽

Retrospective Study ◽

Sudden Onset ◽

Severe Headache ◽

Accurate Diagnosis ◽

Headache Diagnosis ◽

The Uk ◽

Underlying Pathology

Severe headaches are a frequent presentation to the Emergency Department, accounting for around 1% of presentations. Of these, 13-16% will have a sinister underlying pathology but accurate diagnosis of headaches on the medical take remain difficult for non-specialists. A retrospective study from the UK found that, of those presenting to Emergency Department with sudden onset severe headaches, only 60% were given a specific headache diagnosis, with one third of these given their diagnoses despite an inadequate history.

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Management of sepsis and septic shock in the emergency department

Internal and Emergency Medicine ◽

10.1007/s11739-021-02735-7 ◽

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.

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The Red Legs RATED tool to improve diagnosis of lower limb cellulitis in the emergency department

British Journal of Nursing ◽

10.12968/bjon.2021.30.12.s22 ◽

2021 ◽

Vol 30 (12) ◽

pp. S22-S29

Author(s):

Gillian O'Brien ◽

Patricia White

Keyword(s):

Emergency Department ◽

Lower Limb ◽

Treatment Guidelines ◽

Positive Impact ◽

Data Gathering ◽

Pilot Project ◽

Accurate Diagnosis ◽

Evidence Based ◽

Significant Burden ◽

User Friendly

Background: Lower limb cellulitis poses a significant burden for the Irish healthcare system. Accurate diagnosis is difficult, with a lack of validated evidence-based tools and treatment guidelines, and difficulties distinguishing cellulitis from its imitators. It has been suggested that around 30% of suspected lower limb cellulitis is misdiagnosed. An audit of 132 patients between May 2017 and May 2018 identified a pattern of misdiagnosis in approximately 34% of this cohort. Objective: The aim of this pilot project was to develop a streamlined service for those presenting to the emergency department with red legs/suspected cellulitis, through introduction of the ‘Red Leg RATED’ tool for clinicians. Method: The tool was developed and introduced to emergency department clinicians. Individuals (n=24) presenting with suspected cellulitis over 4 weeks in 2018 were invited to participate in data gathering. Finally, clinician questionnaire feedback regarding the tool was evaluated. Results: Fourteen participants consented, 6 female and 8 male with mean age of 65 years. The tool identified 50% (n=7) as having cellulitis, of those 57% (n=4) required admission, 43% (n=3) were discharged. The remainder who did not have cellulitis (n=7) were discharged. Before introduction of the tool, all would typically have been admitted to hospital for further assessment and management of suspected lower limb cellulitis. Overall, 72% (n=10) of patients who initially presented with suspected cellulitis were discharged, suggesting positive impact of the tool. Clinician feedback suggested all were satisfied with the tool and contents. Conclusion: The Red Leg RATED tool is user friendly and impacts positively on diagnosis treatment and discharge. Further evaluation is warranted.

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Patient Suggestions to Improve Emergency Physician Empathy and Communication

Journal of Patient Experience ◽

10.1177/2374373521996981 ◽

2021 ◽

Vol 8 ◽

pp. 237437352199698

Author(s):

Sophia Aguirre ◽

Kristen M Jogerst ◽

Zachary Ginsberg ◽

Sandeep Voleti ◽

Puneet Bhullar ◽

...

Keyword(s):

Emergency Department ◽

Patient Satisfaction ◽

Emergency Physician ◽

Active Listening ◽

Patient Relationship ◽

Emergency Physicians ◽

Future Improvement ◽

Survey Responses ◽

Physician Empathy

Emergency physician empathy and communication is increasingly important and influences patient satisfaction. This study investigated if there is a need for improvement in provider empathy and communication in our emergency department and what areas could be targeted for future improvement. Patients cared for by emergency physicians with the lowest satisfaction scores were surveyed within 1 week of discharge. Patients rated their emergency provider’s empathy and communication and provided feedback on the patient–provider interaction. Compared to survey responses nationally, our providers fell between the 10th and 25th percentiles for all questions, except question 5 (making a plan of action with [the patient]) which was between the 5th and 10th percentile. Areas most frequently cited for improvement were “wanting to know why” (N = 30), “time is short” (N = 15), and “listen to the patient” (N = 13). Survey percentiles and open-ended suggestions demonstrate a need for providers to give thorough explanations, spend more time with the patient, and demonstrate active listening. These themes can be used to strengthen the provider–patient relationship.

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Small animal Review

Companion Animal ◽

10.12968/coan.2021.0008 ◽

2021 ◽

Vol 26 (3) ◽

pp. 5-5

Author(s):

Alex Gough

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Pulmonary Oedema ◽

Potential Role ◽

Lung Ultrasound ◽

Small Animal ◽

Shock Index ◽

Cardiogenic Pulmonary Oedema ◽

The Impact

Summary In this month's Small Animal Review, we summarise three recently published papers from other veterinary journals. The papers for this issue explore the impact of open registries on inbreeding, in the working Australian Kelpie population particularly, and the impact of vehicle trauma on the canine shock index, as well as the potential role for lung ultrasound in monitoring for cardiogenic pulmonary oedema in dogs being treated for left-sided congestive heart failure.

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The International Federation for Emergency Medicine report on emergency department crowding and access block: a brief summary

International Journal of Emergency Medicine ◽

10.1186/s12245-020-00312-x ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

A. P. Javidan ◽

◽

K. Hansen ◽

I. Higginson ◽

P. Jones ◽

...

Keyword(s):

Emergency Department ◽

Emergency Medicine ◽

Task Force ◽

Video Conferencing ◽

International Federation ◽

Emergency Physicians ◽

Emergency Department Crowding ◽

Comprehensive Guidance ◽

The World ◽

Ed Crowding

Abstract Objective To develop comprehensive guidance that captures international impacts, causes, and solutions related to emergency department crowding and access block Methods Emergency physicians representing 15 countries from all IFEM regions composed the Task Force. Monthly meetings were held via video-conferencing software to achieve consensus for report content. The report was submitted and approved by the IFEM Board on June 1, 2020. Results A total of 14 topic dossiers, each relating to an aspect of ED crowding, were researched and completed collaboratively by members of the Task Force. Conclusions The IFEM report is a comprehensive document intended to be used in whole or by section to inform and address aspects of ED crowding and access block. Overall, ED crowding is a multifactorial issue requiring systems-wide solutions applied at local, regional, and national levels. Access block is the predominant contributor of ED crowding in most parts of the world.

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