Evaluating the Impact of Emergency Department Length of Stay in a Military Training Hospital Following the Implementation of a Standardized Paging System.

Emergency department (ED) lengths of stay (LOS) may be unnecessarily extended by inefficient consulting processes. Delays in initiating consultations, returning calls, consultant evaluation of patients, and communication of recommendations can contribute to potentially avoidable increases in LOS. Prolonged ED LOS has been shown to increase patient morbidity and mortality and to decrease patient satisfaction.

Posterior Reversible Encephalopathy Syndrome: A Narrative Review for Emergency Clinicians.

Background: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic disorder characterized by seizures, headache, altered mental status, and visual disturbances, and is often associated with acute hypertension.

Objective: This narrative review provides a focused description of the presentation, diagnostic evaluation, and management of PRES.

Discussion: PRES is associated with a variety of factors, including acute rise in blood pressure, renal disease, preeclampsia/eclampsia, and immunosuppressive therapy.

End-of-Shift Evaluations: Experiences Over a Quarter-Century.

For the past 25 years, the San Antonio Uniformed Services Health Education Consortium (SAUSHEC) Emergency Medicine Residency has used an end-of-shift evaluation (ESE) to provide formative feedback and assess resident progress. The instrument has evolved from a simple half-sheet of paper to a more complex electronic milestones assessment. The length and detail of the evaluation form has grown appreciably, but the precise impact of these changes on the effectiveness of formative feedback unknown.

Advances in novel antibiotics to treat multidrug-resistant gram-negative bacterial infections.

Antimicrobial resistance is a growing threat to public health and an increasingly common problem for acute care physicians to confront. Several novel antibiotics have been approved in the past decade to combat these infections; however, physicians may be unfamiliar with how to appropriately utilize them. The purpose of this review is to evaluate novel antibiotics active against resistant gram-negative bacteria and highlight clinical information regarding their use in the acute care setting.

A Case of Brodie's Abscess With Tibial Erosion and Extravasation Into Surrounding Soft Tissue.

Atraumatic limb pain and limp is a common pediatric presentation in the emergency department in the United States. In a majority of cases, these presentations are benign. However, in cases where pediatric patients are repeatedly presenting for atraumatic limb pain, further investigation is required.

Emergency Physicians: Beware of the Consent Standard of Care.

Many emergency physicians view informed consent as a necessary component of treatments or procedures to be performed on their patients. When such procedures are necessary, often there is a discussion of risks, benefits and alternatives with forms signed to validate the discussion. Two Wisconsin emergency department medical-legal cases have expanded liability of the duty of informed consent.

Comparison of Preloaded Bougie versus Standard Bougie Technique for Endotracheal Intubation in a Cadaveric Model.

Introduction: We compared intubating with a preloaded bougie (PB) against standard bougie technique in terms of success rates, time to successful intubation and provider preference on a cadaveric airway model.

Methods: In this prospective, crossover study, healthcare providers intubated a cadaver using the PB technique and the standard bougie technique. Participants were randomly assigned to start with either technique.

Shared liability? Consultants, pharmacists, and the emergency physician: legal cases and caveats.

In caring for patients in the Emergency Department (ED), the emergency physician (EP) will often utilize consulting specialists and pharmacists. In the event of an untoward patient outcome, disagreement may arise regarding the liability of each provider. Here, we review a series of malpractice cases involving consulting physicians and pharmacists to illustrate the legal principles of physician-patient relationships and physician duty.

Effect of hydroxocobalamin on surface oximetry in nonexposed humans.

Introduction: The newer cyanide antidote, hydroxocobalamin, due to its pigmentation, has been found to cause interferences in some laboratory assays. Co-oximetry may also be affected by hydroxocobalamin, leading to false elevations in hemoglobin concentration, methemoglobin, carboxyhemoglobin, and false decreases in oxyhemoglobin. The Masimo Radical-7 is a medical device that performs noninvasive oximetry and estimates hemoglobin (Hb) concentration and percent carboxyhemoglobin (COHb), methemoglobin (MetHb), and oxyhemoglobin saturation (O2Hb).

A man with purple urine. Hydroxocobalamin-induced chromaturia.

In a clinical study, healthy subjects were given an antidote to a toxin that may be encountered by emergency physicians. Urine was collected for seven days following administration of the antidote. The drastic dark purple color of the urine on day 1, taken immediately after the antidote was given, is clearly of note.

A continuing black hole? The FDA boxed warning: an appeal to improve its clinical utility.

The boxed warning is increasingly utilized by the Food and Drug Administration (FDA) as a clinical warning to prescribers of dangerous adverse drug reactions. As these warnings have expanded, we feel the utility and application of boxed warnings are becoming more nebulous. The use of drugs following issuance of a boxed warning has been variable.