Severe Hyperkalemia, a Case Report.

Unlabelled: This case highlights the classic electrocardiogram (ECG) finding of a severely widened QRS complex with a sinusoidal pattern indicative of severe hyperkalemia. It also emphasizes the importance of the ECG in screening for electrolyte abnormalities and the ability to begin therapy before laboratory confirmation in the correct clinical setting. A 78-year-old male with history of end stage renal disease presented with chest pain.

A workflow task force affects emergency physician compliance for point-of-care ultrasound documentation and billing.

Background: Emergency point-of-care ultrasound (POC u/s) is an example of a health information technology that improves patient care and time to correct diagnosis. POC u/s examinations should be documented, as they comprise an integral component of physician decision making. Incomplete documentation prevents coding, billing and physician group compensation for ultrasound-guided procedures and patient care.

Human Trafficking: A Guide to Identification and Approach for the Emergency Physician.

Human trafficking is a significant human rights problem that is often associated with psychological and physical violence. There is no demographic that is spared from human trafficking. Traffickers maintain control of victims through physical, sexual, and emotional violence and manipulation.

Resident Supervision and Patient Safety: Do Different Levels of Resident Supervision Affect the Rate of Morbidity and Mortality Cases?

Background: In our academic emergency department, our senior residents lead their own patient care team, known as the red team (RT). Attending physicians are responsible for managing their own team (AT) and precepting the senior resident's cases.

Objective: We hypothesized that the RT would have the same number of morbidity and mortality (M&M) cases and similar numbers of adverse outcomes as the AT.

Survey of patient and physician influences and decision-making regarding CT utilization for minor head injury.

Objective: Assess factors that influence both the patient and the physician in the setting of minor head injury in adults and the decision-making process around CT utilization.

Methods: This is a convenience sample survey study of adult minor head injury patients (GCS 15) and their physicians regarding factors influencing the decision to use CT to evaluate for intra-cranial haemorrhage. Once a head CT was ordered and before the results were known, both the patient and physician were given a one-page survey asking questions about their concern for injury and rationale for CT use.

Patterns in computed tomography utilization among emergency physicians in an urban, academic emergency department.

We sought to determine if CT utilization rates varied by characteristics of the physician. A chart review was performed at an urban academic emergency department (ED) to identify all the CT scans ordered and patients seen for subjects 21 years of age and older by physicians between January 2001 and December 2008. "Years of experience" was defined as years of practice after residency.

Computed tomography utilization rates after the placement of a scanner in an emergency department: a single-center experience.

The convenience of a computed tomography (CT) scanner in the emergency department (ED) may impact utilization rates. Our primary aim was to determine the rate of utilization before and after the placement of an ED CT scanner. Secondary aims were to determine the rate of utilization by anatomic region and during a 5-month period when the ED scanner was unavailable.

Increased rates of rapid point-of-care HIV testing using patient care technicians to perform tests in the ED.

Background: Various emergency department (ED) HIV testing models are reported in the literature but may not all be sustainable. We sought to determine whether changing an ED rapid HIV testing program from counselor-based to ED technician-based resulted in more testing.

Methods: We evaluated data from an ED rapid HIV testing program.

Falling through the cracks? Missed opportunities for earlier HIV diagnosis in a New York City Hospital.

Summary Newly diagnosed HIV-positive patients have frequent health care encounters prior to diagnosis representing missed opportunities for diagnosis. This study determines the proportion of patients with new HIV diagnoses with encounters in the 3 years prior to diagnosis. We describe the characteristics of newly diagnosed patients and of "late testers" (CD4 <200 cells/mm(3) at the time of diagnosis).

Magnitude of D-dimer matters for diagnosing pulmonary embolus.

Objective: The objective of this study is to determine whether the magnitude of the D-dimer correlates with a higher likelihood of pulmonary embolus (PE).

Methods: We performed an electronic chart review at our academic, tertiary care center, annual emergency department (ED) census greater than 100000. All patients with a chest computed tomographic (CT) scan with intravenous contrast and an elevated D-dimer level obtained in the ED between January 2001 and July 2008 were identified.

Emergency department rectal temperatures in over 10 years: A retrospective observational study.

Background: Fever in patients can provide an important clue to the etiology of a patient's symptoms. Non-invasive temperature sites (oral, axillary, temporal) may be insensitive due to a variety of factors. This has not been well studied in adult emergency department patients.

Head computed tomography utilization and intracranial hemorrhage rates.

Utilization of computed tomography scans (CTs) has increased dramatically in emergency departments in the USA. This study aimed to retrospectively determine the yield of CTs among all patients that received a CT of the head from 2001 to 2007, which is adjusted for patient volume. For secondary endpoints, we examined the yield of CT of the head for the following hemorrhages: (1) intracerebral, (2) subarachnoid, (3) subdural, and (4) epidural.

Computed tomography use in the adult emergency department of an academic urban hospital from 2001 to 2007.

Study Objective: There is both increasing recognition and growing scrutiny of the increased utilization of computed tomography (CT) in medicine. For our primary objective, we determine and quantify the CT utilization rate in our emergency department (ED) during the last 7 years. As a secondary objective, we compare trends in utilization for various types of CT scans.

Difficulties with gum elastic bougie intubation in an academic emergency department.

Background: The difficulties with gum elastic bougie (GEB) use in the emergency department (ED) have never been studied prospectively.

Objectives: To determine the most common difficulties associated with endotracheal intubation using a GEB in the ED.

Methods: We conducted a prospective, observational study of GEB practices in our two affiliated urban EDs with a 3-year residency training program and an annual census of 150,000 patients.

Pathway for the management of survivors of out-of-hospital cardiac arrest.

The estimated number of out-of-hospital care arrest cases is about 300,000 per year in the United States. Two landmark studies published in 2002 demonstrated that the use of therapeutic hypothermia after cardiac arrest decreased mortality and improved neurologic outcome. Based on these studies, the International Liaison Committee on Resuscitation and the American Heart Association recommended the use of therapeutic hypothermia after cardiac arrest.

Can bedside ultrasound assist in determining whether serum creatinine is elevated in cases of acute urinary retention?

Background: There are no guidelines to determine which patients with acute urinary retention (AUR) require blood testing (i.e., serum creatinine) to assess for renal failure.

Success of the gum elastic bougie as a rescue airway in the emergency department.

Background: The gum elastic bougie (GEB) is a rescue airway device commonly found in the emergency department (ED). However, data documenting its efficacy are lacking in the emergency medicine literature.

Study Objectives: To determine the success rate of endotracheal intubation using a GEB and the reliability of "palpable clicks" and "hold-up" in the ED setting.