Using Systems Thinking and Complexity Theory to understand and improve Emergency Medicine: Lessons from COVID-19 in a safety net health system.

Rationale: COVID-19 has fundamentally changed the practice of Emergency Medicine (EM). Care delivery on the front lines has historically depended upon ostensibly reliable input-output models for staffing, supplies, policies, and therapies. Challenged by the complexity of healthcare during the pandemic, the fallibility of these reductionist models was quickly revealed.

Intracranial Hemorrhage Presenting With ST-Segment Elevation and T-Wave Inversion Concerning for Acute Myocardial Infarction.

Acute neurologic injury and increased intracranial pressure are associated with electrocardiographic (ECG) changes that include rhythm disturbances as well as ECG mimics of myocardial ischemia, such as focal or diffuse ST-segment or T-wave abnormalities. Both the mechanism and significance of these ECG changes are not clear. The authors report a case of a patient with a complex medical history who became hypotensive after he presented with acute intracranial hemorrhage.

Effectiveness of Substance Use Navigation for Emergency Department Patients With Substance Use Disorders: An Implementation Study.

Study Objective: We implemented a whole person care-informed intervention delivered by substance use navigators (SUN) for emergency department (ED) patients with substance use disorders.

Methods: This was an implementation study of adult patients discharged from 3 public hospital EDs between September 1, 2021 through January 31, 2022 with cocaine, methamphetamine, alcohol, and opioid use-related diagnoses. The primary effectiveness outcome was treatment engagement within 30 days of ED discharge among patients with and without the SUN intervention.

Indirect signs of aortic dissection on POC-TTE despite an ADD-RS of 0 and D-dimer < 500 ng/mL.

Aortic dissection (AD) is a "can't miss" diagnosis for emergency physicians. An algorithm combining the Aortic Dissection Detection Risk Score (ADD-RS) with D-dimer has been proposed as a high-sensitivity clinical decision tool for AD that can determine the need for advanced imaging. Here we present a case of a 48-year-old male who presented to the emergency department (ED) with chest pain and dyspnea.