Improving CT scanner efficiency for trauma team activations in the emergency department.

Background And Objectives: A Trauma Team Activation (TTA) is initiated when a patient has sustained a life or limb-threatening injury thereby necessitating resources of a large care team. Previously, a CT scanner was cleared at the time of the prehospital TTA call. Wide variability in the time it took to stabilize patients often led to extended CT scanner idle time.

Use of Needle Guide for Dynamic Real-Time Ultrasound-Directed Aspiration of Peritonsillar Abscess in the Emergency Department: A Case Series.

Background: Needle aspiration is a common treatment of peritonsillar abscess (PTA). Point-of-care ultrasound (POCUS) can be used to guide this procedure. We describe our experience using a commercially available needle guide attached to an endocavitary ultrasound probe for dynamic real-time POCUS-guided PTA needle aspiration.

A new technique for reduction of a posteriorly dislocated hip joint.

Posterior hip dislocation is commonly seen in the emergency department and requires urgent reduction to help avoid complications. Many techniques have been described to perform the reduction, all aimed at helping the physician gain a mechanical advantage to overcome the bony anatomy and large muscles groups involved. We describe a new technique that utilizes a hydraulic patient lift to help provide the traction force necessary to reduce posterior hip dislocations.

Severity of diagnosis among patients with chest pain presenting to the emergency department after calling a nurse line.

Background And Objectives: A Nurse Line (NL) is a resource that is commonly used by patients and hospitals to assist in the triage of patient medical complaints. We sought to determine whether patients with chief complaint of chest pain who presented to the ED after calling a NL were different from patients who presented directly to the ED. The primary aim was to test for differences in the severity of the causes of chest pain between the two groups.

Provider-in-triage prediction of hospital admission after brief patient interaction.

Background And Objectives: We sought to determine if emergency physician providers working in the triage area (PIT) of the ED could accurately predict the likelihood of admission for patients at the time of triage. Such predictions, if accurate, could decrease the time spent in the ED for patients who are admitted to the hospital by hastening downstream workflow.

Methods: This is a prospective cohort study of PIT providers at a large urban hospital.

Pneumothorax Complications During Placement of Peripheral Internal Jugular Intravenous Catheters.

Background: A "peripheral IJ" is a 2.5-in angiocatheter placed in the internal jugular vein with ultrasound guidance but typically no barrier precautions. Previously published literature has shown safety with none to minimal complications.

Elimination of Routine Screening Laboratory Tests for Psychiatric Admission: A Quality Improvement Initiative.

Objective: Research has shown that routine screening laboratory tests for patients with mental health symptoms admitted to psychiatry units find little unexpected clinical abnormalities. This study examined the effects on cost of care and patient safety measures of a hospital change in policy in which such routine tests were no longer required.

Methods: This retrospective cohort study analyzed data from all patients admitted from the emergency department (ED) to inpatient psychiatry at a tertiary care hospital 4 months before and 4 months after the policy change.

An Analysis of Changes in Emergency Department Visits After a State Declaration During the Time of COVID-19.

Study Objective: In the initial period of the coronavirus disease 2019 (COVID-19) pandemic, there has been a substantial decrease in the number of patients seeking care in the emergency department. A first step in estimating the impact of these changes is to characterize the patients, visits, and diagnoses for whom care is being delayed or deferred.

Methods: We conducted an observational study, examining demographics, visit characteristics, and diagnoses for all ED patient visits to an urban level 1 trauma center before and after a state emergency declaration and comparing them with a similar period in 2019.

Serum SNTF, a Surrogate Marker of Axonal Injury, Is Prognostic for Lasting Brain Dysfunction in Mild TBI Treated in the Emergency Department.

Mild traumatic brain injury (mTBI) causes persisting post-concussion syndrome for many patients without abnormalities on conventional neuroimaging. Currently, there is no method for identifying at-risk cases at an early stage for directing concussion management and treatment. SNTF is a calpain-derived N-terminal proteolytic fragment of spectrin (α-spectrin1-1176) generated in damaged axons following mTBI.

Erratum: This Article Corrects: "Systemwide Clinical Ultrasound Program Development: An Expert Consensus Model".

[This corrects the article on p. 649 in vol. 19, PMID: 30013699.

Systemwide Clinical Ultrasound Program Development: An Expert Consensus Model.

Clinical ultrasound (CUS) is integral to the practice of an increasing number of medical specialties. Guidelines are needed to ensure effective CUS utilization across health systems. Such guidelines should address all aspects of CUS within a hospital or health system.

Emergency medicine physicians' ability to predict hospital admission at the time of triage.

Background: We seek to determine if experienced emergency medicine physicians can accurately predict the likelihood of admission for patients at the time of triage. Such predictions, if proven to be accurate, could decrease the time spent in the ED for patients who will ultimately be admitted by hastening downstream workflow.

Methods: This is a prospective cohort study of experienced physicians at a large urban hospital.

Hospital Medicine Point of Care Ultrasound Credentialing: An Example Protocol.

Though the use of point-of-care ultrasound (POCUS) has increased over the last decade, formal hospital credentialing for POCUS may still be a challenge for hospitalists. This document details the Hospital Medicine Department Ultrasound Credentialing Policy from Regions Hospital, which is part of the HealthPartners organization in Saint Paul, Minnesota. National organizations from internal medicine and hospital medicine (HM) have not published recommended guidelines for POCUS credentialing.

Placement of a cervical collar increases the optic nerve sheath diameter in healthy adults.

Introduction: Blunt head trauma is a common cause of increased intracranial pressure (ICP). Ultrasound measurement of the optic nerve sheath diameter (OSND) is an accurate and non-invasive way to detect increased ICP. Blunt trauma patients are often immobilized in a rigid cervical spine collar.

Postsplinting x-rays of nondisplaced hand, wrist, ankle, and foot fractures are unnecessary.

Background: Acute nondisplaced fractures (NDFs) are common in the emergency department (ED), and providers often obtain postsplinting x-rays to identify displacement that potentially occurs during the splinting process. Our objectives are to (1) determine how often x-rays are obtained after splinting of NDFs, (2) identify if postsplinting x-rays change treatment management in the ED, and (3) identify if there are medical complications at follow-up.

Methods: A retrospective chart review of ED patients who were discharged with hand, wrist, ankle, or foot fractures was conducted to determine patients with definite NDFs that were verified by a radiologist, underwent splinting, and either had postsplint x-rays or not.

Does computed tomographic scan affect diagnosis and management of patients with suspected renal colic?

Background: Patients with renal colic commonly present to the emergency department (ED) and are usually treated with analgesics, antiemetics and hydration. Computed tomographic (CT) scan is commonly utilized in evaluating patients with suspected renal colic.

Objectives: We compared diagnosis and treatment plans before and after CT in patients with suspected renal colic with the aim to evaluate how often changes in diagnosis, treatment and disposition are made.

Lacunar stroke in a teenager after minor head trauma: case report and literature review.

Ischemic strokes in children and young adults are fortunately rare. Contrasted with adult ischemic strokes, pediatric stroke etiologies vary greatly and are often unknown. Childhood lacunar strokes and trauma-induced strokes represent particularly uncommon subsets and have been reported infrequently in the literature.

Emergency department patient knowledge and physician communication regarding CT scans.

Objectives: This study evaluated several aspects of patients' and providers' knowledge and attitude regarding emergency CT scan use. Specifically, is patient awareness of radiation risks changing over time and do levels of education affect this knowledge? Meanwhile, do emergency medicine providers discuss risks with patients and do patients want to know about these risks?

Methods: We conducted a survey of clinically stable patients in the emergency department (ED) after undergoing a CT scan.

Results: 200 patients were surveyed.