recent articles

practice updates

Crowding in the Emergency Department: Strategies to End It

A 62 year-old male presents to the emergency department (ED) with low back pain after a mechanical fall as he slipped on a puddle of water. After a 14 hour wait, he finally gets moved to an exam room. Upon examination you notice lumbar spine tenderness with inability to flex his left thigh. A CT of his lumbar spine demonstrates a L2 vertebral body fracture with retropulsion. The patient has to be transferred to another hospital due to unavailability of neurosurgical services. Delays in care were mostly due to boarding patients and lack of staff.

practice updates

R.E.B.E.L. EM – Beyond ACLS: A New Pulseless Electrical Activity Algorithm

Using the new classification system of PEA simplifies the working differential and initial treatment approach in conjunction with bedside ultrasound, however this strategy has not been tested systematically, tested for resuscitation outcomes, and caution should be used before implementing this algorithm until further studies are performed in the clinical setting.

clinical cases

Mimics of Sepsis: What do ED Physicians Need to Know?

A great deal of literature exists on sepsis and providing state of the art care in the ED. As EM physicians, we pride ourselves on resuscitating sick patients, and we are well aware that septic patients can rapidly decline clinically. Finding the source and providing appropriate antibiotics, adequate preload with IV fluids, and vasopressors if necessary are key components. The SIRS criteria are our first line of defense in the early identification of sepsis. But, it is important to recognize that just because a patient has multiple SIRS criteria, they may not actually be septic.