A new study investigates the safety of excluding pulmonary embolism in high-risk patients based on D-dimer testing. The analysis found that ruling out PE based on a low D-dimer level was safe, with no missed cases.
A special issue of Academic Emergency Medicine examines the science of errors in emergency care, highlighting the need for a systemic approach to address gaps in knowledge, communication, and awareness. The journal's findings propose actionable solutions to minimize diagnostic errors and enhance patient safety.
A new study published in Academic Emergency Medicine evaluates the use of a cranial accelerometry device to detect large-vessel occlusion strokes in prehospital settings. The research demonstrates that obtaining adequate recordings with this device is highly feasible, marking an important step forward in stroke management.
A new study published in Academic Emergency Medicine finds that low-dose ketamine is an effective adjunct to morphine for managing acute pain, providing relief to both opioid-tolerant and opioid-naive patients. The study demonstrates significant reductions in pain scores for 30 minutes compared to a placebo.
The Society for Academic Emergency Medicine (SAEM) has released a new guideline for managing nonopioid use disorders in emergency departments. The guidelines provide evidence-based recommendations for evaluating and treating conditions such as alcohol withdrawal syndrome, alcohol use disorder, and cannabinoid hyperemesis syndrome. The ...
A new study found that Black and Hispanic patients were less likely to be restrained in an emergency department compared to White patients. However, female Black and Hispanic patients with mental illness or substance use disorder were more likely to receive restraints than male counterparts.
A systematic review of geriatric ED patients with delirium reveals that 16% of older adults presenting with altered mental status have acutely abnormal head imaging findings. Focal neurological deficits greatly increase the risk of abnormal head CTs, while anticoagulation is not associated with these abnormalities.
The Society for Academic Emergency Medicine has released a new clinical practice guideline for the treatment of acute dizziness and vertigo in emergency departments. The guideline is based on evidence-based recommendations and aims to improve patient care by reducing unnecessary imaging and promoting logical, algorithmic approaches.
The U.S. Department of Veterans Affairs (VA) health system provides a promising career path for emergency physicians, offering competitive salaries and various opportunities for growth and development. The VA's focus on excellent care, education, and research provides a supportive environment for medical professionals to thrive.
A new study assesses sleep and fatigue risk in emergency physicians over two months using a wearable device, revealing that 50% of their shifts are spent in a high cognitive readiness state. The researchers also found that later shift start times are associated with greater fatigue due to circadian rhythm disruption.
A study published in Academic Emergency Medicine found that ECMO significantly improves survival rates among patients with severe hypothermia, compared to conventional rewarming methods. The treatment was also associated with faster rewarming times.
A recent study published in Academic Emergency Medicine found that combining cocaine with ethanol increases the risk of cardiac arrest, higher lactate concentrations, and lower occurrence of myocardial injury. The study suggests that cocaethylene, a metabolite of cocaine and ethanol, is more toxic than either substance alone.
A multidisciplinary panel of experts recommends avoiding repeat CTAP imaging and prioritizing opioid-minimizing pain control strategies for adults with low-risk, recurrent abdominal pain. The guidelines also suggest screening for depression and anxiety during ED evaluations.
A study found that 88% of ED patients with suspected septic olecranon bursitis who received empiric antibiotics without aspiration resolved without needing further treatment. Conservative management may be a reasonable approach for select patients, potentially streamlining care and reducing complications.
Emergency department crowding poses a serious threat to patient safety due to health system dysfunction and funding structure flaws. Institutions can implement actionable solutions, including financial realignment, regulation, and enforceable surge plans, to alleviate ED crowding.
A study of over 1,000 patients in Philadelphia's emergency departments found that vaccine hesitancy is common among this population, driven by concerns about safety and research. The authors suggest that EDs can play a valuable role in addressing vaccine hesitancy through targeted education and outreach efforts.
The SAEM GRACE team developed recommendations for testing, treatment, hospital admission, and screening tools for recurrent, low-risk chest pain. Guidelines prioritize patient-important outcomes and consideration of patients' values and preferences.
A study published in Academic Emergency Medicine found that prescribed light exercise had no effect on recovery or healthcare utilization outcomes for patients with acute mild traumatic brain injury. Standard care without early exercise may be a viable option.
The Canadian Syncope Risk Score is an accurate validated prediction score for emergency department patients with unexplained syncope. The study highlights the weaknesses of several risk tools previously published, and its impact on clinical decision making is not known.
A randomized trial found that droperidol was more effective than lorazepam or ziprasidone for sedation in patients with acute undifferentiated agitation. Additionally, it was associated with lower rates of respiratory depression compared to the other medications. The study suggests that larger studies are needed to confirm these findings.
The HINTS exam, a bedside ocular motor test, is not accurate for central cause identification. The test is frequently misused in patients without nystagmus or intermittent symptoms.
A surveillance project found high COVID-19 vaccine acceptance among physicians and advance practice providers, but lower rates among nurses and nonclinical healthcare workers. The authors suggest educating these groups about the vaccine's safety profile to enhance vaccination rates.
A study of over 61,000 patients with acute pulmonary embolism found that disposition practices vary significantly between hospitals, resulting in high emergency department revisit rates. Most return visits did not lead to hospitalization, highlighting the need for standardized care and improved outpatient management protocols.
A hospital-based violence intervention program effectively engages vulnerable populations by addressing specific client needs. The study highlights the complexities of program attrition and altering life courses for victims of violence, emphasizing the need for targeted strategies to address upstream factors of community violence.
A study published in Academic Emergency Medicine found that methoxyflurane administration resulted in lower pain scores compared to standard care. However, it did not achieve the desired substantial reduction in pain as prescribed.
Researchers found paracetamol alone is superior to high-dose NSAID alone for posttraumatic extremity pain. A study published in Academic Emergency Medicine shows taking paracetamol as a first-line therapy can effectively manage mild to moderate post-traumatic extremity pain after discharge from the emergency department.
A study published in Academic Emergency Medicine found that advanced practice providers (APPs) and emergency physicians deliver similar care to ED patients presenting with chest and abdominal pain. The authors recommend further research on the optimal use of APPs in the emergency department.
Children under 3 years old presenting with rib fractures are 77% likely to be abused; those under 18 months with humeral fractures show similar results. Diagnostic evaluation for abuse is recommended in these cases to minimize morbidity and mortality.
The LOOP technique has been found to be a safe and effective alternative to traditional incision and drainage (I&D) with packing for treating subcutaneous abscesses in adults. In children, the technique resulted in significantly fewer failures compared to standard I&D techniques.
Advanced practice providers (APPs) have lower productivity compared to emergency department physicians, but no apparent impact on patient satisfaction and safety metrics. The study suggests that APPs can be effectively integrated into EDs with staffing models accounting for their lower productivity.
A recent study published in Academic Emergency Medicine found that Black patients are more likely to experience restraint use in emergency settings compared to white patients. The study also identified higher rates of restraint among homeless patients and those with public insurance or no insurance.
A study published in Academic Emergency Medicine found that mobile smartphone technology can improve out-of-hospital cardiac arrest (OHCA) survival. The 'Staying Alive' app, which alerts trained responders to nearby cardiac arrest victims, was found to reduce response times and potentially improve outcomes.
A double-blind, randomized clinical trial found antacid monotherapy to be the most palatable solution and had fewer side effects compared to antacid/lidocaine combinations. Antacid monotherapy was also found to be equally efficacious in relieving epigastric pain as lidocaine/antacid combination therapy.
A study published in Academic Emergency Medicine found that only a few key signs and symptoms significantly change the likelihood of community-acquired pneumonia. The study suggests prioritizing high-value elements of the physical examination to improve diagnostic accuracy and antibiotic use.
A recent study published in Academic Emergency Medicine identified common barriers to using risk stratification tools for evaluating pulmonary embolism in emergency departments. The study found that provider-level factors such as risk avoidance and lack of knowledge of the tools dominated as barriers, while inner-setting factors were i...
Academic emergency departments have a legal, historical, and ethical obligation to provide safe evaluation and care to anyone in need. The Federal Emergency Medical Treatment and Labor Act (EMTALA) prohibits EDs from turning away patients, ensuring access to medical screening and care for all 120 million ED visitors annually.
The Academic Emergency Medicine journal is making its latest COVID-19 research freely available in an easy-to-navigate online collection. New research will be added to the collection as soon as it is accepted and available.
A recent survey found that most emergency physicians (over half of 1,074 respondents) encounter firearms at work annually, yet less than half feel confident in handling them. The study suggests that emergency physicians may benefit from educational interventions targeting firearms safety.
A study published in Academic Emergency Medicine found that troponin testing for acute coronary syndrome (ACS) in selected elderly patients with nonspecific complaints (NCSs) may not be necessary due to a low diagnostic yield. The study revealed an elevated troponin in 20% of patients but only a 1.2% ACS rate.
A study published in Academic Emergency Medicine found that prolonged telemetry (over 12 hours) is a safe alternative to hospitalization for non-low-risk patients with syncope. The sensitivity of ECG monitoring is high, supporting the use of minimum 12-hour monitoring as a diagnostic tool.
A study published in Academic Emergency Medicine found that video discharge instructions in the emergency department lead to a clinically important reduction in acute otitis media (AOM) symptomatology. Children of parents who watched a five-minute video experienced less symptomatology compared to those with paper handouts.
A new study published in Academic Emergency Medicine found that Electronic Medication Complete Communication (EMC2) Opioid Strategy improved safe dosing of opioids, but not actual use. The intervention also boosted patient knowledge about medication risks.
A study published in Academic Emergency Medicine found that Focused Cardiac Ultrasound (FOCUS) can significantly lower the likelihood of pulmonary embolism (PE) diagnosis in ED patients with suspected PE and abnormal vital signs. The results suggest that FOCUS can be an important tool in the initial evaluation of these patients.
A study published in Academic Emergency Medicine found that providing financial incentives to forego testing significantly decreases patient preference for testing, even when accounting for test benefit and risk. Financial incentives also decreased patient preference for low-value diagnostic testing, such as CT imaging of the head.
A multicenter randomized controlled trial confirms an electrical-first approach is more effective in restoring sinus rhythm and shortening ED length of stay. The study found that patients managed with this strategy were discharged within four hours at a higher rate than those receiving a chemical-first approach.
A new study published in Academic Emergency Medicine found that unexpectedness, health and social conditions, lack of support from family or friends, and structural issues like job market and affordable housing availability contribute to homelessness. The findings suggest gaps in current homeless prevention services and can inform futu...
A study found that pay-for-performance programs can reduce access block but may also lead to discharges associated with return visits and admissions. The program's effectiveness depends on the inclusion of specific targets, such as admission time.
A study found that 9% of patients with acute pain conditions continued opioid use 3 months after discharge from the emergency department. Most patients used opioids to manage initial or new pain, not misuse. The study highlights the need for non-narcotic methods to treat acute pain and further research on chronic pain mechanisms.
A study published in Academic Emergency Medicine found that pediatric emergency medicine physicians are at risk for developing compassion fatigue, burnout, and low compassion satisfaction. The researchers recommend improving interpersonal relationships, work environment, and self-care to enhance provider well-being and patient care.
A multicenter study found that antibiotic stewardship interventions can significantly reduce overuse of antibiotics for viral acute respiratory infections. By implementing a bundle of evidence-based strategies, institutions can cut antibiotic overuse by one-third, even among high-performing systems.