Pediatric Cardiac Arrest Resuscitation
Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children. In contrast to adult patients, in whom a primary cardiac dysrhythmia is the most likely cause of cardiac arrest, pediatric patients experience cardiovascular collapse most frequently after an initial respiratory arrest. Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause. Unfortunately, outcomes for pediatric cardiac arrest, whether in hospital or out of hospital, continue t...
Source: Emergency Medicine Clinics of North America - September 9, 2020 Category: Emergency Medicine Authors: Nathan W. Mick, Rachel J. Williams Source Type: research

Updates in Traumatic Cardiac Arrest
Evaluating and treating traumatic cardiac arrest remains a challenge to the emergency medicine provider. Guidelines have established criteria for patients who can benefit from treatment and resuscitation versus those who will likely not survive. Patient factors that predict survival are penetrating injury, signs of life with emergency medical services or on arrival to the Emergency Department, short length of prehospital cardiopulmonary resuscitation, cardiac motion on ultrasound, pediatric patients, and those with reversible causes including pericardial tamponade and tension pneumothorax. Newer technologies such as resusc...
Source: Emergency Medicine Clinics of North America - September 9, 2020 Category: Emergency Medicine Authors: William Teeter, Daniel Haase Source Type: research

The Crashing Obese Patient
This article discusses important anatomic, physiologic, and practical challenges imposed by obesity on resuscitative care. Impacts on hemodynamic monitoring, airway and ventilator management, and pharmacologic therapy are discussed. Finally, several important clinical scenarios (trauma, cardiac arrest, and sepsis), in which alterations to standard treatments may benefit obese patients, are highlighted. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 9, 2020 Category: Emergency Medicine Authors: Sara Manning Source Type: research

The Crashing Toxicology Patient
This article examines, using an organ-systems based approach, rapid diagnosis, resuscitation, and critical care management of the crashing poisoned patient in the emergency department. The topics discussed in this article include seizures and status epilepticus, respiratory failure, cardiovascular collapse and mechanical circulatory support, antidotes and drug-specific therapies, acute liver failure, and extracorporeal toxin removal. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 9, 2020 Category: Emergency Medicine Authors: Aaron Skolnik, Jessica Monas Source Type: research

Extracorporeal Membrane Oxygenation in the Emergency Department
Extracorporeal membrane oxygenation (ECMO) is a mechanical way to provide oxygenation, ventilation, and perfusion to patients with severe cardiopulmonary failure. Extracorporeal cardiopulmonary resuscitation (ECPR) describes the use of ECMO during cardiac arrest. ECPR requires an organized approach to resuscitation, cannula insertion, and pump initiation. Selecting the right patients for ECPR is an important aspect of successful programs. A solid understanding of the components of the ECMO circuit is critical to troubleshooting problems. Current evidence suggests a substantial benefit of ECPR compared with traditional CPR ...
Source: Emergency Medicine Clinics of North America - September 9, 2020 Category: Emergency Medicine Authors: Jenelle H. Badulak, Zachary Shinar Source Type: research

Resuscitation in Emergency Medicine: Now More Important than Ever
Resuscitation has long been a cornerstone of emergency medicine. Whether it is caring for the patient with cardiac arrest, acute respiratory distress, multisystem trauma, or undifferentiated shock, the emergency physician must be an expert at resuscitation. For many critically ill patients, it is the crucial initial hours of illness, when the patient is in the emergency department (ED), when lives can be saved. With our collective goal of saving lives, we have focused this issue of Emergency Medicine Clinics of North America on the resuscitation of our sickest ED patients. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - September 2, 2020 Category: Emergency Medicine Authors: Susan R. Wilcox, Michael E. Winters Tags: Preface Source Type: research

Resuscitation
During the early years in the creation of emergency medicine as its own specialty, questions continually arose about why emergency medicine should be a separate specialty. What is unique about emergency medicine that warrants its own standing as a specialty? After all, every other specialty involves emergencies, so why should there be a specialty focused just on emergencies? If a patient has a heart attack, the cardiologist can manage the emergency; if a patient has profuse hematemesis, the gastroenterologist can manage the emergency; if a patient is the victim of a gunshot wound to the abdomen, a surgeon can manage the em...
Source: Emergency Medicine Clinics of North America - September 2, 2020 Category: Emergency Medicine Authors: Amal Mattu Tags: Foreword Source Type: research

Current Controversies in Caring for the Critically Ill Pulmonary Embolism Patient
Emergency physicians must be prepared to rapidly diagnose and resuscitate patients with pulmonary embolism (PE). Certain aspects of PE resuscitation run counter to typical approaches. A specific understanding of the pathophysiology of PE is required to avoid cardiovascular collapse potentially associated with excessive intravenous fluids and positive pressure ventilation. Once PE is diagnosed, rapid risk stratification should be performed and treatment guided by patient risk class. Although anticoagulation remains the mainstay of PE treatment, emergency physicians also must understand the indications and contraindications ...
Source: Emergency Medicine Clinics of North America - August 12, 2020 Category: Emergency Medicine Authors: Samuel Francis, Christopher Kabrhel Source Type: research

Updates in Cardiac Arrest Resuscitation
This article focuses on current treatment recommendations for adult nontraumatic cardiac arrest, with emphasis on the latest evidence and controversies regarding intracardiac arrest management. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - July 30, 2020 Category: Emergency Medicine Authors: Vivian Lam, Cindy H. Hsu Source Type: research

Massive Gastrointestinal Hemorrhage
Massive gastrointestinal hemorrhage is a life-threatening condition that can result from numerous causes and requires skilled resuscitation to decrease patient morbidity and mortality. Successful resuscitation begins with placement of large-bore intravenous or intraosseous access; early blood product administration; and early consultation with a gastroenterologist, interventional radiologist, and/or surgeon. Activate a massive transfusion protocol when initial red blood cell transfusion does not restore effective perfusion or the patient ’s shock index is greater than 1.0. Promptly reverse coagulopathies secondary to...
Source: Emergency Medicine Clinics of North America - July 30, 2020 Category: Emergency Medicine Authors: Katrina D ’Amore, Anand Swaminathan Source Type: research

Pearls and Pitfalls in the Crashing Geriatric Patient
The geriatric population is growing and is the largest utilizer of emergency and critical care services; the emergency clinician should be comfortable in the management of the acutely ill geriatric patient. There are important physiologic changes in geriatric patients, which alters their clinical presentation and management. Age alone should not determine the prognosis for elderly patients. Premorbid functional status, frailty, and severity of illness should be considered carefully for the geriatric population. Emergency clinicians should have honest conversations about goals of care based not only a patient ’s clini...
Source: Emergency Medicine Clinics of North America - July 25, 2020 Category: Emergency Medicine Authors: David P. Yamane Source Type: research

The Mindset of the Resuscitationist
Excellent resuscitation requires technical skills and knowledge, but also the right mindset. Expert practitioners must master their internal affective state, and create the environment that leads to optimal team performance. Leaders in resuscitation should use structured approaches to prepare for resuscitation, and psychological skills to enhance their performance including mental rehearsal, positive self-talk, explicit communication strategies, and situational awareness skills. Postevent recovery is equally important. Providers should have explicit plans for recovery after traumatic cases, including developing resilience ...
Source: Emergency Medicine Clinics of North America - July 23, 2020 Category: Emergency Medicine Authors: Sara H. Gray, Michael J. Lauria, Christopher Hicks Source Type: research

Postarrest Interventions that Save Lives
Patients resuscitated from cardiac arrest require complex management. An organized approach to early postarrest care can improve patient outcomes. Priorities include completing a focused diagnostic work-up to identify and reverse the inciting cause of arrest, stabilizing cardiorespiratory instability to prevent rearrest, minimizing secondary brain injury, evaluating the risk and benefits of transfer to a specialty care center, and avoiding early neurologic prognostication. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - July 21, 2020 Category: Emergency Medicine Authors: Alexis Steinberg, Jonathan Elmer Source Type: research

Fluid Resuscitation
Intravenous (IV) fluids are among the most common interventions performed in the emergency department. They are at times lifesaving, but if used recklessly can be harmful. Given their ubiquity, it is important to understand the history, physiology, and current strategies that govern the use of IV fluids during the resuscitation of the critically ill. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - July 21, 2020 Category: Emergency Medicine Authors: David Gordon, Rory Spiegel Source Type: research

Emergency Transfusions
Successful emergency transfusions require early recognition and activation of resources to minimize treatment delays. The initial goals should focus on replacement of blood in a balanced fashion. There is an ongoing debate regarding the best approach to transfusions, with some advocating for resuscitation with a fixed ratio of blood products and others preferring to use viscoelastic assays to guide transfusions. Whole-blood transfusion also is a debated strategy. Despite these different approaches, it generally is accepted that transfusions should be started early and crystalloid infusions limited. As hemodynamic stability...
Source: Emergency Medicine Clinics of North America - July 21, 2020 Category: Emergency Medicine Authors: Michael S. Farrell, Woon Cho Kim, Deborah M. Stein Source Type: research

Quality Assurance in the Emergency Department
Quality assurance (QA) of care in the emergency department encompasses activities ensuring that the care provided meets applicable standards. Health care delivery is complex and many factors affect quality of care. Thus, quantification of health care quality is challenging, especially with regard to attribution of outcomes to various factors contributing to such care. A critical component of the process of QA is determination of quality health care and the concept of (unjustified) deviation from the reference applicable standard of care. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 30, 2020 Category: Emergency Medicine Authors: William E. Baker, Joshua J. Solano Source Type: research

Emergency Department Operations and Administration
EMERGENCY MEDICINE CLINICS OF NORTH AMERICA (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 30, 2020 Category: Emergency Medicine Authors: Joshua W. Joseph, Benjamin A. White Source Type: research

Copyright
ELSEVIER (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 30, 2020 Category: Emergency Medicine Source Type: research

Contributors
AMAL MATTU, MD (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 30, 2020 Category: Emergency Medicine Source Type: research

Contents
Amal Mattu (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 30, 2020 Category: Emergency Medicine Source Type: research

Emergency Medicine Clinics of North America
Emergency Department Resuscitation (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 30, 2020 Category: Emergency Medicine Source Type: research

Lean Process Improvement in the Emergency Department
Lean engineering is based on a process improvement strategy originally developed at Toyota and has been used in many different industries to maximize efficiency by minimizing waste. Lean improvement projects are frequently instituted in emergency departments in an effort to improve processes and thereby improve patient care. Such projects have been undertaken with success in many emergency departments in order to improve metrics such as door-to-provider time, left without being seen rate, and patient length of stay. By reducing waste in the system, Lean processes aim to maximize efficiency and minimize delay and redundancy...
Source: Emergency Medicine Clinics of North America - June 11, 2020 Category: Emergency Medicine Authors: Lorna M. Breen, Richard Trepp, Nicholas Gavin Source Type: research

Staffing and Provider Productivity in the Emergency Department
Staffing and productivity are key concepts to understand when managing an emergency department. Provider productivity is not static, starts out high, and decreases throughout the shift in a stepwise manner. It is commonly measured by patients per hour or relative value units per hour, and is impacted by factors from the presence of residents to shift length. Appropriate staffing requires thorough understanding of the workforce and the variable patient demand of the department. Matching capacity to this demand potentially improves overall throughput and efficiency. Once knowledgeable about these factors, we provide a case s...
Source: Emergency Medicine Clinics of North America - June 10, 2020 Category: Emergency Medicine Authors: Bryan A. Stenson, Jared S. Anderson, Samuel R. Davis Source Type: research

Alternative Dispositions for Emergency Department Patients
Alternatives to inpatient admission have been shown to be safe and effective for a variety of clinical conditions and can help relieve emergency department (ED) and inpatient crowding. Evidence-based alternatives include use of rapid ED follow-up clinics, observation units, and home hospital programs. Use of accelerated diagnostic pathways and shared decision making can help support clinicians and patients in appropriately choosing an alternative disposition to traditional inpatient admission. However, many institutions struggle to fully embrace possible alternative depositions because of challenges of patient access, clin...
Source: Emergency Medicine Clinics of North America - June 10, 2020 Category: Emergency Medicine Authors: Alice Kidder Bukhman, Christopher W. Baugh, Brian J. Yun Source Type: research

Optimizing Patient Experience in the Emergency Department
Emergency department (ED) patient experience is a growing area of focus for leaders in the ED and throughout health care. While many factors intrinsic to the ED care environment add to the challenge of providing patients with an excellent experience, doing so holds many benefits, including improved patient compliance and health outcomes, improved workplace satisfaction and reduced provider and staff burnout, decreased malpractice risk, and increased revenue. Although wait time is a major driver of patient experience, provider and staff communication are critically important and excellent communication and perceived empathy...
Source: Emergency Medicine Clinics of North America - June 10, 2020 Category: Emergency Medicine Authors: Jonathan D. Sonis, Benjamin A. White Source Type: research

Management of the Academic Emergency Department
Academic emergency departments (EDs) play a vital role in provision of emergency care and contribute to training of resident physicians. Academic EDs also generate innovations and discoveries through clinical research within academic medical centers. However, academic EDs face challenges when initiating operational process improvement efforts because of the medical complexity of patients, academic culture within academic medical centers, and variability in productivity and specialty training of trainees. To optimize operations within academic EDs, it is critical to understand characteristics shared by academic EDs, how to ...
Source: Emergency Medicine Clinics of North America - June 9, 2020 Category: Emergency Medicine Authors: Deborah Vinton, Leon D. Sanchez Source Type: research

Design of the Academic Emergency Department
This article introduces a clinical audience to the process of emergency department (ED) design, particularly relating to academic EDs. It explains some of the major terms, processes, and key decisions that clinical staff will experience as participants in the design process. Topics covered include an overview of the planning and design process, issues related to determining needed patient capacity, the impact of patient flow models on design, and a description of several common ED design types and their advantages and disadvantages. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 9, 2020 Category: Emergency Medicine Authors: Kenneth D. Marshall, Bryan Imhoff, Frank Zilm Source Type: research

Emergency Department Operations
Emergency department (ED) operations reflect the intersection of factors external and internal to the ED itself, with unique problems posed by community and academic environments. ED crowding is primarily caused by a lack of inpatient beds for patients admitted through the ED. Changes to front-end operations, such as point-of-care testing and putting physicians in triage, can yield benefits in throughput, but require individual cost analyses. Balancing physician workloads can lead to substantial improvements in throughput. Observation pathways can reduce crowding while maintaining safety. Physician and nurse well-being is ...
Source: Emergency Medicine Clinics of North America - June 9, 2020 Category: Emergency Medicine Authors: Joshua W. Joseph, Benjamin A. White Source Type: research

How the Emergency Department Works: A Work in Progress
Emergency medicine is a constantly changing field, and excellent emergency care requires clinicians to possess an intimate and broad knowledge of the principles of clinical care, and the principles needed to sustain a highly functioning emergency department (ED). To be an excellent emergency physician, empathy and a strong clinical acumen are prerequisites, but one must also understand the fundamentals of process flow, time management, team dynamics, efficient and effective communication, and quality improvement. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 9, 2020 Category: Emergency Medicine Authors: Joshua W. Joseph, Benjamin A. White Tags: Preface Source Type: research

Patient Assignment Models in the Emergency Department
Early assignment of patients to specific treatment teams improves length of stay, rate of patients leaving without being seen, patient satisfaction, and resident education. Multiple variations of patient assignment systems exist, including provider-in-triage/team triage, fast-tracks/vertical pathways, and rotational patient assignment. The authors discuss the theory behind patient assignment systems and review potential benefits of specific models of patient assignment found in the current literature. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 8, 2020 Category: Emergency Medicine Authors: Nicole R. Hodgson, Stephen J. Traub Source Type: research

Information Management in the Emergency Department
This article reviews the state of information management in the ED and proposes recommendations to improve the management of information in the future. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 8, 2020 Category: Emergency Medicine Authors: Evan L. Leventhal, Kraftin E. Schreyer Source Type: research

Strategies for Provider Well-Being in the Emergency Department
A variety of operational and administrative factors have the potential to decrease wellness and negatively impact emergency physicians, in terms of both their on-the-job performance and their long-term career satisfaction. Among these are the issues of workload balance, physiologic and circadian stresses, and larger issues of malpractice risk and institutional support. This overview covers both emerging research on how these problems affect emergency physicians and strategies to help mitigate these challenges. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 8, 2020 Category: Emergency Medicine Authors: Matthew L. Wong, Arlene S. Chung Source Type: research

Factors Affecting Emergency Department Crowding
Emergency department crowding is a multifactorial issue with causes intrinsic to the emergency department and to the health care system. Understanding that the causes of emergency department crowding span this continuum allows for a more accurate analysis of its effects and a more global consideration of potential solutions. Within the emergency department, boarding of inpatients is the most appreciable effect of hospital-wide crowding, and leads to further emergency department crowding. We explore the concept of emergency department crowding, and its causes, effects, and potential strategies to overcome this problem. (Sou...
Source: Emergency Medicine Clinics of North America - June 8, 2020 Category: Emergency Medicine Authors: James F. Kenny, Betty C. Chang, Keith C. Hemmert Source Type: research

Queuing Theory and Modeling Emergency Department Resource Utilization
Queueing theory is a discipline of applied mathematics that studies the behavior of lines. Queueing theory has successfully modeled throughput in a variety of industries, including within the emergency department (ED). Queueing equations model the demand for different processes within the ED, and help to factor in effects of variability on delays and service times. Utilization is a measure of the throughput of a process relative to demand, and provides a quick means of comparing the demand for certain resources. Although there have been some significant successes in applying queueing theory to EDs, the field remains underu...
Source: Emergency Medicine Clinics of North America - June 8, 2020 Category: Emergency Medicine Authors: Joshua W. Joseph Source Type: research

Best Practices in Patient Safety and Communication
This article provides an overview of the evidence-based approaches to improve patient safety and communication. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 8, 2020 Category: Emergency Medicine Authors: Dana Im, Emily Aaronson Source Type: research

Emergency Department Operations and Administration
Emergency Medicine Clinics of North America has always been one of the leading sources of cutting-edge information pertaining to the clinical practice of emergency medicine. The reader can frequently take what he or she has learned and apply it during the very next shift. So why in the world do we have an issue focused on emergency department (ED) operations and administration? To many readers, this doesn ’t sound very cutting edge or clinical, nor does it seem likely to be applicable to one’s next shift. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - June 4, 2020 Category: Emergency Medicine Authors: Amal Mattu Tags: Foreword Source Type: research

Emergency Department Operations I
This article discusses potential system opportunities from the prehospital environment through arrival in the ED before provider evaluation. The Emergency Medical Treatment and Active Labor Act is reviewed in detail. Management and the reduction of risk to waiting room patients and patients who leave without being seen is explored. Description of the risks and mitigation strategies are discussed to decrease risk to patients, providers, and hospitals. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Kenneth Knowles, Gerald (Wook) Beltran, Lucas Grover Source Type: research

Emergency Department Operations II
This article reviews specific areas of risk as patients progress through their care in the emergency department and methods by which to mitigate this risk. Beginning with an overview of the current state, commonly used throughput metrics are reviewed before proceeding to a discussion of best practice strategies to decrease risk exposure at input, throughput, and output phases of the patient visit. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Evan Berg, Adam T. Weightman, David A. Druga Source Type: research

Confidentiality and Capacity
This article focuses on confidentiality and capacity issues affecting patients receiving care in the emergency department. The patient-physician relationship begins with presumed confidentiality. The article also clarifies instances where a physician may be required to break confidentiality for the safety of patients or others. This article then discusses risk management issues relevant to determining a patient ’s capacity to accept or decline medical care in the emergency department setting. Situations pertaining to refusal of care and discharges against medical advice are examined in detail, and best practices for ...
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Joseph H. Kahn Source Type: research

High-risk Pediatric Emergencies
This article focuses on diagnosis and management of high-risk diagnoses in pediatric patients presenting to emergency departments, including meningitis, pneumonia, appendicitis, testicular torsion, and fracture. It highlights challenges and pitfalls that may increase risk of liability. It concludes with a discussion on recognition and management of abuse in children, including when to report and decisions on disposition. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: B. Lorrie Edwards, David Dorfman Source Type: research

Physician Well-Being
Burnout is a work-related condition. Although stress may be a part of emergency medicine, excessive levels of chronic stress can lead to maladaptive behaviors and burnout. Burnout can lead to decreased physician longevity and performance and poorer patient outcomes. The first step is recognizing burnout in providers. Efforts can then be made to identify modifiable or unnecessary sources of stress to help reduce chronic stress and burnout. Solutions should be found to eliminate or ameliorate individual-level and system-level sources of stress. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Leon D. Sanchez, Richard E. Wolfe Source Type: research

Surviving a Medical Malpractice Lawsuit
This article reviews the legal system and the medical malpractice process. It details the steps a physician experiences during a medical malpractice case, from being served to the deposition and then to trial and appeals if the physician loses. This article also reviews necessary steps to take in order to proactively participate in one’s own defense. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Kelly Bookman, Richard D. Zane Source Type: research

Managing Emergency Department Risk Through Communication and Documentation
The job description of the emergency physician contains many responsibilities, including identifying and managing life-threatening illness, providing symptomatic relief, determining safe and efficient disposition, managing department flow, providing customer service, improving public health, and ensuring wise resource utilization. Emergency physicians must communicate effectively with patients, interdisciplinary clinical teams, and consultants, both orally and through the medical record. Excellence in clinical care as well as in communication and documentation is critical for managing risk in the emergency department. (Sou...
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Omar Z. Maniya, Jolion McGreevy Source Type: research

The High-Risk Airway
The high-risk airway is a common presentation and a frequent cause of anxiety for emergency physicians. Preparation and planning are essential to ensure that these challenging situations are managed successfully. Difficult airways typically present as either physiologic or anatomic, each type requiring a specialized approach. Primary physiologic considerations are oxygenation, hemodynamics, and acid-base, whereas anatomic difficulty is overcome using proper positioning and skilled laryngoscopy to ensure success. It is essential to be comfortable performing alternative techniques to address varying presentations. Ultimately...
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Jorge L. Cabrera, Jonathan S. Auerbach, Andrew H. Merelman, Richard M. Levitan Source Type: research

High-Risk Chief Complaints I
This article focuses on the 3 most prevalent diagnoses associated with adverse outcomes in patients presenting with nontraumatic chest pain, acute coronary syndrome, thoracic aortic dissection, and pulmonary embolism. Important aspects of clinical evaluation, diagnostic testing, treatment, and disposition and other less common causes of lethal chest pain are also discussed. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Benjamin Bautz, Jeffrey I. Schneider Source Type: research

Emergency Department Evaluation of the Adult Psychiatric Patient
This article addresses high-risk areas of the treatment and management of emergency department patients presenting with behavioral emergencies. This article identifies methods successful in determining whether the patient ’s behavioral emergency is the result of an organic disease process, as well as recognizing other potential acute medical emergencies in this high-risk population. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Lauren M. Nentwich, Curtis W. Wittmann Source Type: research

Physical and Chemical Restraints (an Update)
This article reviews initial de-escalation techniques to reduce the need for patient restraint. It then details the 2 types of restraints (physical and chemical) and the clear indications for each type. The high-risk nature of utilization of restraints is reviewed, as well as the means by which to ensure patient and staff safety and decrease adverse outcomes. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Pilar Guerrero, Mark B. Mycyk Source Type: research

Practice Makes Perfect
Simulation has been steadily changing the safety culture in the healthcare industry and allowing individual clinicians and interdisciplinary teams to be proactive in the culture of risk reduction and improved patient safety. Literature has demonstrated improved patient outcomes, improved team based skills, systems testing and mitigation of latent safety threats. Simulation may be incorporated into practice via different modalities. The simulation lab is helpful for individual procedures, in situ simulation (ISS) for system testing and teamwork, community outreach ISS for sharing of best practices and content resource exper...
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Barbara M. Walsh, Ambrose H. Wong, Jessica M. Ray, Alise Frallicciardi, Thomas Nowicki, Ron Medzon, Suzanne Bentley, Stephanie Stapleton Source Type: research

Supervision of Resident Physicians
Supervision of resident physicians is a high-risk area of emergency medicine, and what constitutes appropriate supervision is a complex question. In this article, policies and procedures for appropriate supervision of resident physicians and the implications for billing are reviewed. Recommendations on supervision of resident physicians in the emergency department are detailed, with attention paid to addressing challenges in balancing patient safety with resident autonomy and education during the course of patient care and graduate medical education. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Alexander Y. Sheng, Avery Clark, Cristopher Amanti Source Type: research

High-Risk Chief Complaints III
This article discusses the approach and risk management of this high-risk subset of abdominal and extremity diagnoses. (Source: Emergency Medicine Clinics of North America)
Source: Emergency Medicine Clinics of North America - April 24, 2020 Category: Emergency Medicine Authors: Sharon Bord, Christopher El Khuri Source Type: research