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December Lifeline

Transient Dizziness: When is it a TIA?

  • Long B, Marcolini E, Gottlieb M. Emergency medicine updates: Transient ischemic attack. Am J Emerg Med. 2024;83:82-90. doi:10.1016/j.ajem.2024.06.023
  • Ohle R, Savage DW, Roy D, et al. Development of a Clinical Risk Score to Risk Stratify for a Serious Cause of Vertigo in Patients Presenting to the Emergency Department. Ann Emerg Med. 2024; doi:10.1016/j.annemergmed.2024.06.003
  • Edlow JA, Bellolio F. Recognizing Posterior Circulation Transient Ischemic Attacks Presenting as Episodic Isolated Dizziness. Ann Emerg Med. 2024;84(4):428-438. doi:10.1016/j.annemergmed.2024.04.006
  • Neto AC, Lima AC, de Souza RA, et al. Vertigo and dizziness due to vertebrobasilar TIA: a prospective study. Front Stroke. 2024;3:1429068. doi:10.3389/fstroke.2024.1429068
  • Choi JH, Park MG, Choi SY, et al. Acute transient vestibular syndrome: Prevalence of stroke and efficacy of bedside evaluation. Stroke. 2017;48(3):556-562. doi:10.1161/STROKEAHA.116.015531

Neonatal Jaundice

 

November Lifeline

Abortion Laws: A Guide for USACS Clinicians

 

October Lifeline

General Guidelines on the Practice of EMS Diversion

These are guidelines created by the USACS EMS Committee regarding the practice of EMS diversion and are NOT intended to replace local EMS protocols or hospital policy. Diversion policies and guidelines must be fully in compliance with federal, state, and local laws. 

Should EMS diversion be used? If so, when?
Ideally EMS diversion should only be used in cases of internal disasters (e.g. active shooter) physical plant failure (e.g. power outage, water leak) or shortage of mission-critical personnel. Though some states (e.g. Massachusetts) have outlawed diversion completely, it still regularly occurs in most states. Diversion’s utility to the hospital should always be weighed against the potential harm to the patient caused by prolonged transport times, which delay definitive care. Diversion should not be based upon the ED staffing level or workload. Excessive diversion means EMS is unavailable to take the next call, strains ED-EMS relations, and negatively impacts hospital financials. Diversion should be for a defined period, at which point those making the decision will re-evaluate the need for continued diversion. A mechanism must be in place to then notify EMS when the hospital comes off diversion.

Divert EMS based on potential for patient admission?
No. Determining whether a patient will ultimately be admitted can be challenging based on the limited information available to pre-hospital personnel.

Selective diversion vs going on diversion to all ambulance traffic
Selective diversion (i.e. only going on diversion to Trauma, Stroke, STEMI) is preferable to putting the hospital on diversion to all ambulances. There may however be patients who are so critically ill that in EMS’ judgment it is not safe to divert them to another facility regardless of hospital status.

Override diversion status based on patient preference?
Diversion is a hospital request, not a medico-legal requirement. The patient has a very significant say in determining the facility to which they are being transported, and their request to go to a specific facility can generally override being diverted away from their facility of choice. This has limits: EMS can give the patient the choice of cath lab capable facilities or choice of area trauma centers, etc. The patient then has their choice of “appropriate” facilities based upon the nature of their presentation. 

Override diversion status based on EMS crew judgment?
EMS is at liberty to override diversion. EMS may always transport a patient to the nearest ED, or their department of choice, when their patient is in extremis, the patient presents with a challenging airway, or the needs of the patient exceed the capabilities of the EMS crew (e.g. the patient is in shock and is being transported by a BLS crew).

Who has final authority over EMS diversion decisions?

  • Case-by-case: Online medical control physician should have final authority over whether a particular patient gets diverted; not an RN or paramedic answering the phone in the ED
  • Hospital-wide: The ED attending should have a collaborative discussion with hospital staff (Charge RN, hospital administrator on-call) regarding decision to put the hospital on diversion (selective or total)

 

Peds Fracture Assessment and Pain Management

  • Mathison D, Agarwal D. General principles of fracture management: Fracture patterns and description in children. In: UpToDate, Connor RF (Ed), Wolters Kluwer. (Accessed on Aug 2, 2024.)
  • Levine RH, Thomas A, Nezwek TA, et al. Salter-Harris Fracture. [Updated 2023 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430688/
  • Thwaites L. Tetanus. In: UpToDate, Connor RF (Ed), Wolters Kluwer. (Accessed on Aug 12, 2024.)
  • Amy C. Plint, Jeffrey J. Perry, Rhonda Correll, Isabelle Gaboury, Louis Lawton; A Randomized, Controlled Trial of Removable Splinting Versus Casting for Wrist Buckle Fractures in Children. Pediatrics March 2006; 117 (3): 691–697. 10.1542/peds.2005-0801
  • Klimek PM, Juen D, Stranzinger E, Wolf R, Slongo T. Trampoline related injuries in children: risk factors and radiographic findings. World J Pediatr. 2013 May;9(2):169-74. doi: 10.1007/s12519-013-0416-2. Epub 2013 May 16. PMID: 23677833.
  • Aydin M, Surucu S. Supracondylar humerus fractures in children caused by monkey bar-related injuries: a comparative study. J Pediatr Orthop B. 2023 Mar 1;32(2):117-120. doi: 10.1097/BPB.0000000000000980. Epub 2022 Apr 5. PMID: 35412504.
  • Hope N, Varacallo M. Supracondylar Humerus Fractures. [Updated 2023 Aug 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560933/
    Modified Xray images from: https://www.orthobullets.com/pediatrics/4007/supracondylar-fracture--pediatric

 

September Lifeline

Patient and Provider Experience Pearls:  The USACS CARE Standard Helps Prevent Burnout

  • Goodman, Michael and Michele Berlinerblau. “Discussion: Treating Burnout by Addressing Its Causes.” American Association for Physician Leadership. Published electronically January 5, 2018.
  • Trzeciak, Stephen and Mazzarelli, Anthony. Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference. 2019. Studer Group: 287-319.
  • Medscape Physician Burnout & Depression Report. Medscape Medical News. Published electronically January 26, 2024.
  • Anderson, Pauline. “Physicians Experience Highest Suicide Rate of Any Profession.” Medscape Medical News. Published electronically May 7, 2018.
  • West, Colin P., Lisolette N. Dyrbye, Patricia J. Erwin, and Tait D. Shanafelt. “Interventions to Prevent and Reduce Physician Burnout: A Systematic Review and Meta-Analysis.” Lancet 388, no. 10,057 (November 5, 2016): 2272-81.
  • Panagioti, Maria, Efharis Panagopoulou, Peter Bower, George Lewith, Evangelos Kontopantelis, Carolyn Chew-Graham, Shoba Dawson, et al. “Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-Analysis.” JAMA Internal Medicine 177, no. 2 (February 1, 2017): 195-205.
  • Luks, Allen. “Doing Good: Helper’s High.” Psychology Today 22 no. 10 (1998): 39-42.
  • Dasan, Sunil, Poonam Gohil, Victoria Cornelius, and Cath Taylor. “Prevalence, Causes and Consequences of Compassion Satisfaction and Compassion Fatigue in Emergency Care: A Mixed-Methods Study of UK NHS Consultants.” Emergency Medicine Journal 32, no. 8 (August, 2015): 588-94.

 

August Lifeline

Wheezing: Sometimes It’s Asthma, Sometimes It’s Viral, and Sometimes…

  • Truong B, Luu K. Diagnostic clues for the identification of pediatric foreign body aspirations and consideration of novel imaging techniques. Am J Otolaryngol. 2023 Jul-Aug;44(4):103919.
  • Gibbons AT, Casar Berazaluce AM, Hanke RE, et al. Avoiding unnecessary bronchoscopy in children with suspected foreign body aspiration using computed tomography. J Pediatr Surg. 2020 Jan;55(1):176-181.
  • Pozailov S, Goldbart A, Aviram M, et al. Foreign body aspiration score (FOBAS) - a prospectively validated algorithm for the management and prediction of foreign body aspiration in children. Eur J Pediatr. 2024 Feb;183(2):815-825.
  • Brown JC, Chapman T, Klein EJ, et al. The utility of adding expiratory or decubitus chest radiographs to the radiographic evaluation of suspected pediatric airway foreign bodies. Ann Emerg Med. 2013 Jan;61(1):19-26.
  • Keil O, Schwerk N. Foreign body aspiration in children - being safe and flexible. Curr Opin Anaesthesiol. 2023 Jun 1;36(3):334-339.

 

May Lifeline

Patient and Provider Experience Pearls:  CARING (using the USACS 5 CARE Behaviors) Improves Patient Outcomes and Compliance

  • Shenoi, Rohit P. et al. “The Pediatric Submersion Score Predicts Children at Low Risk for Injury Following Submersions.” Academic emergency medicine 24.12 (2017): 1491–1500. Web.
  • Sarah A. Denny, Linda Quan, Julie Gilchrist, Tracy McCallin, Rohit Shenoi, Shabana Yusuf, Benjamin Hoffman, Jeffrey Weiss, COUNCIL ON INJURY, VIOLENCE, AND POISON PREVENTION, Phyllis F. Agran, Michael Hirsh, Brian Johnston, Lois K. Lee, Kathy Monroe, Judy Schaechter, Milton Tenenbein, Mark R. Zonfrillo, Kyran Quinlan; Prevention of Drowning. Pediatrics May 2019; 143 (5): e20190850. 10.1542/peds.2019-0850. Drowning (submersion injuries) - UpToDate.
  • Semple-Hess J, Campwala R. Pediatric submersion injuries: emergency care and resuscitation. Pediatr Emerg Med Pract. 2022 Jun 15;19(6 Suppl):1-46. PMID: 35737684

Patient and Provider Experience Pearls: Gratitude

  • Bryant, FB, Veroff J. Savoring: A New Model of Positive Experience. Journal of Positive Psychology, 2007. 7(3):176-187
  • Emmons, RA, McCullough, ME. Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-Being in Daily Life. Journal of Personality and Social Psychology. 2003. 84(2):377-389

 

March Lifeline

Patient and Provider Experience Pearls:  CARING (using the USACS 5 CARE Behaviors) Improves Patient Outcomes and Compliance

  • Trzeciak, Stephen and Mazzarelli, Anthony.Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference.2019. (pp. 47-155). Studer Group.

 

February Lifeline

Gastrostomy Buttons: What, Me Worry?

  • Fuchs S.  Gastrostomy tubes: care and feeding.  Pediatr Emerg Care.  2017:33(12):787-791.
  • Myatt TC, Medak AJ, Lam SHF.  Use of point of care ultrasound to guide pediatric gastrostomy tube replacement in the emergency department.  Pediatr Emerg Care.  2018:34(2):145-148.
  • Weszelits SM, Ridosh MM, O'Connor A. Displaced Gastrostomy Tube in the Pediatric Emergency Department: Implementing an Evidence-based Algorithm and Quality Improvement Project. J Emerg Nurs. 2021 Jan;47(1):113-122.
  • Vezzetti RM.  Chapter 14: Twisting Tubes: Gastrostomy Tube Issues. In: Pediatric Imaging for the Emergency Provider.  2022. (Vezzetti, Pennington, Carlson, eds).  Elsevier, Philadelphia, USA.

Patient and Provider Experience Pearls: Caring (Using the USACS 5 CARE Behaviors) Reduces Your Malpractice Risk

  • Trzeciak, Stephen and Mazzarelli, Anthony.Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference.2019. (pp. 243-4). Studer Group.
  • Bal, B. Sonny. “An Introduction to Medical Malpractice in the United States.” Clinical Orthopedics and Related Research 467, no. 2 (February 2009): 339-47.
  • Harvard Medical Practice Study. “Patients, Doctors, and Lawyers: Medical Injury, Malpractice Litigation, and Patient Compensation in New York: The Report of the Harvard Medical Practice Study to the State of New York.” Cambridge, 1990.
  • Slawson, P.F. “Psychiatric Malpractice: Some Aspects of Cause.” Psychiatric Hospital 15, no. 3 (Summer 1984): 141-4.
  • Lieberman, J.A. The Litigious Society. New York: Basic Books, 1985.
  • Friedman, L. Total Justice. New York: Russel Sage, 1985.
  • Eisenberg, H. “New Light on the Costliest Malpractice Mistakes.” Journal of Medical Economics 16 (1973): 146-50.
  • Hicks, R.G. “Ounces of Prevention. I.” New York State Journal of Medicine 73, no. 18 (September 15, 1973): 2268-9.
  • Vincent, C., M. Young, and A. Phillips. “Why Do People Sue Doctors? A Study of Patients and Relatives Taking Legal Action.” Lancet 343. no. 8913 (June 25, 1994): 1609-13

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