Emergency medicine clinics of North America
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Violent, combative and intoxicated patients are a common problem in the emergency department, and the emergency physician must be prepared to control the situation safely and effectively when a patient begins to exhibit dangerous behavior. 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.
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Emerg. Med. Clin. North Am. · May 2020
ReviewPractice Makes Perfect: Simulation in Emergency Medicine Risk Management.
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. ⋯ 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 experts. Serious medical gaming is developing into a useful training adjunct for the future.
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Emerg. Med. Clin. North Am. · May 2020
ReviewHigh-Risk Chief Complaints I: Chest Pain-The Big Three (an Update).
Nontraumatic chest pain is a frequent concern of emergency department patients, with causes that range from benign to immediately life threatening. Identifying those patients who require immediate/urgent intervention remains challenging and is a high-risk area for emergency medicine physicians where incorrect or delayed diagnosis may lead to significant morbidity and mortality. 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.
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Emerg. Med. Clin. North Am. · May 2020
ReviewEmergency Department Operations I: Emergency Medical Services and Patient Arrival.
The emergency department (ED) is by its nature inherently an environment with the potential for chaos because of the high volume and varied types of patients cared for in an ED setting. This article discusses potential system opportunities from the prehospital environment through arrival in the ED before provider evaluation. ⋯ 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.
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Emergency departments have always been busy, but persistent annual increases in volume and rates of admission have led to high levels of boarding patients, adding additional risk to the situation. 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.