J Emerg Med
-
Simulation use for training residents has become an expectation in emergency medicine in order to improve the educational dimensions of cognitive knowledge, critical thinking, psychomotor skills, and clinical performance. ⋯ SimWars gives educators an opportunity to watch the decision-making process of the learners as they manage simulated complex scenarios in a cooperative competitive environment.
-
Observational Study
Implementation of an Emergency Department Sign-Out Checklist Improves Transfer of Information at Shift Change.
Transitions of care are ubiquitous in the emergency department (ED) and inevitably introduce the opportunity for errors. Few emergency medicine residency programs provide formal training or a standard process for patient handoffs. Checklists have been shown to be effective quality-improvement measures in inpatient settings and may be a feasible method to improve ED handoffs. ⋯ Implementation of a checklist improved the transfer of information without increasing time to sign-out.
-
Observational Study
Septic Shock and Adequacy of Early Empiric Antibiotics in the Emergency Department.
Antibiotic resistance is an increasing concern for Emergency Physicians. ⋯ In this population of ED patients with septic shock, empiric antibiotic coverage was inadequate in a small group of uroseptic patients with recent health care exposure. Current guidelines for UTI treatment do not consider health care setting exposure. A larger, prospective study is needed to further define this risk category and determine optimal empiric antibiotic therapy for patients.
-
Recent clinical advances with new mechanical circulatory systems have led to additional strategies in the treatment of end-stage heart failure. The third-generation HeartWare Left Ventricular Device (LVAD) System utilizes a blood pump and a driveline (cable) that exits the patient's skin connecting the implanted pump to an externally worn controller. We report a rare case of a HeartWare LVAD driveline rewiring after accidental (presumed) transection of the driveline system. ⋯ A 67-year-old male with a medical history of ischemic cardiomyopathy status post HeartWare LVAD implantation presented to the emergency department (ED) after acute LVAD failure. On the morning of presentation, he attempted to cut the paper tape off of his adult diaper with scissors and accidentally (presumed) and unwitnessed severed the driveline system. The patient immediately went into cardiac arrest and was transported to a regional medical center. On arrival, he exhibited no appreciable vital signs and was subsequently intubated, vascular access was placed, and inotropic support initiated. The emergency physician individually stripped and reconnected the color-coded driveline wires using multiple hemostats, electrical tape, and cardboard, which resulted in regeneration of positive LVAD flows. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: VAD patients will present in extremis typically to the ED with manifestations of pump dysfunction ranging from diminished flows needing fluid management or pump adjustments to full pump failure manifesting as cardiogenic shock, needing rapid resuscitation and transfer to a cardiothoracic surgical unit with on-site VAD-perfusion specialists.
-
Observational Study
Resident to Resident Handoffs in the Emergency Department: An Observational Study.
Despite patient handoffs being well recognized as a potentially dangerous time in the care of patients in the emergency department (ED), there is no established standard and little supporting research on how to optimize the process. Minimizing handoff risks is particularly important at teaching hospitals, where residents often provide the majority of patient handoffs. ⋯ The existing system allows for a clear summary of the patient's visit. Two major deficits-frequent interruptions and inconsistent communication regarding medications administered-were noted. There is inconsistency in how information is recorded at the time of handoff. Future studies should focus on handoff improvement and error reduction.