J Emerg Med
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Integrating medical scribes with clinicians has been suggested to improve access, quality of care, enhance patient/clinician satisfaction, and increase productivity revenue. ⋯ Although information quality, quantity, and applicability are limited, in-person medical scribes may improve emergency department efficiency and financial productivity. There was no information on virtual scribes. There was little information on patient or clinician satisfaction, scribe documentation quality, or whether results vary by in-house vs. contracted hiring and training.
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Angioedema is a complication that has been reported in up to 1.0% of individuals taking angiotensin-converting enzyme inhibitors (ACE-Is). Importantly, the onset of angioedema can occur anywhere from hours to several years after initiation of therapy with ACE-Is. Although most cases of ACE-I-induced angioedema (ACE-I-AE) are self-limiting, a major clinical concern is development of airway compromise, which can potentially require emergent airway management. The underlying pathophysiology of ACE-I-AE is incompletely understood, but is considered to be due in large part to excess bradykinin. Numerous medications have been proposed for the treatment of ACE-I-AE. This article is an update to the 2011 Clinical Practice Committee (CPC) statement from the American Academy of Emergency Medicine. ⋯ The primary focus for the treatment of ACE-I-AE is airway management. In the absence of high-quality evidence, no specific medication therapy is recommended for its treatment. If, however, the treating physician feels the patient's presentation is more typical of an acute allergic reaction or anaphylaxis, it may be appropriate to treat for those conditions. Any patient with suspected ACE-I-AE should immediately discontinue that medication.
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Rapidly assessing an undifferentiated patient and developing a gestalt for "sick vs. not sick" is a core component of emergency medicine (EM). Developing this skill requires clinical experience and pattern recognition, which can be difficult to attain during a typical EM clerkship. ⋯ A teaching shift in triage can increase medical students' self-assessed rapid assessment skills for patients in the ED. Benefits to the teaching attending included the opportunity to perform direct observation, give real-time feedback, and identify real-time teaching moments.
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Several studies reported that the National Early Warning Score (NEWS) has shown superiority over other screening tools in discriminating emergency department (ED) patients who are likely to progress to septic shock. ⋯ The discrimination power of the model for screening septic shock using NEWS, age, gender, and the six vital signs collected at ED triage outperformed the baseline NEWS model.
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Multisystem inflammatory syndrome in children is a phenomenon that has emerged during the coronavirus disease 2019 (COVID-19) pandemic. There are, however, few reported cases of a similar disease in adults. ⋯ We describe a 25-year-old man who presented with prolonged fever and conjunctivitis and was found to have a post-COVID inflammatory syndrome. His symptoms improved with colchicine, steroids, and a truncated course of intravenous immunoglobulin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Post-COVID inflammatory syndrome has the potential to lead to dangerous complications. In addition, the identification of occult COVID infections could have public health implications.