scholarly journals Emergency physicians in critical care: where are we now?

2020 ◽  
Vol 1 (5) ◽  
pp. 1062-1070
Author(s):  
Samantha S. Strickler ◽  
Daisi J. Choi ◽  
Daniel J. Singer ◽  
John M. Oropello
Keyword(s):  
Critical Care ◽  
Emergency Physicians

Abdominal ultrasound image acquisition and interpretation by novice practitioners after minimal training on a simulated patient model

CJEM ◽  
2020 ◽  
Vol 22 (S2) ◽  
pp. S62-S66
Author(s):  
Bradley Waterman ◽  
Kristine Van Aarsen ◽  
Michael Lewell ◽  
Homer Tien ◽  
Frank Myslik ◽  
...  
Keyword(s):  
Critical Care ◽  
Training Session ◽  
Ultrasound Image ◽  
Abdominal Ultrasound ◽  
Free Fluid ◽  
Trauma Patients ◽  
Emergency Physicians ◽  
Didactic Training ◽  
Training Course ◽  
Fast Exam

AbstractBackgroundThe Focused Assessment with Sonography in Trauma (FAST) exam is a rapid ultrasound test to identify evidence of hemorrhage within the abdomen. Few studies examine the accuracy of paramedic performed FAST examinations. The duration of an ultrasound training program remains controversial. This study's purpose was to assess the accuracy of paramedic FAST exam interpretation following a one hour didactic training session.MethodsThe interpretation of paramedic performed FAST exams was compared to the interpretation of physician performed FAST examinations on a mannequin model containing 300ml of free fluid following a one hour didactic training course. Results were compared using the Chi-square test. Differences in accuracy rate were deemed significant if p < 0.05.ResultsFourteen critical care flight paramedics and four emergency physicians were voluntarily recruited. The critical care paramedics were mostly ultrasound-naive whereas the emergency physicians all had ultrasound training. The correct interpretation of FAST scans was comparable between the two groups with accuracy of 85.6% and 87.5% (∆1.79 95%CI -33.85 to 21.82, p = 0.90) for paramedics and emergency physicians respectively.ConclusionsThis study determined that critical care paramedics were able to use ultrasound to detect free fluid on a simulated mannequin model and interpret the FAST exam with a similar accuracy as experienced emergency physicians following a one hour training course. This suggests the potential use of prehospital ultrasound to aid in the triage and transport decisions of trauma patients while limiting the financial and logistical burden of ultrasound training.

A call for critical care training of emergency physicians

2002 ◽  
Vol 39 (5) ◽  
pp. 562-563 ◽  
Author(s):  
Tiffany M. Osborn ◽  
Thomas M. Scalea
Keyword(s):  
Critical Care ◽  
Emergency Physicians ◽  
Care Training

scholarly journals Mechanical circulatory assist devices: a primer for critical care and emergency physicians

Critical Care ◽  
2016 ◽  
Vol 20 (1) ◽  
Author(s):  
Ayan Sen ◽  
Joel S. Larson ◽  
Kianoush B. Kashani ◽  
Stacy L. Libricz ◽  
Bhavesh M. Patel ◽  
...  
Keyword(s):  
Critical Care ◽  
Emergency Physicians ◽  
Assist Devices ◽  
Circulatory Assist Devices

scholarly journals Canadian Association of Emergency Physicians Sepsis Guidelines: the optimal management of severe sepsis in Canadian emergency departments

CJEM ◽  
2008 ◽  
Vol 10 (05) ◽  
pp. 443-459 ◽  
Author(s):  
Robert S. Green ◽  
Dennis Djogovic ◽  
Sara Gray ◽  
Daniel Howes ◽  
Peter G. Brindley ◽  
...  
Keyword(s):  
Critical Care ◽  
Severe Sepsis ◽  
Interest Group ◽  
Key Management ◽  
Source Control ◽  
Grading System ◽  
Optimal Management ◽  
Emergency Physicians ◽  
Sepsis Management ◽  
Canadian Association

ABSTRACT Introduction: Optimal management of severe sepsis in the ED has evolved rapidly. The purpose of these guidelines is to review key management principles for Canadian emergency physicians, utilizing an evidence-based grading system. Methods: Key areas in the management of septic patents were determined by members of the CAEP Critical Care Interest Group (C4). Members of C4 were assigned a question to be answered after literature review, based on the Oxford grading system. After completion, each section underwent a secondary review by another member of C4. A tertiary review was conducted by additional external experts, and modifications were determined by consensus. Grading was based on peer-reviewed publications only, and where evidence was insufficient to address an important topic, a “practice point” was provided based on group opinion. Results: The project was initiated in 2005 and completed in December 2007. Key areas which were reviewed include the definition of sepsis, the use of invasive procedures, fluid resuscitation, vasopressor/inotrope use, the importance of culture acquisition in the ED, antimicrobial therapy and source control. Other areas reviewed included the use of corticosteroids, activated protein C, transfusions and mechanical ventilation. Conclusion: Early sepsis management in the ED is paramount for optimal patient outcomes. The CAEP Critical Care Interest Group Sepsis Position Statement provides a framework to improve the ED care of this patient population.

Surgical Critical Care Training for Emergency Physicians: Curriculum Recommendations

2013 ◽  
Vol 217 (5) ◽  
pp. 954-959.e3 ◽  
Author(s):  
Samuel A. Tisherman ◽  
Hasan B. Alam ◽  
William C. Chiu ◽  
Lillian L. Emlet ◽  
Michael D. Grossman ◽  
...  
Keyword(s):  
Critical Care ◽  
Emergency Physicians ◽  
Surgical Critical Care ◽  
Care Training

scholarly journals Teaching Review on Approach of Esophageal Intubation as Complications in Emergency Airway Management

2020 ◽  
pp. 1-6
Author(s):  
Adel Hamed Elbaih ◽  
Adel Hamed Elbaih ◽  
Mohammad Assef Mousa
Keyword(s):  
Critical Care ◽  
Airway Management ◽  
Literature Search ◽  
Respiratory Arrest ◽  
Esophageal Intubation ◽  
Emergency Physicians ◽  
Cardiorespiratory Arrest ◽  
Emergency Intubation ◽  
Emergency Airway Management ◽  
Emergency Airway

Background: Intubation is daily process in hospitals, it’s insertion of tube to secure an airway, nonemergent intubation is done in well controlled circumstances, while emergent intubation is not. Most emergency intubated are cardiac or respiratory arrest patients. Intubation helps to secure airway for patient breathing, also could protect from aspiration. Most common complications are: esophagus intubation and hypotension. This research will be divided into two main topics, emergency intubation as a whole, and unrecognized esophagus intubation as a complication. Emergency intubation discuss: knowledge about the procedure, equipment needed, airway assessment, preoxygenation, difficulties and risks, outcomes. While Unrecognized esophagus intubation will be discussed as complication in ER settings, point to clear: Epidemiology, tools of detection, equipment, human and environmental bias and consideration for cardiac arrest patients. Finishing with a conclusion and recommendation. Therefore, we aim to look into the common pitfalls that both medical students and new physicians face in the recognition, diagnosis, and Emergency Airway Management. Targeted Population: Airway cardiorespiratory arrest patients who are requiring urgent management in the ED, with emergency physicians for teaching approach protocol. Aim of the Study: Appropriate for assessment and priorities for Airway cardiorespiratory arrest patients by training protocol to emergency physicians. Based on patients’ causes of Airway injuries. Methods: Collection of all possible available data about the Esophageal Intubation as Complications in the Emergency department. By many research questions to achieve these aims so a midline literature search was performed with the keywords “critical care”, “emergency medicine”, “principals of airway management”, “Esophageal Intubation as Complications”. Literature search included an overview of recent definition, causes and recent therapeutic strategies. Results: All studies introduced that the initial diagnosis of Esophageal Intubation as Complications is a lifesaving conditions that face patients of the emergency and critical care departments. Conclusion: Intubation in emergency settings require a good preparation, available equipment (e.g. ready cart for all time), and supportive anatomical airway of the patient. Following a checklist will improve outcomes, prevent malpractice and complications. Preoxygenation and RSI play major roles for successful intubations with decrease risk of complications. Follow procedure steps, and expect difficult intubation for any patient, so consider LEMON mnemonic to evaluate risk of difficulty, and after 3 attempts try a different technique or equipment. More training and education are essential to decrease congenital and equipotential mistakes/errors.

Critical care training for emergency physicians

2003 ◽  
Vol 41 (6) ◽  
pp. 0886-0887
Author(s):  
Scott R. Gunn ◽  
Paul L. Rogers ◽  
Mitchell P. Fink ◽  
Ake Grenvik ◽  
Kyle J. Gunnerson ◽  
...  
Keyword(s):  
Critical Care ◽  
Emergency Physicians ◽  
Care Training

scholarly journals Canadian Emergency Medicine and Critical Care Physician Perspectives on Pandemic Triage in COVID-19

2020 ◽  
Author(s):  
Ali Mulla ◽  
Blair L. Bigham ◽  
Andrea Frolic ◽  
Michael D. Christian
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Acute Care ◽  
Legal Protection ◽  
Care Physician ◽  
Multidisciplinary Teams ◽  
Free Text ◽  
Emergency Physicians ◽  
Provider Perspectives ◽  
Critical Care Resource

Abstract Purpose: Local and regional policies to guide the allocation of scarce critical care resources have been developed, but the views of prospective users are not understood. We sought to investigate the perspectives of Canadian acute care physicians towards triaging scarce critical care resources in the COVID-19 pandemic. Methods: We rapidly deployed a brief survey to Canadian emergency and critical care physicians in April 2020 to investigate current attitudes towards triaging scarce critical care resources and identify subsequent areas for improvement. Descriptive and between-group analyses along with thematic coding were used.Results: The survey was completed by 261 acute care physicians. Feelings of anxiety related to the pandemic were common (65%), as well as fears of psychological distress if required to triage scarce resources (77%). Only 49% of respondents felt confident in making resource allocation decisions. Both critical care and emergency physicians favored multidisciplinary teams over single physicians to allocate scarce critical care resources. Critical care physicians were supportive of decision making by teams not involved in patient care (3.4/5 vs 2.9/5 p=0.04), whereas emergency physicians preferred to maintain their involvement in such decisions (3.4/5 vs 4.0/5 p=0.007). Free text responses identified five themes for subsequent action including the need for further guidance on existing triage policies, ethical support in decision making, medico-legal protection, additional tools for therapeutic communications, and healthcare provider psychological support. Conclusion: There is an urgent need for collaboration between policymakers and frontline physicians to develop critical care resource triage policies that wholly consider the diversity of provider perspectives across practice environments.

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