Purpose of Review
This review seeks to discuss the use of RA in the ED including benefits of administration, types of RA by anatomic location, complications and management, teaching methods currently in practice, and future applications of RA in the ED.
Recent Findings
The early use of RA in pain management may reduce the transition of acute to chronic pain. Multiple plane blocks have emerged as feasible and efficacious for ED pain complaints and are now being safely utilized.
Summary
Adverse effects of opioids and their potential for abuse have necessitated the exploration of substitute therapies. Regional anesthesia (RA) is a safe and effective alternative to opioid treatment for pain in the emergency department (ED). RA can manage pain for a wide variety of injuries while avoiding the risks of opioid use and decreasing length of stay when compared to other forms of analgesia and anesthesia, without compromising patient satisfaction.
Objectives
Queuing theory suggests that signing up for multiple patients at once (batching) can negatively affect patients’ length of stay (LOS). At academic centers, resident assignment adds a second layer to this effect. In this study, we measured the rate of batched patient assignment by resident physicians, examined the effect on patient in‐room LOS, and surveyed residents on underlying drivers and perceptions of batching.
Methods
This was a retrospective study of discharged patients from August 1, 2020 to October 27, 2020, supplemented with survey data conducted at a large, urban, academic hospital with an emergency medicine training program in which residents self‐assign to patients. Time stamps were extracted from the electronic health record and a definition of batching was set based on findings of a published time and motion study.
Results
A total of 3794 patients were seen by 28 residents and ultimately discharged during the study period. Overall, residents batched 23.7% of patients, with a greater rate of batching associated with increasing resident seniority and during the first hour of resident shifts. In‐room LOS for batched assignment patients was 15.9 minutes longer than single assignment patients (
P
value < 0.01). Residents’ predictions of their rates of batching closely approximated actual rates; however, they underestimated the effect of batching on LOS.
Conclusions
Emergency residents often batch patients during signup with negative consequences to LOS. Moreover, residents significantly underestimate this negative effect.
Resuscitation of cardiac arrest in coronavirus disease 2019 (COVID-19) patients places the healthcare staff at higher risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Unfortunately, COVID-19 status is unknown in most patients presenting to the emergency department (ED), and therefore special attention must be given to protect the healthcare staff along with the other patients. This is particularly true for out-of-hospital cardiac arrest patients who are transported to the ED. Based on the current data available on transmissibility of SARS-CoV-2, we have proposed a protocolized approach to out-of-hospital cardiac arrests to limit risk of transmission.
In this case report, we describe isolated left ventricular cardiac tamponade, a rare complication of cardiac surgery, diagnosed on point‐of‐care ultrasound (POCUS) in the emergency department (ED). To our knowledge, this is the first report of such a diagnosis made on ED bedside ultrasound. Our patient was a young adult female with a history of recent mitral valve replacement who presented to the ED with dyspnea and was found to have a large loculated pericardial effusion causing left ventricular diastolic collapse. Rapid diagnosis via POCUS in the ED allowed for expedited definitive treatment by cardiothoracic surgery in the operative room and emphasizes the importance of a standard 5‐view cardiac POCUS examination when post–cardiac surgery patients present to the ED.
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