The relief of acute pain is a key link in modern emergency medicine. Procedural sedation and analgesia is a necessary technique for emergency physicians. This article summarizes its application in emergency therapy.
Analgesia ; adverse effects ; instrumentation ; methods ; Emergency Medicine ; methods ; Humans

Hemodynamic monitoring is important for critically ill patients in emergency medicine. While the conventional static hemodynamic monitoring may not accurately reflect the hemodynamic status, functional hemodynamic monitoring can dynamicly and individually monitor the hemodynamic status, and thus becomes a valuable supplementation for conventional static hemodynamic monitoring. This article reviews the limitations of conventional hemodynamic monitoring and introduces the methodology of functional hemodynamic monitoring.
Emergency Medicine ; methods ; Hemodynamics ; physiology ; Humans ; Monitoring, Physiologic ; methods

Competency-Based Education ; Curriculum ; Education, Medical, Graduate ; methods ; Emergency Medicine ; education ; Humans ; Internship and Residency ; methods ; Singapore

PURPOSE: The purpose of this study was to evaluate the predictive value of the measured factors that can be used in an emergency department to assess patients with blow-out fractures (BOFs) who are expected to undergo surgical management. METHODS: This study was conducted on patients with BOFs who attended an emergency department in a tertiary teaching hospital from December 2013 to November 2016. The medical records and radiology findings, such as facial computed tomography (CT), were reviewed retrospectively. The depth of floor displacement (DFD) and cranial-caudal dimension (CCD), which were measured using facial CT, were evaluated to determine the power of the CT parameters as predictors expecting surgical management in BOF patients. Statistical analysis was conducted with SPSS statistics ver. 23.0. RESULTS: The final 44 BOF patients were included in the study. Among them, 21 patients had undergone surgery. From this study, using a threshold DFD value of 0.5 cm, the accuracy of DFD was 86.36%, and the sensitivity and specificity in predicting surgery in BOF patients was 100% and 73.91%, respectively. Using a threshold CCD value of 0.4 cm, the accuracy of CCD was 88.64%, and the sensitivity and specificity in predicting surgery in BOF patients was 100% and 78.26%, respectively. CONCLUSION: With the aid of DFD and CCD, which was measured from facial CT, BOF patients who may require surgical management can be detected easily and more promptly by emergency physicians in emergency settings.
Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Hospitals, Teaching ; Humans ; Medical Records ; Methods* ; Orbital Fractures* ; Prognosis ; Retrospective Studies ; Sensitivity and Specificity

INTRODUCTIONSingapore experienced its second riot in 40 years on 8 December 2013, in the area known as Little India. A retrospective review of 36 casualties treated at the emergency department was conducted to evaluate injury patterns.

METHODSCharacteristics including the rate of arrival, injury severity, type and location, and disposition of the casualties were analysed.

RESULTSThe injuries were predominantly mild (97.2%), with the most common injuries involving the head (50.0%) and limbs (38.9%). 97.2% of the casualties were managed as outpatient cases.

CONCLUSIONThe majority of the injuries in this incident were mild and could be managed as outpatient cases. Important lessons were learnt from the incident about the utilisation of manpower and safety of staff in the emergency department.

Adult ; Emergency Medical Services ; Emergency Medicine ; methods ; Emergency Service, Hospital ; Female ; Humans ; Injury Severity Score ; Male ; Patient Safety ; Retrospective Studies ; Riots ; Singapore ; Triage

Adolescent ; Cardiac Surgical Procedures ; methods ; Cardiac Tamponade ; surgery ; Emergency Medicine ; methods ; Emergency Service, Hospital ; Humans ; Male ; Sternum ; surgery ; Thoracotomy ; methods ; standards

PURPOSE: Shift work is inherent to emergency medicine practice. However, the intershift handoff between emergency physicians has been identified as a high-risk area for medical errors. We evaluated the current handoff processes in an emergency department in Korea and the attitudes of emergency medicine residents toward the need for standardized guidelines. METHODS: A questionnaire survey was conducted on emergency medicine residents working in training hospitals (one resident per hospital) in Korea. The questionnaire asked about the current handoff method, whether there was a standardized handoff format, and asked residents on their experiences and opinions about the handoff practice. RESULTS: A total of 29 emergency medicine residents responded to the survey. A majority of hospitals were found to have no uniform handoff format in their emergency department (26 hospitals, 90%). In addition, only a small number of hospitals had an educational program for intershift handoff (7 hospitals, 24%). A large majority of responders (97%) reported experiencing medical errors related to handoff. CONCLUSION: There is currently a significant lack of handoff format or educational programs on intershift handoff in Korean emergency medicine training hospitals. Further research and effort for the establishment of effective standardized handoff and training programs are strongly needed.
Education ; Emergencies* ; Emergency Medicine* ; Korea* ; Medical Errors ; Methods ; Patient Handoff ; Surveys and Questionnaires

With increasing demands and recognition, emergency medicine has advanced rapidly in China in recent decades. The education and training of professionals in this field are important for the further development of emergency medicine. With an attempt to investigate the way to strengthen residency training system in emergency medicine, this article reviews its potential development direction, training modes, learning materials, and quality control.
China ; Emergency Medicine ; education ; organization & administration ; Internship and Residency ; methods ; standards ; trends

PURPOSE: This study analyzed the effects of the hospitalization decisions made by emergency physicians (EP) on the emergency department length of stay (ED-LOS). METHODS: From March 2016, the hospitalization decisions of six internal medicine departments were made by EP, which has been implemented gradually since 2015. Through a retrospective electronic record review, the ED-LOS between EP hospitalization decision departments (group A) and others (group B) was analyzed and the ED-LOS before and after the hospitalization decision method change was compared (2014 vs. 2016). RESULTS: Compared to 2014, in 2016, the ED-LOS in departments that hospitalization decision made by EP was reduced significantly (median with interquartile range; 478.0 minutes [319.0 to 900.5 minutes] vs. 259.0 minutes [177.0 to 384.0 minutes]; p < 0.001). In addition, the ED-LOS in Group A was reduced more than in Group B (219.0 minutes (45.8%) vs. 30.0 minutes (10.2%). CONCLUSION: ED-LOS can be reduced by the EP hospitalization decisions.
Emergencies* ; Emergency Service, Hospital* ; Hospitalization* ; Internal Medicine ; Length of Stay* ; Methods ; Retrospective Studies

OBJECTIVE: Tube thoracostomy (TT) is a commonly performed intensive care procedure. Simulator training may be a good alternative method for TT training, compared with conventional methods such as apprenticeship and animal skills laboratory. However, there is insufficient evidence supporting use of a simulator. The aim of this study is to determine whether training with medical simulator is associated with faster TT process, compared to conventional training without simulator. METHODS: This is a simulation study. Eligible participants were emergency medicine residents with very few (≤3 times) TT experience. Participants were randomized to two groups: the conventional training group, and the simulator training group. While the simulator training group used the simulator to train TT, the conventional training group watched the instructor performing TT on a cadaver. After training, all participants performed a TT on a cadaver. The performance quality was measured as correct placement and time delay. Subjects were graded if they had difficulty on process. RESULTS: Estimated median procedure time was 228 seconds in the conventional training group and 75 seconds in the simulator training group, with statistical significance (P=0.040). The difficulty grading did not show any significant difference among groups (overall performance scale, 2 vs. 3; P=0.094). CONCLUSION: Tube thoracostomy training with a medical simulator, when compared to no simulator training, is associated with a significantly faster procedure, when performed on a human cadaver.
Animals ; Cadaver ; Chest Tubes ; Critical Care ; Education ; Emergency Medicine ; Humans ; Methods ; Simulation Training ; Thoracostomy*