Emergency medicine practitioners commonly care for acutely violent or agitated patients, some of whom may be psychotic, intoxicated, or affected by another pathology. Consequently, medical personnel are more likely to experience work-place violence than police officers or prison guards, with a full 100% of ED staff experiencing verbal violence, and 35-80% reporting a history of physical violence while at work. While it is critical to initiate a work-up to diagnose the underlying cause of a patient’s behavioral dysregulation, it is of primary importance to control the patient’s behavior both for their safety and the safety of the patient’s caregivers…
Read MoreAcademic emergency medicine is a constant balance between efficiency and education. We developed a new model called swarming, where the bedside nurse, resident, and attending/fellow simultaneously evaluate the patient, including initial vital signs, bedside triage, focused history and physical examination, and discussion of the treatment plan, thus creating a shared mental model.
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While resuscitative thoracotomy and REBOA are often viewed as heroic procedures, both carry an exorbitant amount of mortality and morbidity, and few centers around the country are able to competently offer these options. It seems appropriate to consider alternatives, especially with the emergence of bedside ultrasound and its increasing applicability in the emergency setting. PEAC or US-guided PEAC may be more feasible, performable by mostly untrained staff, and may temporize bleeding to permit transfer to definitive care.
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