Marine Envenomations

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Authors: Grant Barker, MS4
University of Miami Miller School of Medicine

Tim Montrief, MD MPH
Jackson Memorial Health System/University of Miami
AAEM/RSA Publications and Social Media Committee Member

Case
While spearfishing for lionfish off the coast of Key West during one of our yearly excursions, my father was unfortunate enough to graze a lionfish’s spines with his thumb. Within the next ten minutes, he was hyperventilating and in extreme pain. On our small boat with just a rudimentary first aid kit, thirty miles from shore, we had minimal interventions at our disposal. What would your next step in treatment?

Rapid Estimation of Left Ventricular Ejection Fraction with Ultrasound

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Author: Bill Christian, MS-4
Ross University School of Medicine
AAEM/RSA Publications and Social Media Committee

Rapid assessment of the left ventricular ejection fraction (LVEF) may be critical for the emergency physician. Imagine a patient comes into your emergency department (ED) with acute dyspnea. He has a history of congestive heart failure, chronic obstructive pulmonary disease and myocardial infarction. Can ultrasound help differentiate between some of the many potential causes of dyspnea? Yes!

FOUR Score for the Evaluation of the Comatose Patient

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Image Credit: MaxPixel

Authors: Justin Rafael De la Fuente, MSII
Medical Student
University of Miami Miller School of Medicine

Tim Montrief, MD MPH
Emergency Medicine Resident Physician
Jackson Memorial Health System
AAEM/RSA Publications & Social Media Committee

Jeffrey M Scott, DO
Attending Physician
Jackson Memorial Health System

Case
A 63-year-old man is brought in to the emergency department by ambulance after being found unresponsive at home by his family. He was last seen normal about four hours prior to arrival. En route, the patient was exhibiting irregular respirations with an oxygen saturation of 85% and was intubated by paramedics. On arrival, he is unresponsive with an oxygen saturation of 92%, bradycardic at 55 beats per minute, and hypertensive with a blood pressure of 160/95 mmHg.

Emergency Department Boarding: What Can We Do?

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Image Source: PxHere

Authors: Tyler Ericson, MS3
University of Miami Miller School of Medicine

Tim Montrief, MD MPH
Emergency Medicine Resident
Jackson Memorial Health System/University of Miami
AAEM/RSA Publications and Social Media Committee Member

Jeffrey M Scott, DO FACEP EDIC
Assistant Professor of Clinical Medicine, Division of Pulmonary, Critical Care, and Sleep
Medicine, University of Miami Miller School of Medicine

Many emergency departments (EDs) often experience critical overcrowding and heavy demand on scarce emergency resources, hampering the delivery of high-quality medical care and compromising patient safety.[1] The primary cause of overcrowding is boarding—the practice of holding patients in the ED after they have been admitted to the hospital because no inpatient beds are available. Boarding is a prevalent practice in EDs across the country, with nine out of ten hospitals reporting some degree of boarding.[2] Boarding times may vary depending on many factors, including hospital size, time of day, and patient population. Some studies have shown the median boarding time to be 79 minutes, with 32% of admitted patients boarding for longer than two hours.[3]