IntroductionThe traditional methods of communication between nurses and physicians through paging or phone calls have been known to cause patient care interruptions, increase stress and workload, and cause burnout. Our study assessed the impact of using an electronic health record–based messaging system (Epic Secure Chat) for nonemergent communication between nurses and physicians in the emergency department (ED).MethodThis study was performed at a large urban academic ED. Surveys were distributed through e-mail using Google forms. Preimplementation and postimplementation surveys were performed from May 2019 (presurvey) to August 2019 (postsurvey).ResultThe number of nonurgent phone calls from registered nurse staff decreased after intervention (P < 0.001). The frequency of nonurgent calls disrupting workflow decreased after the intervention (P = 0.029). The number of calls that were appropriately alerted to increased but was not significant (P = 0.120), whereas the degree of burnout from nonurgent calls remained relatively the same (P = 0.841).ConclusionsThe findings provide insight into the implementation of an EMR messaging system in an ED setting. These findings suggest the messaging system can decrease unnecessary nonurgent calls from registered nurses and medical doctors, allowing for more efficient workflow in the ED. These findings suggest further research especially regarding burnout implemented on a larger scale and yield redesign suggestions in the ED.

Penetrating wounds to the neck occur in 5-10% of trauma cases and are associated with very high mortality due to proximity to and involvement of vital structures. Emergent airway management and rapid diagnosis in these injuries are essential for life-saving treatment. This case study presents the case of a stab wound to the neck in an adult patient which elicited major concern for cardiovascular, neurological, and airway compromise. In such a high-risk trauma airway, this case shows the importance of keeping a wide differential and the value of expeditious management to prevent anoxic brain injury and stroke. The rapid diagnosis of a left common carotid artery transection and subsequent surgical repair were essential in this patient's full neurological recovery.

Introduction: Lower extremity deep venous thrombosis (DVT) is a common diagnosis in the emergency department (ED). Deep venous thromboses can be the result of anatomical variation in the vasculature that predisposes the patient to thrombosis. May-Thurner syndrome (MTS) is one such anatomic variant defined by extrinsic compression of the left common iliac vein between the right common iliac artery and lumbar vertebrae. Case Report: We report such a case of a 39-year-old woman with no risk factors for thromboembolic disease who presented to the ED with extensive unilateral leg swelling and was ultimately diagnosed with MTS. Conclusion: This diagnosis is an important consideration particularly in patients who are young, female, have scoliosis or spinal abnormalities, or are at low risk for DVT yet who present with extensive lower extremity swelling and are found to have proximal thrombus burden. Often further imaging, anticoagulation, angioplasty, or thrombectomy are indicated to prevent morbidity and post-thrombotic syndrome in these patients.

Audience The lecture and infographic are targeted towards Emergency Medicine physicians and residents. Introduction Pain is the most common presenting symptom in the emergency department. 1 Various classes of medications are used to treat acute and chronic pain. Specifically, opiate medications are often used to relieve moderate to severe pain. About 20% of patients presenting with the chief complaint of non-cancer pain receive an opioid prescription. 2 Since there are many different types of opiates, conversion between one opioid to another has provided a great challenge in terms of addressing the balance between adequately controlling patients’ pain and preventing serious adverse effects. The lack of a readily available standard opiate equivalent guide and physicians’ limited knowledge base about morphine milligram equivalents may contribute to medication errors, insufficient treatment, addiction, and overdose. Educational Objectives The primary aim of this study was to educate residents and attending physicians about opiate equivalent medications, medication metabolism, provide usual dosages, and to provide a standardized method for converting between various opiate medications in the emergency department (ED). By the end of this session, the learner will be able to: 1) define the term, “morphine milligram equivalents;” 2) describe the relative onset and duration of action of different pain medications often used in the emergency department; and 3) convert one opioid dose to another. Additionally, we aimed to evaluate the efficacy of the lecture and the infographic in increasing physicians’ knowledge base of opioid medications and standardize the method of prescribing and converting between opioids in the ED. We designed and placed a simple, eye-catching infographic in the University of California, Irvine Emergency Department that depicted information pertaining to morphine equivalents and pharmacological properties of the opioids. We then presented a lecture on morphine equianalgesic doses, metabolism, and method for conversion between medications. In order to evaluate the functionality of the lecture and chart, we administered multiple surveys to ED providers pre- and post-lecture and placement of the chart in the ED. Our lecture and infographic included up-to-date literature and considered dose reductions, cross tolerance, and patient comorbidities. We designed the infographic to be visually appealing and simple for ease of use in a busy ED environment. Educational Methods A lecture was designed to educate emergency department physicians and residents on the properties, metabolism and techniques for conversion between various opioid medications. Following the lecture, we walked through an example question with the participants. The lecture was presented at an Emergency Department conference. Research Methods Th...

Penetrating wounds to the neck occur in 5–10% of trauma cases and are associated with very high mortality due to proximity to and involvement of vital structures. Emergent airway management and rapid diagnosis in these injuries are essential for life-saving treatment. This case study presents the case of a stab wound to the neck in an adult patient which elicited major concern for cardiovascular, neurological, and airway compromise. In such a high-risk trauma airway, this case shows the importance of keeping a wide differential and the value of expeditious management to prevent anoxic brain injury and stroke. The rapid diagnosis of a left common carotid artery transection and subsequent surgical repair were essential in this patient’s full neurological recovery. Topics Trauma, stab wound, neck hematoma, deviated trachea, carotid artery injury, carotid artery transection.