EM Quick Hits 37 Introducing QI Corner, Skin Abscess, O2 Sat Monitor Pearls, Infantile Spasms, Atrial Fibrillation Rate Control

Topics in this EM Quick Hits podcast Tahara Bhate introducing QI corner! (00:37) Hans Rosenberg & Michael Gottlieb on the evidence around ED diagnosis and management of skin abscesses (9:49) Anand Swaminathan on what the oxygen saturation monitor can tell you besides oxygen saturation (16:45) Sarah Reid on how to pick up infantile spasms and prevent poor neurologic outcomes (23:01) Elisha Targonsky on battle of the ED rate control medications for rapid atrial fibrillation (27:44) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Anton Helman and Sarah Reid Cite this podcast as: Helman, A. Swaminathan, A. Reid, S. Rosenberg, H. Gottlieb, M. Bhate, T. Targonsky, E. EM Quick Hits 37 - Introducing QI Corner, Skin Abscess, O2 Sat Monitor Pearls, Infantile Spasms, Atrial Fibrillation Rate Control. Emergency Medicine Cases. April, 2022. https://emergencymedicinecases.com/em-quick-hits-april-2022/. Accessed [date]. Introducing... QI corner! * Analysis of every missed diagnosis should be broken down into patient, health care providers and systems factors * Risk factor assessment for serious life or limb threatening diagnoses should be considered carefully (eg. IVDU is a risk factor for occult life-threatening infection) * Lack of social supports, drug intoxication and mental health concerns can make patient evaluation challenging and are risk factors for poor outcome * Multiple return visits are a red flag for serious pathology * Systems should ensure that previous health care provider notes, including ones in the past 24hrs that may not appear in EMR yet, are readily available for review * Peer support workers for marginalized populations may help facilitate assessment and management of these patients and prevent 'left without being seen' and 'left against medical advice' both of which are associated with poor outcomes Ottawa M&M Model : A Guide to Enhancing Morbidity and Mortality Rounds Expand to view reference list * DiGiorgio, A. M., Stein, R., Morrow, K. D., Robichaux, J. M., Crutcher, C. L., II, & Tender, G. C. (2019). The increasing frequency of intravenous drug abuse–associated spinal epidural abscesses: a case series, Neurosurgical Focus FOC, 46(1), E4. Retrieved Apr 12, 2022, from https://thejns.org/focus/view/journals/neurosurg-focus/46/1/2018.10.FOCUS18449.xml * http://www.emdocs.net/injection-drug-use-complications/ Evidence around ED diagnosis and management of skin abscesses and PoCUS * While the accuracy of clinical assessment alone is quite good for skin abscesses over all (specificity 94.7%, sensitivity 84.2%), when the ED physician is unsure of the diagnosis the accuracy drops precipitously (specificity 42%, sensitivity 43.7%) * While the overall accuracy of PoCUS is similar to clinical assessment (94.6% sensitive and 85.4% specific) for cases that are clinically unlear PoCUS is far better (specificity 76.9%, sensitivity 91.