Vera Pertsovskaya; Divya Shan; Andrew C. Meltzer, MD

Additional Risk Factors for Restraint Use

In addition to race, other patient characteristics are associated with the use of restraints. In a cross-sectional study conducted of patients with physical restraint orders from five adult EDs in New England from 2013 to 2015, the median age of restrained patients was 47 years, and 67% of the patients were men. Moreover, 48% of the sampled patients were unemployed, and 45% had Medicaid insurance. Thus, patients who were male and had public or no insurance were more likely to be physically restrained. When examining patient…


Vera Pertsovskaya; Divya Shan; Andrew C. Meltzer, MD

Racial Bias in Healthcare

Restraint use, like other disparities in healthcare, can stem from the impact of racial bias in clinical encounters. A disparity, according to the Institute of Medicine in its Unequal Report, is a difference in the quality of healthcare provided to patients that is not attributable to the patients’ wishes or healthcare needs (Smedley et al., 2002). The majority of clinician bias is associated with implicit attitudes, which are unconscious thoughts and feelings that can influence behavior. Clinician bias is common, with physicians often having positive attitudes toward white…


Vera Pertsovskaya; Divya Shan; Andrew C. Meltzer, MD

Background

Restraints serve as a means to manage agitation and other behavioral disorders when attempts at de-escalation fail. National trends show a 50% increase in the number of ED visits for behavioral disorders from 2006 to 2011 (Capp et al., 2016). EDs in the United States see nearly 1.7 million agitated patients per year (Zeller et al., 2010). Both physical and chemical restraints, as well as seclusion, are used in the ED to protect staff and prevent self-harm to patients.

Before further exploring restraints, it is important to define these terms and…


Elise Milani, MD & Jordan Selzer, MD

CXR (left) with patchy peripheral left mid to lower lung opacities (black arrow) corresponding to ground glass opacities (white arrow) on coronal image from contrast-enhanced the contemporaneous chest CT (right). Jacobi A, Chung M, Berheim A, Eber C. Portable chest X-ray in coronavirus disease-19 (COVID-19): A pictorial review. Clinal Imaging. 2020 Aug; 64: 35–42. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141645/

On August 4th 2020, tons of ammonium nitrate improperly stored in a warehouse in a port of Beirut Lebanon exploded and killed over 200 people and injured thousands. For emergency medicine providers, caring for the injured is always challenging in a mass casualty caused by a high-energy blast event. This challenge is greater in the setting of the COVID-19 pandemic. For both the initial survivors of a blast event as well as those infected with COVID-19, respiratory failure is the leading cause of death. …


Kayla Authelet; Andrew C. Meltzer, MD

The United States Food and Drug Administration (FDA) on Monday authorized the use of a drug from the Eli Lilly company

COVID-19 is stressing the capacity and resources of US hospitals in many regions. Any medication that decreases Emergency Department (ED) visits and hospital admissions is welcome news. The FDA recently issued an Emergency Use Authorization (EUA) for bamlanivimab, a monoclonal antibody that may reduce the need for future ED visits and hospitalizations in symptomatic patients with COVID-19 who are at a high risk of getting worse. While an EUA is not equivalent to FDA approval, the EUA does make the drug available for doctors to prescribe it on an emergency basis.¹ Per the manufacturer…


For most people in the United States, COVID-19 has consisted of Zoom calls, quarantine, and trying to keep our living spaces free of germs. For incarcerated individuals, all of the above is still true, but the events of their day-to-day play out differently: Zoom calls are with judges, quarantine involves 23-hour lockdown, and asking for their cells to be cleaned results in reprimand.

I spoke with Eliza Gottfried, a public defender in New Orleans, about how her clients experience COVID-19. Even before the pandemic, the incarcerated population has struggled with high rates of chronic illness, some of which are now…


Dr. Meltzer discusses concussion assessment with Dr. David Levine and Dr. Will Denq.

Dr. Levine is a practicing Emergency Medicine Physician and Regional Medical Director who also works directly with many companies across the county, focusing on utilizing technology to aid and improve the daily operations of clinical teams.

Dr. Denq is a clinical assistant professor of emergency medicine at University of Arizona. Dr. Denq (pronounced Den) specializes in sports medicine. He also is an active blogger and has created an entire video series on EM ortho splinting on ALiEM. He is active in event medicine, including for the…


Marisa Dowling, MD, MPP is the GW Health Policy Fellow for the Class of 2021. Dr. Dowling graduated from Stanford University with a B.A. in Human Biology. She then attended Duke University for medical school and earned a Master in Public Policy degree from the Harvard Kennedy School of Government. Dr. Dowling completed residency training in Emergency Medicine at the University of Maryland in Baltimore.


Justin Hull; Jordan Selzer, MD

With over 7.4 million confirmed cases and over 210,000 deaths from COVID-19 in the United States alone, nearly every aspect of life has been significantly impacted and medical training is no exception.¹ In March 2020, George Washington University School of Medicine and Health Sciences (GWU SMHS), following the recommendation of the American Association of Medical Colleges (AAMC), made the unprecedented decision to suspend all student clerkships and transition to a virtual curriculum in order to keep students safe.² As a result of this decision, hundreds of third- and fourth-year medical students at GWU suddenly found…


A new paradigm in emergency care; Venn diagram: Forward triage and Virtual Care; Proactive engagement of those at risk.

Kevin Biese, MD; Christopher Crowley, PhD; Amy Stuck PhD, RN; Jon Zifferblatt, MD

Today, emergency room physicians see too many patients who have delayed treatment for heart attacks, strokes, and other serious conditions because of COVID-19 fears. In some cases, the results are needlessly catastrophic. Decisions to activate emergency care for life-threatening episodes appear to be dominated by perceptions that our nation’s emergency care infrastructure is either overwhelmed or unable to safely manage a call for help. As the number of COVID-19 cases in the US has crossed the threshold of 2 million people, four in five adults say they…

Urgent Matters

Dedicated to improving emergency care and hospital patient flow. Housed within @GWSMHS @GW_RRIEM. #FOAMed #GWEMED #RRIEM Follow/RT ≠ endorsement.

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