Ep 174 Is Less More? Saving EM and Traumatic Pneumothorax – Highlights from CAEP 2022

Emergency Medicine has undergone many changes over the last couple of decades and especially during the COVID pandemic. Most of these changes have been very positive, but increasing volumes, staff shortages, aging populations, increasing breadth of responsibilities and better access to more imaging have made some of us question how we should define the scope of our practices. In this main episode podcast, highlights from CAEP 2022 conference, Anton discusses the article 'Saving EM: Is Less More?' with Dr. Paul Atkinson and Dr. Grant Innes and offer some solutions to this current state of affairs in EM. In another CAEP highlight, trauma team leader Dr. Mathieu Toulouse delivers the latest on management of traumatic pneumothorax. We explore if less is more when it comes to indications for placing chest tubes, size of chest tubes, antibiotics etc. He answers such questions as: Do all patients with a traumatic pneumothorax require tube thoracostomy? How do CXR and CT differ in determining which patients require a chest tube? Do all patients receiving positive pressure ventilation require a chest tube for their traumatic pneumothorax? Does the presence of hemothorax necessitate placement of a chest tube? Are 14Fr pigtail catheters adequate for all traumatic pneumothoraces? and many more...

Podcast production, sound design & editing by Anton Helman, voice editing by Braedon Paul

Written Summary and blog post by Hanna Jalali, edited by Anton Helman September, 2022

Cite this podcast as: Helman, A. Toulouse, M. Innes, G. Atkinson, P. Episode 174 Saving EM and Traumatic Pneumothorax - Highlights from CAEP 2022. Emergency Medicine Cases. September, 2022. https://emergencymedicinecases.com/saving-em-traumatic-pneumothorax. Accessed May 30, 2024

Résumés EM CasesSaving Emergency Medicine—Is less more?

As EM physicians we pride ourselves in being able to provide care to any patient that steps through the ED doors. Historically, our care has adjusted to provide a wider breadth of knowledge, investigations, and procedures. However, considering the current state of ED including overcrowding with admitted patients, staff shortages and left-without-being-seen rates, it may be time to change our definition of what the scope of emergency department care is.

ED Overcrowding

ED overcrowding is one of the core current and projected concerns for being able to provide the excellent care that emergency physicians do. The problem is not necessarily with the ED itself but rather overall hospital crowding and access block. We currently seem to function under a model where nearly all unscheduled healthcare takes place in the ED.

* The Canadian Foundation of Health Improvement (CFHI) point out that ED visits are increasing at a much faster rate than population growth and are projected to grow an additional 40% by 2043

* There is dependency by Canadians on EDs with the highest rates of ED utilization in the developed world

* Canada performs worst among OECD countries in accessibility to primary care, specialists, surgical procedures, and imaging

Causes of ED Overcrowding: Access Block—Wrong Care, In the Wrong Place

Access block is defined as inability to access the care you need when it is needed. This can be considered as the “wrong care, in the wrong place, by the wrong provider,