Stop and Think

OCTOBER 8, 2024

The puzzle : older trials found big gains in major outcomes (death) and newer trials struggle to show incremental gains in composite endpoints, such as one of many causes of hospitalization. Circa 2001. Yes, hospitalizations for heart failure are 29% lower with the drug. This endpoint represents only 10% of total hospitalizations.

Hospitals 73

Hospitals Academics Outcomes 73

The Skeptics' Guide to EM

JUNE 6, 2020

It was the landmark paper published 19 years ago by Dr. Emanuel Rivers on early goal directed therapy in the treatment of severe sepsis and septic shock that sensitized the medical community ( Rivers et al NEJM 2001). POOs focus on occurrences that matter to patients while MOOs do not. increase in MAP). Reference: Permpikul et al.

Sepsis 52

Sepsis Shock Resuscitation Administration 52

ACEP Now

JULY 7, 2023

Prior to medical school, she received her MBA in Healthcare Management and currently works on health policy and outcomes-based research. Isha Joshi (@ISHAJOSHIII) is a third-year medical student at Penn State College of Medicine in Hershey, Pa. Dr. Marco is professor of emergency medicine at Penn State Health Milton S. Forensic Sci Int.

Forensics 98

Forensics Airway Management Administration Emergency Department 98

PHEM Cast

DECEMBER 12, 2016

Emergency Department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. 2001, 193 (3): 303-309. World Journal of Emergency Surgery; 2006: 1:4. Rhee et al. Survival after Emergency Department thoracotomy: review of published data for last 25 years. J Am Coll Surg; 2000. J Am Coll Surg. Editorial.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

Mind The Bleep

OCTOBER 17, 2024

BASICS responders have additional skills and can provide pre-hospital emergency care to patients delivering time-critical interventions to improve outcomes. The Sandpiper Trust was founded in 2001 following the death of 14-year-old Sandy Dickson. What is a BASICS responder and who can do it? What kit do I need?

Ambulance Services 52

Ambulance Services Hospitals Anaphylaxis Wellness 52

EMDocs

SEPTEMBER 27, 2023

In years previous, the conversion factor has largely stayed the same resulting in physician pay falling 22% from 2001 to 2021 when adjusted for inflation (3). “Association Between Individual Primary Care Physician Merit-based Incentive Payment System Score and Measures of Process and Patient Outcomes.” link] Bond, A.

Emergency Department 63

Emergency Department Research Outcomes Hospitals 63

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. 7-9 The PE model then aims to sell acquired businesses for a profit within three to six years.

Hospitals 113

Hospitals Radiology Radiology Administration 113

Taming the SRU

JUNE 12, 2023

Finally, a randomized-control trial found that prophylactic antibiotics for dog bite wounds did not statistically change infection outcomes and was not cost-effective, recommending that prophylactic antibiotics only be used in high-risk wounds [12]. Annals of Emergency Medicine. 2004;43(3):362-370. Medeiros IM, Saconato H. 2007;14(5).

Infectious Diseases 102

Infectious Diseases Emergency Department Administration Academics 102

The Skeptics' Guide to EM

AUGUST 17, 2019

Some have identified the 2001 Joint Commission making pain the fifth vital sign in an attempt to address the oligoanalgesia issue as part of the opioid misuse problem. You realize you are unsure what to tell her about the chances of continued opiate use after an initial prescription.

Emergency Department 52

Emergency Department Academics Fractures Outcomes 52

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

In an attempt to improve resource utilization, emergency department length of stay, limit cost and improve outcomes, there have been multiple Clinical Decision Rules (CDRs) created to help guide clinicians in their decision-making process. Traditionally CT imaging was obtained for fear of missing intracranial pathology.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

PulmCCM

OCTOBER 9, 2023

Intensive blood glucose control in the ICU: Try, try again (TGC-FAST trial) Hyperglycemia is associated with worse outcomes in the ICU (and in medical patients generally), so correcting it must improve outcomes … right? ICU lengths of stay (the primary outcome) were identical between groups. and many other countries.

Shock 52

Shock Outcomes Hospitals Wellness 52

RebelEM

JANUARY 19, 2023

If aspiration is unsuccessful based on the criteria above → Chest tube is inserted (size 8-14Fr) and admitted to the hospital. Outcomes: Primary Outcome: Total length of hospital stay up to 30 days after randomization, including initial hospital stay and readmissions.

Outcomes 52

Outcomes Hospitals Research EMS 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

J Emerg Med 2001; 20:391-401. Am J Cardiol 2001; 87:970-4; A4. These patients had worse outcomes than patients with ST depression without occlusion; half of these were circumflex. 2001 Jun;13(2):190-3. So treating these as STEMI is well within the bounds of guideline recommendations (6). References: 1.

EKG/ECG 52

EKG/ECG Outcomes Wellness 52

RebelEM

AUGUST 7, 2023

Outcome of delirium in critically ill patients: systematic review and meta-analysis. Over half the patients (540) were hypoactive delirium and we typically don’t see a benefit in treating these patients with antipsychotics The median daily dose of haloperidol given was 8.3mg over 3.6 N Engl J Med. 2022 Dec 29. N Engl J Med.

Outcomes 52

Outcomes Hospitals EMS Administration 52

EMDocs

JANUARY 20, 2025

2001 12 found similar results among a cohort of critically ill patients. One of the hallmarks of sepsis care, based on the Rivers 2001 17 trial and still recommended by the latest SCCM guidelines is early detection of sepsis and initiation of early resuscitation. 9 In terms of assessing volume status in general, Joseph et al.

Dehydration 40

Dehydration Fluid Resuscitation Sepsis Resuscitation 40

All Ohio EM

SEPTEMBER 16, 2019

By Mike Pallaci, DO Research Question: Does rapid lowering of blood pressure improve the outcome in patients with intracerebral hemorrhage? The primary outcome was determined for 2794 of these; 45 patients (1.6%) lost to follow-up. How Many Patients: The investigators enrolled 2839 patients.

Stroke 40

Stroke Outcomes Research Hospitals 40

PulmCCM

APRIL 1, 2024

Physical therapy is probably under-provided to critically ill patients, and improving this might improve outcomes for many. That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Abstract 1995 Table 1 Systematic review of pulmonary fat emboli associated with intraosseous (IO) use in seven controlled swine studies Authors Study Population Bone Flush Infusion method IO system used Relevant outcome measure Relevant results Plewa et al. doi:10.1111/j.1553 1553 n= 16, weight 5.9-12.3kg 12.3kg Proximal tibia 1 ml NaCl 0.9%

Administration 40

Administration Research Outcomes 40

Taming the SRU

OCTOBER 23, 2023

Discrimination between an IUP and an interstitial pregnancy is critical as interstitial pregnancies can have devastating outcomes. 2001 Jan;20(1):27-31; quiz 33. PMID: 25817202. Frates MC, Visweswaran A, Laing FC. Comparison of tubal ring and corpus luteum echogenicities: a useful differentiating characteristic. J Ultrasound Med.

Ultrasounds 97

Ultrasounds Operations Radiology Radiology 97

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Comparative early and late outcomes after primary percutaneous coronary intervention in st-segment elevation and Non–St-segment elevation acute myocardial infarction (from the Cadillac trial). Stuckey, T., Zimetbaum, P. Tcheng, J. Guagliumi, G., Iwaoka, R. O’Neill, W. Lansky, A. & Griffin, J. link] Stone, G. Brodie, B. Morice, M.-C.,

EKG/ECG 113

EKG/ECG Documentation/Coding Wellness Emergency Department 113

RebelEM

JANUARY 23, 2023

Health care professional involved in patient management and outcome assessment was completely blinded. 2, 2001, pp. The effectiveness of IV cetirizine was determined to be statistically non-inferior. Journal of Investigative Dermatology Symposium Proceedings , vol.

Allergic Reactions 52

Allergic Reactions Anaphylaxis Urgent Care Emergency Department 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. 2001; 32: 1458-1471 Rosati A et al. Treatment of convulsive status epilepticus in childhood: Recommendations of the Italian League Against Epilepsy. 2013; 54 Suppl 7:23-34 Chin RFM et al., 2006; 368: 222–29.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

EM Updates

MARCH 24, 2021

The age of VL was ushered in by the 2001 Glidescope, which simultaneously introduced two technologies: video (putting a camera at the end of the blade and projecting the image onto a screen), and hyperangulated geometry (blades with a much steeper curve that are designed not to move the tongue out of the way, but to advance around the tongue).

Operations 52

Operations Airway Management EMS Wellness 52

EB Medicine

OCTOBER 1, 2018

Optimal management of septic patients has been a source of intense research, stemming from the landmark study by Rivers in 2001. Then in 2001, sepsis-2 was introduced. The CMS metrics are slightly different from the 2001 sepsis guidelines also. Jeremy, can you give us a little historical context there? Jeff : Yes it has!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

PHEM Cast

SEPTEMBER 6, 2017

trauma 2004) showed that end-tidal CO2 may be of value in predicting outcome from major trauma (19). Qvigstad et al showed in again in Resuscitation in 2013, confirming inter-individual variation in effectiveness of CPR using ETCO2 as a surrogate for CO Trauma Deakin et al. (J.

CPR 52

CPR Resuscitation Operations Wellness 52

Dr. Smith's ECG Blog

OCTOBER 6, 2018

Chest 2001 1788 patients with acute MI (diagnosed by clinical symptoms and positive CK-MB) were prospectively enrolled and all underwent emergent coronary angiography. Angiographic and clinical outcomes among patients with acute coronary syndromes presenting with isolated anterior ST-segment depressions. mm for women, 2.0 Pride et al.

EKG/ECG 40

EKG/ECG Seizures Documentation/Coding Outcomes 40

PulmCCM

APRIL 18, 2024

Video laryngoscopy was introduced in 2001 as a technique for orotracheal intubation. This outcome measure was less robust than intubation attempts, because the “failure” definition included simply switching devices, which the intubator was permitted to do at any time for any reason.

Airway Management 98

Airway Management Operations EMS Research 98

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S.,

Psychiatric 87

Psychiatric Seizures Emergency Department Pediatrics 87

EMDocs

FEBRUARY 12, 2024

There is well-documented evidence that low systolic blood pressure, a low Glasgow Coma Score (GCS), and a high Injury Severity Score (ISS) are known predictors of poor outcomes, and in combination with serum lactate provide adequate prognostic value. 2001 Oct;27(10):1606-13. Notably, in the initial analysis of blunt chest trauma (i.e.

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

EB Medicine

DECEMBER 4, 2019

Nachi: AEDs are also required and have been since 2001 and amazingly when a shock was delivered in flight, 40% survived to hospital discharge with a good outcome. Of course, there are also gloves, an IV start kit, and a few other basic supplies. Jeff: Just as on the ground, shockable rhythms do well with good BLS care.

Dehydration 40

Dehydration Wellness EMS Burns 40

EB Medicine

AUGUST 1, 2018

A 2001 study described an augmented risk of myocardial infarction within the first hour of cannabis use and found an almost 5-fold increase in those who reported smoking cannabis at least weekly when compared to those who smoked monthly or less. Ask specific questions regarding marijuana use before and during the pregnancy.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

RebelEM

NOVEMBER 11, 2024

Outcomes: Primary outcome: All-cause mortality within 90 days of ED presentation Secondary outcomes: Organ-failure-free days at 28 days, that is how many days in the first 28 after arriving in the ED not requiring mechanical ventilation, vasopressors, or dialysis. Variations in compliance could have impacted patient outcomes.

Sepsis 84

Sepsis Outcomes Administration Shock 84

Dr. Smith's ECG Blog

APRIL 8, 2015

Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. These premonitory symptoms were negative predictors of adverse outcomes in EGSYS. Abnormal ECG – looks for cardiac syncope. Hemoglobin less than 10 (SF rule) 6. Syncope with Exertion (EGSYS) 7. S yncope while supine (EGSYS) 8.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

NOVEMBER 25, 2024

Vision loss carries a high degree of morbidity and is associated with higher all-cause mortality, 4 and it is our role as emergency providers to recognize potentially reversible causes of such adverse outcomes. 5 Epidemiology Onchocerciasis is endemic in 31 African countries but is also problematic in Brazil, Venezuela, and Yemen.

Infectious Diseases 54

Infectious Diseases Emergency Department EMS Administration 54