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Pre-Hospital Antibiotics in Sepsis?

RebelEM

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Three outcomes were evaluated, with none being deemed the primary outcome. Background: Sepsis remains one of the leading causes of morbidity and mortality. to 0.97; p = 0.02 to 2.07; p = 0.91 to 12.33; p = 0.26

Sepsis 132
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Universal Depression Screening Leads to Unnecessary Harm

Sensible Medicine

The adoption of depression screening is, of course, well-intentioned. A 2008 Cochrane review found adult depression screening does not improve outcomes. The last two trials convincingly demonstrate that when patients with postpartum depression have better access to mental health services, outcomes improve.

Outcomes 140
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Glasgow Coma Scale in Children

Pediatric EM Morsels

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

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Tasty Morsels of Critical Care 075 | Vasopressin

Emergency Medicine Ireland

Well, that time has come and it’s time to run through vasopressin. Well this is where the fun beings. First up is the VASST trial, (Russel et al 2008 NEJM). Primary outcome here was kidney based rather than mortality. New Engl J Medicine 358 , 877–87 (2008). How does it work? Nagendran 2019 in CCM.

Shock 52
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Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mass delusion (and Opiate pain relief).

Dr. Smith's ECG Blog

It is one of the few OMI patterns that is really well described: de Winter’s T-waves. Here is her astonishing reply: "Well, they still haven’t taken her to the Cath Lab yet!!!! Opiates are associated with worse outcomes in Myocardial Infarction. They are simply Hyperacute T-waves with depressed ST takeoff. Trop at 5000 by now."

EKG/ECG 81
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Mastering Minor Care: Dog Bites

Taming the SRU

In 2008, this led to greater than 316,000 emergency department (ED) visits and about 9,500 hospitalizations [1]. However, there have been no studies statistically powered well enough regarding dog bite lacerations to confirm or dispute this claim. In the United States, approximately 4.5 million people are bitten by dogs annually [1].

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Prehospital Traumatic Cardiac Arrest: A Systematic Review and Meta-analysis

RebelEM

Nevertheless, mortality of prehospital traumatic cardiac arrest (TCA), and survivability with good neurologic outcome, remain the gold standards of trauma care in and out of the hospital and are effectively the criterion by which we measure outcomes in the trauma literature. Discussion: Dead On Scene: The 96.2% mortality rate and 43.5%