The Skeptics' Guide to EM

JUNE 3, 2023

The primary outcome was an 8% absolute increase in all-cause mortality at seven days for patients allocated to the etomidate group. This outcome was no longer statistically different at 28 days. This goes back to at least 2009 the Ketased study.

Outcomes 111

Outcomes Wellness 111

Pediatric EM Morsels

MAY 24, 2024

In 2009, more than 9,000 children died from accidental injuries. Today we tackle low risk intra-abdominal injury , to find those children in which less may be more. Low Risk Inta-Adbominal Trauma: Pediatric Trauma is Dangerous! Unintentional injuries are the leading cause of death in children. Every hour, 1 child dies from an injury.

Pediatrics 164

Pediatrics Blood Transfusions EMS Fractures 164

RebelEM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Outcomes: Primary Outcome: Reduction of dyspnea measured on a verbal dyspnea scale (VDS) from 0 to 10 recorded at enrollment, then at 2, 4, and 5 hours after arrival.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

RebelEM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Outcomes: Primary Outcome: Pulmonary expansion 24 hours after the procedure. Secondary Outcomes: Pulmonary expansion 7 days after the procedure.

Outcomes 103

Outcomes Hospitals Research Emergency Department 103

The Skeptics' Guide to EM

JULY 8, 2023

In 2009, the Cochrane group questioned Roche about the completeness of the data and after four years of requests, finally got access to all the data in 2013 and updated their review in 2014. The Cochrane collaboration published analyses of the available data in 1999, 2003 and 2006.

CDC 108

CDC Hospitals EMS Emergency Department 108

Don't Forget the Bubbles

NOVEMBER 29, 2023

A retrospective cohort analysis of the ED portion of the National Hospital Ambulatory Medical Care Survey from 2006 to 2009 in the US revealed that less than one-half of patients undergoing ETI in the ED received sedative drugs while in the ED. This could be due to paralysis of the muscles which protect the upper airway. DOI: 10.1097/ANA.0000000000000275

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

EMDocs

SEPTEMBER 7, 2023

Fatal Poisoning Among Young Children from Diethylene Glycol-Contaminated Acetaminophen — Nigeria, 2008—2009”. Long-Term Renal and Neurologic Outcomes among Survivors of Diethylene Glycol Poisoning.” 6, 8 July 2009, pp. 7 Considering epidemiologic trends, the data suggest that DEG mass poisonings will continue to occur.

Poisoning 94

Poisoning CDC Administration Emergency Department 94

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

Groups were categorized based on moderate to severe chest pain (numerical rating scale pain ≥ 5/10) or less than moderate severity to compare procedural and clinical outcomes. And as we have shown before, morphine leads to slower times to treatment and worse outcomes. 414 patients were included in the analysis.

EKG/ECG 119

EKG/ECG Hospitals Outcomes Wellness 119

Mind The Bleep

OCTOBER 29, 2024

Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes. Cardiovasc Intervent Radiol 32 , 155–158 (2009). Specific protocols, such as those for hydrofluoric acid burns, must be followed to address unique complications like hypocalcaemia and cardiac arrhythmias. Sagoschen, I.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

RebelEM

MARCH 8, 2023

Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. Symptom characteristics ( Hollands 2009 ) Any flashers/floaters: (+) LR 1.2 Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. and (–) LR 0.9. >10 floaters, (+) LR 8.1-36

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

EMDocs

JANUARY 16, 2024

Patients can have excellent outcomes despite prolonged resuscitation. Down time and time doing CPR is not nearly as important, and even patients with low end tidal, fixed, dilated pupils, asystole rhythm, and extended low-flow times can have favorable neurologic outcomes. Published 2009 Jun 10. 2009;338:b2085. Carsten L, et al.

Hyperthermia / Hypothermia 110

Hyperthermia / Hypothermia Resuscitation CPR EMS 110

RebelEM

APRIL 29, 2024

Given AHA guidelines recommend early epinephrine administration in cardiac arrest, obtaining access is imperative for resuscitative efforts ( 9) When evaluating over 300,000 out-of-hospital cardiac arrests, a meta-analysis found no significant change in primary outcomes when IV and IO access were compared ( 10 ).

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

ACEP Now

OCTOBER 15, 2023

In 2009, a consensus statement from the American Diabetes Association (ADA) discussed using a low-dose infusion (0.1 Evaluation of outcomes following hospital-wide implementation of a subcutaneous insulin protocol for diabetic ketoacidosis. units/kg/hour) rather than a bolus. Cochrane Libr. 2016;2016(1). JAMA Netw Open.

Hospitals 80

Hospitals Operations Emergency Department Research 80

Taming the SRU

SEPTEMBER 8, 2023

2009 Sep;137(3):856-64, 864.e1. Epub 2009 Jun 12. 2009 Jun;136(7):2159-68. Prognosis of acute severe autoimmune hepatitis (as-AIH): The role of corticosteroids in modifying outcome.” Intravenous N-acetylcysteine improves transplant-free survival in early stage non-acetaminophen acute liver failure. Gastroenterology.

Radiology 59

Radiology Radiology Ultrasounds EMS 59

Cook County EM Blog

MAY 1, 2023

Clinical characteristics and outcomes of septic bursitis.  2009 Jun 25. 2009 Oct;37(3):269-272. Lieber SB, Fowler ML, Zhu C, Moore A, Shmerling RH, Paz Z. 2017 Dec;45(6):781-786. Pritchard RJ, Bodeau H, Bonson P, Borloz M. Septic bursitis: ED presentation, evaluation, and management. emDocs.net. Skeletal Radiol. J Emerg Med.

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Outcomes 52

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Basilar artery occlusion remains a challenging diagnosis to make, and the delays in reaching the diagnosis can have considerable impact on health outcomes. Lancet Neurol 2009; 8:724-730. hour IV thrombolytic window. 2009;40(1):134–9.

EMS 98

EMS Stroke Outcomes Hospitals 98

PEMBlog

MAY 11, 2023

There is inconclusive evidence that it’s better than placebo for IVs too – it may help… ( see Auerbach, 2009 ). The primary outcome was the difference between the Neonatal Faces Coding Scale (NFCS) before the procedure and during LP needle insertion. 2009 May;16(5):388-93. Epub 2009 Apr 15.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Academics 52

Taming the SRU

JUNE 3, 2024

CESAR Trial Published in 2009 Found that even those who didn’t get ECMO, but were transported to a tertiary care center had better outcomes No matter where you go, critical care transport will be part of your life as a sending physician, receiving physician, or both. This shows that we are sometimes limited by the data that we have.

Shock 91

Shock Seizures Airway Management Stroke 91

The Skeptics' Guide to EM

JUNE 4, 2017

Huber-Wagner et al ( Lancet 2009 ) showed a mortality reduction in a retrospective database study of patients who have had a pan scan. There is no validated clinical decision tool to help guide our decisions. Many studies (most retrospective) have assessed the use of pan scanning as an initial radiologic evaluation. Reference: Sierink et al.

Radiology 52

Radiology Radiology CPR Hospitals 52

The Skeptics' Guide to EM

DECEMBER 7, 2018

There was also no increase in survivors with good neurological outcomes with ACLS. JAMA 2009, Hagihara et al. Clinical Question: Does the use of epinephrine in cardiac arrest improve survival rates with a favourable neurological outcome? JAMA 2012 and Cournoyer et al. Reference: Perkins et al.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

PulmCCM

JUNE 10, 2024

Background I’m not sure if you’ve noticed this, but patients and families frequently disagree with their physicians about the likely outcomes from critical illness. The Chest review identified 18 “empirical studies,” but only these two tested TLTs’ effects on patient outcomes in the ICU.) Epub 2023 Dec 13.

COPD 45

COPD Outcomes Hospitals EMS 45

RebelEM

JUNE 5, 2023

This study also identified improvements to study design which includes improving patient engagement with follow-up processes, considering more effective methods to obtain accurate outcomes including but not limited to pharmacy records and hospital records. Drug Alcohol Depend 2009; 104:73. mg tablet) 1 Buprenorphine 0.5 PMID 19443138.

Emergency Department 94

Emergency Department Hospitals Outcomes EMS 94

The Skeptics' Guide to EM

JANUARY 15, 2022

A 2009 randomized control trial conducted in French ICUs supported the use of ketamine in this patient population [5]. One thing we have not covered is the choice of induction agent for intubation. There has been much debate regarding the use of etomidate verses ketamine for induction in the critically ill [1-4].

Sepsis 43

Sepsis Shock Emergency Department Outcomes 43

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

It also did not show an increase in good neurologic outcome in the survivors (78.3% JAMA 2009 * Jacobs et al. vs. 66.8%, p=0.73). There have been a number of papers published since OPALS that support the findings of not using ACLS drugs like epinephrine for OHCA: * Olavseengen et al.

CPR 52

CPR Academics Resuscitation Hospitals 52

The Skeptics' Guide to EM

FEBRUARY 26, 2019

Dr. Hoffman has published a graphic re-analysis of NINDS ( Annals EM 2009 ) and Sayer et al responded in print ( Annals EM 2010 ). We did not re-hash all the trials in our conversation but instead focused on a couple key publications like NINDS and IST-3. The SGEM did a Classic Episode on NINDS with Anand Swaminathan ( SGEM#70 ).

Stroke 52

Stroke EMS Research Outcomes 52

The Skeptics' Guide to EM

JULY 9, 2022

* Another reanalysis was done by Kwiatkowski et al 2005 that also confirmed that the baseline imbalance in the NINDS trial did not account for the better outcome of tPA-treated patients. They published their findings in Annals of EM 2009. Any brief comments on this reanalysis?

Stroke 52

Stroke Emergency Department EMS Outcomes 52

Critical Care Now

APRIL 21, 2022

Outcomes of sustained low-efficiency dialysis versus continuous renal replacement therapy in critically ill adults with acute kidney injury: a cohort study. Clin Infect Dis 2009; 49:433-7. BMC Nephrol 2015;16:127. Sustained low-efficiency dialysis in the ICU: Cost, anticoagulation, and solute removal. Kidney Int 2006;70:963-968.

Burns 52

Burns Administration Outcomes Hospitals 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

The Skeptics' Guide to EM

APRIL 16, 2022

Before we answer that question, let’s remind everyone that only a small number (2.8%) of interventions published in SRMA and relevant to emergency medicine have unbiased and strong evidence for improved outcomes ( SGEM#361 ). JAMA Feb 2009 looked at the ACC/AHA guidelines from 1984 to 2008. This is a broader problem in medicine.

Military 40

Military Operations Emergency Department Pediatrics 40

Dr. Smith's ECG Blog

JULY 7, 2013

and these are associated with larger MI and worse outcomes (2. Apr 28, 2009. Although the patient has had pain for 4 days, could the artery have fully occluded only within hours? Very unlikely. Although acute anterior STEMI frequently has narrow QR-waves within one hour of onset (1. Raitt et al.) [and J Am Coll Cardiol 53(17):1503-9.

Ultrasounds 52

Ultrasounds EKG/ECG Emergency Department Shock 52

PulmCCM

OCTOBER 30, 2023

IDSA cites multiple large observational studies showing no improvement in sepsis outcomes at many centers after SEP-1 implementation. Then, in 2009, the condition disappeared completely. It used to be highly prevalent in U.S. ICUs, and a popular research focus for academics, generating a steady stream of papers. Just kidding!

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

RebelEM

NOVEMBER 3, 2022

Albert 2011, Jabre 2009) However, the existing literature comparing etomidate and ketamine is conflicting. Outcomes: Primary Outcome: Incidence of post-induction hypotension Secondary Outcome : First-pass success rate of endotracheal intubation Primary Results: 84 articles were identified for potential inclusion.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

Pediatric Emergency Playbook

AUGUST 1, 2017

Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. 2009; 197:211-215. 2009 Jun;123(6):1548-55 Chinn WM, Zavala DC, Ambre J. J Med Genet 2008; 45:1. Arshad A, Powell C, Tighe MP.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

ACEP Now

FEBRUARY 11, 2024

Diagnosis and Outcome During her second emergency department visit, an infectious and metabolic workup was performed, demonstrating acute kidney injury (AKI), but otherwise no acute abnormalities. Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016. Published April 12, 2021.

Emergency Department 52

Emergency Department CDC Hospitals EMS 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Methods: Between June 2007 - July 2009 all NT-OHCA patients aged >18, transported to our hospital, an urban, level one trauma teaching hospital were included. Data collected included demographics, initial rhythm, EKG, emergency department (ED) CT and outcomes. This is due to the severity of brain damage.

Resuscitation 52

Resuscitation EKG/ECG Hospitals Emergency Department 52

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. This is a critical error that leads to poorer outcomes for patients in need of critical care. Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

The Skeptics' Guide to EM

FEBRUARY 10, 2018

In 2009, a study by Panickar et al found no positive effect in giving steroids to pre-school children with wheeze (2). Outcome: * Primary: Length of stay in the hospital * Secondary: Re-attendance; readmission; salbutamol usage; and residual symptoms after discharge Dr. Meredith Borland is the senior author on this publication.

Emergency Department 40

Emergency Department Pediatrics Sepsis Hospitals 40