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 95

CDC Hospitals EMS Emergency Department 95

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 65

Poisoning CDC Administration Emergency Department 65

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 107

EKG/ECG Hospitals Outcomes Wellness 107

The Skeptics' Guide to EM

MARCH 5, 2022

JAMA Feb 2009 looked at the ACC/AHA guidelines from 1984 to 2008. The primary outcome was the quality of the evidence for each procedure. Tricoci et al. They found 53 guidelines with 7,196 recommendations. The results were only 11% of recommendations were considered Level A, 39% were Level B and 50% were Level C.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Research Pediatrics Outcomes 40

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

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 102

Resuscitation Administration Emergency Department Hospitals 102

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

Don't Forget the Bubbles

JUNE 10, 2024

Despite advancements in neonatal care, NEC remains a significant concern due to its association with adverse outcomes, including prolonged hospitalisation, the need for surgical intervention, and increased mortality rates. What is the pathophysiology of necrotising enterocolitis? Can we prevent NEC? Fitzgibbons, S.C., Gordon, P. Morrow, A.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

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 84

Shock Seizures Airway Management Documentation/Coding 84

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 84

Hyperthermia / Hypothermia Resuscitation CPR EMS 84

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

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 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 73

EMS Stroke Outcomes Hospitals 73

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

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

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

PHEM Cast

MARCH 3, 2019

Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial. 2009; 64(5): 532-539. Emergency Medicine Journal. 2014 Dec;31(12):1029. Jennings PA, Cameron P, Bernard S, Walker T, Jolley D, Fitzgerald M, et al.

Emergency Department 52

Emergency Department Head Injuries Hospitals Pediatrics 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

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 81

Emergency Department Hospitals Outcomes EMS 81

Taming the SRU

MAY 5, 2023

The CLASSIC trial is a randomized controlled trial conducted in the ICU setting which compared restrictive versus standard fluid strategies with a primary outcome of death by 90 days in patients with septic shock. Safety outcomes Serious adverse event occurrences were similar in both groups. versus 59.2%). versus 14.9% Bauer, M.,

Sepsis 52

Sepsis Shock Administration Resuscitation 52

The Skeptics' Guide to EM

DECEMBER 5, 2020

As an alternative diagnostic method, the HINTS exam was first established in 2009 to better differentiate central from peripheral causes of AVS [4]. MRI diffuse-weighted imagine (DWI) is only 77% sensitive for detecting posterior stroke when performed within 24h of symptom onset [2,3]. But what is the HINTS exam?

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

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

Don't Forget the Bubbles

MARCH 18, 2024

coliO157 and factors influencing the development of typical haemolytic uraemic syndrome: a retrospective cohort study, 2009–2012. Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome. Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). Disease severity of Shiga toxin-producingE.

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

Don't Forget the Bubbles

FEBRUARY 26, 2024

Outcomes of paediatric critical care asthma patients. Changes in the use of invasive and noninvasive mechanical ventilation in pediatric asthma: 2009–2019. Pediatric pulmonology. 2011 Oct;46(10):949-55. Non-invasive ventilation in paediatric critical care. Paediatric respiratory reviews. 2016 Sep 1;20:24-31. 2018 Jun;54(6):633-7.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

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

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. Additionally, environmental factors such as movement, noise, vibrations can make these readings less accurate. But are they good enough? Crit Care Med 2005; 33: 1276 –1280 6. Galluccio, S. Finnis, M. E., & Chapman, M. MD, FCCM; Lipsett, Pamela A.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Taming the SRU

NOVEMBER 14, 2023

A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011 identified 8.6 Complications of auricular hematoma drainage include pain, paresthesia, bleeding, infection, poor cosmetic outcome, scar formation, and re-accumulation of hematoma after the procedure.

Emergency Department 86

Emergency Department Pediatrics Wellness Documentation/Coding 86

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 88

Outcomes Hospitals Research Emergency Department 88

PHEM Cast

APRIL 18, 2016

Blackham & Benger, 2009. The periscope video of the SKEPTIC trial presentation is accessible here: [link] The Royal Flying Doctors Service (RFDS) use infusion of ketamine to manage agitated mental health patient without need for intubation. Muscle spasm is superior to any artificial method.

Fractures 40

Fractures Administration Operations Shock 40

Taming the SRU

OCTOBER 23, 2023

Discrimination between an IUP and an interstitial pregnancy is critical as interstitial pregnancies can have devastating outcomes. Best Practice & Research Clinical Obstetrics & Gynaecology, Volume 23, Issue 4, 2009. PMID: 34146921. 6 – Emma Kirk, Tom Bourne. Diagnosis of ectopic pregnancy with ultrasound. Ultrasonography.

Ultrasounds 92

Ultrasounds Operations Radiology Radiology 92

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 161

Pediatrics Blood Transfusions EMS Fractures 161

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

October 8th, 2009. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Nonconvulsive seizures are common in critically ill children. 2011; 76(12):1071-7 Baren J. Pediatric Seizures and Strokes: Beyond Benzos and Brain Scans. ACEP Scientific Assembly. Boston, MA.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

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 102

Outcomes Wellness 102

Dr. Smith's ECG Blog

JULY 18, 2014

such Q-waves are associated with larger MI and worse outcomes (2. Apr 28, 2009. Very unlikely. Although acute anterior STEMI frequently has narrow QR-waves within one hour of onset (1. Raitt et al.), Armstrong et al.), the presence of such well developed, wide, anterior Q-wave suggests completed transmural STEMI. Brunette D.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

Dr. Smith's ECG Blog

MARCH 13, 2013

2009) similarly found that STE in aVR correlated with proximal (vs. To be complete, Wong also found that STE in aVR in inferior STEMI conferred worse outcomes. "Approximately 10% of patients with anterior STEMI have STE of at least 1 mm in aVR (as measured at 60 ms after the J-point), ( Wong, 2012 ) and 25% have at least 0.5

EKG/ECG 52

EKG/ECG Hospitals Outcomes Wellness 52

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