RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. Int J Emerg Med 2009 PMID: 20157465 4. World J Emerg Surg 2023 PMID: 36918947 3.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

Don't Forget the Bubbles

JUNE 10, 2024

Baby A, a preterm infant, appears to be faring well for the moment—requiring minimal respiratory support, on full feeds, without IV access, and generally in an okay condition. Welcome to your first day with the neonates! Upon arriving for your initial shift, you set down your bag, and shortly after, you’re asked to evaluate Baby A.

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

Critical Care Now

APRIL 21, 2022

Because HD, and subsequently CRRT, have been around for many years, dosing recommendations for medications are generally well established when using these modalities. Outcomes of sustained low-efficiency dialysis versus continuous renal replacement therapy in critically ill adults with acute kidney injury: a cohort study.

Burns 52

Burns Administration Outcomes Hospitals 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. The fact is, large, well-conducted studies with the power to find relatively small effects with high confidence take a long time. Just kidding!

Sepsis 52

Sepsis Shock Hospitals Outcomes 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. The NNT varied from 17 to 32 according to the injury severity. Reference: Sierink et al. Lancet August 2016.

Radiology 52

Radiology Radiology CPR Hospitals 52

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. There were similar baseline characteristics and the groups were well-matched. versus 59.2%). versus 14.9%

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Taming the SRU

NOVEMBER 14, 2023

A retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 through 2011 identified 8.6 B) on right: hand drawn images of layers of ear demonstrating auricular hematoma The epidemiology and incidence of ED presentation for auricular hematomas has not been well-studied because it is a relatively uncommon condition.

Emergency Department 91

Emergency Department Pediatrics Wellness Documentation/Coding 91

Don't Forget the Bubbles

FEBRUARY 26, 2024

Increasing PEEP is thought to cause bronchodilation by providing direct mechanical stimulus as well as secondary stimulation through pulmonary stretch receptors coupled with activation of the non-cholinergic parasympathetic pathway. Outcomes of paediatric critical care asthma patients. Pediatric pulmonology. 2011 Oct;46(10):949-55.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

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

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

PHEM Cast

APRIL 18, 2016

All things Pre Hospital Ketamine – Minh Le Cong Key point: patients remember if you manage their pain well. Blackham & Benger, 2009. Many of the lectures were recorded today and will be available to view soon on the Trauma Care website. Muscle spasm is superior to any artificial method.

Fractures 40

Fractures Administration Operations Shock 40

Dr. Smith's ECG Blog

JULY 18, 2014

such Q-waves are associated with larger MI and worse outcomes (2. the presence of such well developed, wide, anterior Q-wave suggests completed transmural STEMI. 2) premature, gradual reversal of inverted T waves to positive (upright) deflections by 48 to 72 hours after MI onset in the presence of well formed Q-waves.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

This definition includes clinically apparent seizures as well as those seen only on EEG.) Or… is it something else as well? October 8th, 2009. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. In other words – time is brain. Boston, MA.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

The Skeptics' Guide to EM

JUNE 3, 2023

One aspect that has not been well covered on the SGEM is the choice of induction agent when intubating patients. 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.

Outcomes 102

Outcomes Wellness 102

Dr. Smith's ECG Blog

MARCH 13, 2013

There is reciprocal ST depression in I, II, aVL and V4-V6, as well as some very subtle STD in posterior leads V8 and V9 (which also have very low QRS voltage) Here is his initial ECG, which the tech recorded as a 15-lead ECG (the doctors were not sure why): Thus, there is a rightward, anterior, and slightly superior ST axis. Wong, 2012)" 1.

EKG/ECG 52

EKG/ECG Hospitals Outcomes Wellness 52

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 122

Ultrasounds Outcomes COPD Hospitals 122

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

PEMBlog

MAY 11, 2023

Injectable lidocaine, when done well, is reliable – but it can take years to master the ideal technique that doesn’t create a giant mound of subcutaneous lidocaine that can impact needle entry and landmarks. 2009 May;16(5):388-93. Epub 2009 Apr 15. Should we be using it for LPs instead of injecting? Acad Emerg Med.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Outcomes 52

ACEP Now

APRIL 5, 2024

One 2009 study of four tertiary hospitals found that emergency physicians often misdiagnosed this presentation in pregnant women as “panic attack, domestic violence, or gastroenteritis.” Thus, early management is essential for patient outcomes. 1 Rituximab may be given as well, largely due to prevention of relapse.

Domestic Violence 40

Domestic Violence Emergency Department Outcomes EKG/ECG 40

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 Documentation/Coding Academics 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

EMDocs

JUNE 3, 2023

23 Pelvic binding remains a critical resuscitation step well within the purview of the ED physician, and can be reviewed here: [link]. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality. Management and outcomes of open pelvic fractures: An update.

Fractures 54

Fractures Resuscitation Operations EMS 54

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients. Pediatr Cardiol.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

EMDocs

OCTOBER 23, 2023

She had been feeling well until yesterday when she had a follow-up with her surgeon, at which time she reported that they performed an internal exam and inserted a ‘medication disk’ into her vagina. The patient is noted to be mildly tachycardic as well as febrile. 2009 Apr;49(2):198-201. 2020 Sep;127(10):1269-1279. Up to Date.

OB/GYN 67

OB/GYN Operations EMS Ultrasounds 67

Downeast Emergency Medicine

MARCH 13, 2022

Discuss treatment options as well as disposition for your patient once labs and imaging have returned. You can also use ultrasound testing for evaluation of biliary pathology as well as ovarian/testicular torsion. Case Outcome The abdominal CT showed uncomplicated diverticulitis! Be your patient’s advocate! Silverio, Luz.

Ultrasounds 52

Ultrasounds EKG/ECG Radiology Radiology 52

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

Infectious Diseases 96

Infectious Diseases Administration Sepsis Anaphylaxis 96

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. demonstrating that functional outcome at 3 months did not differ between the CTA and MRI groups (38.5% vs. 38.1%) with a good functional outcome.

Stroke 87

Stroke Radiology Radiology Emergency Department 87

Dr. Smith's ECG Blog

APRIL 8, 2015

True Syncope: If, on the other hand, the patient is well, had no other serious symptoms , has a normal sinus rhythm, and normal physical exam , then you need to be certain the syncope was not due to a dangerous brady- or tachydysrhythmia that could recur. These premonitory symptoms were negative predictors of adverse outcomes in EGSYS.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

JANUARY 20, 2024

The most common findings on ECG are ST elevation , most often in the anterior precordial leads, as well as sinus tachycardia and QT interval prolongation. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. Troponin and B – type natriuretic peptide are often elevated. J Neurosurg. 2006;105(2):264-270. Am Heart J.

EMS 74

EMS Fluid Resuscitation Shock EKG/ECG 74

EMDocs

DECEMBER 18, 2023

8 Based on multiple randomized controlled trials (RCTs), SSC 2021 guidelines suggest against using procalcitonin as a screening method to guide initiation of antibiotic therapy, as no difference in clinical outcomes was appreciated. 36 However, the literature has failed to prove that the double coverage has any effect on clinical outcomes.

Sepsis 65

Sepsis Fluid Resuscitation Shock Resuscitation 65

Advanced Emergency Nursing from AENJ

MARCH 27, 2015

Expiratory airway obstruction may well have been frequently misdiagnosed as it can produce breath-stacking and ball-valve obstruction that impedes any airflow with mask ventilation if neither a nasal nor an oral airway is used and the lips have closed under the mask. Lubricate well. Gerkin] Priceless. Rogue Medic. Ludwig’s angina.

Resuscitation 40

Resuscitation Airway Management EMS CPR 40