The Skeptics' Guide to EM

JANUARY 20, 2024

The American Academy of Pediatrics ( AAP ) released guidelines for the management of febrile infants and children 2 to 24 months back in 2011 [2]. UTIs are one of the most common bacterial infections in childhood that we see in the emergency department [1].

Pediatrics 71

Pediatrics Anaphylaxis Emergency Department Outcomes 71

ACEP Now

OCTOBER 9, 2024

In the emergency department (ED), physicians face the challenge of making rapid decisions that can significantly impact patient outcomes. This mindset shift is crucial for improving outcomes and fostering a more inclusive and equitable health care system. Dr. Harrell is a PGY-1 emergency physician at Houston Health. 2003;22(3):465-466.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Ultrasounds Outcomes 52

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 137

Stroke Outcomes Hospitals Administration 137

PulmCCM

JUNE 12, 2023

TTM2 found no improvement in survival or neurologic outcome among patients randomized to cooling to a target of 33 °C, as compared to controls receiving fever prevention (e.g. with acetaminophen) until temperatures reached 37.8 °C who then received external cooling to maintain a target temperature of 37.5 °C.

Hyperthermia / Hypothermia 102

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 102

Sensible Medicine

JANUARY 22, 2024

The STICH trial, published in 2011, randomized about 1200 patients with impaired LV systolic function and severe coronary artery disease amenable to surgery to CABG or medicine alone. The primary outcome was death. Modern heart surgery uses the left internal mammary artery whereas older surgery used mostly vein grafts.

Outcomes 119

Outcomes Research 119

Don't Forget the Bubbles

JANUARY 24, 2024

Mortality is high, between 16-43.5% , and neurological outcomes are generally poor amongst survivors. These poor outcomes are related to both the SRSE itself and as a result of the prolonged PICU stay. One study suggests remission in 6 out of 7 patients where it was used, but long-term clinical outcomes remained poor.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

RebelEM

MARCH 22, 2023

Multiple studies comparing verapamil to adenosine demonstrate equal efficacy of either agent with verapamil causing more hypotension ( Delaney 2011 , Hood 1992 ) Dose: 0.07 2011; 18(3): 148-52. Can J Cardiol 2011; 27(1): 105-9. Can J Cardiol 2011; 27(1): 105-9. Am J Emerg Med 2011; 29(5): 545-8. Eur J Emerg Med.

EKG/ECG 52

EKG/ECG EMS Pediatrics Stroke 52

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. SECONDARY OUTCOMES At day 28 , ceftriaxone group had (vs placebo): Lower VAP risk (20% vs 36%); hazard ratio 0.62 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 126

CDC Outcomes Radiology Radiology 126

EMDocs

JANUARY 29, 2024

Finally, anticipating and addressing known complications such as seizures, increased intracranial pressure, or cerebral edema with appropriate measures, including antiepileptic drugs or osmotic agents, is essential for improving patient outcomes. Lowering the MAP may mitigate these risks and possibly improve outcomes. doi: 10.1161/01.str.0000014509.11540.66.

Stroke 73

Stroke Outcomes EMS Seizures 73

The Skeptics' Guide to EM

OCTOBER 14, 2023

That episode reviewed the 2011 Fleming et al systematic review for the normal ranges of HR and RR in children from birth to 18 years of age. Does he have sepsis?” Background: We have looked at pediatric vital signs on the SGEM back in 2014 with PedEM superhero Dr. Anthony Crocco ( SGEM#98 ).

Pediatrics 88

Pediatrics Sepsis Urgent Care Emergency Department 88

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. The primary outcome was the successful intubation on the second attempt. Secondary outcomes included tracheal intubation adverse events (TIAEs) or severe desaturation.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

PHEM Cast

APRIL 16, 2018

The outcomes from different resuscitative interventions in a haemorrhagic shock model in porcine model: From: Watts et al. Critical Care; 2011. Survival and neurological outcome after OOH TCA in pediatric & adult populations: a systematic review. 2011; 82: 1138-43. Ultrasound during TCA: Cureton et al. Doi: 1098/rstb.2010.0232

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

Don't Forget the Bubbles

JUNE 17, 2024

High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. At its heart lies an unpleasant reality- a critically unwell child with an anxious carer hoping for a positive outcome. 2011 Apr 1;78(2):202-9. Civility Saves Lives The impact of incivility in healthcare cannot be understated.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

RebelEM

FEBRUARY 12, 2024

2011; 18(7):699-707. CT in Detecting Urinary Tract Calculi: Influence on Patient Imaging and Clinical Outcomes Radiology. Radiological Imaging of Patients With Suspected Urinary Tract Stones: National Trends, Diagnoses, and Predictors. Gottlieb RH, La TC, Erturk EN, et al. 2002; 225(2):441-449.

Radiology 85

Radiology Radiology Emergency Department Ultrasounds 85

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. A suggested schema for time-limited trials was suggested by Quill and Holloway in 2011 in JAMA. Expectations and outcomes of prolonged mechanical ventilation.

COPD 45

COPD Outcomes Hospitals EMS 45

Don't Forget the Bubbles

SEPTEMBER 5, 2024

In this study, the Broselow tape had the best overall accuracy, with 50.7% (vs 30.88% for APLS 2011) of estimates occurring within 10% of measured weight and 80.0% (vs 55% for APLS 2011) estimates within 20% of measured weight. Obesity is considered a contributing factor for some musculoskeletal outcomes. years (IQR 2.5–14.2

Ultrasounds 52

Ultrasounds Research Emergency Department Outcomes 52

RebelEM

MARCH 13, 2023

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%

Basic Life Support 52

Basic Life Support EMS Outcomes Resuscitation 52

PHEM Cast

FEBRUARY 25, 2021

Prognostication Better outcomes: Rescued and BLS commenced < 5-10 min Children Those who have not aspirated Water temperature < 10 o C, core body temperature 33-35 o C Neurologically intact on arrival at hospital Minimum blood pH > 7.1, Tipton & Golden (2011). New Engl J Med. 366: 2102–10. Resuscitation. 82: 819-824.

Resuscitation 52

Resuscitation Hospitals Outcomes Wellness 52

Taming the SRU

SEPTEMBER 25, 2023

Functional outcome of bimalleolar ankle fractures treated with fibular plate for lateral malleolus and C.C. Functional outcome of bimalleolar ankle fractures treated with fibular plate for lateral malleolus and C.C. 2011 Jan-Feb;50(1):62-7. Figure 1 highlights the mechanism of injury and range of severity. Abhiraj Patel.

Fractures 101

Fractures Operations Emergency Department EMS 101

EMDocs

SEPTEMBER 7, 2024

Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. Epub 2011 Sep 10. Clinical spectrum, risk factors, management and outcome of patients with retroperitoneal hematoma: a retrospective analysis of 3-year experience. J Emerg Med. 2012 Aug;43(2):e157-61. doi: 10.1016/j.jemermed.2011.06.006.

EMS 74

EMS Fluid Resuscitation Resuscitation Radiology 74

Pediatric Emergency Playbook

OCTOBER 1, 2017

2011; 7:491-500. Journal of Chemical Neuroanatomy; 2011; 42: 288–296. Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices: A Multi-Institutional Study. 2011; 58(11):1183–90 Fraser CD, Jaquiss RDB, Rosenthal DN et al. J Neurosurg Pediatrics. Groves DA, Brown VJ. 2005; 29: 493–500.

Pediatrics 52

Pediatrics Seizures Stroke Ultrasounds 52

EMDocs

AUGUST 22, 2024

Certified interpreter use can improve communication and patient outcomes. Conducting research regarding best practices for improving health outcomes for NELP patients. Pearls NELP patients have worse health outcomes despite widespread language-access policies. February 2011. Youdelman M. National Health Law Program.

Documentation/Coding 81

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 81

Sensible Medicine

APRIL 16, 2024

The tool developed on the PLCO participants was used to analyze the CXRs of outpatients taken in 2010 or 2011 at 1 of 2 hospitals ( The General or The Brigham ). The primary outcome was incident MACE within 10 years of the CXR in populations who either did or did not have data from which ASCVD could be calculated.

Radiology 77

Radiology Radiology Stroke Hospitals 77

PHEM Cast

APRIL 21, 2021

The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury. 2011 Dec;82(12):1519-24. Epub 2011 Jul 2. Click here to hear what our friends over at the Resus Room think about Airways 2 References (kindly shared by Rich) Davis DP et al. J Trauma 2003; 54:444-453 Mort TC. 2011.06.028.

Airway Management 52

Airway Management Resuscitation EMS Hospitals 52

Don't Forget the Bubbles

AUGUST 7, 2023

The controversy around what is ‘normal’ in infants’ and children’s vitals was demonstrated in a 2011 systematic review by Fleming et al. The study also did not assess outcomes for each patient, and as such, the impact on deviation from the normal range was not explored. Yes Was the outcome accurately measured to minimize bias?

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

Don't Forget the Bubbles

FEBRUARY 26, 2024

2011 Oct;46(10):949-55. Outcomes of paediatric critical care asthma patients. 2011 Aug;37:1338-43. Non‐invasive ventilation in pediatric status asthmaticus: a prospective observational study. Pediatric pulmonology. Non-invasive ventilation in paediatric critical care. Paediatric respiratory reviews. 2016 Sep 1;20:24-31.

Pediatrics 72

Pediatrics Research Documentation/Coding Outcomes 72

Taming the SRU

JULY 3, 2023

Population 7180 noncritical febrile infants ≤60 days old presenting to a PECARN ED (list of centers: [link] ) between March 2011 and April 2019. Their last outcome was determining the prevalence of IBI in febrile infants with a positive UA who were deemed low risk by the PECARN febrile infant rule.

Pediatrics 91

Pediatrics Research Outcomes 91

RebelEM

MARCH 23, 2023

The primary outcome, hospital length of stay, was significantly shorter both before and after propensity score adjustment for the phenobarbital group. A broad range of variables were included that potentially influences treatment decisions and/or outcomes. The protocols used in the study were using symptom-driven medications.

Emergency Department 52

Emergency Department Outcomes Burns Hospitals 52

RebelEM

SEPTEMBER 15, 2022

What They Did: Acetazolamide in Decompensated Heart Failure with Volume Overload (ADVOR) trial Multicenter, parallel-group, double-blind, randomized, placebo-controlled trial Performed at 27 sites in Belgium Patients with acute decompensated heart failure, clinical signs of volume overload (i.e. Placebo: 30.5% RR 1.46; 95% CI 1.17 Placebo: 27.8%

Hospitals 52

Hospitals Outcomes EMS 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. 2011, 10:1002-1014. hour IV thrombolytic window. hour IV thrombolytic window.

EMS 74

EMS Stroke Outcomes Hospitals 74

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 95

Sepsis Documentation/Coding Administration Fractures 95

The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 * Population: Adults 18 years and older with non-traumatic OHCA between 2011 and 2015treated by 192 EMS agencies in the USA. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

The Skeptics' Guide to EM

DECEMBER 7, 2018

There was also no increase in survivors with good neurological outcomes with ACLS. published in Resuscitation 2011. Clinical Question: Does the use of epinephrine in cardiac arrest improve survival rates with a favourable neurological outcome? JAMA 2009, Hagihara et al. Reference: Perkins et al.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 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. Crit Care Med 2011; 39:3 PEER Reviewed by Dr. Mike Tom PEER Reviewed by Dr. Lauren Igneri PEER Reviewed by Dr. Ruben Santiago BMC Nephrol 2015;16:127.

Burns 52

Burns Administration Outcomes Hospitals 52

PHEM Cast

DECEMBER 12, 2016

Emergency Department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. Resuscitation; 2011: 1194-1197 Emergency thoracotomy in thoracic trauma: a review. Injury; 2006 (37): 1-19. Clay et al. World Journal of Emergency Surgery; 2006: 1:4. Rhee et al. J Am Coll Surg; 2000.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

Taming the SRU

SEPTEMBER 8, 2023

“Prognosis of acute severe autoimmune hepatitis (as-AIH): The role of corticosteroids in modifying outcome.” 16, 2011, p. Journal of Hepatology, vol. 4, 2014, pp. 876–882, [link] Potts, Jonathan R. Optimizing management in autoimmune hepatitis with liver failure at initial presentation.” World Journal of Gastroenterology, vol.

Radiology 59

Radiology Radiology Ultrasounds EMS 59

SheMD

APRIL 30, 2023

How they measured things: They performed a cross-sectional survey of women in emergency medicine to determine the rate of impaired fecundity and compared it to the national 2011–2015 CDC National Survey of Family Growth database. What were their outcomes: Impaired fecundity was found in 24.9%

CDC 52

CDC EMS Outcomes 52