Ken Grauer, MD

MARCH 12, 2023

T oday's C ASE C oncludes : Although the ventricular rate in ECG #2 was reduced in half following administration of IV Metoprolol — the patient remained in AFlutter with the rapid ventricular response of ~140-145/minute.

EKG/ECG 195

EKG/ECG Administration Wellness 195

EMDocs

NOVEMBER 7, 2023

2012 Apr;99(4):532-9. In patients requiring antibiotic therapy, we recommend oral administration whenever possible, primarily, because an early switch from intravenous to oral therapy may facilitate a shorter inpatient length of stay (strong recommendation based on moderate-quality evidence, 1B).” 2012 Apr;99(4):532-9.

Sepsis 108

Sepsis Best Practices Hospitals Outcomes 108

Cook County EM Blog

APRIL 27, 2022

2019.09.007 What : Retrospective cohort study of all droperidol administrations between January 2012 and April 2018 at an academic and pediatric emergency department in the US with 77,000 annual visits. Zero deaths were attributed to droperidol administration. Zero deaths were attributed to droperidol administration.

Administration 52

Administration EKG/ECG Emergency Department EMS 52

EMDocs

AUGUST 17, 2023

The study was performed when Surviving Sepsis Campaign Guidelines were used, so it was more common to see large volume fluid administration in the setting of sepsis. vs 48.4% (OR 3.4, 5.53) Takeaways: Positive trial => there was a statistically significant rate of shock control attained with the treatment arm.

Sepsis 86

Sepsis Shock Resuscitation Fluid Resuscitation 86

PEMBlog

MAY 24, 2023

Marianne Gausche-Hill New England EMSC: New England Regional Behavioral Health Toolkit Disclaimer The Emergency Medical Services for Children Innovation and Improvement Center is supported by the Health Resources and Services Administration (HRSA) of the U.S. 2012 Jan;109(3):27-32. 2012 Feb;13(1):35-40. Dtsch Arztebl Int.

Emergency Department 59

Emergency Department Pediatrics Psychiatric Administration 59

Pediatric Emergency Playbook

AUGUST 1, 2017

2012; 43(1):49-51. BMJ 2012; 345:e5521. 2012; 3:247-250. 2012; 92:527-39. 2012; 30:426-431. 2012; 29:231-236 Blakely ML et al. 2012; 10:4255-428. 2012; 10:115-119. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. J Am Coll Surg. 2004; 199(4):628-635. Lee HC et al. Int J Surg.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

DECEMBER 16, 2024

Since January 2024, measles cases in the UK have surged, reaching 2,563 reported casesthe highest level since 2012. Following a 2012 outbreak, an emergency maternal pertussis vaccination programme was introduced in the UK, offering the vaccine to women in the third trimester of pregnancy.

Infectious Diseases 59

Infectious Diseases Documentation/Coding Pediatrics CDC 59

RebelEM

NOVEMBER 2, 2022

grams/kg on day 3 of treatment Patients with a single episode of SBP should be considered for antibiotic prophylaxis (with norfloxacin, ciprofloxacin or TMP/SMX) ( Runyon 2012 ) Take Home Points SBP is a difficult diagnosis to make because presentations are variable. Management of Adult Patients with Ascites Due to Cirrhosis: Update 2012.

EMS 52

EMS Administration Hospitals 52

EMDocs

JANUARY 17, 2024

The US Food and Drug Administration (FDA) approved benzonatate in 1958 for cough relief in patients ≥ 10 years. 5) From 2012 to 2019, pediatric benzonatate prescribing soared by 62%. (9) Analysis of benzonatate overdoses among adults and children from 1969-2010 by the United States Food and Drug Administration. Pharmacotherapy.

Poisoning 81

Poisoning Seizures Pediatrics EMS 81

EMDocs

FEBRUARY 7, 2024

22 Regardless of one’s ethical stance on the issue, increases in strike frequency will pose challenges to health systems, while also putting pressure on administrators to offer better support to workers. 2012 Feb 1;4(1):127-57. One study found that labor unionization among U.S. Why does it matter? 5 January 2023. Gruber J, Kleiner SA.

Hospitals 95

Hospitals Research Patient Safety Wellness 95

Downeast Emergency Medicine

APRIL 26, 2021

2][3] If earlier treatment with TXA is better, would there be benefit in its administration in the prehospital setting? Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. If so, could this be done safely? These questions are asked in the first paper that we reviewed.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

EMDocs

SEPTEMBER 7, 2024

In this patient with a penetrating posterior flank injury, trace-free fluid in the pelvis on eFAST, and ongoing signs of hemorrhagic shock despite fluid and blood product administration, transferring to the operating room for exploration is indicated, especially with high probability of zone III injury-related retroperitoneal bleeding.

EMS 93

EMS Fluid Resuscitation Resuscitation Radiology 93

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

She stabilized after electrolyte administration with no further episodes of TdP. mEq/L for Mg++ ) — given that ECF levels of these cations comprise only ~1-2% of total body stores ( Jahnen-Dechent and Ketteler — Clin Kidney J 5(Suppl 1):i3-i14, 2012 — and — Udensi and Tchounwou — Int J Clin Exp Physiol 4(3): 111-122, 2017 ).

Seizures 114

Seizures EKG/ECG EMS Stroke 114

ACEP Now

JULY 7, 2023

First, oral administration is preferred, as this route can often be as effective as intramuscular administration. 2012 Feb;13(1):17-25. 2012 Feb;13(1):26-34. Once trust is established and patients are willing to accept calming medication, emergency physicians should consider these guiding principles. West J Emerg Med.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

The Skeptics' Guide to EM

JUNE 5, 2021

Based on your institution’s current guidelines, the patient is a candidate for endovascular therapy, but they are also within the current window for the administration of thrombolytics. Background: Management of acute ischemic stroke has been discussed on the SGEM ever since this knowledge translation project was launched in 2012.

Urgent Care 52

Urgent Care Stroke Critical Access Outcomes 52

PHEM Cast

APRIL 10, 2016

The control group received many similar treatments as the ‘intervention’ group (just not full protocolised EGDT) highlighting that with good sepsis care (fluid resuscitation, close monitoring, early appropriate antibiotic administration), mortality can be reduced. 2012 Jan;30(1):51–6. 2012 Dec 15;186(12):1264–71. Am J Emerg Med.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Don't Forget the Bubbles

MAY 29, 2023

Journal of Business Ethics [Internet] 2012:109:3:275–287. JONA: The Journal of Nursing Administration. BMC Health Serv Res [Internet] 2014:14:61 (2014). Available at: [link] Palanski ME. Forgiveness and Reconciliation in the Workplace: A Multi-Level Perspective and Research Agenda. Available at: [link] Porath CL, Foulk T, Erez A.

Leadership 98

Leadership Patient Safety Academics Research 98

RebelEM

JANUARY 25, 2023

J Trauma Acute Care Surg 2012; 73(5): S362-9. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 PMID: 23758299 Maung AA et al.

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Four Components to Successful Pain Management and Intranasal Medication Administration Right drug, right dose, right patient, right timing Right Drug – Not every medication is easily amenable to intranasal administration. 2012 Jul-Aug;8(4):237-41. This is mostly from an old culture of misunderstanding or fear of overdose.

Administration 40

Administration Seizures Emergency Department Ultrasounds 40

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Background: We have covered sepsis many times on the SGEM since 2012. He triggers a sepsis alert, and you get a pop-up suggesting IV antibiotics and 30cc/kg of IV fluids. So, you ask yourself, is this guy really septic and should we bypass those fluids?

Sepsis 40

Sepsis Emergency Department COPD Hospitals 40

PulmCCM

NOVEMBER 11, 2021

Accordingly, the baseline PPV was 20%, suggesting greater preload dependency prior to phenylephrine administration. Journal of applied physiology 2012, 113(6):984-984. Journal of applied physiology 2012, 113(2):281-289. British journal of anaesthesia 2011, 107(2):209-217. Gelman S, Pizov R: Phenylephrine and cardiac output.

Stroke 40

Stroke Sepsis Administration Wellness 40

EM Guide Wire

NOVEMBER 2, 2020

of the total visits Average time to administration was 154 minutes 11.1% of patients were able to be discharged home after administration 6.8% Administration of 2 g of IV magnesium sulfate improves pulmonary function when used as an adjunct to standard therapy in patients with very severe, acute asthma. final FEV1 was 51.1%

Pediatrics 52

Pediatrics Anaphylaxis Emergency Department Administration 52

Pediatric Emergency Playbook

MAY 1, 2017

Also, newborns have a double-whammy administrative load. 2012; 129(4). 2012 Aug;130(2):e352-7. Newborns are terrible at answering emails. There is a lot of unread unconjugated bilirubin is floating around. The liver and spleen are just not able to keep up. The infant’s gut is relatively sterile, so no admin assistance there.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Taming the SRU

APRIL 10, 2023

1] OAHL has been reported after various dosages, administration routes, and lengths of opioid use. [5] 5] There are reports of OAHL occurring after oral, intranasal, intravenous, and transdermal administration, as well as one case of intra-arterial administration. Sudden Sensorineural Hearing Loss Due to Drug Abuse.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Administration Emergency Department 52

Dr. Smith's ECG Blog

JULY 22, 2023

A Brugada-1 pattern may either be observed spontaneously ( with leads V1 and/or V2 positioned normally — or positioned 1 or 2 interspaces higher than usual ) — or — a Brugada-1 pattern may be observed on provocative drug testing after IV administration of a sodium-channel blocking agent such as ajmaline, flecainide or procainamide.

EKG/ECG 91

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 91

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

" The impact of this paper led to massive government regulation, grants, and reorganization of many local ambulance groups to Emergency Medical Services under administrative authorities and with shifts to contracted operators or public agencies such as fire departments who welcomed additional service justification and operating funds.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Advanced Emergency Nursing from AENJ

MAY 27, 2014

Davies reported in the British Medical Journal of " A simple portable apparatus for the therapeutic administration of carbon dioxide." A SIMPLE PORTABLE APPARATUS FOR THE THERAPEUTIC ADMINISTRATION OF CARBON DIOXIDE. In 1927, H.W. New England Journal of Medicine, 206(4), 151-155. DAVIES, H. Efforts to repeal Prohibition.

Resuscitation 40

Resuscitation Poisoning Research Administration 40

RebelEM

AUGUST 7, 2023

Trial design allowed for as needed administration of haloperidol or placebo and the use of rescue medications such as propofol, alpha 2 agonist and benzodiazepines so that clinical staff could safely care for patients with delirium. Crit Care 16, R115 (2012).

Outcomes 52

Outcomes Hospitals EMS Administration 52

Taming the SRU

MARCH 31, 2023

Charon, Academic Med 2012) embracing fear in emergency medicine WITH dr. arlene chung What is fear? Narratives trigger changes of many kinds in both the teller and the listener, yielding meanings that are reciprocally produced by each teller-listener dyad.”

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

Northwestern EM Blog

MAY 16, 2022

Emergency department visits, use of imaging, and drugs for urolithiasis have increased in the United States. Kidney international , 83 (3), 479-486. Coursey, C. Casalino, D. Arellano, R. Bishoff, J. Dighe, M., & Leyendecker, J. ACR Appropriateness Criteria® acute onset flank pain–suspicion of stone disease. Ultrasound quarterly, 28(3), 227-233.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

SheMD

OCTOBER 15, 2023

I am less likely to get promoted as quickly in academic and administrative leadership. 1 This flying in the face of the fact that since 2012, almost half of all residents are female.2 As a woman I earn less than my male equivalent. 2 Progress has been made, but women still lag behind for a multitude of reasons.

Emergency Department 52

Emergency Department EMS Leadership Academics 52

Thinking Critical Care

MAY 18, 2023

In the UK the Committee for Safety of Medicines merely drew attention to potential hazards of etomidate administration. 14] A final PS that I forgot to add is that my notoriety in the adrenal insufficiency arena got me tasked with a Working Party on the topic back in 2012. We did not achieve a publishable consensus until 2020.

Shock 40

Shock Research Sepsis Resuscitation 40

EMDocs

NOVEMBER 16, 2024

In stable patients, fluid/tissue cultures should be obtained prior to administration of antibiotics. 2012 Sep;3(3):107-20. Periprosthetic Joint Infection : Diagnosis requires joint fluid sampling, which is typically obtained in consultation with Interventional Radiology and Orthopedic Surgery. Curr Rev Musculoskelet Med.

EMS 94

EMS Dislocations Fractures Operations 94

Pediatric Emergency Playbook

JANUARY 1, 2017

For example, a very anxious caregiver can easily transmit his or her anxiety to the child, which may either inhibit or amplify presentation of symptoms ( Bearden 2012 ). Once the pain is controlled, less frequent administration of medications, with frequent reassessments, are indicated. Knowing the context of the episode may help.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

EB Medicine

AUGUST 1, 2018

Also, be aware that there are various formulations of cannabis that allow for different routes of administration. Basically, any way you can imagine, it seems like a route of administration has been explored. On the longer end, rectal cannabis administration can take up to 8 hours to reach peak plasma concentrations.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Advanced Emergency Nursing from AENJ

MAY 27, 2015

Dolan, LA Times] Administrators often insist that the hospital be a “weapons-free” zone (as if there was any protection in that), that guards are often unarmed –perhaps with just a radio and a flashlight, and often wearing a “friendly” blazer rather than a uniform of obvious authority. Occupational Safety and Health Administration. (No

Federal Emergency Management Agency 40

Federal Emergency Management Agency Military Hospitals Administration 40

EB Medicine

FEBRUARY 1, 2019

Nachi: Unfortunately, the 2008 ACEP guideline and 2012 AHA guidelines still recommend a lumbar puncture in those being worked up for SAH. Nachi: In addition to monitoring ABCs, early care involves the administration of analgesics and anti-emetics. In addition, one 2016 study demonstrated a LR of 0.01

Emergency Department 40

Emergency Department Stroke Outcomes Ultrasounds 40