The Skeptics' Guide to EM

DECEMBER 12, 2020

Way back in 2012 we looked at packing after incision and drainage (I&D) on SGEM#13 and concluded routine packing might not be necessary. Secondary Outcomes: Ease of procedure, pain at the time of treatment, ease of care at 36 hours, pain at 36 hours. Background: We have covered the issue of abscesses multiple times on the SGEM.

Operations 52

Operations Research Outcomes Academics 52

EMDocs

JANUARY 11, 2025

Operative management is necessary for signs of peritonitis, evidence of perforation, extensive bowel involvement >40cm, or after failed medical management. 2-4, 6, 8, 9, 12, 13, 14 Operative intervention typically consists of emergency laparotomy with bowel resection, colostomy formation, and Hartmann pouch creation. Mathis, K.

EMS 94

EMS Sepsis Shock Fluid Resuscitation 94

RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Ultrasounds Resuscitation 52

The Skeptics' Guide to EM

JUNE 4, 2017

A systematic review by the authors of the present study confirmed a possible benefit of the pan scan, but it showed a need for a well-designed, large, prospective randomized clinical trial with patient oriented outcomes ( Sierink et al 2012 ). Reference: Sierink et al.

Radiology 52

Radiology Radiology CPR Hospitals 52

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Don't Forget the Bubbles

JULY 26, 2023

Cardiac testing and outcomes in infants after an ALTE, Hoki et al, Archives of Disease in Childhood 2012 showed significant cardiac disease was present in <1% of patients presenting with ALTE (although cardiac abnormalities were found in 4% overall). How might these present in a less catastrophic way to the ED?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Mind The Bleep

OCTOBER 22, 2024

Whether you enjoy working in the high-stakes setting of a cath lab or improving patient outcomes through prevention and rehabilitation, cardiology offers something that aligns with your interests and career aspirations. Cardiology applications typically open around November, and since 2012, there has been no Round 2 for Cardiology.

Evidence-Based Practice 52

Evidence-Based Practice Academics Operations Hospitals 52

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Raised inflammatory markers BMJ 2012; 344 :e454 doi:10.1136/bmj.e454 Gabay C, Kushner I. 2012 Jul 23;2(1):32.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. Failure rates An ambispective, observational cohort study from 2012 - 2016 found that femoral arterial lines fail significantly less often than radial arterial lines with an absolute risk reduction of line failure of 20%. But are they good enough?

Shock 59

Shock Resuscitation Ultrasounds Research 59

EB Medicine

MARCH 1, 2019

In one RCT, the FAST exam reduced the time from arrival in the ED to operative care by 64% in the setting of trauma. Nachi: This is all well and good, and certainly accurate, but let’s not forget that hemodynamically unstable trauma patients, like those with myocardial rupture, need to be in the operating room, not the CT scanner.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Taming the SRU

MARCH 14, 2023

Ultimately, definitive management is in the operating room with revision or replacement of the VP shunt. Estimated incidence of normal pressure hydrocephalus and shunt outcome in patients residing in assisted-living and extended-care facilities. Lumbar puncture is an option with limited data for success. Lancet Neurol. Neurosurg Focus.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

RebelEM

JANUARY 24, 2024

Schedule follow up with orthopedics within 1 week for discussion of operative management vs early rehab protocols. Wallace 2011 ) If addressed early and appropriately, most patients have good self-reported long-term outcomes regardless of the treatment modality Links Orthobullets: Achilles Tendon Rupture Resources: Sheth U et al.

Operations 90

Operations Ultrasounds Fractures Outcomes 90

EMDocs

NOVEMBER 16, 2024

4 Pain is the most common reason for presentation in the early post operative period. 5 Highest risk of dislocation early in the post operative course due to laxity of the soft tissue after surgery. 6 Hip flexion or adduction in the early post-operative period can cause atraumatic dislocations (typically avoided for 6 weeks post-op).

EMS 94

EMS Dislocations Fractures Operations 94

EMDocs

OCTOBER 23, 2023

Operative complications requiring surgical intervention or hospitalization occur in about 3-6% of all hysterectomies (5). difficile infection, and post-operative hemorrhage. Abscess and Infected Hematoma : This condition is typically delayed, occurring most commonly 10-14 days post-operatively.

OB/GYN 86

OB/GYN Operations EMS Ultrasounds 86

EB Medicine

AUGUST 1, 2018

According to data from 2012, of the 130 million people reporting illicit drug use within their lifetime, 25% were children between 12 and 17 years of age. Jeff: It’s also worth noting that cannabis is known to cause adverse outcomes on babies such as low birth weight and more frequent perinatal ICU placement.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EB Medicine

JANUARY 2, 2019

With opportunities to improve outcomes for both the fetus and the mother, I’m confident that this episode will be worth your time. Nachi: For patient who have a threatened miscarriage in the first trimester, there is a 2-fold increased risk of subsequent maternal and fetal adverse outcomes. Jeff: Up first is the urine pregnancy test.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

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 103

Stroke Radiology Radiology Emergency Department 103

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. A comparison between pre-operative ultrasonography and surgical findings. 2012 Nov; 470(11):3270-3274. Injuries discussed are shown in Image 1. 2001;220:406-12.

Fractures 77

Fractures Dislocations Operations Radiology 77

EMDocs

SEPTEMBER 9, 2023

Answer : Extensor tendon laceration Epidemiology: Hand extensor injuries make up >25% of orthopedic soft tissue injuries 2, 3 Common in young men in manual labor Dominant hand more likely to be injured 4 2012 study on 86 patients reported 83% men with a mean age of 34.2 doi:10.1097/GOX.0000000000003278 Arch Orthop Trauma Surg.

EMS 97

EMS Fractures Soft Tissue Injuries Ultrasounds 97

Don't Forget the Bubbles

JANUARY 13, 2025

Neonates with significant obstructed TAPVD will require intubation, ventilation and inotropic support pre-operatively. Outcome Surgical outcomes in non-obstructive TAPVD are generally good, with a reported mortality of 5% to 10% 3,4. Pulmonary hypertensive crisis can occur post-operatively in approximately 50% of patients.

Operations 59

Operations Outcomes Pediatrics EKG/ECG 59

Mind The Bleep

JANUARY 24, 2025

7) Allergies Social History Hand dominance Profession and hobbies Could influence the operation performed in cases where the restoration of hand function is vitally important e.g. in musicians; or where speed of recovery and need to return to work take precedence. Epidemiology and outcome of vascular trauma at a British Major Trauma Centre.

Dislocations 52

Dislocations Fractures Soft Tissue Injuries Infectious Diseases 52

ACEP Now

FEBRUARY 19, 2025

AI started to make its mark in the ED by maximizing the efficiency of certain tasks like patient triage, clinical presentation diagnosis, mortality prediction, clinical decision making, and operational workflow management (see Figure 1). Published April 25, 2012. Published April 2012. References Edmondson AC. Ann Emerg Med.

Teamwork 51

Teamwork Clinical Decision Support Systems Administration Radiology 51

Advanced Emergency Nursing from AENJ

MARCH 27, 2015

They also proved that only expired air resuscitation guaranteed sufficient inflation volumes; that exhaled air was a suitable resuscitating gas; and that the operator would have continuous feedback from each breath. Open Journal of Anesthesiology, 2012, 2, 38-43 doi: 10.4236/ojanes.2012.22010 Rogue Medic. Buffington, C.

Airway Management 40

Airway Management Resuscitation EMS CPR 40

PulmCCM

MARCH 7, 2025

Any self-respecting surgeon or anesthesiologist will tell you that patients undergoing surgery before the weekend receive just as high a quality of care as those operated on earlier in the week. More Weekend Worries An even larger study a decade earlier had raised concerns for worse outcomes occurring after Friday surgeries.

Hospitals 116

Hospitals Outcomes Operations Radiology 116