EMDocs

NOVEMBER 7, 2023

Antibiotics are recommended for those with complicated diverticulitis, as well as surgical specialist consult if necessary (e.g., 2012 Apr;99(4):532-9. No difference in their primary outcome of complications and need for emergency surgery (1.9% Included 480 patients, with primary outcome return visit with hospital admission.

Sepsis 88

Sepsis Best Practices Hospitals Outcomes 88

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

Sensible Medicine

JULY 31, 2024

Fama’s series includes many of our favorite topics—doubts regarding plausibility, confounding in observational data, competing causes of outcomes, and, for the win, inadequate consideration of the downsides of a sweeping recommendation. They slept well and thrived. We will publish this series in four parts.

Research 97

Research Pediatrics Outcomes Wellness 97

Don't Forget the Bubbles

JANUARY 17, 2024

Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. Mirza and Sheikh reported perhaps the first unfortunate case in 2012. There have been reports of the Orbeez Challenge leading to serious outcomes.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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

Northwestern EM Blog

SEPTEMBER 26, 2022

It is well-documented that ED physicians have historically high rates of burnout compared to other specialties as well as a high incidence of post-traumatic stress disorder (PTSD) compared to the general population. PTSD is 2 times more prevalent in physicians (14.8%), with EM resident physicians falling in the range from 11.9%-21.5%.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 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, References Szpilman D, Bierens JJ, Handley AJ, Orlowski JP (2012) Drowning.

Resuscitation 52

Resuscitation Hospitals Outcomes Wellness 52

The Skeptics' Guide to EM

DECEMBER 12, 2020

She is systemically well and there is no sign of tracking, so you decide to perform incision and drainage in the ED. 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. Kirsty is also the creator of the wonderful infographics called #PaperinaPic.

Operations 52

Operations Outcomes Research Academics 52

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. 2012 PMID: 21893125. Resuscitation. 9 Zhang W et al. Medicine (Baltimore).

Resuscitation 105

Resuscitation Administration Emergency Department Hospitals 105

RebelEM

JANUARY 25, 2023

J Trauma Acute Care Surg 2012; 73(5): S362-9. Small bowel obstruction: Outcome and cost implications of admitting service. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

The Skeptics' Guide to EM

AUGUST 17, 2019

Attempting to decrease a patient’s pain to zero is certainly well-intentioned but you have to ask yourself how many patients are being harmed by such a goal? Pain 2012). ACEP has a clinical policy regarding prescribing of opioids for adult ED patients that was published in 2012 ( Cantrill et al ). Volkow et al. JAMA 2011).

Emergency Department 52

Emergency Department Academics Fractures Outcomes 52

RebelEM

JANUARY 19, 2023

If aspiration is unsuccessful based on the criteria above → Chest tube is inserted (size 8-14Fr) and admitted to the hospital. Outcomes: Primary Outcome: Total length of hospital stay up to 30 days after randomization, including initial hospital stay and readmissions. Investigators asked a patient-oriented research question.

Outcomes 52

Outcomes Hospitals Research EMS 52

ACEP Now

JULY 7, 2023

However, rapid initiation of treatment is actually patient-centered care that can both lead to better outcomes and limit ED boarding. The article also will not address severe agitation, which is already well covered elsewhere and is the topic of an ACEP clinical policy currently in development. 2012 Feb;13(1):17-25. J Emerg Med.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

RebelEM

AUGUST 7, 2023

Outcome of delirium in critically ill patients: systematic review and meta-analysis. Crit Care 16, R115 (2012). No mention was made of what kind, how much or how often Critical Results: Median time from ICU admission to randomization was 3.9 days (1.8 – 9.7 IQR) in the haloperidol group and 4.1 days (1.6 – 8.9 N Engl J Med.

Outcomes 52

Outcomes Hospitals EMS Administration 52

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 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. 2012 Jul;28(7):687-90. Ferayorni A, Yniguez R, Bryson M, Bulloch B. Pediatr Emerg Care. doi: 10.1097/PEC.0b013e31825d210b.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Outcomes 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2012; 43(1):49-51. BMJ 2012; 345:e5521. 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. 2012; 3:247-250. 2012; 92:527-39. 2012; 30:426-431. J Am Coll Surg.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

RebelEM

DECEMBER 28, 2022

However, the optimal treatment duration for UTI in men is not well studied, and current practice guidelines are based on historical dogma. Conducted at 2 US Veterans Affairs medical centers from 2012–2019. No difference in exploratory outcomes. Appropriately used a noninferiority study design. No patients were lost to follow-up.

Outcomes 52

Outcomes Documentation/Coding Hospitals EMS 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

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. The Chest review identified 18 “empirical studies,” but only these two tested TLTs’ effects on patient outcomes in the ICU.) 2023.12.014.

COPD 45

COPD Outcomes Hospitals EMS 45

Dr. Smith's ECG Blog

OCTOBER 8, 2023

ECG#1 ECG#2 ECG#3 ECG#4 ECG#5 See outcomes of all 5 below, with the Queen of Hearts AI Bot interpretation. There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. There again are well for med R-waves. All of the patients presented with chest pain , and they are all in triage. False positive.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia EKG/ECG Wellness Shock 109

Sensible Medicine

SEPTEMBER 29, 2023

The promise is that well-constructed and validated prediction models will lead to diseases being diagnosed earlier and treatment for the right patients, in the right place, at the right time. In some cases, models that appear to perform well may pose risks to patients if used to make clinical decisions. 2012 05;9(5):1-13. [5]

Research 58

Research Hospitals Academics Emergency Department 58

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. Use your exam to guide your initial management as well as your imaging decisions and differential diagnosis. 2012 Nov; 470(11):3270-3274. 12): e0244291.

Fractures 76

Fractures Dislocations Operations Radiology 76

Taming the SRU

JUNE 12, 2023

However, there have been no studies statistically powered well enough regarding dog bite lacerations to confirm or dispute this claim. There are multiple factors to consider when managing dog and mammalian bites in the ED, including closure, prophylactic antibiotic administration, and rabies post-exposure prophylaxis. Chihuahua Dog Bite.;

Infectious Diseases 102

Infectious Diseases Emergency Department Administration Academics 102

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

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. On arrival at hospital the child was well with normal observations. In some specific congenital heart diseases, the prevalence of arrhythmias is now being seen as a late surgical complication as children now survive into adulthood.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

EM Guide Wire

NOVEMBER 2, 2020

Primary outcome was discharge to home at 24 hours. mg/kg/hr Narrow therapeutic index and is associated with a wide range of adverse effects Does an aminophylline injection in addition to bronchodilators for an asthma attack improve lung function and other outcomes or cause harm? mg may be nebulized Q4-6 hours. final FEV1 was 51.1%

Pediatrics 52

Pediatrics Anaphylaxis Administration Hospitals 52

Dr. Smith's ECG Blog

MAY 8, 2023

There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessively discordant TE in V2-V4. Annals of Emergency Medicine 2012; 60(12):766-776. Queen of Hearts Interpretation: Would 20 minutes earlier diagnosis have made a difference in his clinical outcome?

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Sensible Medicine

SEPTEMBER 29, 2023

The promise is that well-constructed and validated prediction models will lead to diseases being diagnosed earlier and treatment for the right patients, in the right place, at the right time. In some cases, models that appear to perform well may pose risks to patients if used to make clinical decisions. 2012 05;9(5):1-13. [5]

Research 40

Research Hospitals Academics Emergency Department 40

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? 2012; DOI 10.1007/s12028-012-9695-z Capovilla G et al. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. 2012; 79:2355-2358.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

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

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Brief aside: "Early repolarization" is a frequently proclaimed and poorly understood electrocardiographic phenomenon which mostly serves to reassure clinicians that not all ST elevations are ischemic (something readers of this blog know well). linking the finding with long term risk of idiopathic ventricular fibrillation. Stuckey, T.,

EKG/ECG 117

EKG/ECG Documentation/Coding Wellness Emergency Department 117

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 Published 2020 Dec 21. doi:10.1097/GOX.0000000000003278

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

Taming the SRU

MARCH 14, 2023

He appears well and is triaged to an ESI 4. She was doing well, but recently has had the “stomach flu” with a couple weeks of abdominal pain, nausea and vomiting. Estimated incidence of normal pressure hydrocephalus and shunt outcome in patients residing in assisted-living and extended-care facilities. Lancet Neurol. Amer J Rad.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

Furthermore although there is no literature on morphology of ST-elevation in posterior leads, it is interesting to note that the morphologies of these elevations are in and of themselves concerning as well. So treating these as STEMI is well within the bounds of guideline recommendations (6). 2012 Sep;45(5):463-75. O'Gara et al.

EKG/ECG 52

EKG/ECG Outcomes Wellness 52

EB Medicine

MARCH 1, 2019

Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST. But don’t be reassured by normal vitals, especially in the young, who may be compensating well despite being quite ill. of cases and contributed to the death of 45.2%

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40