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

ACEP Now

OCTOBER 9, 2023

percent) do not speak English as a primary language, and 25 million of those speak English less than well (known as “limited English proficiency” or LEP); many indicators show this number will only continue to grow. 2012; 60(5): 545-553. Census Bureau, 60.6 million Americans (approximately 20.8 These include ASL interpreters.

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

EMDocs

JULY 3, 2023

Introduction SAH has the potential for rapid progression and devastating outcomes. All patients with concern for SAH need a rapid primary survey to assess the airway, breathing, and circulation as well as a comprehensive neurologic exam to create a baseline for the patient. What are the next steps in the management of this patient?

Seizures 85

Seizures Stroke Outcomes EMS 85

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).

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Resuscitation Administration Emergency Department Hospitals 102

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

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

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

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

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

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 112

Hyperthermia / Hypothermia EKG/ECG Wellness Shock 112

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 59

Research Hospitals Academics Emergency Department 59

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 75

Fractures Dislocations Operations Radiology 75

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 101

Infectious Diseases Emergency Department Administration Academics 101

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 Hospitals Administration 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

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. The pathologic vasodilation observed in sepsis is thought to result from failure of the vascular smooth muscle to constrict appropriately, leading to hypotension as well as tissue hypoperfusion (2). Ospina-Tascón GA, Teboul J-L, Hernandez G, et al.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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

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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

Don't Forget the Bubbles

AUGUST 2, 2023

Early management leads to better outcomes. That being said, younger patients tend to have better outcomes with a multidisciplinary team approach leading to remission in approximately 90% of children. in 2012 of 19 children with CRPS treated with CBT and physical therapy showed that 89% eventually had full symptom resolution.

Psychiatric 98

Psychiatric Pediatrics Outcomes Academics 98

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

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. mental status, urine output, capillary refill) is more important than an actual goal PERMISSIVE HYPOTENSTION IN PTS WITH TBI Brotfain E et al. NEJM 1994. [2]

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Resuscitation Fluid Resuscitation Head Injuries Shock 145

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

EMDocs

JULY 13, 2024

Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. 2012 May;27(5):1368-74. Epub 2012 Mar 14. Incidence, treatment and outcome of peripartum sepsis. PMID: 10439801. Jindal UN, Verma S, Bala Y. Hum Reprod.

OB/GYN 64

OB/GYN EMS Sepsis Fluid Resuscitation 64

ALiEM

JANUARY 29, 2024

It requires immediate consultation with ophthalmology as well as neurology as it is considered a stroke equivalent. Case Question: What treatments can you perform in the ED for this diagnosis and do they improve outcomes? 2012 Dec;33(7):E263-E267. Epub 2012 Sep 21. Ultraschall Med. doi: 10.1055/s-0032-1312925.

Stroke 64

Stroke Ultrasounds Academics Outcomes 64

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

Pediatric Emergency Playbook

JANUARY 1, 2016

Consider surgical causes of forceful vomiting, especially if the child does not look anything other than well. 2012; 43(1): e49–e51. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. They are not allowed to vomit (forceful, unpleasant contraction of abdominal muscles).

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

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

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

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

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

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

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

EB Medicine

AUGUST 1, 2018

Jeff: Because the current DEA controlled substances schedule designations are based on original chemical names, synthetics have gained popularity as manufacturers are able to produce newer compounds and circumvent DEA designation as well as routine urine drug screening tests. Jeff: And the etiology of CHS is not well understood.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40