RebelEM

MAY 11, 2023

3, 4 Much of the appeal of phenobarbital lies in its ability to stave off severe alcohol withdrawal symptoms days after administration, without the necessity of daily redosing. J Emerg Med 2013 , 44 (3), 592-598.e592. Am J Emerg Med 2013 , 31 (4), 734-742. 5 Paper: Lebin J et al. DOI: 10.1016/j.jemermed.2012.07.056

Emergency Department 95

Emergency Department Administration Hospitals Academics 95

ALiEM

FEBRUARY 20, 2024

Here is the patient’s EKG after administration of a 300 mEq sodium bicarbonate showing significant improvement of the cardiac sodium channel blockade as evidenced by a narrower QRS complex. 2013 Dec;15(4):90-2. Epub 2013 Nov 7. What are other agents that block cardiac socium channels? Acute Card Care. PMID: 24200150.

Shock 73

Shock EKG/ECG Poisoning Burns 73

Taming the SRU

JANUARY 1, 2024

Establishing reliable vascular access is absolutely critical for ED patients requiring resuscitation, airway management, or medication administration. IOs can be used both for resuscitation, medication administration, and for laboratory testing, but there are a few important considerations. 2013 Jul;30(7):521–6. Emerg Med J.

Emergency Department 93

Emergency Department Ultrasounds Administration Burns 93

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 92

Sepsis Shock Resuscitation Fluid Resuscitation 92

The Skeptics' Guide to EM

FEBRUARY 18, 2023

Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019. Rising high-acuity emergency care services independently billed by advanced practice providers, 2013 to 2019.

Emergency Department 52

Emergency Department EMS Administration 52

EMDocs

JANUARY 29, 2024

hypertensive emergency, need for thrombolytic administration) [1]. 2013 Jul;44(7):1846-51. Epub 2013 May 23. Current guidelines do not recommend acute treatment of hypertension in these patients unless extreme (SBP > 220 mmHg or DBP > 120 mmHg), or another indication is present (e.g. doi: 10.1161/STROKEAHA.113.001212.

Stroke 98

Stroke Outcomes EMS Seizures 98

RebelEM

JANUARY 25, 2023

Acad Emerg Med 2013; 20(6): 528-44. 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. 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

DECEMBER 15, 2018

Eur J Paediatr Neurol 2013) that concluded antipyretics were ineffective in reducing the recurrence of febrile seizures in children. Standard advice has always been that the regular administration of an antipyretic won’t reduce the risk of recurrence but a recent publication in Pediatrics has challenged this position.

Seizures 52

Seizures Pediatrics Emergency Department Administration 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. 2013 Jun;44(6):1116–25. 2013 Apr;28(2):104–6. Elsevier B.V;

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2013; 95(6): 474-477. 2013; 48:1789-1793. 2013; 44(1):53-57. 2013; 200:969-973. 2013; 50:54-86 Intestinal Obstruction Babl FE et al. Plasma levels of lidocaine following nebulized aerosol administration. Mercer AE, Phillips R. Arch Dis Child. 2012; 92:527-39. Peters B et al. Expert Rev Gastroenterol Hepatol.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Mind The Bleep

DECEMBER 19, 2023

Especially important is educating children and their carers on sick day rules- proper sick day management at home could reduce the risk of progression to DKA. ISPAD Guideline for Diabetes in Childhood and Adolescence. International Diabetes Federation. Marcdante, R. Nelson Essentials of Paediatrics, 9th ed. Tasker, R. Oxford University Press.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

RebelEM

MARCH 22, 2023

An alternate administration approach can be found on ALiEM. If unsuccessful, dose can be doubled to 12 mg Onset of action: 5-20 seconds Duration of effect: 30 – 40 seconds Key Point : because of adenosine’s short half-life, it must be given through a proximal peripheral IV (antecubital or closer) and as a rapid IV push.

EKG/ECG 52

EKG/ECG EMS Pediatrics Stroke 52

ACEP Now

AUGUST 1, 2023

This is an important opportunity for board certified emergency physicians to secure those positions today, impressing upon hospital administrations the essential benefits to the patients, the medical staff, and the hospital itself uniquely enabled by board certified emergency physicians.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

RebelEM

MARCH 23, 2023

and IM, and the physician was able to choose the method of administration. This study differed in that the phenobarbital administration was administered in a symptom-triggered protocol as opposed to a bolus. J Emerg Med 2013. The protocols in the hospitals in the study included phenobarbital and lorazepam IV, p.o.,

Emergency Department 52

Emergency Department Burns Outcomes Hospitals 52

EMDocs

OCTOBER 30, 2023

3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013. Contrast Media, Iodinated, Dose, and Administration. 3 EDs have also been increasingly supporting primary care providers in the US by helping with diagnostic workups that cannot be performed in physician offices. J Am Coll Radiol.

Radiology 99

Radiology Radiology Emergency Department Hospitals 99

Pediatric Emergency Playbook

MAY 1, 2017

Also, newborns have a double-whammy administrative load. 2013 Apr-Jun; 2(2): 61–69. 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. Pediatrics.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

EB Medicine

AUGUST 6, 2019

Make sure to get the name, dose, and time of last administration of any DOAC. High dose infusions for those on rivaroxaban doses of >10 mg or apixaban doses >5 mg within the last 8 hours and for unknown doses and unknown time of administration. Nachi: Extremely important to identify DOAC use early.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

PulmCCM

JANUARY 15, 2025

In 2013, FDA issued a suggestion that manufacturers test devices on patients “with a range of skin pigmentations.” Draft Guidance for Industry and Food and Drug Administration Staff. ” But the standard was lax: only two darkly pigmented subjects, or 15% of the total pool were needed. January 2025.

Academics 81

Academics Documentation/Coding Administration Research 81

Pediatric EM Morsels

NOVEMBER 3, 2023

2013 Sep 4; 89(3): 527–530. Food and Drug Administration Approval of Artesunate for Severe Malaria: Enough to Achieve Best Practice? References Arends JE, Oosterheert JJ, Kraaij-Dirkzwager MM, Kaan JA, Fanoy EB, Haas PJ, Scholte EJ, Kortebeek LM, Sankatsing SUC. Am J Trop Med Hyg. PMID: 23857021 Centers for Disease Control.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

EMDocs

NOVEMBER 16, 2024

In stable patients, fluid/tissue cultures should be obtained prior to administration of antibiotics. 2013 Dec;6(4):350-6. Periprosthetic Joint Infection : Diagnosis requires joint fluid sampling, which is typically obtained in consultation with Interventional Radiology and Orthopedic Surgery. 2018 Fall;18(3):242-252. doi: 10.31486/toj.17.0079.

EMS 97

EMS Dislocations Fractures Operations 97

ACEP Now

APRIL 9, 2025

When I was an inpatient pharmacy manager in 2013, my hospital was visited by the California Department of Public Health (CDPH), concerned about droperidol and ECG monitoring, or rather, lack thereof. CDPH still insists that following the Food and Drug Administrations (FDA) package insert is the gold standard when it comes to medical practice.

Emergency Department 52

Emergency Department Administration EKG/ECG Resuscitation 52

Pediatric EM Morsels

JULY 28, 2023

Risk Factors that seem to stay consistent: Administration of Bicarb for correction of acidosis has been shown to be associated with cerebral edema and DOES persist after correcting for severity of DKA! 2013 Sep;163(3):761-6. If you are concerned for developing cerebral edema, consider using Hypertonic Saline over Mannitol.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

Pediatric EM Morsels

MAY 24, 2024

Low Risk Intra-Abdominal (IAI) Trauma – Derivation of the Rule The PECARN Group first released their derivation of a pediatric prediction rule for intra-abdominal injury in 2013. 2013 Aug 1;167(8):700-707. Lancet Child Adolesc Health. 2024;8:339-344. Miglioretti DL, Johnson E, Williams A, et al. JAMA Pediatr.

Pediatrics 164

Pediatrics Blood Transfusions EMS Fractures 164

ALiEM

MARCH 5, 2024

Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. 2013 May;5(5):330. Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. The Aspirin Story – from Willow to Wonder Drug. British Journal of Haematology. 2017;177(5):674-683. PMID: 28106908.

Hyperthermia / Hypothermia 114

Hyperthermia / Hypothermia Anaphylaxis Poisoning Administration 114

RebelEM

MAY 15, 2024

Early administration of antibiotics is the only factor known to reduce this mortality. Pathogens ( Gudiol 2013 ) : The pathogens responsible for neutropenic fever have changed over time. Early administration of antibiotics is the only factor known to reduce this mortality. Clin Microbiol Infect 2013; 19:474 Klastersky J.

Infectious Diseases 98

Infectious Diseases Administration Sepsis Anaphylaxis 98

ALiEM

NOVEMBER 15, 2023

Urine discoloration is seen after administration as seen in ALiEM Toxicology Visual Pearl: Discolored Skin and Urine [9]. 2013 ;2013:610648. PREFERRED: Hydroxocobalamin (more favorable safety profile) Binds to cyanide, forming cyanocobalamin (i.e., ISRN Toxicol. PMID: 24171123 Suchard JR, Wallace KL, Gerkin RD. Ann Emerg Med.

Poisoning 67

Poisoning Pediatrics Seizures Administration 67

RebelEM

JANUARY 29, 2024

PMID: 37188358 Clinical Question: What is the efficacy and safety of low-dose (25mg) prolonged administration (over 6hrs) of alteplase in patients with massive PE? Am J Cardiol 2013. Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. Clin Exp Emerg Med 2023. JACC Cardiovasc Interv 2018.

Stroke 136

Stroke Outcomes Hospitals Administration 136

Sensible Medicine

NOVEMBER 14, 2023

As of 2017, just 15% of patients admitted to residential programs with opioid use disorder received any of the medications approved by the US Food and Drug Administration for treatment opioid use disorder – this despite the fact that those medicines save lives. Practices are improving, but not quickly.

Psychiatric 136

Psychiatric Research CDC Best Practices 136

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. 2013 Dec;14:1-0. One study found that labor unionization among U.S. Why does it matter? March 23, 2023. BMC Medical Ethics.

Hospitals 97

Hospitals Research Patient Safety Wellness 97

Don't Forget the Bubbles

NOVEMBER 29, 2023

Even though sedation after endotracheal intubation (ETI) reduces the risk of self-extubation, uncontrolled pain, and awakening awareness, several small single-centre studies demonstrate low rates of sedative drug administration after ETI in the emergency department (ED). 2013 Jan;31(1):222-6. PMID: 33485698; PMCID: PMC8166299.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

Advanced Emergency Nursing from AENJ

APRIL 29, 2015

It may be reasonable, when the appropriate equipment is available, to titrate oxygen administration to maintain the arterial oxyhemoglobin saturation ≥94%. Emergency Medicine News: November 2013 - Volume 35 - Issue 11 - p 12–13. January 22, 2013 Shiang-Hu, Ang. Has oxygen administration delayed appropriate respiratory care?

Resuscitation 40

Resuscitation Pediatrics Administration Emergency Nursing 40

RebelEM

SEPTEMBER 28, 2023

neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. PMID: 37439219 Armstrong P et al.

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138

Don't Forget the Bubbles

JUNE 30, 2023

CRASH 2 , published in 2013 – was huge. Tranexamic acid administration to pediatric trauma patients in a combat setting: the pediatric trauma and tranexamic acid study (PED-TRAX). 2013 Mar;17(10):1-79. But, there’s always been a worry that giving TXA could cause clotting in the cerebral vessels. This is not good.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

EMDocs

SEPTEMBER 25, 2023

First described in 1970, RSI with the near-simultaneous administration of a sedative agent and NMBA has been shown to have increased first-pass success compared with intubation facilitated by a sedative alone (6,7). Resuscitation 2013; 84(11): 1500 – 4. 2013): 71-78. Hypotension and bradycardia, especially on induction.

Emergency Department 90

Emergency Department Soft Tissue Injuries Airway Management Operations 90

Pediatric Emergency Playbook

AUGUST 1, 2016

The subcutaneous tissues will swell to a point where you have a steady state fluid administration rate, and as soon as you stop the infusion, the remaining fluid will start to subside as it is absorbed. in 2007 compared subcutaneous administration of lactated ringer’s solution by gravity with and without hyalurondase. Kuensting et al.

Allergic Reactions 52

Allergic Reactions Dehydration Pediatrics Geriatric Emergencies 52

EMDocs

JANUARY 16, 2024

Be careful with excessive medication administration. For warmed IV fluids, the Belmont can be used but generally the fluid administration rates will be much lower than for sick trauma patients. 2013 Jan 24;368(4):394]. This is because medications will accumulate and may only fully metabolize once the patient is normothermic.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

Cook County EM Blog

MAY 29, 2023

Analysis of benzonatate overdoses among adults and children from 1969-2010 by the United States Food and Drug Administration. 2013 Jan;33(1):38-43. Food and Drug Administration (FDA). Pharmacotherapy. doi: 10.1002/phar.1153. PMID: 23307543. Steven Evans, G. Benton Maglinger, Anita M. Fletcher, Stephen R. 2015.09.020. "FDA

Seizures 52

Seizures Poisoning Resuscitation Administration 52