EMDocs

JANUARY 29, 2024

Authors: Sameer Desai, MD (EM Attending Physician, University of Kentucky); Omar Abbas Ahmed Malik, MBBS (Patients’ Aid Foundation, Jinnah Postgraduate Medical Center) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine in St.

Stroke 102

Stroke Outcomes EMS Seizures 102

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% Welcome back to the “52 in 52” series. This collection of posts features recently published must-know articles.

Sepsis 96

Sepsis Shock Resuscitation Fluid Resuscitation 96

RebelEM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Outcomes: Primary Outcome: Reduction of dyspnea measured on a verbal dyspnea scale (VDS) from 0 to 10 recorded at enrollment, then at 2, 4, and 5 hours after arrival.

Ultrasounds 128

Ultrasounds Outcomes COPD Hospitals 128

The Skeptics' Guide to EM

MAY 8, 2021

He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR […] The post SGEM#329: Will Corticosteroids Help if…I Will Survive a Cardiac Arrest? He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR Safety Team. first appeared on The Skeptics Guide to Emergency Medicine.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

EMDocs

OCTOBER 30, 2023

Pillai, MBBS (@sspillai01, EM Resident Physician, University of Kentucky) and Christopher N. 2 In response to the constrained availability of contrast media, emergency medicine (EM) and radiology departments were compelled to enact modifications in their imaging techniques. Authors: Saran S. 11 Table 1.

Radiology 102

Radiology Radiology Emergency Department Hospitals 102

EMDocs

AUGUST 22, 2024

Certified interpreter use can improve communication and patient outcomes. Conducting research regarding best practices for improving health outcomes for NELP patients. Pearls NELP patients have worse health outcomes despite widespread language-access policies. September 2013. Zong J and Batalova J.

Documentation/Coding 105

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 105

RebelEM

MAY 11, 2023

J Emerg Med 2013 , 44 (3), 592-598.e592. Am J Emerg Med 2013 , 31 (4), 734-742. Rezaie, MD (Twitter: @srrezaie ) The post Return Encounters in Emergency Department Patients Treated with Phenobarbital Versus Benzodiazepines for Alcohol Withdrawal appeared first on REBEL EM - Emergency Medicine Blog. DOI: 10.1016/j.jemermed.2012.07.056

Emergency Department 95

Emergency Department Administration Hospitals Academics 95

PHEM Cast

JULY 27, 2021

The Sonosite website has some excellent resources, which you can filter according to specialty, including prehospital using ‘EMS/Air Med/Ambulance’. Crit Care Med 2013; 41: 1774-81. The radiopaedia website is an amazing resource for all things imaging. Their section on POCUS is here. Kenji Inaba. 2015 Marik PE, Cavallazzi R.

Ultrasounds 52

Ultrasounds Fractures Resuscitation EMS 52

Taming the SRU

SEPTEMBER 8, 2023

NAC: Jiang SX, Hussaini T, Yoshida EM. 2013 Sep;145(3):695. 2013 May;58(5):1397-402. 2013 May;58(5):1397-402. Epub 2013 Jan 17. 2, 2013, pp. Prognosis of acute severe autoimmune hepatitis (as-AIH): The role of corticosteroids in modifying outcome.” emDOCs.Net - Emergency Medicine Education, 26 Nov.

Radiology 59

Radiology Radiology Ultrasounds EMS 59

PHEM Cast

APRIL 16, 2018

The outcomes from different resuscitative interventions in a haemorrhagic shock model in porcine model: From: Watts et al. Survival and neurological outcome after OOH TCA in pediatric & adult populations: a systematic review. Anneals of EM; 2015: 297-307. 2013; 74: 634-8. Ultrasound during TCA: Cureton et al.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

PHEM Cast

APRIL 10, 2016

And from our buddies at HEFT EM CAST: [link] A bit more detail covering some of the research in an easy to understand way. This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. 2013 Jun;44(6):1116–25.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

RebelEM

JANUARY 19, 2023

Previous studies regarding ambulatory management included randomized trials that lacked adequate power, and recently, a 2013 systematic review that, although showed promise in the ambulatory approach, had poor data quality with a high risk of bias. Prespecified criteria were established to determine if medical treatment failed.

Outcomes 52

Outcomes Hospitals Research EMS 52

ACEP Now

AUGUST 1, 2023

Factoring such, an order to transfer the patient immediately by ground or air EMS is the only actual support per se these non-physicians receive. Recent data published in Annals showed that between 2013 and 2019, the percentage of clinicians working in rural areas who were emergency physicians actually dropped slightly.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 98

The Skeptics' Guide to EM

JUNE 24, 2017

His background includes working as a Research Assistant with the Ottawa Hospital Research Institute, Professor at Fanshawe College and currently, Superintendent of Education for Middlesex-London EMS, in London, Ontario, Canada. By-standard CPR is started and EMS is called. They arrive quickly and take over the resuscitation.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia CPR Resuscitation EMS 40

The Skeptics' Guide to EM

APRIL 24, 2021

On investigating you find a collection of nursing, EMS and hospital security personnel surrounding an obviously agitated patient with blood on his head who is attempting to punch them. AEM April 2021 Case: You are sitting minding your own business charting on shift when you become aware of shouting and banging from your ambulance bay.

Emergency Department 40

Emergency Department Research Outcomes Documentation/Coding 40

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

RebelEM

MARCH 8, 2023

Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. Philadelphia: Elsevier, 2013 (Ch) 26: p. Rezaie, MD (Twitter: @srrezaie ) The post REBEL Core Cast 97.0 – Acute Vision Loss II appeared first on REBEL EM - Emergency Medicine Blog. 209-225 Walker R, Adhikari S.:

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

ACEP Now

JULY 7, 2024

35-year-old man presents by EMS with seizures. He has been seizing for 30 minutes, despite treatment of intravenous lorazepam by EMS. 2 A study of routine EEG in the ED in 2013 found that five percent of ED patients with altered mental status had nonconvulsive seizures (of whom 75 percent were in nonconvulsive status epilepticus).

Seizures 52

Seizures Emergency Department Outcomes EMS 52

RebelEM

MARCH 22, 2023

Amal Mattu’s ECG Blog has an excellent review of AVNRT vs. VT and REBEL EM reviews the sensitivity and specificity of various algorithms. Serum troponin testing in patients with paroxysmal supraventricular tachycardia: outcome after ED care. Troponin elevation in supraventricular tachycardia: primary dependence on heart rate.

EKG/ECG 52

EKG/ECG EMS Pediatrics Stroke 52

PHEM Cast

APRIL 21, 2021

The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury. Difficult prehospital endotracheal intubation – predisposing factors in a physician based EMS. Int J Emerg Med 6, 38 (2013). J Trauma 2003; 54:444-453 Mort TC. DOI:10.1002/14651858.CD011136.pub2. Resuscitation.

Airway Management 40

Airway Management Resuscitation EMS Hospitals 40

RebelEM

MARCH 23, 2023

The primary outcome, hospital length of stay, was significantly shorter both before and after propensity score adjustment for the phenobarbital group. A broad range of variables were included that potentially influences treatment decisions and/or outcomes. The protocols used in the study were using symptom-driven medications.

Emergency Department 52

Emergency Department Outcomes Burns Hospitals 52

The Skeptics' Guide to EM

MARCH 13, 2021

You page neurosurgery at the bigger ED in town, and while you wait for the page back, you wonder if giving tranexamic acid (TXA) could help improve the patient’s chances for a good outcome given its effects in other bleeding processes. This article was covered on the SGEM with EM Nerd Dr. Rory Spiegel.

Stroke 40

Stroke Emergency Department EMS Outcomes 40

Dr. Smith's ECG Blog

MAY 23, 2023

EMS arrived and recorded this ECG: What do you think? This " imbalance of precordial T waves" is not seen very often — and in the “right” clinical setting, has been associated with acute OMI ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM ). Am J Emerg Med. 2022 Jan;51:384-387. 2021.11.023.

EKG/ECG 98

EKG/ECG Wellness Emergency Department EMS 98

EMDocs

NOVEMBER 16, 2024

We’ll keep it short, while you keep that EM brain sharp. 13 Management: Dislocation As with all dislocation, early reduction improves outcomes. Epidemiology of total hip arthroplasty: demographics, comorbidities and outcomes. 2013 Dec;6(4):350-6. Initial vital signs include T 36.8, 2015;97(17):1386-1397. Zalikha, A.K.

EMS 98

EMS Dislocations Fractures Operations 98

Dr. Smith's ECG Blog

DECEMBER 16, 2019

This case was texted to me by one of our residency graduates, and with the outcome, so I don't know how I would have interpreted it blindly. The provider, and former HCMC EM resident, was exceedingly perceptive and able to accurately diagnose LAD occlusion from this very subtle ECG. Often this would include resolution of the LBBB.

EKG/ECG 52

EKG/ECG EMS Outcomes Wellness 52

EB Medicine

JULY 8, 2019

Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

DECEMBER 18, 2024

Upon EMS arrival the male is noted to be anxious and tremulous with a GCS of 14. 2013; 88(9): 589-595. Alcohol withdrawal syndrome: improving outcomes through early identification and aggressive treatment strategies. A 36-year-old male presents to the emergency department after being found down at home by his spouse.

Seizures 106

Seizures Hyperthermia / Hypothermia Emergency Department EMS 106

EB Medicine

AUGUST 6, 2019

In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. This strategy reduces hospital days and costs with otherwise similar outcomes - total win all around.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Pediatric EM Morsels

JULY 28, 2023

2013 Sep;163(3):761-6. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. 13406 The post Cerebral Edema and Diabetic Ketoacidosis: Rebaked appeared first on Pediatric EM Morsels. Is your patient hyperglycemic, acidotic, with ketonuria? Then we’ve likely got DKA.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

Pediatric EM Morsels

MAY 24, 2024

Evaluation of unintentional injury and trauma is one of the hallmarks of the EM and PEM physician. Low Risk Inta-Adbominal Trauma: Just Light ‘Em Up? 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.

Pediatrics 167

Pediatrics Blood Transfusions EMS Fractures 167

Pediatric EM Morsels

AUGUST 9, 2024

Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306. If not treated early, then increased risk of poor outcomes and death. 2013 Aug;20(4):337-9. Epub 2013 Feb 27. The post Congenital Syphilis appeared first on Pediatric EM Morsels. Rates of congenital syphilis are increasing. Emerg Radiol.

Hyperthermia / Hypothermia 157

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 157

Intensive Blog

MARCH 13, 2024

This involved thirty-six centres in Japan between 2013 and 2018. This showed a similar rate of survival to discharge (27%), of whom approximately 50% had a favourable neurological outcome on discharge (CPC 1 or 2). RCTs The last few years has seen some notable RCTs with patient important outcomes published (14-16).

CPR 130

CPR Resuscitation Outcomes Hospitals 130

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 136

Stroke Outcomes Hospitals Administration 136

ACEP Now

OCTOBER 10, 2023

Both INTERACT-2 and ATACH-2 showed no statistical difference in their primary outcome between intensively lowering the BP and a less-intensive strategy. Background There have been a couple of large and influential trials published on BP management after an intracranial hemorrhage (ICH). Reference Ma LM, Hu X, Song L, et.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. 2009;338:b2085.

Hyperthermia / Hypothermia 111

Hyperthermia / Hypothermia Resuscitation CPR EMS 111

EMDocs

SEPTEMBER 25, 2023

Still, there are those that believe that FPS is more of a physician-centered endpoint that does not fully reflect important patient-centric outcomes (16). Resuscitation 2013; 84(11): 1500 – 4. 2013): 71-78. We don’t want to go backwards! References: Heffner AC et al. PMID: 23911630 Kim WY et al. PLoS One 2014; 9(11): e112779.

Emergency Department 94

Emergency Department Soft Tissue Injuries Airway Management Operations 94

RebelEM

SEPTEMBER 28, 2023

appeared first on REBEL EM - Emergency Medicine Blog. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. Primary PCI: 95.7% Stents Placed: Pharmaco-Invasive Treatment: 97.4% Primary PCI: 95.7% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% Primary PCI: 78.4% Primary PCI: 13.3%

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138