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. IAI Rule – The Validation A multicenter prospective validation was planned at hospitals distinct from those where the initial derivation was performed.

Pediatrics 164

Pediatrics Blood Transfusions EMS Fractures 164

The Skeptics' Guide to EM

JANUARY 6, 2024

July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC. July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC.

Emergency Department 136

Emergency Department Pediatrics Anaphylaxis Leadership 136

ETM Course

JUNE 28, 2015

Just over a year ago London HEMS performed the first pre-hospital regtrograde endovascular balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg 2013; 75(3): 506–11 5. Markov et al.Physiologic Tolerance of Descending Thoracic Aortic Balloon Occlusion in a Swine Model of Hemorrhagic Shock Surgery 2013; 153(6): 848–56 10.

Hospitals 52

Hospitals Resuscitation Shock Military 52

The Trauma Pro

DECEMBER 19, 2023

Our hospital blood bank infrastructure isn’t prepared to handle this product yet, for the most part. J Trauma 74(1):84-91, 2013. Although there are a few flaws in the collection aspect of this study, it gives good evidence that never frozen plasma has better coagulation properties when compared to thawed plasma.

Military 147

Military Hospitals Resuscitation 147

Northwestern EM Blog

MARCH 1, 2025

2013; Mi et. 2013 Jun 6;368(23):2159-68. The PROSEVA study is the most recent and famous randomized control trial. In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. N Engl J Med. Blog Post References Caputo, N.D.,

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

The Skeptics' Guide to EM

JULY 8, 2023

Evaluation of oseltamivir used to prevent hospitalization in outpatients with influenza: a systematic review and meta-analysis. Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at Staten Island University Hospital. Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023. JAMA Int Med 2023.

CDC 108

CDC Hospitals EMS Emergency Department 108

PulmCCM

MAY 27, 2024

There are limits to these benefits: neither the INTERACT2 trial (NEJM 2013) nor the ATACH-2 trial (NEJM 2016) showed c… Read more Standard practice is to rapidly reduce elevated blood pressure in patients with intracerebral hemorrhage.

Stroke 52

Stroke Hospitals 52

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

Casey currently splits his time between Broome, a small rural hospital in the remote Kimberley region of Western Australia, and a large tertiary ED in sunny Perth. This includes SGEM#19 way back in 2013 reporting a bandage wrap is a safe alternative to traditional casting for children with greenstick fractures.

Fractures 138

Fractures Ultrasounds Pediatrics Outcomes 138

The Trauma Pro

OCTOBER 4, 2024

years from 2013 to 2016. This was reduced based on our experience of no delayed complications and guidance from our sister pediatric trauma center at Children’s Hospital in Minneapolis. A pediatric multi-center study of study on adherence to activity restrictions was published last year. ” This means they probably did not.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

Don't Forget the Bubbles

NOVEMBER 29, 2023

A retrospective cohort analysis of the ED portion of the National Hospital Ambulatory Medical Care Survey from 2006 to 2009 in the US revealed that less than one-half of patients undergoing ETI in the ED received sedative drugs while in the ED. 2013 Jan;31(1):222-6. PMID: 33485698; PMCID: PMC8166299. Am J Emerg Med. 2012.05.015.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

Stop and Think

MARCH 31, 2024

As I walk through the hospital these days, having looked at the actual evidence for what we do, my brain struggles to resolve the tension between the popularity of treatments vs the dubious evidence. Our main finding was that industry paid doctors more than $12 billion dollars between 2013-2022. Subscribe now So. B as in billions.

Research 138

Research Shock Hospitals 138

EMDocs

JANUARY 11, 2025

Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Annals of emergency medicine, 82(1), 3746. link] Chakravartty, S., Chang, A., & Nunoo-Mensah, J. A systematic review of stercoral perforation. link] Wu CH, Huang CC, Wang LJ, Wong YC, Wang CJ, Lo WC, Lin BC, Wan YL, Hsueh C.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

EMDocs

SEPTEMBER 8, 2024

Authors extracted proportions dichotomous outcomes (in-hospital mortality) and calculated risk ratios. Dichotomous outcomes: In-hospital mortality no different in 1 RCT. One study reported in-hospital mortality with similar mortality rates across both groups (20% nicardipine vs 15.7% 2013 Jun 20;368(25):2355-65.

Stroke 104

Stroke Outcomes Hospitals 104

EMDocs

JULY 25, 2024

The brother’s wife calls the airport police who are able to locate him and send him to a nearby hospital. A lawsuit is filed by the patient’s family against the PA-C, the oncoming EP, both CC’s, and the hospital. Blogpost, June 2013. We have a 2-hour meeting once a month and case consultations every 3 months.

Documentation/Coding 104

Documentation/Coding Hospitals Patient Safety Emergency Department 104

Ken Grauer, MD

JULY 22, 2023

Although this " Imbalance " of precordial T waves is not see n very often — in the “right” clinical setting, it has been associated with recent OMI ( O cclusion-based MI ) , most often from a LCx culprit artery ( See Manno et al: JACC 1:1213, 1983 — and the July 17, 2013 post by Salim Rezaie in ALiEM — and ECG Blog #350 ).

EKG/ECG 195

EKG/ECG Burns EMS Wellness 195

EMDocs

AUGUST 22, 2024

3,4 Notably, institutions receiving federal funding (such as hospitals receiving Medicare reimbursement) must abide by Title VI of the 1964 Civil Rights Act, which entitles persons with NELP to language assistance. Improving patient safety systems for patients with limited English proficiency: a guide for hospitals. September 2013.

Documentation/Coding 104

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 104

EMDocs

FEBRUARY 7, 2024

3 Increasing Strikes and Unions Labor actions in healthcare can disrupt normal hospital operations, potentially impacting costs and threatening patient quality of care. One study from the National Bureau of Economic Research on nursing strikes in New York State from 1984 to 2004 found that hospital mortality increased by 19.4%

Hospitals 98

Hospitals Research Patient Safety Wellness 98

RebelEM

SEPTEMBER 28, 2023

In non-PCI-capable hospitals this goal is not always achievable due to delays in transfer. Background: Primary PCI is the recommended reperfusion strategy in patients with STEMI and should be initiated within 2 hours after first medical contact. In these cases, thrombolysis is recommended to improve morbidity and mortality. Primary PCI: 95.7%

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138

Sensible Medicine

NOVEMBER 14, 2023

In one scene Shakur asks his friend, played by Roth, to stab him because a knife wound seems to be the only way to get past the emergency room's crowded waiting area and into the hospital. A systematic review of studies from 2013-2018 examined 23 papers that studied residential treatment programs lasting from four weeks to 12 months.

Psychiatric 134

Psychiatric Research CDC Best Practices 134

RebelEM

JANUARY 29, 2024

Am J Cardiol 2013. 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). A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Reisk Pulmonary Embolism: The OPTALYSE PE Trial. JACC Cardiovasc Interv 2018.

Stroke 136

Stroke Outcomes Hospitals Administration 136

RebelEM

MAY 29, 2024

If you treat a posterior bleed at a hospital without ENT, I would transfer as surgical intervention is pretty common REBEL EM: Do Patients with Epistaxis Managed by Nasal Packing Require Prophylactic Antibiotics? Laryngoscope 2013; 123: 2928-9. This will be pretty location specific. Acad Emerg Med 1995; 25(5): 592-6.

PPE 104

PPE EMS Hospitals Wellness 104

Ken Grauer, MD

APRIL 23, 2023

A cknowledgment : My appreciation to Chaim Katalan ( Laniado Hospital, Israel ) for the case and this tracing. = = R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation. It did — and the patient recovered uneventfully. =

EKG/ECG 195

EKG/ECG Wellness Operations Hospitals 195

RebelEM

MAY 11, 2023

History of liver disease, history of substance abuse disorder, and history of delirium tremens were also extracted from the hospital EMR. 11 of those were admitted to the hospital. J Emerg Med 2013 , 44 (3), 592-598.e592. Am J Emerg Med 2013 , 31 (4), 734-742. DOI: 10.1016/j.jemermed.2012.07.056 2012.07.056 From NLM. (5)

Emergency Department 97

Emergency Department Administration Hospitals Academics 97

EMergucate

DECEMBER 21, 2013

man is brought in by ambulance post out of hospital VF arrest with ROSC and this ECG

EKG/ECG 40

EKG/ECG Hospitals EMS 40

EMergucate

DECEMBER 26, 2013

Following on from last week, this 58 yr old male is brought to your Emergency Department following an out-of-hospital cardiac … Continue reading →

EKG/ECG 40

EKG/ECG Emergency Department Hospitals EMS 40

Pediatric EM Morsels

AUGUST 18, 2023

Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. From 2001 to 2009, in a pediatric hospital gram negative culture showed a drop in sensitivity to ciprofloxacin from 96% to 93%. J Pediatric Infect Dis Soc.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

RebelEM

JANUARY 25, 2024

Interestingly, though not statistically significant, patients in the serial US group had a longer length of hospital stay compared to the control group (4d vs 3d). Additionally, the serial US group had higher hospital readmission rates on days 0-7 and 8-30 without improving hospital or 30-day mortality. R I Med J (2013).

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

Don't Forget the Bubbles

JUNE 30, 2023

CRASH 2 , published in 2013 – was huge. NEPTUNE 2023 was inaugural UK PEM trauma conference, hosted by Nottingham University Hospitals Trust, one of the largest major trauma centres in the UK. 2013 Mar;17(10):1-79. But, there’s always been a worry that giving TXA could cause clotting in the cerebral vessels.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

PHEM Cast

JULY 14, 2016

2013 May 13;30(6):516–6. Out-of-hospital spinal immobilization: its effect on neurologic injury. 2013 Jul 19;30(8):679–82. 2013 Dec 22;31(1):86–6. Elsevier Ltd; 2013 Jan 1;44(1):122–7. Connor D, Greaves I, Porter K, Bloch M, consensus group Faculty of Pre-Hospital Care. 2013 Dec 1;30(12):1067–9.

Fractures 52

Fractures Hospitals Shock Research 52

EMDocs

AUGUST 13, 2024

From 2006-2013, HTN emergencies occurred in approximately 2 of every 1000 adult ED visits. Of note, they caution against lowering the BP of patients with asymptomatic markedly elevated BP prior to going to the hospital floor, as this is not evidence based and furthers the myth that treatment of the BP is necessary.

Stroke 98

Stroke Administration Outcomes Hospitals 98

EMDocs

SEPTEMBER 23, 2023

Admit symptomatic patients to the hospital for further evaluation and EP studies. HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndromes: document endorsed by HRS, EHRA, and APHRS in May 2013 and by ACCF, AHA, PACES, and AEPC in June 2013. Heart Rhythm.

EMS 105

EMS EKG/ECG Documentation/Coding Emergency Department 105

Mind The Bleep

OCTOBER 29, 2024

First aid done pre-hospital. 2013 May;74(5):1363-6. The AMPLE framework offers a structured approach [2]. A Allergies M Medications P Past medical history L Last meal and drink E Events surrounding the injury: Time of chemical burn. Type of chemical and strength. Was the patient wearing any protective equipment? doi: 10.1097/TA.0b013e31828b82f5.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Ken Grauer, MD

OCTOBER 27, 2023

My Immediate Impression — was that this elderly woman with a several week history of symptoms would most likely leave the hospital with a pacemaker. Section 20 ( 54 pages = the " long " Answer ) from my ACLS-2013-Arrhythmias Expanded Version provides detailed discussion of WHAT th e AV Blocks are — and what they are not !

EKG/ECG 257

EKG/ECG Resuscitation Hospitals Wellness 257

Taming the SRU

DECEMBER 11, 2023

11] A nationwide study conducted in 2013 found that the rate of presentation to emergency departments for suicidal ideation was nearly double for economically disadvantaged persons compared to their wealthier peers.[11,13] Development and Implementation of a Universal Suicide Risk Screening Program in a Safety-Net Hospital System.

EMS 97

EMS Psychiatric Emergency Department Poisoning 97

PHEM Cast

JANUARY 4, 2017

Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model. 2013; 22: 468-477. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. Patterson MD, Geis GL, Falcone RA, LeMaster T, Wears RL. BMJ Quality & Safety. Boet S, Bould MD, Layat Burn C, Reeves S.

Teamwork 52

Teamwork Burns Emergency Department Resuscitation 52

PHEM Cast

APRIL 27, 2023

: Anesthesia & Analgesia Blood pressure in trauma resuscitation: ‘pop the clot’ vs. ‘drain the brain’? – Wiles – 2017 – Anaesthesia Blood pressure management in trauma: from feast to famine?

Resuscitation 52

Resuscitation Shock Operations Hospitals 52

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% vs 48.4% (OR 3.4,

Sepsis 93

Sepsis Shock Resuscitation Fluid Resuscitation 93