EMDocs

SEPTEMBER 8, 2024

Delaying treatment of elevated BP in patients may lead to worse outcomes, and an optimal IV antihypertensive medication will reach the BP goal rapidly while avoiding hypotension and causing end organ injury. Authors extracted proportions dichotomous outcomes (in-hospital mortality) and calculated risk ratios. clevidipine).

Stroke 104

Stroke Outcomes Hospitals 104

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

The Trauma Pro

OCTOBER 4, 2024

years from 2013 to 2016. Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. ” This means they probably did not.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

EMDocs

JANUARY 11, 2025

Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Fecal Impaction and Nonperforated Stercoral Colitis: Red Flags for Poor Outcomes. L., & Lindor, R. Annals of emergency medicine, 82(1), 3746. link] Chakravartty, S., Chang, A., & Nunoo-Mensah, J. Korean J Radiol.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

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 129

Ultrasounds Outcomes COPD Hospitals 129

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

Don't Forget the Bubbles

JUNE 30, 2023

CRASH 2 , published in 2013 – was huge. The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Even if they excluded patients with a GCS of 3 or unreactive pupils at enrollment, outcomes were not better in the TXA group ( 12.5% This is not good.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

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. This is referred to as CPR I nduced C onsciousness ( CPRIC ).

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

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

PulmCCM

OCTOBER 16, 2024

RenalRIPC Trial In the RenalRIPC trial, investigators at four hospitals in Germany randomized 240 patients planned for cardiac surgery who were at high risk for acute kidney injury in 2013 and 2014 to receive remote ischemic preconditioning or sham remote ischemic preconditioning (control).

Outcomes 52

Outcomes Operations Research Hospitals 52

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

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. Certified interpreter use can improve communication and patient outcomes. Lion KC, et al. Pediatrics. 135:e709-e716.

Documentation/Coding 104

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

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, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 93

Sepsis Shock Resuscitation Fluid Resuscitation 93

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.

Research 134

Research Psychiatric CDC Best Practices 134

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes. This cohort included patients from 28 hospitals in 5 different South American countries. Ann Intensive Care 2020;10(1):41.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

RebelEM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

Outcomes 81

Outcomes Hospitals Operations Shock 81

EMDocs

AUGUST 13, 2024

From 2006-2013, HTN emergencies occurred in approximately 2 of every 1000 adult ED visits. If the patient has asymptomatic elevated BP, the optimal management strategy is not clear, and there are no data that treating asymptomatic elevated BP (marked versus not) in the acute care setting improves clinical outcomes.

Stroke 98

Stroke Administration Outcomes Hospitals 98

EMDocs

JANUARY 29, 2024

Finally, anticipating and addressing known complications such as seizures, increased intracranial pressure, or cerebral edema with appropriate measures, including antiepileptic drugs or osmotic agents, is essential for improving patient outcomes. Lowering the MAP may mitigate these risks and possibly improve outcomes. doi: 10.1161/01.str.0000014509.11540.66.

Stroke 99

Stroke Outcomes EMS Seizures 99

Mind The Bleep

OCTOBER 29, 2024

First aid done pre-hospital. Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes. 2013 May;74(5):1363-6. The AMPLE framework offers a structured approach [2]. Type of chemical and strength. Was the patient wearing any protective equipment? J Trauma Acute Care Surg.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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

EMDocs

JANUARY 16, 2024

He subsequently walks out of the hospital with a normal neurologic exam two weeks after admission. Patients can have excellent outcomes despite prolonged resuscitation. Our patient’s HOPE Score estimated he had a 78% chance of survival to hospital discharge. 2013 Jan 24;368(4):394]. Resuscitation. N Engl J Med.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

RebelEM

JANUARY 19, 2023

However, management continues to be debated and may lead to unnecessary hospitalization. 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.

Outcomes 52

Outcomes Hospitals Research EMS 52

PulmCCM

JANUARY 22, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

EMDocs

OCTOBER 30, 2023

1 The shortage in supply posed difficulties for hospitals that significantly depend on GE Healthcare as their supplier, which encompassed approximately 50% of hospitals in the United States (US). 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013. 11 Table 1. 11 Table 1.

Radiology 99

Radiology Radiology Emergency Department Hospitals 99

The Skeptics' Guide to EM

MAY 8, 2021

CPR is initiated and a hospital rapid response team is called. Background: Cardiac arrests have high morbidity and mortality rates both in-hospital cardiac arrests (IHCAs) and out of hospital cardiac arrests (OHCAs). The resuscitation team arrives and ACLS protocols are continued. I have not seen a validation study published.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

Don't Forget the Bubbles

AUGUST 7, 2023

This prospective cohort study included patients between 0-16 years old, who presented to one of four NHS hospital sites in Greater Manchester (a large metropolitan area in the North of England), consisting of an Urgent Care Centre and three Emergency Departments. Yes Was the outcome accurately measured to minimize bias? Pediatrics.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

Don't Forget the Bubbles

JANUARY 10, 2024

Severe anaemia is a common and life-threatening cause of hospital admission in children in sub-Saharan Africa. 8% die in hospital, with a further 12% dying in the six months following discharge. Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. What were the research questions?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

The Skeptics' Guide to EM

JULY 3, 2021

Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. Hypothermia resulted in a large improvement in neurologic outcomes, defined as well enough to be sent home or to a rehab facility. Reference: Dankiewicz et al: TTM2 Trial Investigators.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Outcomes Wellness 52

Don't Forget the Bubbles

OCTOBER 19, 2023

Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. This time, the group asked a different question – does using early high-flow nasal cannula oxygen instead of standard oxygen therapy reduce hospital length of stay? Which brings us to PARIS-2.

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

RebelEM

SEPTEMBER 12, 2022

Whether reversal of myocardial hibernation by coronary revascularization is possible and can improve outcomes is debatable. The incidence of death from any cause (the primary outcome) at 5 years was similar between groups, but the CABG group had more early death compared to medical therapy alone. OMT: 38.0% HR 0.99; 95% CI 0.78

Outcomes 52

Outcomes Hospitals EMS Wellness 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Several prognostic tools have been developed to predict the outcome of Major Trauma patients that present acutely to hospital. Aims The aim is to assess the prognostic accuracy of the qSOFA score in both the Pre-Hospital and Emergency Department (ED) setting in predicting mortality in Major Trauma patients.

Hospitals 40

Hospitals Emergency Department Outcomes Research 40

Pediatric Emergency Playbook

OCTOBER 1, 2017

2013; 49:138–144. 2013; 29:347–349. Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices: A Multi-Institutional Study. Predictors of In-Hospital Mortality in Children After Long-Term Ventricular Assist Device Insertion. Pediatr Neurosurg. Yang TF, Wang JC, Chiu JW et al. Childs Nerv Syst.

Pediatrics 52

Pediatrics Seizures Stroke Ultrasounds 52

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. 2013; 74: 634-8. Ultrasound during TCA: Cureton et al. 2012; 73: 102-10. Grasner et al. Smith et al.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

PHEM Cast

APRIL 10, 2016

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. Severe Sepsis in Pre-Hospital Emergency Care. 2013 Jun;44(6):1116–25. 2013 Apr;28(2):104–6. 2013 Apr 12;30(5):397–401. 2009;13(5):R167.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

The Skeptics' Guide to EM

APRIL 24, 2021

Date: April 19th, 2021 Guest Skeptic: Dr. Kirsty Challen (@KirstyChallen) is a Consultant in Emergency Medicine and Emergency Medicine Research Lead at Lancashire Teaching Hospitals Trust (North West England). The nurse wants to know what medications he can get to chemically restrain the patient.

Emergency Department 40

Emergency Department Research Outcomes Documentation/Coding 40

Downeast Emergency Medicine

MAY 16, 2022

3, pp 592-598, 2013.[ The primary outcome was admission or discharge, and bounce-back to the ED within 48 hours. Secondary outcomes were level of care on admission, ED length of stay, first and highest CIWA score, and adverse events. All three groups had similar rates or admission to the hospital and return to the ED.

Outcomes 52

Outcomes Emergency Department Hospitals Wellness 52

Don't Forget the Bubbles

JUNE 26, 2023

Staged reconstructions are a topic in itself (click here for a nice summary by Children’s Hospital of Philadelphia), but here we focus on Stage 1. These cases illustrate some of the common issues associated with each shunt type, but what does the evidence say about outcomes? 2014;129(20):2013-2020. 2018;37(7):879-885.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128