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

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. Is your patient hyperglycemic, acidotic, with ketonuria? Then we’ve likely got DKA. Triple bag, triple bag, triple bag! References : White PC, Dickson BA. PMID: 23499379. PubMed] [Read by QxMD] Rosenbloom AL.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

This includes SGEM#19 way back in 2013 reporting a bandage wrap is a safe alternative to traditional casting for children with greenstick fractures. There have been no randomized trials that have compared the patient-centered, functional outcomes after a wrist injury based upon the choice of initial diagnostic test modality.

Fractures 139

Fractures Ultrasounds Pediatrics Outcomes 139

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

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

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

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

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

The Skeptics' Guide to EM

JANUARY 6, 2024

Two previous studies conducted assessing the state of nationwide pediatric readiness were conducted in 2003 and 2013. Intervention: Web-based open assessment questionnaire containing 92 questions. * Comparison: Previous pediatric readiness scores. * Outcome: Are general emergency departments ready to care for children?

Emergency Department 137

Emergency Department Pediatrics Anaphylaxis Leadership 137

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. J Ped Surg 54:335-339, 2019.

Pediatrics 113

Pediatrics Operations Emergency Department Outcomes 113

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

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

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. Intensive care medicine 39 (2013): 165-228. Ospina-Tascón GA, Teboul J-L, Hernandez G, et al. Opal, Jonathan E. TamingtheSRU.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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

Don't Forget the Bubbles

NOVEMBER 29, 2023

In studies including patients with trauma or Glasgow Coma Scale less than 8, intubation without sedation led to poorer neurological outcomes. The Impact of Prehospital Intubation with and Without Sedation on Outcome in Trauma Patients With a GCS of 8 or Less. 2013 Jan;31(1):222-6. MD * ; Rueger, Johannes M. DOI: 10.1097/ANA.0000000000000275

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

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

The Skeptics' Guide to EM

JULY 8, 2023

In 2009, the Cochrane group questioned Roche about the completeness of the data and after four years of requests, finally got access to all the data in 2013 and updated their review in 2014. The Cochrane collaboration published analyses of the available data in 1999, 2003 and 2006. We covered this SRMA on SGEM#98.

CDC 108

CDC Hospitals EMS Emergency Department 108

The Skeptics' Guide to EM

OCTOBER 20, 2018

Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. Background: There has been a huge increase in the number of CT scans performed with more than 75 million CT scans performed in the US in 2013. NEJM 2018 (ClinicalTrials.gov NCT01467466.)

Emergency Department 73

Emergency Department Outcomes Pediatrics 73

RebelEM

SEPTEMBER 28, 2023

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% to 1.0mm Median amount of ST deviations declined from 15.0 Primary PCI: 78.4% Primary PCI: 13.3%

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138

Taming the SRU

JULY 25, 2024

More efficacious than parenteral opioids alone Safer than opioids Decreased delirium Patients have been shown to have improved functional outcomes at 30 days Early pain control matters! Atheroslerosis (2013) found that dyspnea had OR 1.9 Currently EVT for large core is being looked at and so far the outcomes seem to be favorable

Stroke 98

Stroke Fractures Operations Outcomes 98

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 104

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

Don't Forget the Bubbles

OCTOBER 2, 2023

mmol/L) with acute illness between 2013 and 2018. The most common negative ones were stress and fear, loss of equilibrium due to the child’s medical fragility, concerns about developmental outcomes and the child’s vulnerability. This raises an interesting point about using NDI as an important outcome in neonatal research.

Outcomes 138

Outcomes Research Wellness Emergency Department 138

Dr. Smith's ECG Blog

AUGUST 14, 2024

Similar to the prognostic implications of Mobitz I AV block — SA Wenckebach is not necessarily pathologic, and not necessarily associated with adverse outcome. In contrast — true Type II SA Exit Block ( like the Mobitz II form of AV block ) — is much more likely to be associated with adverse outcome and potential need for cardiac pacing. (

EKG/ECG 110

EKG/ECG Outcomes Wellness 110

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

Mind The Bleep

OCTOBER 29, 2024

Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes. 2013 May;74(5):1363-6. Specific protocols, such as those for hydrofluoric acid burns, must be followed to address unique complications like hypocalcaemia and cardiac arrhythmias. J Trauma Acute Care Surg. doi: 10.1097/TA.0b013e31828b82f5.

Burns 52

Burns Fluid Resuscitation PPE 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

Sensible Medicine

NOVEMBER 14, 2023

A systematic review of studies from 2013-2018 examined 23 papers that studied residential treatment programs lasting from four weeks to 12 months. These higher quality studies usually achieved better outcomes. The evidence suggests that residential treatment programs offer something more than a sanctuary.

Psychiatric 129

Psychiatric Research CDC Best Practices 129

Sensible Medicine

MARCH 11, 2024

In the assessment of a clinical trial, we want to know if differences in baseline characteristics may have played a role in the observed outcome. The question to consider is…are the actual differences seen between the groups with regards to baseline characteristics large enough to have influenced the outcome?

Outcomes 117

Outcomes Research Stroke COPD 117

RebelEM

MAY 11, 2023

J Emerg Med 2013 , 44 (3), 592-598.e592. Am J Emerg Med 2013 , 31 (4), 734-742. Phenobarbital for acute alcohol withdrawal: a prospective randomized double-blind placebo-controlled study. DOI: 10.1016/j.jemermed.2012.07.056 2012.07.056 From NLM. (5) 5) Stehman, C. A rational approach to the treatment of alcohol withdrawal in the ED.

Emergency Department 97

Emergency Department Administration Hospitals Academics 97

American Medical Compliance

APRIL 17, 2024

Evidently, ICU survivability has grown in importance, and strategies to improve patient outcomes and recuperation are crucial goals for medical professionals, patients’ families, and researchers. Also, this update was made to offer suggestions to physicians on how to provide better care for critically ill patients.

Evidence-Based Practice 52

Evidence-Based Practice Outcomes Research 52

Northwestern EM Blog

APRIL 15, 2024

Tracheostomy: Epidemiology, Indications, Timing, Technique, and Outcomes.” Tracheotomy outcomes and complications: a national perspective. This is to minimize the risk of creating a false passage. Figure 3: Depiction of creation of false passage through subcutaneous tissue when replacing tracheostomy tube. Borrowed from: Morris, L.L.,

Emergency Department 98

Emergency Department Resuscitation Pediatrics Outcomes 98

EMDocs

JANUARY 16, 2024

Patients can have excellent outcomes despite prolonged resuscitation. Down time and time doing CPR is not nearly as important, and even patients with low end tidal, fixed, dilated pupils, asystole rhythm, and extended low-flow times can have favorable neurologic outcomes. 2013 Jan 24;368(4):394]. Resuscitation. N Engl J Med.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

Taming the SRU

SEPTEMBER 8, 2023

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.” Erratum in: Gastroenterology. Dosage error in article text. PMID: 19524577; PMCID: PMC3189485.

Radiology 59

Radiology Radiology Ultrasounds EMS 59

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

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

EMDocs

AUGUST 8, 2023

Bimodal age of distribution: at birth and 12-18 years 14% of cases occur in adults; older patients have worse outcomes Bell clapper deformity – bilateral in 80% of patients Prior episode of torsion Family history Trauma (can be minor) Clinical Presentation: Sudden/severe testicular pain Often unilateral, may radiate.

Ultrasounds 94

Ultrasounds Documentation/Coding Outcomes Emergency Department 94

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. doi: 10.1053/j.sult.2013.01.004. 2013.01.004. PMID: 23522778.]

Stroke 110

Stroke EMS EKG/ECG Radiology 110