RebelEM

SEPTEMBER 28, 2023

neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. 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%

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. The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Again, there was no increase in thrombotic stroke in the TXA group – TXA looks safe. This is not good. There have been a couple of landmark trials.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

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

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 118

Outcomes Research Stroke COPD 118

PulmCCM

JULY 10, 2023

At 28 days, there were no observed differences in the primary outcome (an odd composite of mortality and emergence of antibiotic resistance), and no difference in survival at 90 days. There’s a period of time after ischemic stroke when damaged cerebral blood vessels are susceptible to bleeding. access, etc., detailed here.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

The Skeptics' Guide to EM

JUNE 11, 2017

Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Non-contrast head CT shows a hemorrhagic stroke. [display_podcast] Date: June 5th, 2017 Reference: Baharoglu et al. Lancet 2016. Lancet 2016.

Stroke 52

Stroke EMS Outcomes 52

RebelEM

MARCH 8, 2023

Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. CRAO is a stroke of the eye; patients should be considered for a complete stroke work up. Philadelphia: Elsevier, 2013 (Ch) 26: p. Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions.

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

All Ohio EM

SEPTEMBER 16, 2019

By Mike Pallaci, DO Research Question: Does rapid lowering of blood pressure improve the outcome in patients with intracerebral hemorrhage? The primary outcome was determined for 2794 of these; 45 patients (1.6%) lost to follow-up. How Many Patients: The investigators enrolled 2839 patients.

Stroke 40

Stroke Outcomes Research Hospitals 40

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

Pediatric Emergency Playbook

OCTOBER 1, 2017

Also used for severe MS, stroke, TBI, chronic pain. 2013; 49:138–144. 2013; 29:347–349. Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices: A Multi-Institutional Study. Are VNS safe in everyday life? Verify the medication and identify the toxidrome if symptomatic. Pediatr Neurosurg.

Pediatrics 52

Pediatrics Seizures Stroke Ultrasounds 52

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest. TXA also seems to improve patient-oriented outcomes in epistaxis ( SGEM#53 and SGEM#210 ). The Lancet 2020 This was an SGEM Journal Club episode recorded live at McGill University Grand Rounds.

Academics 52

Academics Resuscitation EMS Stroke 52

EMDocs

OCTOBER 30, 2023

Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013. West J Emerg Med.

Radiology 101

Radiology Radiology Emergency Department Hospitals 101

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Case 3: Headache and Arteriovenous Malformation Unlike in adults, stroke in children is divided evenly between hemorrhagic and ischemic etiologies. Pediatric Seizures and Strokes: Beyond Benzos and Brain Scans. 2013; 54 Suppl 7:23-34 Chin RFM et al., Nonconvulsive seizures are common in critically ill children. Boston, MA.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. We could use it to track treatment , and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults. Myopericarditis in Children: Elevated Troponin I Level Does Not Predict Outcome.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

PulmCCM

JANUARY 24, 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 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. 2013 Jun 15;13:272. 2013 May;13(5):426-35. Epub 2013 Feb 1. days (secondary endpoint) [51].

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

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. Dr. Perry did publish a prospective implementation of the Ottawa SAH Rule ( Stroke 2019 ).

Stroke 40

Stroke Emergency Department EMS Outcomes 40

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. He endorses nausea without vomiting and denies fever.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

ACEP Now

JULY 7, 2024

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). Early and established status epilepticus: the impact of timing of intervention, treatment escalation and dosing on outcome. J Pharm Pract.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

RebelEM

MARCH 22, 2023

Resources REBEL EM: SVT with Aberrancy Versus VT Amal Mattu’s ECG Case of the Week: August 26th, 2013 ALiEM: Tricks of the Trade: Valsalva Maneuver By Using a 10cc Syringe Larry Mellick: Treating SVT with Adensoine ALiEM: Trick of the Trade: Combining Adenosine with the Flush References Brugada P et al. Can J Cardiol 2011; 27(1): 105-9.

EKG/ECG 52

EKG/ECG EMS Pediatrics Stroke 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Stroke-volume:50 ml. Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. Left ventricular end-diastolic volume: 99 ml. Left ventricular systolic volume: 49 ml. Left ventricular ejection fraction:50 %. Normal wall thickness. References: 1.

EKG/ECG 109

EKG/ECG Ultrasounds Wellness Stroke 109

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

ACEP Now

MARCH 14, 2024

Fatal outcomes postoperatively may be due to re-bleeding after attempts to preserve flow in the innominate artery or using sutures or prosthetic material in an infected area.22,23 2013:1960-62. Tracheo-innominate artery fistula after stroke. 169:334-48. Quereshi AZ. Ann Thorac Cardiovasc Surg. NMC Case Report Journal.

Operations 52

Operations Pediatrics Radiology Radiology 52

EB Medicine

MAY 3, 2019

Jeff: And finally, how many of you wish there was a clearly outlined evidence-based approach to managing such patients to improve care and outcomes? The strongest predictor for suicide-related outcomes is history of prior suicidal ideation or suicide attempt. Washington DC : American Psychiatric Association ; 2013.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

Don't Forget the Bubbles

FEBRUARY 7, 2024

This week, NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) produced a much-anticipated report on how we manage acute testicular torsion in young people. “Time is brain” urges us to think about thrombolysis or clot retrieval in acute strokes. International urology and nephrology , 53 , pp.7-11.

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. demonstrating that functional outcome at 3 months did not differ between the CTA and MRI groups (38.5% 8 The data in Mayer et al.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

EM Literature of Note

OCTOBER 14, 2024

link] “Reviewer Experience Detecting and Judging Human Versus Artificial Intelligence Content: The Stroke Journal Essay Contest” Who wins an essay competition on controversial topics in stroke and neurology – humans or LLMs? That said, the five suggested strategies to address vigilance seem … precarious.

Stroke 89

Stroke Emergency Department Resuscitation Best Practices 89

RebelEM

DECEMBER 4, 2024

Cardioversion recommendations exclude patients with recent strokes or valvular heart disease. MD Calc: CHA2DS2-VASc for Atrial Fibrillation Stroke Risk References Yealy D, Kosowsky JM: Dysrhythmias, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. Louis, Mosby, Inc.,

Emergency Department 96

Emergency Department Stroke EMS Shock 96

PulmCCM

NOVEMBER 20, 2024

Large observational series and meta-analyses followed, suggesting strong tendencies toward improved outcomes in patients without ARDS treated with low tidal volumes. After 28 days, patients in the protective ventilation group had worse outcomes (all statistically significant): 28.9% 2013 Feb 28;2013(2):CD003844. versus 45.3%.

Stroke 98

Stroke Outcomes 98