RebelEM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Funding: The Cardinal Health Laboratory provided Turkel thoracentesis kits to two hospitals Trial Registry: Clinicaltrials.gov: NCT01008228.

Outcomes 103

Outcomes Hospitals Research Emergency Department 103

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Basilar artery occlusion remains a challenging diagnosis to make, and the delays in reaching the diagnosis can have considerable impact on health outcomes. In hospital mortality estimated at 30-40%. hour IV thrombolytic window.

EMS 97

EMS Stroke Outcomes Hospitals 97

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 98

Stroke Outcomes EMS Seizures 98

EMDocs

JANUARY 3, 2024

The goal of these devices is to detect a heart failure decompensation early and to reduce hospital admissions. 2 These implantable devices offer physiological parameters to direct therapies and reduce hospitalizations. The device group experienced 39% fewer HF hospitalizations over the study period.

Allergic Reactions 112

Allergic Reactions Hospitals EMS Emergency Department 112

PHARM

SEPTEMBER 21, 2023

Maintaining physiology of brain tissue to the greatest extent possible through optimal management of blood pressure, airway, ventilation, and oxygenation, improves patient outcome. We assessed systolic blood pressure (SBP), end-tidal partial pressure of CO2 (PetCO2), and PaCO2 at hospital admission as well as prehospital and on-scene time.

Hospitals 40

Hospitals Resuscitation Wellness Outcomes 40

Don't Forget the Bubbles

JUNE 17, 2024

High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. At its heart lies an unpleasant reality- a critically unwell child with an anxious carer hoping for a positive outcome. 2014 Jun 26;23(12):653-9. Civility Saves Lives The impact of incivility in healthcare cannot be understated.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

RebelEM

SEPTEMBER 22, 2022

Racial Differences in Detection of Fever Using Temporal vs Oral Temperature Measurements in Hospitalized Patients. This could lead to delays in antibiotics and medical care all of which could be associated with worsened patient outcomes Race is a social construct and patients self-identified to race (which is appropriate). 95% CI 0.89

EMS 52

EMS Hospitals Outcomes Wellness 52

EMDocs

SEPTEMBER 27, 2023

This would be similar to how all other Medicare providers (long-term care facilities, hospital payments, etc.) Burleson (2014). “Association Between Individual Primary Care Physician Merit-based Incentive Payment System Score and Measures of Process and Patient Outcomes.” are already reimbursed (5). link] Bond, A.

Emergency Department 86

Emergency Department Research Outcomes Hospitals 86

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. N Engl J Med 2014 , 371 (22), 2109-2113. Strengths Investigators asked a clinically valuable question that is patient-oriented. 2) Schuckit, M.

Emergency Department 95

Emergency Department Administration Hospitals Academics 95

RebelEM

MARCH 23, 2023

REBEL Cast Ep115 – Phenobarbital vs Lorazepam in Alcohol Withdrawal Click here for Direct Download of the Podcast Clinical question : Is a phenobarbital-based or lorazepam-based alcohol detoxification protocol associated with a lower hospital length of stay compared to Ativan for alcohol withdrawal? Paper : Hawa F et al.

Emergency Department 52

Emergency Department Burns Outcomes Hospitals 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. 2014 Oct 28;:1–9. UK Sepsis Trust; 2014 Nov pp. 2009;13(5):R167. Am J Respir Crit Care Med.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

RebelEM

DECEMBER 1, 2022

Heterogeneity was 0% for the primary outcome, and overall heterogeneity was low for secondary outcomes, which increases external validity. While clinically relevant and heavily debated, the primary outcome is disease-oriented and not patient-oriented. Investigators assessed publication bias depicted as a funnel plot. Air is Air?

Outcomes 52

Outcomes Hospitals Research Critical Access 52

Sensible Medicine

AUGUST 7, 2024

This is an astounding difference in the quality of sleep, and to this day, premature infants in the hospital are slept on their stomachs. Moreover, a 2014 Brazilian study shows that prone-sleeping premature babies have lower salivary cortisol concentration, a better Brazelton sleep score, and a lower respiratory rate, indicating deeper sleep.

CDC 113

CDC Documentation/Coding Research Pediatrics 113

The Skeptics' Guide to EM

NOVEMBER 20, 2021

AEM November 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). Moving the Needle on Fall Prevention: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement.

Geriatric Emergencies 52

Geriatric Emergencies Elder Abuse Research Academics 52

The Injectable Orange

APRIL 4, 2017

For many Australian hospitals, April is ‘No Falls Month’ This month we have a full-scale education attack against one of the most prevalent forms of in hospital patient harm – the fall. As part of our education this month, I would encourage the enthusiastic ED nurse to read the following article. Avidan, M.

Emergency Department 52

Emergency Department Evidence-Based Practice Academics Documentation/Coding 52

ACEP Now

NOVEMBER 7, 2023

Out-of-hospital cardiac arrest unfortunately occurs relatively commonly and emergency physicians must be equipped to diagnose and treat this rapidly. The primary outcome was survival to hospital discharge. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

The Skeptics' Guide to EM

DECEMBER 16, 2017

NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. The paramedics report another seizure on route to the hospital.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

Pediatric Emergency Playbook

AUGUST 1, 2017

Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. J Pediatr Surg 2014; 49:1619. 2014; 8(5):533-541. Management of the child after enema-reduced intussusception: hospital or home?

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Northwestern EM Blog

FEBRUARY 14, 2022

The primary outcome of the study was the response in MAP three hours after the start of angiotensin II infusion. It showed improvement in blood pressure which is a clinically important parameter but not a patient-oriented outcome. Crit Care 2014; 18(5): 534. References Chawla LS et al. PMID: 25286986 Russell JA et al.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Dr. Smith's ECG Blog

JUNE 18, 2013

He was admitted to the hospital for a "rule out." These patients have worse outcomes: higher mortality, more CHF, higher biomarkers, and worse ejection fractions than the NonSTEMI patients with open arteries. Incidence Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction.

EKG/ECG 52

EKG/ECG Outcomes Emergency Department Hospitals 52

The Skeptics' Guide to EM

MARCH 6, 2019

Date: February 18th, 2019 Guest Skeptic: Dr. Shahriar Zehtabchi is a tenured professor and Vice Chair of Academic Affairs in the Department of Emergency Medicine at SUNY Downstate Medical Center & Kings County Hospital. JAMA 2014 * Banks and Marotta. Additional Resources: * SketchyEBM – Knowing NNT * Chiong et al.

Stroke 40

Stroke Academics Hospitals Outcomes 40

The Skeptics' Guide to EM

JANUARY 12, 2019

The study reviewed does not provide enough high-quality information to implement this guideline at my hospital. Acetaminophen: Williams et al (Lancet 2014) showed acetaminophen did not affect recovery time compared with placebo in low-back pain. The case scenario for this episode is a woman with worsening low-back pain for a month.

Emergency Department 40

Emergency Department Research Outcomes Hospitals 40

Taming the SRU

AUGUST 30, 2023

In a small study involving 79 hospitalized children, PCT was found to be elevated in bacterial infections, with a decrease after appropriate antibiotic therapy, and decreased in viral infections [24]. Epub 2014 Dec 3. . + Procalcitonin (PCT) Etiology: PCT was first discovered in 1984. days (secondary endpoint) [51]. Int J Rheum Dis.

Infectious Diseases 90

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 90

Taming the SRU

OCTOBER 23, 2023

After a short period of recovery in the hospital, she is discharged home in stable condition with follow-up with OBGYN. Discrimination between an IUP and an interstitial pregnancy is critical as interstitial pregnancies can have devastating outcomes. Ultrasonography. 2020 Apr;39(2):178-189. doi: 10.14366/usg.19043. Epub 2019 Oct 16.

Ultrasounds 99

Ultrasounds Operations Radiology Radiology 99

Pediatric Emergency Playbook

APRIL 1, 2016

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. 2014; 14:83. The confusion and frustration with lactate is that we often test the wrong people for it.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Pediatric Education

AUGUST 20, 2023

per 100,000 hospitalizations in 2014. Incidence Trends, Comorbidities, and Outcomes of Pyogenic Liver Abscess Among Children: A Nationwide Population-based Analysis. Treatment duration again was lengthy for many (up to 154 days) and they had a survival rate of 95.8%. Mortality rate was 0.8%. J Pediatr Gastroenterol Nutr.

Pediatrics 40

Pediatrics Infectious Diseases Wellness Sepsis 40

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Methods STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. However, STE-aVR with multilead ST depression was associated with 31% in-hospital mortality compared with only 6.2% Thirty-two patients (40%) had mild to moderate or no significant disease.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

EMDocs

NOVEMBER 13, 2024

Older age, recurrent episodes of SBP, hepatorenal syndrome, hepatic encephalopathy, acute kidney injury (AKI), concurrent GI bleeding, and higher MELD scores are predictors of worse outcomes. Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies. 2014 Sep;109(9):1436-42.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 105

EMDocs

DECEMBER 18, 2024

2014; 28(5): 401-410. Alcohol withdrawal syndrome: improving outcomes through early identification and aggressive treatment strategies. This series provides evidence-based updates to previous posts so you can stay current with what you need to know. Management of drug and alcohol withdrawal. Br J Addict. 1989; 84(11): 1353-1357.

Seizures 105

Seizures Hyperthermia / Hypothermia Emergency Department EMS 105

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. SECONDARY OUTCOMES At day 28 , ceftriaxone group had (vs placebo): Lower VAP risk (20% vs 36%); hazard ratio 0.62 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 119

CDC Radiology Radiology Head Injuries 119

Don't Forget the Bubbles

JANUARY 24, 2024

Mortality is high, between 16-43.5% , and neurological outcomes are generally poor amongst survivors. These poor outcomes are related to both the SRSE itself and as a result of the prolonged PICU stay. These poor outcomes are related to both the SRSE itself and as a result of the prolonged PICU stay. 2014 Dec;76(6):911-5.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

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. 2014 May;32(5):452-6. Epub 2014 Jan 15. DOI: 10.1097/PEC.0b013e3182713316

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

ACEP Now

APRIL 14, 2025

15 Loosened prescriber restrictions have also extended to the emergency setting with passage of the Three-Day Rule, which enables the on-site provision of three days of methadone to a patient not currently enrolled in an OTP, from one ED visit or inpatient hospitalization. 2014 Apr 9. References Drug Overdose Deaths: Facts and Figures.

Research 52

Research Infectious Diseases Hospitals Administration 52

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

RebelEM

MAY 15, 2024

Follow your hospital’s protocol (if available). High Risk Patients will need hospitalization and IV antibiotics. 2014 Aug 21;124(8):1251-8; quiz 1378. doi: 10.1182/blood-2014-02-482612. Epub 2014 May 28. Time to antibiotics and outcomes in cancer patients with febrile neutropenia. 2014, November 10).

Infectious Diseases 98

Infectious Diseases Administration Sepsis Anaphylaxis 98