Sensible Medicine

APRIL 14, 2024

For instance, CAR-T was given to myeloma patients in 2014, but we only learned it can cause Parkinsonism in 2021. Medicine has become a financial commodity with the rare adverse event of better health outcomes. A few companies will get rich doing this, and many well-intentioned people will be cheering us over the cliff.

Patient Safety 145

Patient Safety Academics Outcomes Wellness 145

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

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

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. One study suggests remission in 6 out of 7 patients where it was used, but long-term clinical outcomes remained poor.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

ACEP Now

AUGUST 14, 2024

This recommendation is a departure from the 2014 guideline iteration that only recommended against CCBs in patients with decompensated heart failure. as well as conversion to sinus rhythm (OR 1.75; 95 percent CI 1.08-2.84).7 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. J Emerg Med.

Emergency Department 105

Emergency Department Outcomes Research Wellness 105

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

EMDocs

JANUARY 29, 2024

However, other sources suggest that the optimal blood pressure target is not well established and may vary depending on the individual patient’s characteristics and the type of hemorrhagic transformation [7]. Lowering the MAP may mitigate these risks and possibly improve outcomes.

Stroke 99

Stroke Outcomes EMS Seizures 99

Don't Forget the Bubbles

JUNE 17, 2024

High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. Loss of psychological safety and mental well-being persist long after the episode and can impact future episodes of care. 2014 Jun 26;23(12):653-9. The lasting effects of incivility cannot be understated. 2015 May;30:656-74.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Sensible Medicine

AUGUST 7, 2024

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. This is an astounding difference in the quality of sleep, and to this day, premature infants in the hospital are slept on their stomachs.

CDC 114

CDC Documentation/Coding Research Pediatrics 114

Northwestern EM Blog

APRIL 15, 2024

“Tracheostomy: Epidemiology, Indications, Timing, Technique, and Outcomes.” Respiratory Care 59 (2014): 895 - 919. Tracheotomy outcomes and complications: a national perspective. Rajendram, R., Repositioning a displaced tracheostomy tube with an Aintree intubation catheter mounted on a fibre-optic bronchoscope." 2006): 576-579.

Emergency Department 98

Emergency Department Resuscitation Pediatrics Outcomes 98

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. J Pediatr Surg.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

The Skeptics' Guide to EM

MAY 1, 2021

Our goal was simply to explain the science as well as we could, so people could understand why there is a debate – and the uncertainty that underlies that debate. Their efficacy endpoint was good functional outcome, defined as a modified Rankin Score (mRS) of 3 or less. improvement in good neurologic outcome, a 5.4%

Stroke 52

Stroke Outcomes Wellness 52

EMDocs

SEPTEMBER 7, 2023

DGA concentrates in the kidney tissue and causes nephrotoxicity, as well as neurotoxicity. Elimination half-life data is not well established but increases in larger overdoses and as renal injury begins to occur. Long-Term Renal and Neurologic Outcomes among Survivors of Diethylene Glycol Poisoning.” 6, 1 June 2014, pp.

Poisoning 92

Poisoning CDC Administration Emergency Department 92

PHEM Cast

FEBRUARY 25, 2021

Prognostication Better outcomes: Rescued and BLS commenced < 5-10 min Children Those who have not aspirated Water temperature < 10 o C, core body temperature 33-35 o C Neurologically intact on arrival at hospital Minimum blood pH > 7.1, Golden & Hervey, 1981 Oakley & Pethybridge, 1997 Tipton 2016 Bierens 2014.

Resuscitation 52

Resuscitation Hospitals Outcomes Wellness 52

RebelEM

SEPTEMBER 22, 2022

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). to 0.05C; p = 0.18 Prevalence of fever in Black was 10.1% with a temporal thermometer and 13.2% with a temporal thermometer and 10.2%

EMS 52

EMS Hospitals Outcomes Wellness 52

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

Taming the SRU

MAY 5, 2023

2014, Hjortrup, Haase et al. The CLASSIC trial is a randomized controlled trial conducted in the ICU setting which compared restrictive versus standard fluid strategies with a primary outcome of death by 90 days in patients with septic shock. There were similar baseline characteristics and the groups were well-matched.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). PLoS One 2014; 9(11): e112779. Resuscitation 2013; 84(11): 1500 – 4. PMID: 23911630 Kim WY et al. Chest 2000; 117(1): 260 – 7.

Emergency Department 92

Emergency Department Soft Tissue Injuries Airway Management Operations 92

Don't Forget the Bubbles

JANUARY 10, 2024

Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. 3,950 children were recruited between September 2014 to May 2017. Outcomes Primary outcome Mortality at 28 days after randomisation. The authors chose a patient-centred, primary outcome in keeping with their pragmatic design.

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

EMDocs

JANUARY 3, 2024

10 This procedure has well-described rare complications including infection, blood loss, allergic reaction, arrhythmia, pneumothorax if approaching via the internal jugular vein, embolization of the device, and pulmonary artery perforation or dissection. Published May 2014. 8 The device itself is 2 x 2.5 Circ Arrhythm Electrophysiol.

Allergic Reactions 113

Allergic Reactions Hospitals EMS Emergency Department 113

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

Case: It’s a busy night in the emergency department, your next patient is a well appearing 70-year-old man, presenting after a mechanical fall from standing with loss of consciousness. million emergency department visits in the US in 2014 [1], with the most significant proportion of visits occurring in the elderly ≥75 (1,682/100,000) [1].

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

RebelEM

MARCH 23, 2023

The primary outcome, hospital length of stay, was significantly shorter both before and after propensity score adjustment for the phenobarbital group. A broad range of variables were included that potentially influences treatment decisions and/or outcomes. The protocols used in the study were using symptom-driven medications.

Emergency Department 52

Emergency Department Burns Outcomes Hospitals 52

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. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 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.

Outcomes 52

Outcomes Hospitals Research Critical Access 52

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The note also says "slight lateral ST elevations noted, likely early repolarization since unchanged compared to 2014." Comparative early and late outcomes after primary percutaneous coronary intervention in st-segment elevation and Non–St-segment elevation acute myocardial infarction (from the Cadillac trial). Stuckey, T., Tcheng, J.

EKG/ECG 131

EKG/ECG Documentation/Coding Wellness Emergency Department 131

RebelEM

MARCH 13, 2023

Nevertheless, mortality of prehospital traumatic cardiac arrest (TCA), and survivability with good neurologic outcome, remain the gold standards of trauma care in and out of the hospital and are effectively the criterion by which we measure outcomes in the trauma literature. Discussion: Dead On Scene: The 96.2% mortality rate and 43.5%

Basic Life Support 52

Basic Life Support EMS Outcomes Resuscitation 52

Stop and Think

JUNE 27, 2022

The primary endpoints were simple: AF recurrences and safety outcomes. The CHAMPION trial, published in 2014, found that patients in the group that used the invasive data had lower rates of readmissions to the hospital for heart failure compared to those managed without the internal data. And there were hints that it might work.

Outcomes 52

Outcomes Stroke Hospitals Wellness 52

Dr. Smith's ECG Blog

JUNE 18, 2013

His ECG was repeated at this point: This shows a well developed anterior STEMI. These patients have worse outcomes: higher mortality, more CHF, higher biomarkers, and worse ejection fractions than the NonSTEMI patients with open arteries. His first troponin was normal. He was admitted to the hospital for a "rule out." Marti D et al.

EKG/ECG 52

EKG/ECG Outcomes Emergency Department Hospitals 52

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. 2014; 15(4):859-871. J Med Genet 2008; 45:1. Hirschsprung's disease.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

RebelEM

JANUARY 25, 2023

Emery Med J 2014; 31(3): 248-9. Small bowel obstruction: Outcome and cost implications of admitting service. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e.

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

EM Guide Wire

NOVEMBER 2, 2020

Primary outcome was discharge to home at 24 hours. mg/kg/hr Narrow therapeutic index and is associated with a wide range of adverse effects Does an aminophylline injection in addition to bronchodilators for an asthma attack improve lung function and other outcomes or cause harm? final FEV1 was 51.1% p = not significant).

Pediatrics 52

Pediatrics Anaphylaxis Emergency Department Administration 52

Pediatric Emergency Playbook

JANUARY 1, 2016

Consider surgical causes of forceful vomiting, especially if the child does not look anything other than well. 2014; (38): 1275–1281. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. ISPAD Clinical Practice Consensus Guidelines 2014. 2014 Sep;15 Suppl 20:154-79.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients. Pediatr Cardiol.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Pediatric Education

AUGUST 20, 2023

Patient Presentation An 8-year-old male came to clinic for his well-child care after moving to the area. Patients needed prolonged treatment and followup (up to 88 days) but did well without recurrences. per 100,000 hospitalizations in 2014. Patients presented with fever (83%), abdominal pain (58%) and hepatomegaly (38%).

Pediatrics 40

Pediatrics Infectious Diseases Wellness Sepsis 40

Dr. Smith's ECG Blog

MARCH 6, 2019

There is a new Q-wave in aVL, with STE and large T-wave as well. She requires maximal medical management per all current guidelines (including heparin and P2Y12 inhibitor per cardiology), as well as consideration for emergent cath in the case of persistent ischemia. The patient did well. V2 still has STE and hyperacute T-waves.

EKG/ECG 52

EKG/ECG Outcomes Hospitals Wellness 52

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 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]. Epub 2014 Dec 3.

Infectious Diseases 89

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

Don't Forget the Bubbles

MAY 3, 2023

There was no difference between the low-dose and high-dose insulin infusion groups regarding the time to resolution of hyperglycaemia, time to resolution of acidosis as well as the rate of blood glucose change. Overall survival was poor, and as such, the effect of chest compressions on clinical outcomes, could not be analysed.

CPR 52

CPR Airway Management Emergency Department Resuscitation 52