Ken Grauer, MD

FEBRUARY 3, 2024

Figure-3: Comparison between ST elevation in lead V3 due to a repolarization variant ( TOP — from 4/27/2019 ) — vs acute OMI ( BOTTOM — from 9/20/2015 ) , which manifests T-QRS-D ( See text ). What is M INOCA?

EKG/ECG 411

EKG/ECG Resuscitation Hospitals Wellness 411

RebelEM

MARCH 30, 2023

Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. Article: How-Berlemont C, Lamhaut L, Diehl J, et al.

Hospitals 66

Hospitals Outcomes EKG/ECG Resuscitation 66

Don't Forget the Bubbles

JULY 3, 2023

This time we have our first group of colleagues from Birmingham Children’s Hospital Emergency Department. The post The 72nd Bubble wrap x Birmingham Children’s Hospital Emergency Department appeared first on Don't Forget the Bubbles. With millions of journal articles published yearly, it is impossible to keep up.

Emergency Department 105

Emergency Department Hospitals Domestic Violence Pediatrics 105

Pediatric EM Morsels

AUGUST 18, 2023

Binz 2015) Remember, dogs grow 18 times as fast an infant in the first year of life. Binz 2015) More recent lamb studies have been performed, where the growth more closely approximates a human child. Binz 2015). Oral Fluoroquinolone Prescribing to Children in the United States From 2006 to 2015. This myth is: BUSTED-ish.

Pediatrics 130

Pediatrics Infectious Diseases Seizures Hospitals 130

The Trauma Pro

OCTOBER 6, 2023

vs. 2.1%), but significantly shorter ICU stay (7 vs 10 days) When patients who died within the first 24 hours were excluded, the in-hospital mortality remained significantly higher, and the ICU and hospital lengths of stay were significantly shorter Bottom line: Some society guidelines began recommending delayed TEVAR in 2015.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

American Medical Compliance

APRIL 10, 2023

Rise in Cases of Sexual Harassment There were 4,738 cases of improper sexual conduct reported from 2005-2015. MeToo’s Impact on Sexual Harassment in Hospitals Victims have recently gone to Twitter and used the hashtag #MeTooMedicine, connecting these individuals with others that share their experiences.

Hospitals 52

Hospitals Wellness 52

RebelEM

MAY 25, 2023

JAMA 2015 [7] The PROPPR Trial 680 severely injured adult trauma patients Patients randomized to Plasma, Platelets, and PRBCs in a 1:1:1 ratio vs 1:1:2 ratio No difference in overall mortality at 24 hrs BUT 1:1:1 achieved hemostasis faster and fewer experienced death due to exsanguination at 24hrs Crombie N et al. NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

The Trauma Pro

DECEMBER 26, 2023

Everyone knows that venous thromboembolism (VTE) is a potential problem in hospitalized patients, and especially so in trauma patients. A meta-analysis of 13 studies published in 2015 showed that early ambulation was not associated with a higher incidence of new PE. Couldn’t just moving around cause pieces to break off?

Fractures 124

Fractures Documentation/Coding Hospitals Research 124

The Trauma Pro

APRIL 26, 2024

In the last post in the series, I’ll discuss a paper in press that compares the efficacy and hospital charges of the two techniques. A multi-center trial published in 2015 showed an astounding 32% mortality rate for patients with shock from pelvic fracture.

Fractures 147

Fractures Head Injuries Radiology Radiology 147

Emergency Medicine Journal

JULY 22, 2024

Methods This was a retrospective data linkage study on consecutive adult EMS patients discharged at scene by paramedics in Victoria, Australia, between 1 January 2015 and 30 June 2019. were admitted to hospital and 0.3% The odds of hospital admission were increased in cases related to infection (AOR 3.14 (95% CI 2.80

Outcomes 98

Outcomes EMS Hospitals Research 98

EMDocs

MARCH 18, 2025

A 2018 RCT included 47 patients with hemoptysis (excluded MH) evaluated nebulized TXA three times per day compared to normal saline and found reduced expectorated blood volume, greater chance of hemoptysis resolution (96% versus 50%), shorter hospital LOS, less need for procedures for hemoptysis control (0% vs. 18.2%) (17). of the IV-TXA arm.

COPD 82

COPD Radiology Radiology PPE 82

The Skeptics' Guide to EM

OCTOBER 21, 2023

Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Implementation of a Clinical Management Tool for Spinal Epidural Abscess Early Diagnosis. AEM October 2023.

Emergency Department 135

Emergency Department Radiology Radiology Hospitals 135

The Skeptics' Guide to EM

JULY 27, 2024

Ann Emerg Med 2024 Date: July 25, 2024 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: Your hospital is running Morbidity and Mortality (M&M) rounds after a few recent cases in which the diagnosis of sepsis was identified late, and antibiotics were delayed.

Sepsis 99

Sepsis Outcomes Documentation/Coding Hospitals 99

Don't Forget the Bubbles

MARCH 19, 2024

This has coincided with a widespread shortage of specialist placements for children facing behavioural, psychiatric, and child protection challenges, leading to an over-reliance on the placement of these children in hospitals. A paediatric social admission is one where a child is admitted to the hospital but not for a medical reason.

Hospitals 52

Hospitals Psychiatric Documentation/Coding Pediatrics 52

ETM Course

JUNE 28, 2015

Just over a year ago London HEMS performed the first pre-hospital regtrograde endovascular balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg 2015 Apr;78(4):721-8 4. This is a potentially lifesaving treatment pioneered by the US military 1 for patients with exsanguinating pelvic and lower limb haemorrhage. Brenner et al.

Hospitals 52

Hospitals Resuscitation Shock Military 52

EMDocs

DECEMBER 14, 2023

A lawsuit is filed against the hospital (including the ED physician) the surgeon, his surgical group, the hospital ’ s trauma service director, and the hospital ’ s chief medical officer. Takeaways : Be certain that your emergency call schedule responsibilities are clearly defined in hospital policy. Patient dies in ED.

Hospitals 97

Hospitals Patient Safety Operations Wellness 97

RebelEM

APRIL 29, 2024

In these situations, the American Heart Association (AHA) and the European Resuscitation Council (ERC) of 2015 recommend the intraosseous (IO) route after the peripheral route and before the central venous route ( 1). Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Don't Forget the Bubbles

AUGUST 19, 2024

References Children’s Health Queensland Hospital and Health Service. link] The Royal Children’s Hospital Melbourne. 2015 Apr;34(4):e92-e101. 2015 Sep;35(6):634-9. The Royal Children’s Hospital Melbourne. Differentials of Paedatric Chest Pain. Sept 5, 2022. Accessed Jul 1, 2023. Chest Pain. Accessed Jul 2, 2023.

Infectious Diseases 104

Infectious Diseases Pediatrics Emergency Department Hospitals 104

Don't Forget the Bubbles

JUNE 30, 2023

A rapid rewarming rate greater than 5°C/hr is associated with higher in-hospital mortality. 593-600 Therapeutic hypothermia is no longer recommended in survivors of pediatric out-of-hospital cardiac arrest due to drowning. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. The “sweet spot” is between 0.5-2⁰C

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

EMDocs

FEBRUARY 7, 2024

3 Increasing Strikes and Unions Labor actions in healthcare can disrupt normal hospital operations, potentially impacting costs and threatening patient quality of care. One study from the National Bureau of Economic Research on nursing strikes in New York State from 1984 to 2004 found that hospital mortality increased by 19.4%

Hospitals 98

Hospitals Research Patient Safety Wellness 98

RebelEM

MAY 27, 2024

Background: The REVERT Randomized Controlled Trial demonstrated the superiority of the modified valsalva maneuver (MVM) over the standard valsalva maneuver (VM) in re-establishing normal sinus rhythm (NSR) in patients with PSVT (Appelboam 2015). Using MVM in parallel while establishing IV access or preparing medications is practical.

Outcomes 137

Outcomes Research Operations Hospitals 137

EMDocs

AUGUST 22, 2024

have limited English proficiency according to the 2015 U.S. 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. Patient centered communication standards for hospitals.

Documentation/Coding 105

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 105

PulmCCM

JANUARY 6, 2025

Their spread has coincided with the Centers for Medicare and Medicaid’s “sepsis bundle quality measure” (SEP-1) going live in 2015. With financial penalties coming for noncompliance with the new rule, hospital administrators rapidly deployed the alerts to fire on all eligible inpatients. And have they fired.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

RebelEM

JANUARY 25, 2024

Interestingly, though not statistically significant, patients in the serial US group had a longer length of hospital stay compared to the control group (4d vs 3d). Additionally, the serial US group had higher hospital readmission rates on days 0-7 and 8-30 without improving hospital or 30-day mortality. 2015 Oct;50(4):480-7.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

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 104

Outcomes Hospitals Research Emergency Department 104

EMDocs

JUNE 28, 2023

He is transported to a different hospital as possible trauma. A lawsuit is filed against the first hospital and ED physician. Result: The hospital agreed to a seven-figure settlement during mediation. He is confused, his wallet and shoes are missing, and his pants are around his ankles. Pre-trial settlement negotiations ensued.

Documentation/Coding 95

Documentation/Coding EMS Stroke Patient Safety 95

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. Stratified by center (different hospital practices may affect results) and GCS (<8 or ≥8) (higher VAP risk inherent to lower GCS). 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 122

CDC Radiology Radiology Head Injuries 122

RebelEM

JANUARY 29, 2024

JACCC Cardiovasc Interv 2015. 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). A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study.

Stroke 136

Stroke Outcomes Hospitals Administration 136

RebelEM

JANUARY 9, 2024

Additionally, multiple studies demonstrate increased harm with IV antibiotics such as increased rate of diarrhea ( Haran 2014 ), complications from IV placement ( Li 2015 ), and increased length of stay or cost ( Lorgelly 2010 ). The use of oral temafloxacin compared with a parenteral cephalosporin in hospitalized patients with pneumonia.

Infectious Diseases 99

Infectious Diseases Pediatrics EMS Administration 99

Sensible Medicine

JUNE 24, 2024

In 2015, FDA approved Impella again using data primarily from a trial called PROTECT II , which compared Impella to another LV support device called the intra-aortic balloon pump. Doctors and hospitals are paid extra to use the expensive device. FDA still approved the device. Finally a Trial Can you imagine?

Shock 105

Shock Hospitals 105

Don't Forget the Bubbles

JUNE 17, 2024

Riskin (2015) showed that rudeness accounted for a 12% reduction in diagnostic and procedural performance in a simulated resuscitation. Creating a culture of safety and respect through professional accountability: case study of the Ethos program across eight Australian hospitals. 2015 May;30:656-74. 2015 Sep 1;136(3):487-95.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

PulmCCM

MAY 2, 2024

For example, Maryland public health investigators collected surveillance cultures from hundreds of mechanically ventilated patients at 33 hospitals and 18 long-term acute care hospitals (LTACHs) in the spring and summer of 2023. Candida auris is a multi-drug resistant fungus discovered in 2009 in Japan. Since 2018, C.

Hospitals 52

Hospitals 52

Don't Forget the Bubbles

NOVEMBER 20, 2023

Royal Children’s Hospital. Royal Children’s Hospital, Melbourne. DOI 10.1016/j.cpha.2017.12.003 2017.12.003 Machado De Carvalho G, Silva de Lavor M et al. Pediatric Neck Mass. International Journal of Pediatrics. Cervical Lymphadenopathy. April 2021 Russell F, Lowe D. Paediatric neck lumps (diagnosis and management).

Pediatrics 124

Pediatrics Documentation/Coding Emergency Department Ultrasounds 124

Don't Forget the Bubbles

JANUARY 22, 2024

Repeated GP and hospital attendance might stimulate increased testing and unnecessary prescriptions. 2015) highlighted that a poor understanding of statistics often results in a belief that screening is more beneficial than it actually is. 2015 ;24(2):167-74. 2015 May 12;350:h2308 Malhotra A, Maughan D, Ansell J, et al.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

The Skeptics' Guide to EM

MAY 20, 2023

Guest Skeptic: Dr. Kat Priddis is a paediatric emergency medicine consultant and trauma director at Watford General Hospital. Guest Skeptic: Dr. Kat Priddis is a paediatric emergency medicine consultant and trauma director at Watford General Hospital. Which hospital should you transfer the patient to? NEJM Evidence.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics CPR Hospitals 52

Sensible Medicine

OCTOBER 21, 2024

It was a small study at one hospital. The story begins in Nottingham UK in 1980. But its lessons are large. First the background. I believe the CAST trial (1991) was the most important trial in all of modern medicine. But they also observed that 9 of 48 patients died in the lorcainide group vs only 1 of 47 in the placebo arm.

Evidence-Based Practice 111

Evidence-Based Practice Shock Fractures Outcomes 111

ALiEM

OCTOBER 30, 2024

Clinical impact: Rather than arguing with the patient about the likelihood of this phenomenon occurring and whether this is a true allergy, the patient is informed that they do not need to immediately start treatment to receive care in the hospital. 2015 Apr 28;313(16):1636-44. PMID 25919527 Sue KL, Cohen S, Tilley J, Yocheved A.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64