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). The unblinded nature of the study could influence outcomes due to observer bias.

Outcomes 137

Outcomes Research Operations Hospitals 137

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 98

Sepsis Outcomes Documentation/Coding Hospitals 98

Don't Forget the Bubbles

JULY 3, 2023

This time we have our first group of colleagues from Birmingham Children’s Hospital Emergency Department. This retrospective cohort study compared pre- and post-guideline outcomes. The post The 72nd Bubble wrap x Birmingham Children’s Hospital Emergency Department appeared first on Don't Forget the Bubbles.

Emergency Department 105

Emergency Department Hospitals Domestic Violence Pediatrics 105

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 134

Emergency Department Radiology Radiology Hospitals 134

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

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 81

COPD Radiology Radiology PPE 81

Don't Forget the Bubbles

JUNE 30, 2023

A rapid rewarming rate greater than 5°C/hr is associated with higher in-hospital mortality. Extracorporeal life support rewarming rate is associated with survival with good neurological outcome in accidental hypothermia. 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

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

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

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 122

CDC Radiology Radiology Head Injuries 122

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

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. Over 25 million individuals in the U.S. Lion KC, et al.

Documentation/Coding 104

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

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). The surgery is then performed. Circulation.

Outcomes 52

Outcomes Operations Research Hospitals 52

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

JUNE 17, 2024

High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. Riskin (2015) showed that rudeness accounted for a 12% reduction in diagnostic and procedural performance in a simulated resuscitation. 2015 May;30:656-74. Conclusion Critical care resuscitation is stressful. Edmondson, Amy C.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Sensible Medicine

OCTOBER 21, 2024

It was a small study at one hospital. One of those rules was (and remains) that if differences are observed in outcomes that were not pre-specified these should be regarded merely as generating hypotheses for testing in further studies But then something happened. The story begins in Nottingham UK in 1980. But its lessons are large.

Evidence-Based Practice 112

Evidence-Based Practice Shock Fractures Outcomes 112

Emergency Medicine Journal

MAY 23, 2023

We validated the score in a large patient data set and constructed a model that allows early prediction of the probability of clinical outcomes based on the individual’s NEWS+L Score. The outcomes were hospital death or a composite of hospital death and intensive care unit admission at 24 hours, 48 hours and 72 hours.

Outcomes 40

Outcomes Emergency Department Academics Operations 40

EMDocs

MAY 25, 2023

Outcome: No statistically significant difference in primary outcome, which was absence of clinically apparent seizures without the need for additional anti-convulsant medications AND improving responsiveness at 60 minutes after the start of trial-drug infusion, as determined by the treating physician.

Seizures 89

Seizures Administration Anaphylaxis Outcomes 89

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

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

Mind The Bleep

OCTOBER 29, 2024

First aid done pre-hospital. Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes. 2015 Jun;11(2):227-31. The AMPLE framework offers a structured approach [2]. Type of chemical and strength. Was the patient wearing any protective equipment? J Toxicol Clin Toxicol.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

RebelEM

APRIL 17, 2023

2015 May;204(5):1064-8. 33 studies selected for full review Of those 33 studies, 17 of those met criteria for inclusion Of the 18 studies, 1 was an RCT, 14 were prospective cohort studies, and 3 were retrospective cohort studies Total of 812 patients of whom 541 had PTA from 17 studies. Epub 2020 Jun 2. PMID: 32482146. AJR Am J Roentgenol.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

EMDocs

JUNE 12, 2024

HypoCa is common in trauma patients and is associated with poor outcomes. We need RCTs to determine if Ca administration in trauma impacts mortality and other patient-centered outcomes. All are associated with critical illness and severe hemorrhage. However, this triad does not include hypoCa, which has a major role in trauma.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 105

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. 2020;34(1):47-63.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 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. Journal of general internal medicine. 2017 Jun;32:660-6.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

PHEM Cast

APRIL 16, 2018

It might be better to consider traumatic cardiac arrest as a completely different disease eg LOST: Low Output State due to Trauma The 2015 European Resuscitation Council and UK Resuscitation Council Algorithms for Traumatic Cardiac Arrest: To read the whole ERC guideline on special circumstances cardiac arrest including trauma, click here.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

Don't Forget the Bubbles

JANUARY 8, 2024

Dr Elyssia Bourke, based at Ballarat Base Hospital, is actively engaged in this area through her ongoing PhD research. This led to her death at 19, an outcome ruled as homicide at inquest, indicating others’ contribution to her demise. As we are not used to sedating children in this way, choosing drugs and doses can be difficult.

Research 105

Research Emergency Department Psychiatric Academics 105

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

Broome Docs

MARCH 28, 2024

PMID: 38050078 Bottom line: High dose nitroglycerin seems to result in better outcomes in SCAPE, at least according to this small, single center, unblinded trial. Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. Emerg Med J. 2024 Jan 22;41(2):96-102. Resuscitation.

PPE 96

PPE Ultrasounds Resuscitation Emergency Department 96

Don't Forget the Bubbles

JANUARY 10, 2024

Severe anaemia is a common and life-threatening cause of hospital admission in children in sub-Saharan Africa. 8% die in hospital, with a further 12% dying in the six months following discharge. Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. What were the research questions?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

EMDocs

JULY 13, 2024

A) Administer ceftriaxone 500 mg IM and doxycycline 100 mg PO B) Consult OB/GYN for incision and drainage C) Establish IV access and administer clindamycin and gentamicin D) Prescribe doxycycline with metronidazole and ensure close OB/GYN follow-up Answer: C Most postpartum infections are identified after hospital discharge. Am J Clin Pathol.

OB/GYN 89

OB/GYN EMS Sepsis Fluid Resuscitation 89

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes. 2015 Jul;115(1):76-83. Epub 2015 May 19.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Emergency Medicine Journal

DECEMBER 22, 2023

Using CPMs to identify patients, rather than prespecified criteria, accommodates for the dynamic hospital user population and for sufficient time to provide preventative support. Co-primary outcomes were emergency hospitalisation and ED attendances, which will be reported separately. Mortality at 24 months was a safety endpoint.

Emergency Department 52

Emergency Department Hospitals Outcomes 52

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. The primary outcome was the successful intubation on the second attempt. Secondary outcomes included tracheal intubation adverse events (TIAEs) or severe desaturation.

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

RebelEM

JUNE 5, 2023

One study from a county in Massachusetts found that of all nonfatal opioid doses seen in the emergency department from 2011-2015, 1 in 20 patients subsequently died within one year of initial visit with 66% of these deaths being directly related to an opioid overdose (4). Initial doses ranged between 0.2 mg tablet) 1 Buprenorphine 0.5

Emergency Department 97

Emergency Department Hospitals Outcomes EMS 97

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]. . + Procalcitonin (PCT) Etiology: PCT was first discovered in 1984. However, it was not until a 1993 study that its significance was realized.

Infectious Diseases 89

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

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Background: The liberal use of supplemental oxygen therapy in acutely ill adults has a long history in the hospital, but high-quality therapy supporting its practice is unclear. The patient has an oxygen saturation of 98% on room air and your nurses ask if you want the patient to receive supplemental oxygen. The Lancet 2018.

Poisoning 52

Poisoning Administration Hospitals Sepsis 52