Don't Forget the Bubbles

JANUARY 8, 2024

This led to her death at 19, an outcome ruled as homicide at inquest, indicating others’ contribution to her demise. Verbal de-escalation not only helps in avoiding the need for physical intervention but also fosters a therapeutic relationship, crucial for successful treatment outcomes in these sensitive situations. Mulraney, M.,

Research 105

Research Emergency Department Psychiatric Academics 105

PHEM Cast

DECEMBER 12, 2016

For an entertaining and insightful discussion about the impact of undertaking thoracotomy, listen to Dr John Hinds talk from SMACC 2015. Journal of the Royal Society of Medicine 2015. Emergency Department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. Highly recommended. 108(1): 11-16.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. A comparison between pre-operative ultrasonography and surgical findings. 2015 Dec;8(1):76. Epub 2015 Jul 25. Injuries discussed are shown in Image 1.

Fractures 77

Fractures Dislocations Operations Radiology 77

Taming the SRU

OCTOBER 23, 2023

At this point, the patient is taken to the operating room for a diagnostic laparoscopy. Discrimination between an IUP and an interstitial pregnancy is critical as interstitial pregnancies can have devastating outcomes. She was taken to the operating room and found to have a right tubal ectopic pregnancy with a pseudogestational sac.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

Taming the SRU

MAY 23, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. 2015 Apr 28]. 2015 Dec;8(1):76. Epub 2015 Jul 25. This post will cover some of the most common and important injuries, but is not comprehensive.

Fractures 57

Fractures Dislocations Operations EMS 57

Taming the SRU

SEPTEMBER 1, 2023

2015) reported a sensitivity of 98.9% 2015) reported a sensitivity of 98.9% to divert the plane).

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

The Skeptics' Guide to EM

NOVEMBER 20, 2021

Background: We looked at geriatric falls on an SGEM Xtra in 2015. Case: Mid-shift, you realise that the next patient you are about to see is the third in a row aged over 70 who has fallen at home, and that this is her third attendance for a fall in the last two months. Reference: Hammouda et al.

Geriatric Emergencies 52

Geriatric Emergencies Elder Abuse Research Academics 52

PulmCCM

APRIL 1, 2024

Physical therapy is probably under-provided to critically ill patients, and improving this might improve outcomes for many. That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

Don't Forget the Bubbles

JULY 26, 2023

REVERT trial (adults); Appelboam et al, Lancet 2015 showed that by modifying the traditional valsalva manoeuvre to be done semi-recumbent with a passive leg raise immediately afterwards increased the success from 17% cardioversion to 43%. Image from: [link] with thanks How often does the Valsalva manoeuvre work?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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. A cluster randomized trial using all-cause mortality as an outcome was always needed to determine whether EMR alerts improve outcomes for suspected severe infection.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. 12) Axillary While axillary arterial line placement has been uncommon, in the age of facile ultrasound operators it may become a more advantageous and accessible site particularly in patients with high BMIs. 2015 Sep;94(39):e1557.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Taming the SRU

MARCH 14, 2023

Ultimately, definitive management is in the operating room with revision or replacement of the VP shunt. Estimated incidence of normal pressure hydrocephalus and shunt outcome in patients residing in assisted-living and extended-care facilities. Lumbar puncture is an option with limited data for success. Lancet Neurol. Neurosurg Focus.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

PHEM Cast

SEPTEMBER 6, 2017

trauma 2004) showed that end-tidal CO2 may be of value in predicting outcome from major trauma (19). Qvigstad et al showed in again in Resuscitation in 2013, confirming inter-individual variation in effectiveness of CPR using ETCO2 as a surrogate for CO Trauma Deakin et al. (J. 2013;118(1):192-201. doi:10.1097/ALN.0b013e318278c8b6

CPR 52

CPR Resuscitation Operations Wellness 52

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. These procedures require an experienced operator.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). Epub 2015 Aug 22. That sounds reasonable, so what has changed?

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

Taming the SRU

JULY 25, 2024

Femoral nerve block case review - morbidity & mortality - community practice - r2 Clinical pathologic case - visual diagnosis - when time matters - operational aspects of stroke care Femoral nerve Block Case Review WITH dr. stolz Why do we care about regional anesthesia, specifically femoral nerve blocks?

Stroke 97

Stroke Fractures Operations Outcomes 97

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. Afro-Caribbean patients should be screened for sickle cell before anaesthesia for possible pre-operative transfusion. Anemia ; 2015.DOI:10.1155/2015/791498. DOI:10.1155/2015/791498.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

JANUARY 17, 2024

2015 But we all know that what happens in the lab does not always mirror what happens in real life. They passed away a few days after a second operation. There have been reports of the Orbeez Challenge leading to serious outcomes. The liquids were chosen to “approximate a pediatric digestive environment.”

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

EMDocs

SEPTEMBER 25, 2023

Still, there are those that believe that FPS is more of a physician-centered endpoint that does not fully reflect important patient-centric outcomes (16). Improved Visualization: Video laryngoscopes allow for the use of standard or hyperangulated geometry, essentially allowing the operator to “look around the corner” on an anterior airway.

Emergency Department 76

Emergency Department Soft Tissue Injuries Airway Management Operations 76

RebelEM

JANUARY 24, 2024

Schedule follow up with orthopedics within 1 week for discussion of operative management vs early rehab protocols. Wallace 2011 ) If addressed early and appropriately, most patients have good self-reported long-term outcomes regardless of the treatment modality Links Orthobullets: Achilles Tendon Rupture Resources: Sheth U et al.

Operations 86

Operations Ultrasounds Fractures Outcomes 86

PulmCCM

APRIL 18, 2024

The real world success rates by operators experienced with intubation remained unknown. This outcome measure was less robust than intubation attempts, because the “failure” definition included simply switching devices, which the intubator was permitted to do at any time for any reason.

Airway Management 98

Airway Management Operations EMS Research 98

PulmCCM

SEPTEMBER 4, 2024

OP is operating point, the operating point defines the cardiac output on the y-axis and Pra on the x-axis; Rcardiac is cardiac resistance (i.e., OP1 is operating point 1 at baseline. With tamponade, operating point 2 (OP2) is formed. Might this novel measure predict outcome in critically-ill patients [ @ross_prager ]?

Ultrasounds 84

Ultrasounds Operations Research Outcomes 84

EB Medicine

MARCH 1, 2019

In one RCT, the FAST exam reduced the time from arrival in the ED to operative care by 64% in the setting of trauma. Nachi: This is all well and good, and certainly accurate, but let’s not forget that hemodynamically unstable trauma patients, like those with myocardial rupture, need to be in the operating room, not the CT scanner.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Taming the SRU

AUGUST 30, 2023

A 2015 prospective, cross-sectional study of 78 Thai patients published in the International Journal of Rheumatic Disease demonstrated a sensitivity of 59% and specificity of 84% for PCT with a cut-off of 0.5 This finding was not significantly different among operators with different levels of experience, or between adults and children.

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

EMDocs

OCTOBER 23, 2023

Operative complications requiring surgical intervention or hospitalization occur in about 3-6% of all hysterectomies (5). difficile infection, and post-operative hemorrhage. Abscess and Infected Hematoma : This condition is typically delayed, occurring most commonly 10-14 days post-operatively.

OB/GYN 78

OB/GYN Operations EMS Ultrasounds 78

EMDocs

JUNE 3, 2023

4 This is the framework the ED resuscitationist should be operating under, as hemodynamically unstable pelvic trauma patients require a different approach compared to stable patients who will undergo CT, routine pelvic fixation, and definitive surgical repair. An x-ray in the trauma bay demonstrated an AP grade III fracture.

Fractures 57

Fractures Resuscitation Operations EMS 57

ACEP Now

AUGUST 28, 2024

John Hospital since 2015, when it acquired ownership of the hospital’s ED physician group, St. With plenty of warning from the union, TeamHealth and the hospital implemented contingency staffing plans to keep the ED fully operational. John’s Emergency Services, PC. Only time will tell,” he says.

Emergency Department 98

Emergency Department Hospitals Patient Safety Leadership 98

The Skeptics' Guide to EM

NOVEMBER 28, 2020

It was surgeons in the late 1890’s that began wearing masks in the operating theaters. There was one recent cluster randomized control trial looking at surgical masks, cloth masks or a control group in healthcare workers ( MacIntyre et al BMJ 2015 ).

Infectious Diseases 52

Infectious Diseases Operations Outcomes Wellness 52

EB Medicine

JULY 8, 2019

Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. These patients often require emergent operative intervention. First up, the kids.

Emergency Department 40

Emergency Department Sepsis Operations Ultrasounds 40

EB Medicine

JUNE 6, 2019

Nachi: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic. In 2015, the american college of radiology noted in their manual on contrast media that the concern for the development of contrast induced nephropathy is not an absolute contraindication for using IV contrast.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EMDocs

NOVEMBER 16, 2024

4 Pain is the most common reason for presentation in the early post operative period. 5 Highest risk of dislocation early in the post operative course due to laxity of the soft tissue after surgery. 6 Hip flexion or adduction in the early post-operative period can cause atraumatic dislocations (typically avoided for 6 weeks post-op).

EMS 88

EMS Dislocations Fractures Operations 88

EB Medicine

JANUARY 2, 2019

With opportunities to improve outcomes for both the fetus and the mother, I’m confident that this episode will be worth your time. Nachi: For patient who have a threatened miscarriage in the first trimester, there is a 2-fold increased risk of subsequent maternal and fetal adverse outcomes. Jeff: Up first is the urine pregnancy test.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

ALiEM

OCTOBER 30, 2024

Your patient ultimately is diagnosed with a spinal epidural abscess requiring operative care. Emergency department-initiated buprenorphine for opioid dependence with continuation in primary care: outcomes during and after intervention. 2015 Apr 28;313(16):1636-44. Journal of general internal medicine. 2017 Jun;32:660-6.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

Don't Forget the Bubbles

SEPTEMBER 23, 2024

suprapubic catheters, gastrostomy tubes, haemodialysis or peritoneal dialysis lines – may have been left in situ in the initial post-operative period), and central vascular catheters. Look for scars indicating previous central lines, peritoneal dialysis catheters or operations. Long-term outcomes of kidney transplantation in children.

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

EB Medicine

AUGUST 1, 2018

Jeff: A systematic review and meta-analysis from 2015 found low-quality evidence to support cannabis therapy for appetite suppression in HIV and aids patients; moderate-quality evidence for treatment of chronic pain and spasticity; and also moderate quality evidence for some chronic debilitating diseases. Counsel them on drug abuse also.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

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% vs. 38.1%) with a good functional outcome.

Stroke 98

Stroke Radiology Radiology Emergency Department 98