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

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 187

Pediatrics Emergency Department Outcomes Sepsis 187

The Skeptics' Guide to EM

JULY 27, 2024

It is a medical emergency that requires prompt recognition and treatment to improve patient outcomes. The primary outcome reported was no statistical difference in mortality at 28 days (8% in both groups) despite giving antibiotics 96 minutes earlier [2]. A similar review by Sanders et al 2015 concludes that clinica.

Sepsis 99

Sepsis Outcomes Documentation/Coding Hospitals 99

ETM Course

JUNE 11, 2015

If you’re interested in trauma systems and their effect on patient outcomes, this is a great presentation by Russell Gruen at the recent TAC – MUARC Symposium.

Outcomes 52

Outcomes 52

PulmCCM

OCTOBER 16, 2024

This is a remarkable example of the differences between societies, which might influence the processes of clinical trials and their outcomes. RIPC has not been shown to improve cardiovascular outcomes more generally after cardiac surgery. Circulation. 2024 Sep 25. doi: 10.1161/CIRCULATIONAHA.124.071408. 124.071408. Epub ahead of print.

Outcomes 52

Outcomes Operations Research Hospitals 52

The Trauma Pro

OCTOBER 6, 2023

Although many of these injuries were managed within hours, a growing number were delayed by a few days to improve outcomes. We learned that temporizing with strict blood pressure control worked wonders at protecting the patient. Nowadays, thoracic endovascular aortic repair (TEVAR) is routine and much less morbid than the open procedure.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

The Skeptics' Guide to EM

OCTOBER 21, 2023

SGEM#366 concluded that we could not recommend the routine use of skeletal muscle relaxants, SGEM#304 agreed that adding acetaminophen to ibuprofen did not improve one-week outcomes, while SGEM#173 concluded the same about diazepam (there’s a theme here!).

Emergency Department 135

Emergency Department Radiology Radiology Hospitals 135

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

PulmCCM

SEPTEMBER 21, 2023

A 2015 meta-analysis of 13 randomized trials enrolling >12,000 patients suggested that active blood pressure management after ischemic strokes had little effect on eventual outcomes, and that delaying blood pressure control for three days did not lead to worse outcomes (death or disability).

Stroke 105

Stroke Outcomes 105

Don't Forget the Bubbles

JUNE 30, 2023

Extracorporeal life support rewarming rate is associated with survival with good neurological outcome in accidental hypothermia. The THAPCA-OH trial found that hypothermia did not result in a statistically significant benefit for survival with good functional outcomes at one year compared to normothermia. Saczkowski, R., Meert et al.

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

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. 2015 Sep 1;136(3):487-95. British journal of nursing. Pediatrics.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

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

RebelEM

SEPTEMBER 23, 2024

Proponents of its use often dismissed this effect of the drug as there had never been any evidence it impacted clinical outcomes. Opponents of ketamine often point to the risks of spiking intracranial pressure but this concern has been widely debunked ( Cohen 2015 ). Ann Emerg Med 2015; 65(1): 43-51. Intensive Care Med.

EMS 74

EMS Resuscitation Outcomes Wellness 74

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. Outcomes: Primary Outcome: Pulmonary expansion 24 hours after the procedure. Secondary Outcomes: Pulmonary expansion 7 days after the procedure.

Outcomes 103

Outcomes Hospitals Research Emergency Department 103

EMDocs

MAY 11, 2024

2015 Sep;66(3):322-333.e31. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion. Nov 10 th , 2015. Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department. Ann Emerg Med. 2015.06.031.

Stroke 111

Stroke EMS EKG/ECG Radiology 111

Don't Forget the Bubbles

AUGUST 2, 2023

Early management leads to better outcomes. That being said, younger patients tend to have better outcomes with a multidisciplinary team approach leading to remission in approximately 90% of children. Orthop Traumatol Surg Res 2015; 101: pp. Published 2015 Jul 29. Achieving this can improve quality of life. Pain Res Manag.

Psychiatric 98

Psychiatric Pediatrics Outcomes Academics 98

EMDocs

AUGUST 22, 2024

have limited English proficiency according to the 2015 U.S. Certified interpreter use can improve communication and patient outcomes. Conducting research regarding best practices for improving health outcomes for NELP patients. Pearls NELP patients have worse health outcomes despite widespread language-access policies.

Documentation/Coding 105

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

EMDocs

MARCH 18, 2025

Hirshberg B, Biran I, Glazer M, Kramer MR. Hemoptysis: etiology, evaluation, and outcome in a tertiary referral hospital. 2015 Mar;45(3):756-64. Ittrich H, Bockhorn M, Klose H, et al. The Diagnosis and Treatment of Hemoptysis. Dtsch Arztebl Int. 2017;114:371-81. 1997 Aug;112(2):440-4. Johnston H, Reisz G. Respiration. Eur Respir J.

COPD 82

COPD Radiology Radiology PPE 82

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

Sensible Medicine

OCTOBER 21, 2024

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. They did not expect this 9-fold higher death rate. They tried to publish their study.

Evidence-Based Practice 112

Evidence-Based Practice Shock Fractures Outcomes 112

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 91

Seizures Administration Anaphylaxis Outcomes 91

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

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

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 62

Hospitals Outcomes EKG/ECG Resuscitation 62

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). 2015 PMID: 25768683 8 Leidel BA. This can often lead to significant delays in proper resuscitation. Trauma 1996.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Taming the SRU

JULY 25, 2024

More efficacious than parenteral opioids alone Safer than opioids Decreased delirium Patients have been shown to have improved functional outcomes at 30 days Early pain control matters! Currently EVT for large core is being looked at and so far the outcomes seem to be favorable

Stroke 98

Stroke Fractures Operations Outcomes 98

Don't Forget the Bubbles

JULY 19, 2023

2015 ) found an incidence of true papilloedema of 25% and 6%, respectively, in children referred to tertiary ophthalmology departments with suspected optic disc swelling. Outcome of pediatric patients referred for papilledema. 2015 Aug 1;19(4):344–8. Interestingly, the child’s gender made a difference. 2023 and Kovarik et al.,

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

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

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 130

Ultrasounds Radiology Radiology Operations 130

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. 2015 Jul;5(3):142-50. 2015 Jan;46(1):102-7. hour IV thrombolytic window.

EMS 98

EMS Stroke Outcomes Hospitals 98

RebelEM

JANUARY 24, 2024

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. 2015; 3(4): PMID: 26665055 Post Peer Reviewed By: Salim R. J Bone Joint Surg Br 2011; 93(10):1362-6.

Operations 98

Operations Ultrasounds Fractures Outcomes 98

Mind The Bleep

OCTOBER 29, 2024

Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes. 2015 Jun;11(2):227-31. Specific protocols, such as those for hydrofluoric acid burns, must be followed to address unique complications like hypocalcaemia and cardiac arrhythmias. J Toxicol Clin Toxicol. 1993;31(2):307-13.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

The American Journal of Emergency Medicine 2015; 33(6):786-790. Smith : "What was the outcome?" Electrocardiographic Criteria to Differentiate Acute Anterior ST Elevation Myocardial Infarction from Left Ventricular Aneurysm. link] So I responded with these words: Smith : "There are QS waves, which suggest old MI.

EMS 114

EMS CPR EKG/ECG Wellness 114

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

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

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 They recommended synovial fluid analysis as essential to the diagnosis [30].

Infectious Diseases 89

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

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. There have been reports of the Orbeez Challenge leading to serious outcomes. The liquids were chosen to “approximate a pediatric digestive environment.” ” ( Ed. After Darracq et al., Darracq, M.A., Rentmeester, L.,

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111