The Trauma Pro

APRIL 26, 2024

A multi-center trial published in 2015 showed an astounding 32% mortality rate for patients with shock from pelvic fracture. Years ago, we tried to pack the pelvis from the inside (peritoneal cavity), but it never worked very well. As I continue to preach, going anywhere but the OR is dangerous for the patient.

Fractures 147

Fractures Head Injuries Radiology Radiology 147

EMDocs

DECEMBER 18, 2024

2015; 17(6): 1-19. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold Br J Addict. 1989; 84(11): 1353-1357. Yanta J, Swartzentruber G, Pizon A. Alcohol withdrawal syndrome: improving outcomes through early identification and aggressive treatment strategies. Emerg Med Pract.

Seizures 105

Seizures Hyperthermia / Hypothermia Emergency Department EMS 105

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

He did well and was discharged. Rituparna et al — as well as Chauhan and Brahma ( Int. Sci 5[4] 268-270, 2015 ) both highlight a likely association between acute development of ischemic J waves — and high risk of developing malignant ventricular arrhythmias ( My Comment in the September 23, 2020 post ). Smith’s ECG Blog ).

Hyperthermia / Hypothermia 138

Hyperthermia / Hypothermia EKG/ECG Wellness 138

The Trauma Pro

DECEMBER 26, 2023

Screening looks at patient factors such as age, obesity, and previous VTE, as well as injury risk factors like spine and pelvic fractures and decreased mobility. A meta-analysis of 13 studies published in 2015 showed that early ambulation was not associated with a higher incidence of new PE. Chest 127(5):1631-1636, 2005.

Fractures 124

Fractures Documentation/Coding Hospitals Research 124

The Trauma Pro

OCTOBER 6, 2023

At the time, there was a debate about whether the procedure should be done immediately versus waiting until the patient was well-resuscitated. This was a big procedure, with the possibility of several major complications, with postop paraplegia being one of them. The concern was that death was nearly certain if the aortic lesion progressed.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

The Skeptics' Guide to EM

FEBRUARY 22, 2020

Bringing value, balance and humanity to the emergency department: The Right Care Top 10 for emergency […] The post SGEM Xtra: Right, You’re Bloody Well Right, You’ve got the Bloody Right to Care first appeared on The Skeptics Guide to Emergency Medicine. Reference: Dorsett et al. How is it different from the Choosing Wisely Campaign?

Wellness 52

Wellness Emergency Department EMS 52

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. British Journal of Anaesthesia 2015. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] PMID: 28559036 Holcomb JB et al.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Hope you’re doing well! The American Journal of Emergency Medicine 2015; 33(6):786-790. You taught us well!" Most of these Q waves are unusually wide with respect to QRS amplitude in the lead being looked at — as well as fragmented in multiple leads, including lead V3 ( BLUE arrow ) and leads III, aVF, V2 and V4.

EMS 114

EMS CPR EKG/ECG Wellness 114

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. 2015 Jun;11(2):227-31.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

ALiEM

APRIL 12, 2023

The thin alcohol layer serves to eliminate any air bubbles under the adhesive cover as well as minimizes residual adhesive material sticking to the probe when removing the cover. The adhesive cover itself serves as a sterile barrier and a slick surface to improve probe maneuverability. Accessed April 5, 2023.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

EMDocs

FEBRUARY 7, 2024

Unionization of healthcare providers can create opportunities to improve staff’s financial and general well-being, but may also facilitate future strikes. Trainees and attending providers should be informed about both the opportunities that come with unionization, as well as the challenges that come with managing strikes.

Hospitals 98

Hospitals Research Patient Safety Wellness 98

RebelEM

SEPTEMBER 23, 2024

However, it is well-established that even a single dose of etomidate can cause adrenal suppression ( Albert 2011 ). 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. 2011;37(6):901-910.

EMS 74

EMS Resuscitation Outcomes Wellness 74

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

EMDocs

DECEMBER 14, 2023

If a physician is allowed to be on call for more than one hospital – or to be in the OR when on call – define the procedure for simultaneous calls as well as when a surgeon is operating. Reference : See similar case in “ Where ’ s all that blood coming from” in the November 2015 issue of MMI-LFL. Patient dies in ED.

Hospitals 97

Hospitals Patient Safety Operations Wellness 97

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. Loss of psychological safety and mental well-being persist long after the episode and can impact future episodes of care. 2015 May;30:656-74. 2015 Sep 1;136(3):487-95. BMC medicine.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

EMDocs

JULY 9, 2024

Addressing social determinants of health at well child care visits: a cluster RCT. 2015 Feb;135(2):e296-304. Epub 2015 Jan 5. Epub 2015 Jul 14. Epub 2016 Nov 7. PMID: 27599265. Garg A, Toy S, Tripodis Y, Silverstein M, Freeman E. Pediatrics. doi: 10.1542/peds.2014-2888. PMID: 25560448; PMCID: PMC4306802. Acad Pediatr.

Pediatrics 75

Pediatrics Emergency Department Research Burns 75

ALiEM

FEBRUARY 26, 2024

Otherwise, he was well-appearing, acting normally, and eating/voiding/stooling normally. Additional Images Physical Exam General : Well appearing, acting appropriately for age HEENT : Scalp normal. 2015 Mar-Apr;60(2):211. The patient presented with a vesicular rash on his face including around his eyes. Pediatr Dermatol.

Academics 78

Academics Pediatrics Wellness 78

EMDocs

AUGUST 22, 2024

have limited English proficiency according to the 2015 U.S. Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter. Lion KC, et al.

Documentation/Coding 105

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

Don't Forget the Bubbles

JULY 19, 2023

Olivia, a previously well 13-year-old girl, is referred to the paediatric ED from the Ophthalmology ED. 2015 ) found an incidence of true papilloedema of 25% and 6%, respectively, in children referred to tertiary ophthalmology departments with suspected optic disc swelling. 2015 Aug 1;19(4):344–8. 2023 and Kovarik et al.,

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. 2015 May;28(7):793-8. A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in. Triage vital signs (VS) include BP 88/45, HR 121, T 97.1,

EMS 111

EMS Resuscitation Blood Transfusions Seizures 111

ACEP Now

SEPTEMBER 11, 2023

While summitting Carstensz in Indonesia in October 2015, he and his wife led a Wild Med Kilimanjaro Expedition and summited Kili in March 2016. He also became close friends with Chris Imray, a vascular surgeon and leading frostbite expert, on that 2015 Indonesia climb, and they reconnected to summit Mt.

Wellness 126

Wellness 126

Don't Forget the Bubbles

JUNE 30, 2023

20 (2015): 1898-1908 As the PICU reg finishes their teaching and prescribes some warm IV fluids, Elsa’s sats drop to 54%. The ECMO team are on their way… Three hours later, Elsa’s gases are better, her PEEP is down to 8, and she’s oxygenating well on 80% oxygen. Christensen, Vinay M. Nadkarni, Kathleen L. Meert et al. Meert et al.

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

EMDocs

DECEMBER 4, 2023

The Wells’ Criteria for DVT can help risk stratify [2,3]. If the patient’s Wells score is ≤ 0, DVT is nearly clinically excluded and no further immediate lab or ultrasound is necessary. In patients with a Wells’ score of 1-2 (moderate risk), DVT can be ruled out with a negative d-dimer rather than an US. Published 2020 Feb 11.

Ultrasounds 97

Ultrasounds Documentation/Coding Wellness EMS 97

Northwestern EM Blog

MARCH 1, 2025

In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Position arms in a comfortable position, avoiding any position that could cause a brachial plexus injury, and ensure they are well-supported to avoid pressure ulcers.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

RebelEM

APRIL 17, 2023

However, It is unclear how well POCUS performs in ruling in or ruling out the diagnosis of PTA. Question: How well does the US perform in diagnosing PTA compared to CT, needle aspiration, or Incision and Drainage? 2015 May;204(5):1064-8. Article: Kim DJ et al. Acad Emerg Med. 2023 Jan 10. Epub ahead of print. PMID: 36625850.

Ultrasounds 130

Ultrasounds Radiology Radiology Operations 130

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. Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. ” ( Ed. After Darracq et al., Darracq, M.A.,

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 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 2015 Mar;18(3):352-9.

Infectious Diseases 89

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

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Systolic function normal by visual assessment only, unable to visualize well for further characterization. The patient did well and was discharged. 2015, March 1). RV: Cavity size normal. 1900: RBBB and LAFB are almost fully resolved. 2300: QRS now within normal limits. No other significant injuries were found. Cramer, M.

EKG/ECG 115

EKG/ECG Wellness Fractures Emergency Department 115

Pediatric Emergency Playbook

OCTOBER 1, 2016

Well appearing? Consider allergic proctocolitis if the child is well. Think -- pink stain, without clot: Infants and Young Children Well appearing? Pitfalls in the infant and young child Epistaxis; food-related misadventures Older Child and Adolescent Well appearing? Neonates Well appearing? 2015 Jul;17(7):27.

Pediatrics 52

Pediatrics Wellness Shock Resuscitation 52

Don't Forget the Bubbles

JANUARY 22, 2024

2015) highlighted that a poor understanding of statistics often results in a belief that screening is more beneficial than it actually is. Blood cultures are commonly drawn for certain focal infections such as pneumonia , skin and soft tissue infections (SSTIs), asthma , bronchiolitis as well and UTIs. 2015 ;24(2):167-74.

Emergency Department 90

Emergency Department Best Practices Radiology Radiology 90

Don't Forget the Bubbles

AUGUST 2, 2023

As well as nonpharmacological treatments included physiotherapy and psychological therapy, 79% were also prescribed medication, most commonly gabapentin. Orthop Traumatol Surg Res 2015; 101: pp. Published 2015 Jul 29. More recently, Mesaroli et al. References Bayle-Iniguez X., Audouin-Pajot C., Sales de Gauzy J., 2015;351:h2730.

Psychiatric 98

Psychiatric Pediatrics Outcomes Academics 98

Taming the SRU

JUNE 24, 2024

Conduction Abnormalities AV blocks, which can also be seen in patients with MI, may require pacing as well, due to ischemia affecting the electrical pathways of the heart. MedEdPORTAL Publications; 2015. Circulation , vol. 1103–1104, [link] Cousar J, Bohanske M, Hill J. Transvenous Cardiac Pacemaker Educational Resource.

Advances Cardiac Life Support (ACLS) 90

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

Taming the SRU

JULY 24, 2023

Risk factors associated with increased risk of acute perforated cholecystitis include age greater than 65 years old, as well as diabetes mellitus, atherosclerosis, or organ failure (1, 2). The most well-accepted classification of acute perforated cholecystitis is the Niemeier classification which is outlined as below (3,6).

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

EMDocs

NOVEMBER 1, 2023

ECG – May show tachycardia or rate related ST depressions Laboratory evaluation: CBC w/ differential – may reveal leukocytosis with left shift CMP, Lipase – can reveal alternative intra-abdominal diagnoses as well as show findings of end-organ hypoperfusion (elevated serum creatinine, transaminitis, etc.) McGraw-Hill Education; 2015.

Operations 95

Operations Radiology Radiology Fluid Resuscitation 95

American Medical Compliance

JANUARY 9, 2024

trillion in 2015. More than 3,900 cases of medical identity theft involving patients and providers were recorded in 2015, according to the most recent FTC data, with over 10,000 cases reported between 2013 and 2015. As a result of their large size, these healthcare systems are easy targets for fraud. Learn more below.

Wellness 52

Wellness 52

The Skeptics' Guide to EM

APRIL 6, 2019

This changed in 2015 when the Food and Drug Administration (FDA) approved idarucizumab for the reversal of dabigatran. We covered the interim analysis of 90 patients included in a prospective cohort study by Pollack et al NEJM 2015 on SGEM#139. Dabigatran is a direct thrombin inhibitor.

Stroke 52

Stroke Administration EMS Wellness 52

ALiEM

MAY 19, 2023

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. Published July 13, 2015. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood right in front of you.

Emergency Department 98

Emergency Department Ultrasounds Wellness EMS 98