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 99

Ultrasounds Operations Radiology Radiology 99

RebelEM

NOVEMBER 6, 2023

Methylene Blue for Vasoplegic Syndrome After Cardiac Operation: Early Administration Improves Survival. Epub 2017 May 24. J Cardiothorac Vasc Anesth. 2023 Jul 19. Epub ahead of print. PMID: 37586951 Mehaffey JH, et al. Ann Thorac Surg. PMID: 28551045 Bak MA, et al. 2022 Aug 22.

Shock 71

Shock Administration Academics Hospitals 71

The Skeptics' Guide to EM

FEBRUARY 2, 2018

AEM Dec 2017. AEM Dec 2017. Might his examination be enough to convince the urologists to take him straight to the operating room without a preceding diagnostic ultrasound? AEM Dec 2017. [display_podcast] Date: January 31st, 2018 Reference: Frohlich LC, et al. Your index of suspicion for testicular torsion is high.

Pediatrics 40

Pediatrics Ultrasounds Emergency Department Research 40

Don't Forget the Bubbles

MARCH 4, 2024

This study retrospectively identified 1,414 children, presenting to 15 UK EDs (2016 -2017), who had been screened for malaria. This was a secondary outcome embedded in the Travel Fever study – a multi-centre, retrospective diagnostic accuracy study for imported malaria. Emerg Med J. 2024 Jan 22;41(2):76-82. PMID: 38123983.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

ACEP Now

NOVEMBER 16, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes, including successful development of a niche in the specialty. 11 What Should We Take Away?

Academics 52

Academics EMS Telemedicine Research 52

RebelEM

NOVEMBER 3, 2022

In 2017, a single-centered, retrospective study found a lower incidence of clinical hypotension with ketamine compared to etomidate following endotracheal intubation in septic patients. ( Van Berkel 2017) In 2020 the NEAR study reported peri-intubation hypotension rates of 18.3% in the ketamine cohort compared to 12.4%

Emergency Department 52

Emergency Department Outcomes Sepsis Operations 52

Taming the SRU

AUGUST 30, 2023

A 2017 review in the American Journal of Emergency Medicine reiterates that no single inflammatory markers (including CRP, ESR, and PCT) can be used as a stand-alone test to confirm or exclude infection, but instead advocates for using the tests as adjunctive information for emergency physicians to shape their pre-test probability of infection [26].

Infectious Diseases 90

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 90

EB Medicine

JULY 8, 2019

Nachi: Taken all together, the rising rates of obesity and the rising success and availability of bariatric procedures has led to an increased number of bariatric procedures, with 228,000 performed in the US in 2017. In 2017, these were performed 60%, 18%, and 3% of the time. Patients present with abd pain, n/v, and peritonitis.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 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 97

EMS Dislocations Fractures Operations 97

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 98

Stroke Fractures Operations Outcomes 98

Medagadget

AUGUST 4, 2023

This leads to suboptimal outcomes, and the frequent need to repeat the biopsy procedure because the first attempt did not yield an adequate sample. In fact, since 2017, the prevalence of uterine cancer amongst African American women has increased 8% year-over-year and 5-6% in Hispanic women. A positive result is generally correct.

Operations 92

Operations Urgent Care Outcomes OB/GYN 92

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 90

Emergency Department Soft Tissue Injuries Airway Management Operations 90

EMDocs

OCTOBER 17, 2023

Systematic review found increasing age, diffuse rather than localized abdominal pain, guarding or pain with rebound, initial episode of diverticulitis, steroid use, fever, constipation and vomiting, elevated CRP, and elevated WBC count were associated with greater risk of complication such as abscess or perforation (Bolkenstein 2017).

Radiology 93

Radiology Radiology Operations Best Practices 93

Don't Forget the Bubbles

NOVEMBER 29, 2023

Awake fiberoptic intubation where the patient consents, co-operative AND the airway is prepared with local anaesthesia. In studies including patients with trauma or Glasgow Coma Scale less than 8, intubation without sedation led to poorer neurological outcomes. Journal of Neurosurgical Anesthesiology 29(2): p 161-167, April 2017. |

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

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

EMDocs

JULY 17, 2023

7 While post-operative adhesive disease is also a risk factor, it is far less commonly implicated in LBO compared to SBO. Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients. World J Gastroenterol. 2018;13:36.

Operations 97

Operations EMS Fluid Resuscitation Resuscitation 97

The Skeptics' Guide to EM

SEPTEMBER 3, 2017

[display_podcast] Date: September 2nd, 2017 Reference: Caputo et al. display_podcast] Date: September 2nd, 2017 Reference: Caputo et al. There have been some studies in various clinical settings (operating room, critical care and pre-hospital) that have demonstration benefit of apneic oxygenation. Reference: Caputo et al.

Emergency Department 52

Emergency Department Resuscitation Operations EMS 52

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 92

OB/GYN Operations EMS Ultrasounds 92

The Skeptics' Guide to EM

JUNE 4, 2017

[display_podcast] Date: June 3rd, 2017 Reference: Sierink et al. display_podcast] Date: June 3rd, 2017 Reference: Sierink et al. Immediate total-body CT scanning versus conventional imaging and selective CT scanning in patients with severe trauma (REACT-2): a randomised controlled trial. Lancet August 2016. Reference: Sierink et al.

Radiology 52

Radiology Radiology CPR Hospitals 52

Don't Forget the Bubbles

MAY 10, 2023

Then the patient is rapidly moved to the operating theatre. 2017; 55(5); 449-453. The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre. Communication is closed-loop. with a shared collective mindset. Green B, Oeppen S, Smith W, Brennan P. Andenæs, E.,

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

Don't Forget the Bubbles

JULY 26, 2023

Upside-down position for the out of hospital management of children with SVT, Bronzetti et al, International Journal of Cardiology 2017 this showed that a modified position (upside down) improved cardioversion rates from 33% to 67%. This has been trialled (out of hospital) in known children with SVT.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

PulmCCM

FEBRUARY 28, 2022

What they did Adult patients admitted to one of 53 intensive care units in New Zealand or Australia between September 2017 and December 2020 were eligible. Death, from any cause, within 90 days of randomization was the primary outcome. The analysis was performed as an intention-to-treat.

Fluid Resuscitation 40

Fluid Resuscitation Resuscitation Outcomes Sepsis 40

Dr. Smith's ECG Blog

NOVEMBER 24, 2017

However, none of the formulas have proven to be definitively better than another and none are well correlated with outcomes or events! None is considered definitive due to the paucity of data (and conflicting data) relating QTc to outcomes. Heart 2002;87:220228 This 2017 article by Vandenberk B et al. This study by Patel et al.

EKG/ECG 52

EKG/ECG Outcomes Wellness Hospitals 52

EB Medicine

JUNE 6, 2019

Nachi: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic. For patients with suspected ruptured AAA, torsion, or mesenteric ischemia - the disposition is easy - they need immediate surgical consultation and likely operative intervention. 2nd edition.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EMDocs

NOVEMBER 4, 2024

million patient complaints in 2017, making it the second most common ED complaint. A comprehensive, patient-centered approach to pain management ensures effective treatment across these diverse pain syndromes, ultimately improving patient outcomes. Cause and outcome of atypical chest pain in patients admitted to hospital.

Emergency Department 106

Emergency Department Fractures Burns EMS 106

Don't Forget the Bubbles

FEBRUARY 7, 2024

This week, NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) produced a much-anticipated report on how we manage acute testicular torsion in young people. One systematic review of 1283 patients showed that if you got to the operating room within 6 hours, you had a 97% chance of saving the testicle. MacDonald, C.,

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

EMDocs

JUNE 3, 2023

For a broader overview of pelvic trauma, please review Dr. Lupez’s 2017 article here: [link]. This is less critical in ED management of the unstable pelvic fracture, as the optimal site for identification of rectal or vaginal tears is the operating room. 2 Vertical shear fractures are also unstable.

Fractures 63

Fractures Resuscitation Operations EMS 63

Dr. Smith's ECG Blog

APRIL 8, 2015

Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. These premonitory symptoms were negative predictors of adverse outcomes in EGSYS. Abnormal ECG – looks for cardiac syncope. Hemoglobin less than 10 (SF rule) 6. Syncope with Exertion (EGSYS) 7. S yncope while supine (EGSYS) 8.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EB Medicine

JANUARY 2, 2019

Nachi: This month’s issue was authored by Dr. Ryan Pedigo, you may remember him from the June 2017 episode on dental emergencies, though he is perhaps better known as the director of undergraduate medical education at Harbor-UCLA Medical center. This result was for the most part re-confirmed in a 2017 cochrane review.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 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 105

Stroke Radiology Radiology Emergency Department 105

Dr. Smith's ECG Blog

FEBRUARY 10, 2025

Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving Global Outcomes conference. West J Emerg Med 2017. The vicious cycle of "BRASH" Syndrome is operative. Eur J Emerg Med 2020. Durfey et al. Severe hyperkalemia: can the electrocardiogram risk stratify for short-term adverse events.

EKG/ECG 117

EKG/ECG Shock Operations Emergency Department 117

Mind The Bleep

JANUARY 24, 2025

7) Allergies Social History Hand dominance Profession and hobbies Could influence the operation performed in cases where the restoration of hand function is vitally important e.g. in musicians; or where speed of recovery and need to return to work take precedence. Epidemiology and outcome of vascular trauma at a British Major Trauma Centre.

Dislocations 52

Dislocations Fractures Soft Tissue Injuries Infectious Diseases 52

PulmCCM

MARCH 7, 2025

Any self-respecting surgeon or anesthesiologist will tell you that patients undergoing surgery before the weekend receive just as high a quality of care as those operated on earlier in the week. More Weekend Worries An even larger study a decade earlier had raised concerns for worse outcomes occurring after Friday surgeries.

Outcomes 116

Outcomes Hospitals Operations Radiology 116

Don't Forget the Bubbles

MARCH 21, 2025

set out to explore in the Kids THRIVE study investigating whether NHF apnoeic oxygenation could improve intubation outcomes in critically unwell children needing emergency airway management. Secondary outcomes There were no differences between groups in any of the secondary outcomes. Thats exactly what Shane George et al.

Outcomes 108

Outcomes Operations Airway Management Hospitals 108

EMDocs

JANUARY 16, 2025

Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. but PPV ranges from 25.1-39.5% years Internal validation cohort: 43,400 patients with mean age 3.7 years External validation cohort: 45,855 patients with mean age 2.6 0.38 (95% CI 0.20-0.39) 0.39) AUROC of 0.71-0.92

Sepsis 94

Sepsis Pediatrics Shock Hospitals 94

ACEP Now

FEBRUARY 11, 2025

Recent proposals by Centers for Medicare and Medicaid Services (CMS) to further decrease Medicare reimbursements threaten the financial and operational capacity of emergency medicine. This can lengthen ED wait times, delay critical interventions, and potentially worsen health outcomes, especially among vulnerable populations.

Hospitals 80

Hospitals Emergency Department Wellness Outcomes 80

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. Pediatr Allergy, Immunol Pulmonol 2017; 30: 191–201. Anemia ; 2015.DOI:10.1155/2015/791498.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126