RebelEM

MAY 27, 2024

What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy. The unblinded nature of the study could influence outcomes due to observer bias.

Outcomes 137

Outcomes Research Hospitals Operations 137

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. One study suggests remission in 6 out of 7 patients where it was used, but long-term clinical outcomes remained poor.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

Sensible Medicine

JUNE 21, 2024

” I, then a 50-year-old associate professor of medicine, said those words over the phone to a friend late one night in 2017. By 2017, I had started to take a position that was uncomfortable for me, not because I didn’t believe it but because I knew it displeased others. . “I’m nervous. Why was I unsettled?

Academics 72

Academics Research Burns Outcomes 72

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

PulmCCM

FEBRUARY 12, 2024

The Society of Critical Care Medicine (SCCM) expanded its prior 2017 guidance, now recommending strongly that corticosteroids be given for severe community-acquired pneumonia, and also suggesting steroids for patients with acute respiratory distress syndrome (ARDS) and septic shock of any severity.

Shock 52

Shock Administration Sepsis Fractures 52

RebelEM

MAY 25, 2023

Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8% vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

EMDocs

JUNE 1, 2023

Several secondary outcomes suggest a signal toward harm with hypothermia, including incidence of pneumonia, bradycardia, and more days ventilated. Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients with Severe Traumatic Brain Injury: The POLAR Randomized Clinical Trial. Bradycardia: 18.8%

Hyperthermia / Hypothermia 61

Hyperthermia / Hypothermia Outcomes Hospitals Emergency Department 61

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 97

Stroke Fractures Outcomes Operations 97

RebelEM

MAY 29, 2023

What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 66

Sepsis Shock Resuscitation Fluid Resuscitation 66

Mind The Bleep

OCTOBER 17, 2024

BASICS responders have additional skills and can provide pre-hospital emergency care to patients delivering time-critical interventions to improve outcomes. What is a BASICS responder and who can do it? Doctors can volunteer as responders with BASICS Scotland if they have undertaken a Pre-Hospital Emergency Care Course (PHECC).

Ambulance Services 52

Ambulance Services Hospitals Anaphylaxis Wellness 52

Taming the SRU

SEPTEMBER 8, 2023

2017 May;66(5):1047-1081. 2017 Feb;152(3):644-647. 2017 Feb;152(3):644-647. Epub 2017 Jan 2. 2017 May;37(5):473-482. Prognosis of acute severe autoimmune hepatitis (as-AIH): The role of corticosteroids in modifying outcome.” doi: 10.1016/j.jhep.2016.12.003. 2016.12.003. PMID: 28417882. Gastroenterology.

Radiology 59

Radiology Radiology Ultrasounds EMS 59

EB Medicine

APRIL 30, 2017

The podcast is based on the full-length review published in the May 2017 issue of Emergency Medicine Practice. The podcast is based on the full-length review published in the May 2017 issue of Emergency Medicine Practice.

Outcomes 40

Outcomes Best Practices Burns Ultrasounds 40

RebelEM

FEBRUARY 5, 2024

Outcomes: Primary Outcome: Pulmonary expansion 24 hours after the procedure. Secondary Outcomes: Pulmonary expansion 7 days after the procedure. Blinding the outcome assessors to the initial assessment reduces the risk of measurement bias, enhancing the objectivity of the results.

Outcomes 105

Outcomes Hospitals Research Emergency Department 105

ACEP Now

JULY 11, 2024

This medication has limited outcomes data and multiple contraindications. On the other hand, naltrexone and acamprosate are well-tolerated, affordable medications with promising outcomes data for harm reductions and, in some cases, abstinence. Anton RF, O’Malley SS, Ciraulo DA, et al.

Emergency Department 98

Emergency Department Psychiatric Outcomes Wellness 98

RebelEM

AUGUST 14, 2023

days 2 most common sites of infection were lung (44.8%) and inta-abdominal (32.1%) Majority of infections were community-acquired (≈84%) Over half the patients were on mechanical ventilation (≈53%) Primary Outcome Results: 28-day mortality rate: Placebo 26.1% (230/882) vs. XBJ 18.8% (165/878); P<0.001 The risk difference was 7.3% (95% CI, 3.4-11.2)

Sepsis 98

Sepsis Outcomes Administration EMS 98

Cook County EM Blog

MAY 1, 2023

2017 Oct;53(4):475-484. Clinical characteristics and outcomes of septic bursitis.  2017 Dec;45(6):781-786. Blumberg G, Long B, Koyfman A. Clinical mimics: an emergency medicine-focused review of cellulitis mimics.  J Emerg Med. Lieber SB, Fowler ML, Zhu C, Moore A, Shmerling RH, Paz Z. Pritchard RJ, Bodeau H, Bonson P, Borloz M.

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Outcomes 52

SheMD

MAY 11, 2023

In medical emergencies, provider qualities which lead to greater performance and patient outcomes include leadership and teamwork. What were their outcomes: Of the 182 teams analyzed, females contributed significantly less leadership statements (53% vs 76%, p=0.001) and critical treatment decisions (57% vs 76%, p=0.018). Crit Care Med.

Leadership 52

Leadership Documentation/Coding Teamwork CPR 52

Don't Forget the Bubbles

JULY 17, 2023

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases. 2023 Jun Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5-year experience. Paediatr Child Health. Van Rossem EJD, et al.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

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 63

Seizures Administration Anaphylaxis Outcomes 63

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

EMDocs

NOVEMBER 7, 2023

No difference in their primary outcome of complications and need for emergency surgery (1.9% 2017 Jan;104(1):52-61. Outcome measures were complicated diverticulitis, recurrent diverticulitis and sigmoid resection at 24 months’ follow up. Included 480 patients, with primary outcome return visit with hospital admission.

Sepsis 88

Sepsis Best Practices Hospitals Outcomes 88

Don't Forget the Bubbles

NOVEMBER 29, 2023

In studies including patients with trauma or Glasgow Coma Scale less than 8, intubation without sedation led to poorer neurological outcomes. The Impact of Prehospital Intubation with and Without Sedation on Outcome in Trauma Patients With a GCS of 8 or Less. Journal of Neurosurgical Anesthesiology 29(2): p 161-167, April 2017. |

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

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. Published online June 08, 2022.

Hospitals 83

Hospitals Outcomes EKG/ECG Resuscitation 83

Sensible Medicine

JULY 6, 2023

In the CLEAR Outcomes trial, it was found effective in modestly reducing cholesterol and cardiovascular outcomes in statin-intolerant patients. The authors have now published a subanalysis of the main CLEAR Outcomes study. Bempedoic Acid is a cholesterol-lowering drug. Let’s first look at the original trial. placebo vs 11.7%

Outcomes 69

Outcomes Stroke Wellness 69

The Skeptics' Guide to EM

OCTOBER 14, 2023

March 2023 * Population: Children 0-16 years recruited consecutively from October 2017 to September 2020 from three emergency departments and one urgent care centre in England- serving populations with significant inequalities in health and life expectancty. A prospective study. J Paediatr Child Health.

Pediatrics 88

Pediatrics Sepsis Urgent Care Emergency Department 88

The Skeptics' Guide to EM

JULY 8, 2023

Despite these findings, the World Health Organization (WHO), Infection Disease Society of America (IDSA) and the Center for Disease Control and Prevention (CDC) all continue to recommend use of oseltamivir, particularly in patients at increased risk of hospitalization and bad outcomes.

CDC 95

CDC Hospitals EMS Emergency Department 95

The Trauma Pro

MAY 10, 2024

And its correlation with outcomes varies. J Trauma Nursing 24(3):150-157, 2017. The most important one is that it relies only on the Injury Severity Score (ISS) to judge whether some type of mistriage occurred. The ISS is usually calculated after discharge, so it can only be applied after the fact. What is NFTI, Exactly?

Blood Transfusions 147

Blood Transfusions Documentation/Coding Radiology Radiology 147

EMDocs

MAY 9, 2024

judgment vs. negligence” and “causation,” or the likelihood of a better outcome with earlier surgery). The case would last over several years, and with 85-90% of cases that go to trial resulting in a defense verdict, the outcome was unpredictable and risky. Updated: Oct 27, 2017. Medscape eMedicine.

Seizures 81

Seizures Dehydration Documentation/Coding Infectious Diseases 81

Taming the SRU

JULY 3, 2023

2017-3068). 2017-0695) WBC count Absolute neutrophil count Procalcitonin (one model done without procal and one with) They repeated the same model for factors associated with IBI in febrile infants with UTIs. This definition of a positive UA and UTI were based on a prior PECARN study (doi.org/10.1542/peds.2017-3068).

Pediatrics 91

Pediatrics Research Outcomes 91

RebelEM

JANUARY 19, 2023

If aspiration is unsuccessful based on the criteria above → Chest tube is inserted (size 8-14Fr) and admitted to the hospital. Outcomes: Primary Outcome: Total length of hospital stay up to 30 days after randomization, including initial hospital stay and readmissions.

Outcomes 52

Outcomes Hospitals Research EMS 52

EB Medicine

JUNE 20, 2022

Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome. 2017 Nov 21;318(19):1913-1924. Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome. Epub 2021 Mar 23.

Outcomes 52

Outcomes 52

RebelEM

SEPTEMBER 29, 2022

Outcomes: Primary: Progression to moderately severe or severe acute pancreatitis (according to the Revised Atlanta Classification). Secondary outcomes were pre-specified which helps in terms of minimizing bias (i.e. non-statistically significant difference in the primary outcome. to 9.8L) Moderate: 5.5L (Range 4.0

Administration 52

Administration Fluid Resuscitation Resuscitation Outcomes 52

Taming the SRU

MAY 5, 2023

2017, Silversides, Major et al. The CLASSIC trial is a randomized controlled trial conducted in the ICU setting which compared restrictive versus standard fluid strategies with a primary outcome of death by 90 days in patients with septic shock. Safety outcomes Serious adverse event occurrences were similar in both groups.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Pediatric Emergency Playbook

JULY 1, 2020

Central Nervous System Manifestations of Childhood Shigellosis: Prevalence, Risk Factors, and Outcome. 2017 Jul; 96(30): e7641. Pediatrics. 1999 Feb;103(2):E18 Lee JY et al. Diagnostic yield of stool culture and predictive factors for positive culture in patients with diarrheal illness. Medicine (Baltimore). Nelson JD et al.

Poisoning 52

Poisoning Pediatrics Outcomes 52

ACEP Now

OCTOBER 11, 2024

1,2 Clinical outcomes in submersion injuries are largely dependent on the degree of hypoxic injury experienced by the victim, making prehospital care of paramount importance. Pediatric hypothermic submersion injury and protective factors associated with optimal outcome: a case report and literature review. pediatric hospitals.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation 52