The Skeptics' Guide to EM

DECEMBER 16, 2017

[display_podcast] Date: November 27th, 2017 Reference: Legriel et al. display_podcast] Date: November 27th, 2017 Reference: Legriel et al. There was no statistical difference in the primary outcome between 33C vs. 36C ( SGEM#82 ). Hypothermia for Neuroprotection in Convulsive Status Epilepticus. Reference: Legriel et al.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. MI or stroke).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Pediatric Education

JULY 23, 2023

In adults, cryptogenic stroke is a current indication for treatment of an identified PFO. Adults with a cryotogenic stroke are more likely to have a PFO (up to 40-50%), and a 2017 New England Journal of Medicine study found that interventional closure of adult PFO decreased recurrent ischemic strokes. N Engl J Med.

Stroke 40

Stroke Pediatrics Outcomes Hospitals 40

PulmCCM

JANUARY 24, 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 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

Don't Forget the Bubbles

FEBRUARY 5, 2025

There is significant evidence in adults and developing in the paediatric population that TXA results in better outcomes if given early in patients with mild to moderate traumatic brain injury (TBI) and does not cause harm. Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

EMDocs

MAY 11, 2024

Answer : Brainstem stroke specifically in the pons resulting in locked in syndrome. CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis?

Stroke 101

Stroke EMS EKG/ECG Radiology 101

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. The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EB Medicine

SEPTEMBER 1, 2018

Both are at the University of Florida Jacksonville, and they reviewed a total of 120 articles from 2006-2017, in addition to reviews from both Cochrane and Dare. Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them. Nachi: Let’s move on to diagnostic studies.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EMDocs

OCTOBER 21, 2023

Answer : Basilar Artery Occlusion Epidemiology:  Basilar artery occlusion (BAO) is a subset of the posterior circulation strokes. Posterior circulation strokes are estimated to account for 20% of all strokes, with BAO accounting for ~1% of all strokes. Symptoms may range from days to months prior to stroke onset.

EMS 86

EMS Stroke Outcomes Hospitals 86

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

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

Don't Forget the Bubbles

AUGUST 21, 2023

Stimulation of baroreceptors results in a catecholamine-mediated increase in heart rate , stroke volume, contractility, and systemic vascular resistance (SVR). What are the long-term outcomes for children with dilated cardiomyopathy? Outcomes at 1 year seem to be influenced by the severity of illness at presentation.

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

EMDocs

JULY 3, 2023

National Institutes of Health Stroke Scale (NIHSS) is 13; vital signs include pulse 86 beats/minute (bpm), blood pressure 164/94 mmHg, and saturation of 98% on room air. Introduction SAH has the potential for rapid progression and devastating outcomes. Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage.

Seizures 95

Seizures Stroke Outcomes EMS 95

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Don't Forget the Bubbles

NOVEMBER 18, 2024

Research and guidelines from Australian centres, like those published by the Australian and New Zealand Neonatal Network (ANZNN), emphasize early detection and management to improve outcomes. CO = SV x HR SV is Stroke Volume (the amount of blood ejected with each heartbeat). After any stressful situation, don’t forget to debrief.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

The Skeptics' Guide to EM

APRIL 3, 2021

mg/kg) was beneficial for unknown onset stroke above a certain core size. Stroke 2021 Case: A 74-year-old man presents to the emergency department after waking up with left sided weakness. Background: We have talked about stroke management a number of times recently including SGEM#297 on the reanalysis of ECASS-3 by Alper et al 2020.

Stroke 52

Stroke Research Outcomes Hospitals 52

PulmCCM

FEBRUARY 26, 2024

Tenecteplase for acute ischemic stroke presenting after 4.5 Because it can be infused more rapidly than alteplase, TNK is gaining prominence as thrombolytic treatment for acute ischemic stroke, in patients presenting within 4.5 hours post-stroke, but those trials were conducted before mechanical thrombectomy (performed a.s.a.p.

Stroke 40

Stroke Psychiatric CDC Hospitals 40

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 88

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

EB Medicine

MAY 3, 2019

Jeff: And finally, how many of you wish there was a clearly outlined evidence-based approach to managing such patients to improve care and outcomes? Jeff: a 2017 ACEP clinical policy also recommends against routine lab testing in those with acute psychiatric complaints. Nachi: That would certainly be helpful.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

Taming the SRU

MAY 3, 2023

Furthermore, these rapid changes in pulmonary vascular resistance can lead to significant reduction in RV stroke volume and subsequent RV dilation & tricuspid regurgitation (16). 2017 conducted a systematic review of two randomized control trials (7,20,21).

Wellness 52

Wellness Hospitals Shock Outcomes 52

EMDocs

DECEMBER 16, 2023

Both can result in heat exhaustion and heat stroke and have many overlapping symptoms. Patients with heat stroke have hot, dry skin and altered mental status (e.g., C, and heat stroke occurs at a core temperature > 40°C. C, and heat stroke occurs at a core temperature > 40°C. Temps greater than 41.5C Bendall, J.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia EMS Stroke Seizures 80

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. “Time is brain” urges us to think about thrombolysis or clot retrieval in acute strokes. Frontiers in Pediatrics , 8 , p.601892. MacDonald, C.,

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

RebelEM

FEBRUARY 22, 2024

Background : Concurrent anemia worsens outcomes in patients that present with acute myocardial infarctions. The Myocardial Ischemia and Transfusion (MINT) trial is the largest study to date examining the impact of a liberal versus restrictive transfusion strategy on outcomes in this patient population. Paper : Carson JL, et al.

Blood Transfusions 58

Blood Transfusions Outcomes Wellness Research 58

EMDocs

NOVEMBER 4, 2024

million patient complaints in 2017, making it the second most common ED complaint. 80 It can be caused by traumatic nerve, spinal cord, or brain injury (including stroke) or can be a sequela of conditions like diabetes, HIV/AIDS, postherpetic neuropathies, multiple sclerosis, cancer, or chemotherapies. Am J Emerg Med. Epub 2021 Jan 2.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

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% 8 The data in Mayer et al.

Stroke 98

Stroke Radiology Radiology Emergency Department 98

Pediatric EM Morsels

NOVEMBER 15, 2024

There are associated co-morbiditiested [Lee 2017, Steinrueke 2023] BECTS Seizures / Benign Rolandic Epilepsy- Moral of the Morsel It’s not a stroke, it’s a seizure. Symptoms can be unilateral and involve the face and tongue, but it’s not a stroke! 2017 Jun 30;7(1):1-6. Available from: [link] Lee YJ, Hwang SK, Kwon S.

Seizures 152

Seizures Stroke Pediatrics Wellness 152

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

PulmCCM

FEBRUARY 3, 2025

Patients with oxygen-starved tissues (during strokes, myocardial infarction, sepsis) have been hypothesized (but never shown) to benefit from higher oxygen delivery. and MEGA-ROX (based in Australia), are enrolling many patients with many various illnesses (strokes, cardiac arrest, sepsis, etc.)

Sepsis 52

Sepsis Stroke Outcomes Hospitals 52