The Skeptics' Guide to EM

JULY 8, 2023

She looks well enough to go home but asks if she should be prescribed oseltamivir (Tamiflu) because some of her friends have been given it recently by their doctors. Safety issues popped up soon after widespread use of the drug including neuropsychiatric effects as well as the more common adverse effects of nausea and vomiting.

CDC 108

CDC Hospitals EMS Emergency Department 108

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

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. “Well,” my friend advised, “if you’re feeling nervous right now, that is because the thing you are about to do might upset people, and that takes courage.”

Academics 84

Academics Research Burns Outcomes 84

Sensible Medicine

NOVEMBER 14, 2023

Criticism of these programs is both well-deserved and unfair. As of 2017, just 15% of patients admitted to residential programs with opioid use disorder received any of the medications approved by the US Food and Drug Administration for treatment opioid use disorder – this despite the fact that those medicines save lives.

Research 129

Research Psychiatric CDC Best Practices 129

EMDocs

NOVEMBER 7, 2023

Antibiotics are recommended for those with complicated diverticulitis, as well as surgical specialist consult if necessary (e.g., No difference in their primary outcome of complications and need for emergency surgery (1.9% 2017 Jan;104(1):52-61. Included 480 patients, with primary outcome return visit with hospital admission.

Sepsis 113

Sepsis Best Practices Hospitals Outcomes 113

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 89

Seizures Administration Anaphylaxis Outcomes 89

ACEP Now

JULY 11, 2024

The United States Preventive Services Task Force (USPSTF) recommends screening for problem drinking in the primary setting, but we know that patients who present to the ED are twice as likely to engage in dangerous drinking, so arguably the ED is an important venue for screening as well. 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

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 Burns Best Practices Ultrasounds 40

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Heart disease and stroke statistics-2017 update: A report from the American Heart Association.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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 84

Outcomes Stroke Wellness 84

The Skeptics' Guide to EM

SEPTEMBER 16, 2017

[display_podcast] Date: September 12th, 2017 Reference: Sinert et al. J Allergy Clin Immunol Pract 2017. display_podcast] Date: September 12th, 2017 Reference: Sinert et al. J Allergy Clin Immunol Pract 2017. J Allergy Clin Immunol Pract 2017. Reference: Sinert et al.

Anaphylaxis 52

Anaphylaxis Administration EMS Emergency Department 52

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. EmergeNcy Department use of Apneic Oxygenation versus usual care during rapid sequence intubation: A randomized controlled trial (The ENDAO Trial).

Emergency Department 52

Emergency Department Resuscitation Operations EMS 52

EMDocs

AUGUST 22, 2024

Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Certified interpreter use can improve communication and patient outcomes. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter.

Documentation/Coding 104

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 104

Sensible Medicine

AUGUST 7, 2024

There is evidence that, for children and adults, elevated cortisol levels and chronic stress can lead to behavioral, mental-health, and mood issues, as well as changes in inflammation and immunity. A 2017 paper found that 49.6% Sleep affects learning, memory formation, and physical growth. times a day, and only 24.1%

CDC 114

CDC Documentation/Coding Research Pediatrics 114

Don't Forget the Bubbles

NOVEMBER 27, 2023

And lastly, it’s actually quite hard to see how well the cardiovascular system is working, and this is one of its measurable features. This works well for a while, but eventually, the heart beats too fast to fill adequately. It’s only a piece of the puzzle, though. The next element of stroke volume is the emptying. link] Roland D.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

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

Northwestern EM Blog

APRIL 15, 2024

“Tracheostomy: Epidemiology, Indications, Timing, Technique, and Outcomes.” Tracheotomy outcomes and complications: a national perspective. Tracheotomy outcomes and complications: a national perspective. Critical care nursing clinics of North America 29 2 (2017): 251-258. Respiratory Care 59 (2014): 895 - 919.

Emergency Department 98

Emergency Department Resuscitation Pediatrics Outcomes 98

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

The Skeptics' Guide to EM

JANUARY 20, 2018

BMJ 2017 Guest Skeptic: Meghan Groth is an Emergency Medicine Pharmacist at the UMass Memorial Medical Center in Worcester, Massachusetts. BMJ 2017 Guest Skeptic: Meghan Groth is an Emergency Medicine Pharmacist at the UMass Memorial Medical Center in Worcester, Massachusetts. Reference: Sadeghirad B, et al.

Academics 52

Academics Emergency Department EMS Administration 52

SheMD

MAY 11, 2023

In medical emergencies, provider qualities which lead to greater performance and patient outcomes include leadership and teamwork. Transcripts were coded to sort data into “leadership occurrences” or “unrelated to leadership” as well as critical treatment decisions. 2017; 177(2): 206- 213. [link] ,Why is this article important?

Leadership 52

Leadership Documentation/Coding CPR Teamwork 52

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

SEPTEMBER 29, 2022

Outcomes: Primary: Progression to moderately severe or severe acute pancreatitis (according to the Revised Atlanta Classification). Baseline disease severity was well-balanced between groups. Secondary outcomes were pre-specified which helps in terms of minimizing bias (i.e. Median Fluid Received: Aggressive: 7.8L (Range 6.5

Administration 52

Administration Fluid Resuscitation Resuscitation Outcomes 52

Dr. Smith's ECG Blog

AUGUST 14, 2024

Similar to the prognostic implications of Mobitz I AV block — SA Wenckebach is not necessarily pathologic, and not necessarily associated with adverse outcome. In contrast — true Type II SA Exit Block ( like the Mobitz II form of AV block ) — is much more likely to be associated with adverse outcome and potential need for cardiac pacing. (

EKG/ECG 110

EKG/ECG Outcomes Wellness 110

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

There is some upwards concave ST segment elevation in the inferior leads with what seems to be well formed J-waves. maybe not seen well on these echo-loops) The CW doppler at the tricuspid valve showed a maximum TR velocity of 2,55m/s with a TRP gradient of 26mmHg. 21, 2017 ). Not much difference from 1st ECG. The RV > LV.

EKG/ECG 116

EKG/ECG COPD Shock Wellness 116

EMDocs

SEPTEMBER 7, 2023

DGA concentrates in the kidney tissue and causes nephrotoxicity, as well as neurotoxicity. Elimination half-life data is not well established but increases in larger overdoses and as renal injury begins to occur. Long-Term Renal and Neurologic Outcomes among Survivors of Diethylene Glycol Poisoning.” 1, 2010, pp. JAMA , vol.

Poisoning 92

Poisoning CDC Administration Emergency Department 92

Don't Forget the Bubbles

OCTOBER 23, 2023

It is well worth looking at videos of spasms to familiarise yourself with the potential presentation – look at the awareness video at the end of this blog. The ICISS study in 2017 showed dual therapy to be more effective at stopping spasms than steroids or Vigabatrin alone. Babies cannot be distracted during the episode.

Seizures 75

Seizures Outcomes Wellness 75

Cook County EM Blog

MAY 1, 2023

Findings suggestive of septic bursitis include complex fluid in the bursa with septations (as seen in this case), as well as hyperemia on color flow doppler or gas. 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. J Emerg Med.

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Outcomes 52

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. This is also based on where you live and what resources are already available, as well as how you get on with your PHECC. What is a BASICS responder and who can do it?

Ambulance Services 52

Ambulance Services Hospitals Anaphylaxis Wellness 52

Dr. Smith's ECG Blog

OCTOBER 18, 2023

1-3] But these studies were very short duration and used cardiology interpretation of ECGs or emergent angiography rather than patient outcomes. 2017 ; 24 ( 1 ): 120 - 124 2. Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. Hughes KE , Lewis SM , Katz L , Jones J. Acad Emerg Med.

EKG/ECG 119

EKG/ECG Documentation/Coding Emergency Department Outcomes 119

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. doi:10.1155/2017/6014967 Light RW. Published 2017 Sep 7. Persistent air-leak in spontaneous pneumothorax--clinical course and outcome. Respir Med.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Mount Sinai EM

OCTOBER 11, 2024

2017 of three RCTS totaling 153 patients (unable to pool given heterogeneity) administered adjuvant steroids after PTA drainage, showed statistically significant improvement in body temperature in all three RCTs. There was significant heterogeneity among studies and outcomes were not measured consistently. And there you have it!

Ultrasounds 100

Ultrasounds Wellness Outcomes Hospitals 100

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

EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). 2017 Dec;10(1):1. Epub 2017 Jan 25. Int J Emerg Med. doi: 10.1186/s12245-017-0129-8.

Emergency Department 92

Emergency Department Soft Tissue Injuries Airway Management Operations 92

ALiEM

OCTOBER 30, 2024

The Wounds Common among patients who use xylazine, the necrotic and exudative wounds are still not fully understood [5-8], but are likely due in part to direct cytotoxic effects of the drug and its impurities, as well as possible nutritional deficiencies common in those with dependence. 2017 Jun;32:660-6.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

Dr. Smith's ECG Blog

MARCH 10, 2017

Years later, I sent this to the Queen of Hearts: The Queen can see Hyperacute T-waves incredibly well. Acad Emerg Med 2017; 24(1): 120 – 24. Comment : Had we not seen those subtle hyperacute T-waves, and then sought out the prehospital ECG, the patient would have ruled out, with one of three outcomes: 1. link] Hughes KE et al.

EKG/ECG 52

EKG/ECG Outcomes EMS Wellness 52

The Injectable Orange

JUNE 20, 2017

While well evaluated, you see the residents go back to the shop floor and struggle to apply any of the lessons that the group agreed had been take homes from the previous sim session. Hicks (2017). How do they do it so well?” Simulcast Journal Club Podcast March 2017 [link] Breakout Group 3 – Debriefing. Well done”…….

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52