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

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 Teamwork CPR 52

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 95

CDC Hospitals EMS Emergency Department 95

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% 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% NEJM 1994. [2] NEJM 1994.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

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

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

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

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

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

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 73

Outcomes Stroke Wellness 73

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

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

SheMD

AUGUST 24, 2023

How they measured things: The study measured the number of female vs male award recipients from published recognition award lists from medical specialty societies in 2017. Similar Articles For further reading on the topic, check out these articles!

Leadership 52

Leadership Academics Outcomes Wellness 52

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 88

Sepsis Best Practices Hospitals Outcomes 88

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 117

Research Psychiatric CDC Best Practices 117

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

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. There were similar baseline characteristics and the groups were well-matched.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

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

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 Outcomes Urgent Care OB/GYN 92

Northwestern EM Blog

SEPTEMBER 26, 2022

It is well-documented that ED physicians have historically high rates of burnout compared to other specialties as well as a high incidence of post-traumatic stress disorder (PTSD) compared to the general population. PTSD is 2 times more prevalent in physicians (14.8%), with EM resident physicians falling in the range from 11.9%-21.5%.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

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

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

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 81

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 81

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 107

CDC Documentation/Coding Research Pediatrics 107

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. Investigators asked a patient-oriented research question.

Outcomes 52

Outcomes Hospitals Research EMS 52

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

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

PEMBlog

MAY 11, 2023

Injectable lidocaine, when done well, is reliable – but it can take years to master the ideal technique that doesn’t create a giant mound of subcutaneous lidocaine that can impact needle entry and landmarks. Epub 2017 Dec 26. Acad Emerg Med. 2018 Mar;25(3):310-316. doi: 10.1111/acem.13351. PMID: 29160002.

Documentation/Coding 52

Documentation/Coding Pediatrics Emergency Department Outcomes 52

RebelEM

DECEMBER 1, 2022

Searched for randomized control trials and cohort studies published up to October 9, 2017, using search terms: pneumothorax, pneumothoraces, thoracentesis, drainage catheter, pigtail catheter, chest tube, and thoracostomy. While clinically relevant and heavily debated, the primary outcome is disease-oriented and not patient-oriented.

Outcomes 52

Outcomes Hospitals Research Critical Access 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

RebelEM

SEPTEMBER 26, 2022

A meta-analysis of fifteen RCTs comparing blood product transfusion rates of cardiothoracic and surgery patients found significantly lower transfusion rates of FFP in TEG/ROTEM guided group compared to traditional tests, with no difference in survival rates (Fahrendorff 2017). Article: Kumar M et al. Significant coagulopathy: INR > 1.8

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

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. However, if the infant is well-perfused, cardiovascularly stable, and showing no signs of organ dysfunction, active treatment may not be necessary.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

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

JANUARY 10, 2024

Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. 3,950 children were recruited between September 2014 to May 2017. Outcomes Primary outcome Mortality at 28 days after randomisation. The authors chose a patient-centred, primary outcome in keeping with their pragmatic design.

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. To reverse these effects as well as refractory hypotension, hydrocortisone is the preferred agent due to both its glucocorticoid and mineralocorticoid properties. 2) Boyd J, Walley K.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52