ACEP Now

JUNE 21, 2023

emergency medicine (EM) residency training length has been a decades-long dilemma: four vs. three years. First, is three years enough time to become an EM physician? But critical questions remain unanswered when it comes to specialization, career trajectory, and actual competence as an EM physician. 11 What should we take away?

EMS 114

EMS Academics Telemedicine Operations 114

EMDocs

APRIL 27, 2024

We’ll keep it short, while you keep that EM brain sharp. However, the bioavailability of antipseudomonal antibiotics has improved outcomes, limiting surgery as a confirmatory diagnostic procedure and as needed for granulation tissue removal. He says the pain is worse at night and when he is chewing. link] Carlton, D. Blanchet, H.,

EMS 102

EMS Infectious Diseases Radiology Radiology 102

Pediatric EM Morsels

JUNE 14, 2024

Tavasoli 2018, Wolf 2012) More common in adults; children comprise 20% of total cases (Pidcock 2007, Wang 2019) Bimodal age distribution (Absoud 2016) Children < 5 years Children > 10 years Symptoms evolve over 2-4 days and peak at 5-6 days (Absoud 2016) ATM may occur alone OR as part of another disorders (e.g. 28,1 (2008): 105-20.

Pediatrics 143

Pediatrics EMS Outcomes 143

EMDocs

NOVEMBER 18, 2023

We’ll keep it short, while you keep that EM brain sharp. Published 2018 Mar 6. Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Sonographic diagnosis and outcome of hepatic artery thrombosis after orthotopic liver transplantation in adults.

EMS 89

EMS Ultrasounds Emergency Department Outcomes 89

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). 2018 Mar;28(3):210-217. That sounds reasonable, so what has changed?

Pediatrics 187

Pediatrics Emergency Department Outcomes Sepsis 187

Pediatric EM Morsels

JUNE 9, 2023

Carneiro de Moura, 2018 ] Seen in 57% of cohort. Banc-Husu, 2023 ; Luoto, 2020; Carneiro de Moura, 2018 ] Basics are best (always)! Banc-Husu, 2023 ; Luoto, 2020; Carneiro de Moura, 2018 ] Basics are best (always)! Long-term Outcomes and Health Perceptions in Pediatric-onset Portal Hypertension Complicated by Varices.

Pediatrics 154

Pediatrics Head Injuries Airway Management Administration 154

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" 25 minutes later, EMS called back with this new ECG: Super obvious STEMI(+) OMI.

EKG/ECG 127

EKG/ECG EMS Outcomes Wellness 127

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Three outcomes were evaluated, with none being deemed the primary outcome. appeared first on REBEL EM - Emergency Medicine Blog. Background: Sepsis remains one of the leading causes of morbidity and mortality.

Sepsis 130

Sepsis Hospitals Administration Outcomes 130

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 139

Administration Outcomes Resuscitation Radiology 139

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 97

Sepsis Outcomes Administration EMS 97

Pediatric EM Morsels

AUGUST 9, 2024

Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306. If not treated early, then increased risk of poor outcomes and death. The post Congenital Syphilis appeared first on Pediatric EM Morsels. Worldwide, congenital syphilis complicates about 1 million pregnancies / year. A case of congenital syphilis.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

RebelEM

SEPTEMBER 7, 2023

OUTCOMES Primary: Occurrence of at least one clinical or electrographic seizure recorded on continuous EEG within 72 hours after inclusion. 0.38, p=0.0021) No statistically significant results were reported in the other clinical outcomes studied. The primary outcome was patient-oriented. OR 0.07, 95% CI 0.01-0.38,

Seizures 123

Seizures Stroke Outcomes Research 123

EMDocs

JUNE 1, 2023

Several secondary outcomes suggest a signal toward harm with hypothermia, including incidence of pneumonia, bradycardia, and more days ventilated. Bradycardia: 18.8% Average ventilator days (8.3 Bradycardia: 18.8% Average ventilator days (8.3 Bradycardia: 18.8% Average ventilator days (8.3 Bradycardia: 18.8% Average ventilator days (8.3

Hyperthermia / Hypothermia 76

Hyperthermia / Hypothermia Outcomes Hospitals Emergency Department 76

RebelEM

JULY 27, 2023

In this group of patients, the use of alteplase poses a fine line of potential benefit (functional outcomes) vs potential harm (symptomatic intracranial hemorrhage). Many patients, however, will have minor strokes (defined as an NIHSS score ≤5). Alteplase: 91.4% Risk Diff: 2.3%; 95% CI -1.5 Alteplase: 0.9% Any Bleeding Events: DAPT: 1.6%

Stroke 98

Stroke Outcomes EMS Hospitals 98

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 133

Stroke Outcomes Hospitals Administration 133

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

[display_podcast] Date: September 21st, 2018 Reference: Kawano et al. Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado. display_podcast] Date: September 21st, 2018 Reference: Kawano et al.

Basic Life Support 52

Basic Life Support Airway Management CPR Resuscitation 52

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. Resuscitation 2018.

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation CPR EMS 104

RebelEM

JANUARY 25, 2024

A 2018 systematic review and meta-analysis of 25 studies focusing on the accuracy of emergency lung ultrasound showed sensitivity of 85-95% and specificity of 75-90% for pneumonia, sensitivity of 78% and specificity of 94% for COPD/asthma, and sensitivity of 75-90% and specificity of 80-90% for acute heart failure [4].

Ultrasounds 125

Ultrasounds Outcomes COPD Hospitals 125

ACEP Now

JULY 7, 2023

2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity. Heart disease and stroke statistics—2018 update: A report from the American Heart Association. Benjamin EJ, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

EMDocs

SEPTEMBER 26, 2024

This story, while unlikely to reflect the standards of most readers, has a somewhat surprising outcome. An attorney is consulted and a lawsuit filed against the hospital, the first ED physician, the EM group, and the PCP. J Am Coll Rad 15:4;639-647, April 1, 2018. What role do discharge instructions play? Baccei SJ et al.

Radiology 93

Radiology Radiology EKG/ECG Documentation/Coding 93

EMDocs

JANUARY 29, 2024

Authors: Sameer Desai, MD (EM Attending Physician, University of Kentucky); Omar Abbas Ahmed Malik, MBBS (Patients’ Aid Foundation, Jinnah Postgraduate Medical Center) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine in St.

Stroke 91

Stroke Outcomes EMS Seizures 91

RebelEM

APRIL 17, 2023

However, in a small retrospective study of 214 patients, investigators found that abscesses >2cm in size were more likely to fail antibiotic treatment (Urban 2018). appeared first on REBEL EM - Emergency Medicine Blog. In some patients, the presence of CT confirmed abscess might not change management.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

The Skeptics' Guide to EM

DECEMBER 7, 2018

Date: December 6th , 2018 Reference: Perkins et al. Date: December 6th , 2018 Reference: Perkins et al. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). There was also no increase in survivors with good neurological outcomes with ACLS.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

The Skeptics' Guide to EM

OCTOBER 31, 2018

[display_podcast] Date: October 30th , 2018 Reference: Raskob GE et al. NEJM 2018 Guest Skeptic: Dr. Anand Swaminathan is an assistant professor of Emergency Medicine at the St. He is a deputy editor for EM: RAP and, associate editor for REBEL EM. […] The post SGEM#235: Edoxaban for Cancer Associated VTE – Would the NEJM Lie to You?

EMS 52

EMS Outcomes Wellness 52

The Skeptics' Guide to EM

MARCH 2, 2019

Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome. Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome. Case: EMS arrive to your emergency department with a 68-year-old man post cardiac arrest patient. JAMA 2018 * Population: Adults who had a non-traumatic OCHA.

Airway Management 52

Airway Management CPR Hyperthermia / Hypothermia Outcomes 52

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. SECONDARY OUTCOMES At day 28 , ceftriaxone group had (vs placebo): Lower VAP risk (20% vs 36%); hazard ratio 0.62 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 111

CDC Radiology Radiology Head Injuries 111

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Outcome: All 4 serial hs troponin I, out to 6 hours, were undetectable. For examples of this phenomenon — See My Comment in the February 14, 2018 — July 21, 2020 — and December 22, 2022 posts in Dr. Smith's ECG Blog ). EMS arrived — and recorded 2 ECGs. 14 minutes later — ECG #2 was recorded by EMS.

EKG/ECG 118

EKG/ECG EMS Stroke Outcomes 118

Taming the SRU

JUNE 11, 2023

Methods This was a prospective observational study enrolling all patients who presented to the ED through the lobby and via EMS. Enrollment period was from February 2016 to August 2018. Study protocol involved investigators measuring EtCO2 of patients arriving via the lobby or EMS. The primary outcome was in-hospital mortality.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

The Skeptics' Guide to EM

JULY 17, 2018

[display_podcast] Date: July 16th, 2018 Reference: Gupta M et al. AEM July 2018 Guest Skeptics: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. display_podcast] Date: July 16th, 2018 Reference: Gupta M et al. AEM July 2018 Guest Skeptics: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia.

Pediatrics 52

Pediatrics Head Injuries Academics Emergency Department 52

RebelEM

AUGUST 22, 2024

hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Outcomes: Primary Outcome: Visual Acuity (VA) Improvement Measured using logarithm of the minimum angle of resolution (logMAR). Within 24 hours after treatment. 1 week after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

RebelEM

NOVEMBER 20, 2023

Outcome: Primary Outcome: All-cause mortality at 90 days. The primary outcome focused on patient-centered outcomes. The outcomes were predominantly binary and objective, reducing the potential for subjective interpretation and bias. 97% of patients sustained blunt trauma.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

The Skeptics' Guide to EM

MAY 15, 2021

Daniel Schwerin is employed with Prisma Health-Upstate as a clinical assistant professor, emergency medicine GME director for emergency medical services and medical director for several local EMS agencies and has lectured on prehospital stroke management. Their local EMS service arrives quickly with a conventional ambulance.

Stroke 52

Stroke EMS Outcomes 52

The Skeptics' Guide to EM

FEBRUARY 23, 2019

JAMA 2018 Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. JAMA 2018 Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. This was updated in 2018 with the 3-hour and 6-hour bundles combined into a single 1-hour bundle.

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

The Skeptics' Guide to EM

AUGUST 14, 2021

Missy is also now the director for Difficult Airway EMS course in Washington State Case: An EMS crew arrives to your emergency department (ED) with a 58-year-old female who suffered a witnessed ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA). Background: We have covered OHCA multiple times on the SGEM.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

The Skeptics' Guide to EM

MARCH 11, 2023

He is a former New York City paramedic and this summer will be starting fellowship training in EMS medicine at UNM. Prehospital Emergency Care 2023 * Population: Adult OHCA patients treated by EMS contained within the ESO database from 2018-2021 who received prehospital iGel or King-LT supraglottic airway insertion.

Airway Management 52

Airway Management Basic Life Support CPR Resuscitation 52

The Skeptics' Guide to EM

JULY 30, 2022

CT is generally the first choice of imaging, the “abdominal series” of plain X-rays have been demonstrated to have poor predictive value, but a 2018 meta-analysis found 92.4% AEM July 2022 * Population: Patients with ICD-10 coding “intestinal obstruction” from 2018 National Hospital Ambulatory Medical Care Survey. sensitivity and 96.6%

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

The Skeptics' Guide to EM

APRIL 21, 2018

[display_podcast] Date: April 12th, 2018 Reference: Ohle R et al. AEM April 2018 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. display_podcast] Date: April 12th, 2018 Reference: Ohle R et al. AEM April 2018 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia.

Emergency Department 52

Emergency Department Academics EKG/ECG Research 52