EMDocs

JANUARY 11, 2025

Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Fecal Impaction and Nonperforated Stercoral Colitis: Red Flags for Poor Outcomes. Pediatric Emergency Care 34(9):p e159-e160, September 2018. | Mathis, K. L., & Lindor, R. link] Chakravartty, S., DOI: 10.1097/PEC.0000000000001600

EMS 94

EMS Sepsis Shock Fluid Resuscitation 94

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 Trauma Pro

OCTOBER 25, 2024

To sum up, both are equally effective in controlling hemorrhage, but the hospital costs for patients undergoing angioembolization are significantly less. The primary outcome was the development of VTE during the hospitalization. DVT was detected using duplex ultrasound, and PE was detected by CT angiography.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

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

Emergency Medicine Journal

OCTOBER 26, 2023

Background Blood transfusion for bleeding trauma patients is a promising pre-hospital intervention with potential to improve outcomes. However, it is not yet clear which patients may benefit from pre-hospital transfusions. Decisions are influenced by experience and are subject to bias.

Blood Transfusions 52

Blood Transfusions Hospitals Outcomes 52

EMDocs

JUNE 1, 2023

Take Aways: The data do not suggest that targeted hypothermia improves neurological function, reduces death, or reduces hospital length of stay as compared to normothermia. 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%

Hyperthermia / Hypothermia 76

Hyperthermia / Hypothermia Outcomes Hospitals Emergency Department 76

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

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

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. Benjamin EJ, et al. Circulation. 2018;137(12). Kimblad H, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

See these 2 articles Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study Author links open overlay panel [link] 1 Background We sought to determine if an association exists between prehospital chest pain severity and markers of myocardial injury.

EKG/ECG 121

EKG/ECG Hospitals Outcomes Wellness 121

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

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

EMDocs

NOVEMBER 7, 2023

No difference in their primary outcome of complications and need for emergency surgery (1.9% The recurrence rate and length of hospital stay were the same. Hospital stay was significantly shorter in the observation group (2 versus 3 days; P = 0·006). 2018 Jul;113(7):1045-1052. 623 patients included. vs. 2.1%).

Sepsis 108

Sepsis Best Practices Hospitals Outcomes 108

Emergency Medicine Journal

FEBRUARY 20, 2024

Background Andexanet alfa was approved in 2018 for reversal of direct oral anticoagulants but due to issues of cost and access, four-factor prothrombin complex concentrate (4F-PCC) continues to be used for this indication. Primary outcome includes rate of mortality/hospice at hospital discharge.

Hospice 74

Hospice Outcomes Hospitals 74

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. Even if we don’t know who the second EP was, he was an agent of the hospital, so the hospital is also liable.

Radiology 93

Radiology Radiology EKG/ECG Documentation/Coding 93

Don't Forget the Bubbles

DECEMBER 25, 2023

Interpreting Research Outcomes with a Little Bathroom Humour You have learned a method for how to read a research paper , and now you are faced with a bunch of outcomes. There are primary, secondary, composite , and safety outcomes. What are these outcomes? We know there is a bias towards reporting positive outcomes.

Research 83

Research Outcomes Fractures Pediatrics 83

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. These poor outcomes are related to both the SRSE itself and as a result of the prolonged PICU stay. N Engl J Med.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

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

PulmCCM

JUNE 26, 2023

Antipsychotics have been overused in hospitalized patients, in and out of ICUs. After the 2018 MIND-USA trial found neither haloperidol nor ziprasidone reduced delirium in the ICU, critical care guidelines advised against their wide use. No outcomes regarding the delirium itself were reported (i.e.,

Outcomes 98

Outcomes Ultrasounds Hospitals Wellness 98

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. They had a difficult time getting a definitive airway pre-hospital. Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome.

Airway Management 52

Airway Management CPR Hyperthermia / Hypothermia Outcomes 52

Sensible Medicine

NOVEMBER 14, 2023

In one scene Shakur asks his friend, played by Roth, to stab him because a knife wound seems to be the only way to get past the emergency room's crowded waiting area and into the hospital. A systematic review of studies from 2013-2018 examined 23 papers that studied residential treatment programs lasting from four weeks to 12 months.

Research 133

Research Psychiatric CDC Best Practices 133

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

[display_podcast] Date: September 21st, 2018 Reference: Kawano et al. Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. display_podcast] Date: September 21st, 2018 Reference: Kawano et al. BLS for out-of-hospital cardiac arrest (OHCA).

Basic Life Support 52

Basic Life Support Airway Management CPR Resuscitation 52

RebelEM

NOVEMBER 20, 2023

Outcome: Primary Outcome: All-cause mortality at 90 days. Patients in the standard care alone group had more intensive care unit-free and hospital-free days. The primary outcome focused on patient-centered outcomes. 97% of patients sustained blunt trauma. No serious adverse device events were reported.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

EMDocs

JUNE 8, 2023

and 9 hours after onset of symptoms, with non-infarcted brain tissue, does the administration of alteplase improve functional outcome at 90 days? and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. Intervention: Alteplase 0.9

Stroke 95

Stroke Administration Documentation/Coding Outcomes 95

Taming the SRU

MARCH 12, 2024

ED visits per 1000 adults with diabetes based on 2018 data resulting in over 500,000 annual hospital days. This amounts to annual hospital costs of $5.1 The study’s primary outcomes were the operational impacts of the SQuID protocol on EDLOS and ICU admission rates.

Operations 97

Operations Hospitals Best Practices Wellness 97

Emergency Medicine Journal

AUGUST 23, 2023

Methods We conducted a before and after, retrospective, observational study using anonymised, routinely collected, patient-level data from a single English NHS ED between April 2018 and December 2019. Conclusion Lifting the 4-hour access standard reporting was associated with a drop in short-stay admissions to the hospital.

Hospitals 73

Hospitals Research Outcomes 73

The Skeptics' Guide to EM

DECEMBER 7, 2018

Date: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. Date: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

The Skeptics' Guide to EM

FEBRUARY 17, 2018

[display_podcast] Date: February 14th, 2018 Reference: Alam N et al. Case: EMS is dispatched to a retirement […] The post SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis. display_podcast] Date: February 14th, 2018 Reference: Alam N et al. The Lancet Nov 2017. per hour (Kumar et al). .

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

The Skeptics' Guide to EM

APRIL 28, 2018

[display_podcast] Date: April 25th, 2018 Reference: Stern A et al, Corticosteroids for pneumonia (Review). display_podcast] Date: April 25th, 2018 Reference: Stern A et al, Corticosteroids for pneumonia (Review). Outcome: * Primary Outcome: All-cause mortality at 30 days after randomization. December 2017. December 2017.

Hospitals 40

Hospitals Emergency Department Outcomes Shock 40

ACEP Now

MARCH 10, 2025

Koo is faculty and an emergency physician at MedStar Washington Hospital Center in Washington, D.C., Marys Hospital in Leonardtown, Maryland. The Experiment ; 2018. Ikigai and subsequent health and wellbeing among Japanese older adults: longitudinal outcome-wide analysis. References Nyanchama V. Published June 13, 2024.

Academics 52

Academics Wellness CPR Hospitals 52

The Skeptics' Guide to EM

FEBRUARY 23, 2019

Association Between Early Intravenous Fluids Provided by Paramedics and Subsequent In-Hospital Mortality Among Patients With Sepsis. JAMA 2018 Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service. This led to a petition requesting the SSC retract their 2018 guidelines ( SGEM Xtra ).

Sepsis 52

Sepsis Administration Documentation/Coding Hospitals 52

The Skeptics' Guide to EM

FEBRUARY 2, 2019

The Lancet 2018. The Lancet 2018. Background: The liberal use of supplemental oxygen therapy in acutely ill adults has a long history in the hospital, but high-quality therapy supporting its practice is unclear. The Lancet 2018. Date: January 28th, 2019 Reference: Chu DK et al. This is Bob’s ninth visit to the SGEM.

Poisoning 52

Poisoning Administration Hospitals Sepsis 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. Finally, most hospitals lack the necessary protocols and processes to coordinate the complex interdisciplinary care patients with RAO may require. Paper: Lema GMC, De Leacy R, Fara MG, et al.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

The Trauma Pro

MAY 10, 2024

And its correlation with outcomes varies. It also standardizes comparisons between hospitals that use STAT. 2018 May;84(5):718-726. The most important one is that it relies only on the Injury Severity Score (ISS) to judge whether some type of mistriage occurred. What is NFTI, Exactly? undertriage (Cribari) reduced to 3.3%

Blood Transfusions 113

Blood Transfusions Radiology Radiology Documentation/Coding 113

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). Furthermore, another small retrospective study found that approximately 30% of patients with CT-diagnosed PTA lacked purulence on drainage attempts (Eliason 2023).

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

EMDocs

JANUARY 16, 2024

He subsequently walks out of the hospital with a normal neurologic exam two weeks after admission. Patients can have excellent outcomes despite prolonged resuscitation. Our patient’s HOPE Score estimated he had a 78% chance of survival to hospital discharge. Resuscitation 2018. Monika BM, Martin D, Balthasar E, et al.

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation CPR EMS 104

The Skeptics' Guide to EM

JULY 30, 2022

AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. She is also the creator of all those wonderful Paper in a Pictures. sensitivity and 96.6%

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52