Taming the SRU

MARCH 12, 2024

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. ED visits per 1000 adults with diabetes based on 2018 data resulting in over 500,000 annual hospital days. 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

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

JUNE 21, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes including successful development of a niche in the specialty. 11 What should we take away?

EMS 114

EMS Academics Telemedicine Operations 114

RebelEM

NOVEMBER 20, 2023

Comparator: The control group received standard care provided at a major trauma center, including intubation, blood product transfusion, interventions like tourniquet application, and early operative or endovascular hemorrhage control. Outcome: Primary Outcome: All-cause mortality at 90 days.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes. These procedures require an experienced operator.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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. Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Documented at the following time points: Before treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

The Skeptics' Guide to EM

JULY 30, 2022

Background: Somewhere between two and four percent of patients presenting to US EDs with abdominal pain have a small bowel obstruction (SBO) – those who are managed operatively (who are only 20-30%) account for 60,000 hospitalizations and 565,000 inpatient care days per year. sensitivity and 96.6% specificity with ultrasound [1].

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

Don't Forget the Bubbles

JUNE 17, 2024

High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. At its heart lies an unpleasant reality- a critically unwell child with an anxious carer hoping for a positive outcome. John Wiley & Sons, 2018 Edward KL, Ousey K, Warelow P, Lui S. Australian Health Review. Edmondson, Amy C.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Taming the SRU

OCTOBER 23, 2023

At this point, the patient is taken to the operating room for a diagnostic laparoscopy. Discrimination between an IUP and an interstitial pregnancy is critical as interstitial pregnancies can have devastating outcomes. She was taken to the operating room and found to have a right tubal ectopic pregnancy with a pseudogestational sac.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

The Skeptics' Guide to EM

MAY 11, 2019

JAMA Surgery 2018 Guest Skeptic: Dr. Robert Leeper is an assistant professor of surgery at Western University and the London Health Sciences Centre. J AMA Surgery 2018 Guest Skeptic: Dr. Robert Leeper is an assistant professor of surgery at Western University and the London Health Sciences Centre. Reference: Sceats et al.

Documentation/Coding 40

Documentation/Coding Operations Academics Ultrasounds 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Methods This multicentre randomised controlled trial was undertaken between December 2018 and July 2020 in the ED of four hospitals in the Netherlands. The primary outcome was the proportion of patients requiring more than one reduction attempt.

Fractures 40

Fractures Ultrasounds Emergency Department Operations 40

Taming the SRU

JUNE 11, 2023

Utilized in the pre-hospital setting, ICU and the Operating Room, it is a non-invasive measurement that reflects a patient’s current state of metabolism, circulation and ventilation. Enrollment period was from February 2016 to August 2018. The primary outcome was in-hospital mortality.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

Don't Forget the Bubbles

JULY 26, 2023

Cardiac testing and outcomes in infants after an ALTE, Hoki et al, Archives of Disease in Childhood 2012 showed significant cardiac disease was present in <1% of patients presenting with ALTE (although cardiac abnormalities were found in 4% overall). How might these present in a less catastrophic way to the ED?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

The Skeptics' Guide to EM

APRIL 16, 2022

Before we answer that question, let’s remind everyone that only a small number (2.8%) of interventions published in SRMA and relevant to emergency medicine have unbiased and strong evidence for improved outcomes ( SGEM#361 ). The level of high-quality evidence had not changed much when looking at the ACC/AHA guidelines from 2008-2018.

Military 40

Military Operations Emergency Department Pediatrics 40

ACEP Now

MAY 9, 2024

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon. These questionable practices led to a rash of bad outcomes.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Emergency Medicine Ireland

FEBRUARY 8, 2021

SBS is not a common thing to find in the ICU and the most likely context here is going to be receiving someone from the operating theatre who has had. Lengths are not particularly useful in predicting outcomes but having <180cm puts you at risk and <100 cm means you’re almost undoubtedly in trouble. Epub 2018 Aug 18.

Operations 40

Operations Outcomes 40

The Skeptics' Guide to EM

FEBRUARY 2, 2018

[display_podcast] Date: January 31st, 2018 Reference: Frohlich LC, et al. display_podcast] Date: January 31st, 2018 Reference: Frohlich LC, et al. Might his examination be enough to convince the urologists to take him straight to the operating room without a preceding diagnostic ultrasound? AEM Dec 2017. AEM Dec 2017.

Pediatrics 40

Pediatrics Ultrasounds Emergency Department Research 40

PulmCCM

APRIL 1, 2024

Physical therapy is probably under-provided to critically ill patients, and improving this might improve outcomes for many. That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

ACEP Now

NOVEMBER 16, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes, including successful development of a niche in the specialty. 11 What Should We Take Away?

Academics 52

Academics EMS Telemedicine Research 52

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. 2018 Aug 1;10(8):a028456. Epub 2018 Oct 19. ng/mL (strongly recommended against antibiotics), 0.1-0.25

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

EMDocs

NOVEMBER 18, 2023

Liver Transplantation: Operative Techniques and Medical Management. 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

ALiEM

OCTOBER 30, 2023

The same goes for clinical operations and research – interesting, but there hasn’t been any “a ha” moment to illuminate her calling. 2018; 10(2):227-228. 2018 May;19(3):619-629. Garcia finds herself at a bit of a crossroad. She likes teaching, but are not sure residency or medical student education leadership is for her.

Academics 64

Academics Leadership Wellness Research 64

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. 12) Axillary While axillary arterial line placement has been uncommon, in the age of facile ultrasound operators it may become a more advantageous and accessible site particularly in patients with high BMIs. 2018 Mar;19(2):364-371.

Shock 59

Shock Resuscitation Ultrasounds Research 59

EMDocs

NOVEMBER 16, 2024

4 Pain is the most common reason for presentation in the early post operative period. 5 Highest risk of dislocation early in the post operative course due to laxity of the soft tissue after surgery. 6 Hip flexion or adduction in the early post-operative period can cause atraumatic dislocations (typically avoided for 6 weeks post-op).

EMS 94

EMS Dislocations Fractures Operations 94

EB Medicine

JUNE 6, 2019

Nachi: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic. A 2018 study involving 288 women 14-20 years old found that the pelvic didn’t increase sensitivity or specificity of diagnosis of chlamydia, gonorrhea, or trichomoniasis when compared with history alone.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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. One systematic review of 1283 patients showed that if you got to the operating room within 6 hours, you had a 97% chance of saving the testicle. Bandarkar, A.N.

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

EMDocs

OCTOBER 17, 2023

A 2018 risk score incorporates the presence of abdominal guarding, WBC, and CRP. Those with abdominal guarding, WBC over 20,000, and CRP over 25 mg/dL demonstrated a risk of complicated diverticulitis of over 85% (Bolkenstein 2018). Limitations: operator dependent, may be inconclusive, is not reliable for diagnosing complications.

Radiology 87

Radiology Radiology Operations Best Practices 87

EMDocs

JULY 17, 2023

7 While post-operative adhesive disease is also a risk factor, it is far less commonly implicated in LBO compared to SBO. Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients. Published 2018 Aug 13.

Operations 95

Operations EMS Fluid Resuscitation Resuscitation 95

EMDocs

JUNE 21, 2023

Functional outcomes Severe soft tissue injuries and damage to the bony structures => poor functional outcomes. Common operator errors Failing to enter joint capsule before injecting STS. 2018 Jun;39(6):736-740. 2018 Jun;39(6):736-740. You can range the joint which may help you see fluid extruding.

Soft Tissue Injuries 88

Soft Tissue Injuries Fractures Dislocations Radiology 88

EMDocs

JUNE 3, 2023

4 This is the framework the ED resuscitationist should be operating under, as hemodynamically unstable pelvic trauma patients require a different approach compared to stable patients who will undergo CT, routine pelvic fixation, and definitive surgical repair. An x-ray in the trauma bay demonstrated an AP grade III fracture.

Fractures 60

Fractures Resuscitation Operations EMS 60

The Skeptics' Guide to EM

MARCH 5, 2022

The level of high-quality evidence had not changed much when looking at the ACC/AHA guidelines from 2008-2018. The comparison was the clinical efficacy of the most common orthopaedic procedures with no treatment, placebo, or non-operative care. The primary outcome was the quality of the evidence for each procedure.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Research Pediatrics Outcomes 40

RebelEM

DECEMBER 19, 2022

While many healthcare systems across the world operate in a similar fashion, the United States does not. Within the United States, due to paramedic shortages, this dual-medic setup does not exist in many EMS systems.

EMS 52

EMS CPR Shock Resuscitation 52

EB Medicine

AUGUST 1, 2018

I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the August 2018 issue of Emergency Medicine Practice. Nachi: To attain the most up to date information for this article, Dr. Williams searched the PubMed and Cochrane Databases from 1950 to 2018. Jeff: Let’s get started with the pathophysiology.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

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% vs. 38.1%) with a good functional outcome.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

EMDocs

NOVEMBER 4, 2024

A comprehensive, patient-centered approach to pain management ensures effective treatment across these diverse pain syndromes, ultimately improving patient outcomes. Cause and outcome of atypical chest pain in patients admitted to hospital. 2018 Nov;19(6):952-960. Epub 2018 Sep 10. Am J Emerg Med. May 2014;32(5):421-31.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. Most frequent reasons for emergency department visits, 2018. A comparison between pre-operative ultrasonography and surgical findings. Foot & Ankle Specialist.

Fractures 77

Fractures Dislocations Operations Radiology 77

Sensible Medicine

JANUARY 27, 2025

Doctors seek therapies that reduce the chance of bad outcomes. When treating patients with suspected coronary disease, typical bad outcomes to prevent are myocardial infarction (MI) and death due to heart disease. The Edinburgh-based team presented their 5-year results in 2018, and their 10-year results last week.

Outcomes 121

Outcomes EKG/ECG Documentation/Coding Academics 121