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

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

Dr. Smith's ECG Blog

JUNE 5, 2024

This combination is often extremely effective for maintaining good longterm outcome ( Lanza and Shimokawa — Eur Cardiol 18: e38, 2023 ). As a result — an ICD may need to be considered in selected cases.

EKG/ECG 126

EKG/ECG Outcomes 126

RebelEM

NOVEMBER 6, 2024

2018 Jun;54(6):849-854. Epub 2018 Apr 19. 2018 Apr 4;100(7):e46. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30521261 Gottlieb M, Schiebout J. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. doi: 10.1016/j.jemermed.2018.02.011. 2018.02.011. J Am Acad Orthop Surg.

Dislocations 107

Dislocations Fractures Soft Tissue Injuries Outcomes 107

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. Background: Sepsis remains one of the leading causes of morbidity and mortality. to 0.97; p = 0.02 to 2.07; p = 0.91 to 12.33; p = 0.26

Sepsis 130

Sepsis Hospitals Administration Outcomes 130

The Skeptics' Guide to EM

OCTOBER 20, 2018

[display_podcast] Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Ann Emerg Med 2018 (CRD42017056195) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. NEJM 2018 (ClinicalTrials.gov NCT01467466.)

Emergency Department 72

Emergency Department Outcomes Pediatrics 72

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

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

Sensible Medicine

SEPTEMBER 18, 2023

The title gives away the results: Here is what they did: They took 159 patients who had severe TR and were operated on from 2004-2018. They then looked at a primary outcome of death. Earlier surgery may improve outcomes in these high-risk patients. These were operations solely for the tricuspid valve. vs 18.2% ; P =.036).

Operations 133

Operations Academics Shock Outcomes 133

Emergency Medicine Journal

OCTOBER 26, 2023

Methods We investigated four 18-month periods between 2005 and 2018. Primary outcome was survival at hospital discharge with a good neurological outcome. Results Of 21 781 patients under consideration, 3476 (16%) met the inclusion criteria.

Resuscitation 75

Resuscitation Basic Life Support Hospitals CPR 75

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

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

The Trauma Pro

OCTOBER 25, 2024

Here are the factoids: The original data were derived from a 17-center study conducted from 2018-2020; this study only included 1,387 patients who had pelvic fractures (as well as other injuries). The primary outcome was the development of VTE during the hospitalization.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

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

EMDocs

JUNE 1, 2023

Several secondary outcomes suggest a signal toward harm with hypothermia, including incidence of pneumonia, bradycardia, and more days ventilated. Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients with Severe Traumatic Brain Injury: The POLAR Randomized Clinical Trial. 2018; 320(21):2211-2220.

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

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

EMDocs

DECEMBER 1, 2024

The disease is generally mild, but in untreated cases, it can lead to more severe outcomes, especially in patients with underlying conditions such as glucose-6-phosphate dehydrogenase deficiency. Even though the disease often resolves spontaneously, prompt antibiotic therapy is essential for optimal outcomes. pregnant patients).

EMS 101

EMS Infectious Diseases Shock Airway Management 101

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. Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Hussain, 2023 ] Leads to >300,000 perinatal deaths / year globally.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

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

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

Emergency Medicine Journal

JANUARY 22, 2024

1–3 However, the literature is sparse surrounding the characteristics, treatment, outcomes, costs, disposition and resource utilisation of people who co-use compared with those who use opioids alone. Many overdose deaths are associated with patient co-use of opioids and other substances, such as benzodiazepines.

Outcomes 40

Outcomes Emergency Department Poisoning Documentation/Coding 40

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

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

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

NOVEMBER 13, 2024

Older age, recurrent episodes of SBP, hepatorenal syndrome, hepatic encephalopathy, acute kidney injury (AKI), concurrent GI bleeding, and higher MELD scores are predictors of worse outcomes. Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies. 2018 Apr;36(4):689-698.

Hyperthermia / Hypothermia 103

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 103

EMDocs

NOVEMBER 7, 2023

No difference in their primary outcome of complications and need for emergency surgery (1.9% 2018 Jul;113(7):1045-1052. Outcome measures were complicated diverticulitis, recurrent diverticulitis and sigmoid resection at 24 months’ follow up. Included 480 patients, with primary outcome return visit with hospital admission.

Sepsis 108

Sepsis Best Practices Hospitals Outcomes 108

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

Groups were categorized based on moderate to severe chest pain (numerical rating scale pain ≥ 5/10) or less than moderate severity to compare procedural and clinical outcomes. And as we have shown before, morphine leads to slower times to treatment and worse outcomes. 414 patients were included in the analysis.

EKG/ECG 122

EKG/ECG Hospitals Outcomes Wellness 122

Sensible Medicine

SEPTEMBER 23, 2024

They also found that the largest difference between truncated and nontruncated trials occurred when the truncated trials had fewer than 500 outcome events. In 2018, three modern trials comparing asa vs placebo for primary prevention were published. This difference easily met statistical significance. All were nonsignificant.

Stroke 110

Stroke Academics Outcomes Shock 110

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

PulmCCM

JUNE 26, 2023

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., Read in NYT Deadly fungal infections are on the rise, and are often diagnosed late, leading to worse outcomes.

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. Clinical Question #1: Are superglottic airway devices non-inferior to endotracheal intubation in OHCA with regards to neurologic outcome?

Airway Management 52

Airway Management CPR Hyperthermia / Hypothermia Outcomes 52

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

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

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

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

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