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

ACEP Now

MAY 9, 2024

1,2 You’ll also find the story of Sheila Powell, a woman who suffered a pneumothorax during her 2018 Miami BBL and whose 16-year-old daughter worried that in “just a blink of the eye, I could have lost my mom.” These questionable practices led to a rash of bad outcomes. References Garcia SE. Butt Lifts Are Booming. Healing Is No Joke.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 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

EMDocs

NOVEMBER 18, 2023

A point of care ultrasound of the liver reveals the following: Image 1: Ultrasound of the liver showing abnormal hepatic artery flow and resistance index 1 Question: What is the diagnosis? Published 2018 Mar 6. Sonographic diagnosis and outcome of hepatic artery thrombosis after orthotopic liver transplantation in adults.

EMS 69

EMS Ultrasounds Emergency Department Outcomes 69

EMDocs

JANUARY 16, 2024

Patients can have excellent outcomes despite prolonged resuscitation. VF/asystole), a pulse cannot be identified via Doppler ultrasound for a full minute, or if lack of organized cardiac activity is confirmed on bedside echocardiogram. This is a good time to utilize an arterial line or use the ultrasound to find a central pulse.

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation CPR EMS 84

RebelEM

FEBRUARY 12, 2024

“Mp50-20 national imaging trends for acute kidney stone disease: do renal ultrasounds for nephrolithiasis in the emergency department pave the way to computerized tomography? ” The Journal of Urology 199.4S (2018): e683-e684. Moore CL, Carpenter CR, Heilbrun ME, et al. 2011; 18(7):699-707. 2002; 225(2):441-449.

Radiology 69

Radiology Radiology Emergency Department Ultrasounds 69

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. His practice is in trauma, emergency general surgery, and critical care with an academic interest in ultrasound and medical simulation. Reference: Sceats et al.

Documentation/Coding 52

Documentation/Coding Operations Academics Ultrasounds 52

Taming the SRU

MAY 5, 2023

2018, Kuttab, Lykins 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. Sixty centers participated during the years 2018-2022. 2019, Evans, Rhodes et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 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 Research 114

PulmCCM

JULY 10, 2023

A 2018 meta-analysis reviewed here suggested that prolonged infusion of antipseudomonal beta-lactams reduced mortality by 30% compared with shorter infusions, and more observational data has accumulated since that time. Mortality was about 30% in each group, and most patients had hospital-acquired sepsis. access, etc., detailed here.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

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

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 Research Telemedicine 52

Taming the SRU

SEPTEMBER 8, 2023

2018, www.emdocs.net/acute-liver-failure-evidence-based-evaluation-and-management/. Prognosis of acute severe autoimmune hepatitis (as-AIH): The role of corticosteroids in modifying outcome.” Diagnostic accuracy of Doppler ultrasound, CT and MRI in Budd Chiari Syndrome: Systematic Review and meta-analysis.” Hepatology, vol.

Radiology 59

Radiology Radiology Ultrasounds EMS 59

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion. 2018 Apr 26;378(17):1573-1582. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. doi: 10.1053/j.sult.2013.01.004.

Stroke 89

Stroke EMS EKG/ECG Radiology 89

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

The Skeptics' Guide to EM

MARCH 4, 2018

[display_podcast] Date: February 27th, 2018 Reference: Moran et al. display_podcast] Date: February 27th, 2018 Reference: Moran et al. With point of care ultrasound, you diagnose cellulitis without the presence of an abscess affecting a 6cm diameter area. JAMA May 2017.

Infectious Diseases 40

Infectious Diseases Documentation/Coding Outcomes Ultrasounds 40

Don't Forget the Bubbles

FEBRUARY 5, 2024

The study surveyed 2855 Canadian adolescents in 2018 and found that those who skipped breakfast were 2.55 Their main outcome measure was the proportion of pictures inconsistent with current safety recommendations. Are sucking patterns and early spontaneous movements related to later developmental functioning outcomes?

Pediatrics 52

Pediatrics Research Resuscitation Outcomes 52

Dr. Smith's ECG Blog

MAY 30, 2023

Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. The primary outcomes were sensitivity/specificity of 1) STD in lead I ≥ 0.5 mm and 2) STE in lead V1 ≥ 0.5 mm, stratified by presence or absence of posterior (inferobasal) MI, as determined by ≥0.5 mm STD in lead V2, for differentiating RVMI from non-RVMI.

Shock 81

Shock EKG/ECG Academics Stroke 81

EMDocs

JULY 17, 2023

3 Point of care ultrasound (POCUS) can be highly sensitive for free fluid and pneumoperitoneum when used by a trained physician in the appropriate patient population. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. Published 2018 Aug 13. World J Gastroenterol. 2007 Jan 21;13(3):432-7.

Operations 77

Operations EMS Fluid Resuscitation Resuscitation 77

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. Point-of-care ultrasound (POCUS) can evaluate for Achilles tendon rupture with a high sensitivity (96-100%) and specificity (83-100%) [8,9]. MRI can be used in place of CT.

Fractures 75

Fractures Dislocations Operations Radiology 75

RebelEM

JANUARY 25, 2024

Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. Impact of serial cardiopulmonary point-of-care ultrasound exams in patients with acute dyspnoea: a randomized, controlled trial. PoCUS evaluations included lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS).

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: Diagnosis of appendicitis, in a pregnant patient, ultrasound vs. mri. Which is reasonable, as that is the crux of our job as emergency physicians. Jeff: Indeed. Sounds familiar.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Can J of Cardiol 2018, 34: 132-145 Here are some other cases: LVH, LBBB, RBBB, and RVH may manifest ST depression without any ischemia! Methods STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. A emergent cardiology consult can be helpful for equivocal cases.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Dr. Smith's ECG Blog

JUNE 20, 2018

Also, the ST elevation has diminished as myocardium infarcts Outcome and comments by the source of the case: "The following morning the cardio consult service saw the patient. Journal of Electrocardiology 2018. However, in almost every case, one should confirm absence of OMI (Occlusion MI) at least by contrast ultrasound.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness Ultrasounds 52

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

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 144

Administration Outcomes Resuscitation Radiology 144

EB Medicine

SEPTEMBER 1, 2018

I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations. Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

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. It was peer-reviewed by Joseph Habboushe, assistant professor at NYU and Nadia Maria Shaukat, director of the emergency and critical care ultrasound at Coney Island Hospital in Brooklyn, New York.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

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]. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. ng/mL, 0.25-0.5

Infectious Diseases 86

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 86

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Am J Cardiol 2018; 122(8):1303-1309. Outcome The cath lab was activated by the emergency physician. Outcome : The third troponin I, drawn 4.5 This outcome is perfectly consistent with all the ECGs. This was missed by the physicians, even with a bedside speckle tracking ultrasound: no wall motion abnormality was seen.

EKG/ECG 52

EKG/ECG Outcomes Emergency Department Ultrasounds 52

EMDocs

JUNE 21, 2023

Functional outcomes Severe soft tissue injuries and damage to the bony structures => poor functional outcomes. Can Ultrasound Identify Traumatic Knee Arthrotomy in a Cadaveric Model? 2018 Jun;39(6):736-740. 2018 Jun;39(6):736-740. J Orthop Trauma. 2013 Sep;27(9):509-14. PMID: 23412508. Kongkatong M, et al.

Soft Tissue Injuries 68

Soft Tissue Injuries Fractures Dislocations Radiology 68

Taming the SRU

JANUARY 10, 2024

Additionally, ED boarding is a now a larger factor than in 2018. Phenobarbital has been proven to be equivalent to benzodiazepines with regard to clinical, pharmacologic and utilization outcomes. It usually takes 4-6 weeks for a coronary artery to heal from dissection.

EKG/ECG 91

EKG/ECG Shock Fractures Emergency Department 91

EB Medicine

AUGUST 6, 2019

In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. But next we should talk about ultrasound. Nachi: Though you can, in theory, test for plasma DOAC concentrations, such tests are not routinely indicated as levels don’t correspond to bleeding outcomes. of patients per year.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EMDocs

JANUARY 6, 2024

A bedside cardiac ultrasound is performed which shows biventricular failure with a dilated inferior vena cava. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-fifth Adult Heart Transplantation Report-2018; Focus Theme: Multiorgan Transplantation. Circulation.

EMS 63

EMS Infectious Diseases Shock Emergency Department 63

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. What is the role of ultrasound? Whilst we all love to wield the ultrasound probe, its use in diagnosing torsion remains controversial. Sharma, A.P.,

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

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 87

Stroke Radiology Radiology Emergency Department 87

EMDocs

JANUARY 20, 2024

Bedside ultrasound shows hypokinesis of the basal portion of the left ventricle with an apparent sigmoid-shaped septum and a dilated inferior vena cava. Ultrasound findings can show bulging of the interventricular septum into the LVOT , which can be interpreted as a sigmoid-shaped septum on bedside evaluation. The oral mucosa is moist.

EMS 74

EMS Fluid Resuscitation Shock EKG/ECG 74