Taming the SRU

JUNE 28, 2024

In 2018, Cheskes et al in Canada decided to examine these therapies and compare their outcomes. They utilized paramedic services to compare outcomes of dual sequence vs vector change defibrillation in regards to survival to hospital discharge as well as termination of v fib, rates of ROSC, and neurologic outcome at discharge.

Shock 74

Shock Hospitals Outcomes CPR 74

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 Hospitals 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. to 53.54, p=0.053).

Stroke 78

Stroke Administration Outcomes Documentation/Coding 78

EMDocs

JULY 20, 2023

A second primary outcome was added at the 30-month time frame by request of the FDA, the trial was still blinded at that time. A second primary outcome was added at the 30-month time frame by request of the FDA, the trial was still blinded at that time. POWER: 86% to detect a 1-point difference in the group’s first primary outcome.

Stroke 73

Stroke Outcomes Head Injuries Psychiatric 73

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. Well more than a million views per month far exceeds are expectations.

Stroke 88

Stroke Outcomes Academics Shock 88

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

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

ALiEM

DECEMBER 8, 2023

Major risk factors for their development include prior abdominal surgeries that weaken the musculature as well as cardiovascular co-morbidities. Incidence, etiology, management, and outcomes of flank hernia: review of published data. 2018 Apr;22(2):353-361. Epub 2018 Jan 27. PMID: 32310432. Zhou DJ, Carlson MA.

Academics 60

Academics Emergency Department Outcomes Wellness 60

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 Outcomes Pediatrics 145

RCEM Learning

JANUARY 23, 2024

I had completed the ELECT feasibility study successfully in 2018, with a Pathway to Portfolio grant (only available in Wales). The approvals process was held over TEAMS and I attended with one of my patient representatives, which seemed to be well-received by the ethics committee. We passed that with just minor amendments.

Research 72

Research Wellness Outcomes Documentation/Coding 72

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Queen of hearts interpretations: Patient 1, ECG1: Patient 2, ECG1: Patient 1 Clinical Course and Outcome: The EM physician did not see that the S wave voltage has been truncated and squared off at 10 mm, thereby greatly limiting the assessment of proportionality. But he did well.

EKG/ECG 110

EKG/ECG EMS Outcomes Wellness 110

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

The Skeptics' Guide to EM

DECEMBER 15, 2018

Date: December 13th , 2018 Reference: Murata et al. 2018 Guest Skeptic: Dr. Damian Roland is a Consultant at the University of Leicester NHS Trust and Honorary Associate Professor for the University of Leicester’s SAPPHIRE group. Date: December 13th , 2018 Reference: Murata et al. Pediatrics. Pediatrics.

Seizures 52

Seizures Pediatrics Emergency Department Outcomes 52

EMDocs

JANUARY 29, 2024

However, other sources suggest that the optimal blood pressure target is not well established and may vary depending on the individual patient’s characteristics and the type of hemorrhagic transformation [7]. Lowering the MAP may mitigate these risks and possibly improve outcomes.

Stroke 73

Stroke Outcomes EMS Seizures 73

EMDocs

NOVEMBER 7, 2023

Antibiotics are recommended for those with complicated diverticulitis, as well as surgical specialist consult if necessary (e.g., No difference in their primary outcome of complications and need for emergency surgery (1.9% 2018 Jul;113(7):1045-1052. 2018 Jul;113(7):1045-1052. perforation). 623 patients included.

Sepsis 88

Sepsis Best Practices Hospitals Outcomes 88

RebelEM

FEBRUARY 12, 2024

Research from our very own SIUH department of radiology recommended that contrast-enhanced CT scans can safely exclude obstructive urolithiasis just as well as noncontrast CTs. ” The Journal of Urology 199.4S (2018): e683-e684. CT in Detecting Urinary Tract Calculi: Influence on Patient Imaging and Clinical Outcomes Radiology.

Radiology 83

Radiology Radiology Emergency Department Ultrasounds 83

ALiEM

OCTOBER 30, 2023

Well, instead of passively waiting for Godot, you can seize the initiative and bend the arc of your career into alignment with your values, strengths, and passions, and, by extension, toward fulfillment. The most supportive data for coaching in medicine is for physician wellness and mitigating burnout [7]. 2018; 10(2):227-228.

Academics 64

Academics Leadership Wellness Research 64

RebelEM

DECEMBER 1, 2022

Additionally, small-bore catheter placement is performed via the Seldinger technique;’ a skill possessed by all Emergency Physicians (Bauman 2018). 153,5 (2018): 1201-1212. Heterogeneity was 0% for the primary outcome, and overall heterogeneity was low for secondary outcomes, which increases external validity.

Outcomes 52

Outcomes Hospitals Research Critical Access 52

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 102

EKG/ECG Hospitals Outcomes Wellness 102

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. 2018 Aug;46(3):144-151. Epub 2018 Oct 17. C or 100.4 mg/kg, max 0.4

Pediatrics 76

Pediatrics Dehydration EMS Hospitals 76

RebelEM

APRIL 17, 2023

However, It is unclear how well POCUS performs in ruling in or ruling out the diagnosis of PTA. Question: How well does the US perform in diagnosing PTA compared to CT, needle aspiration, or Incision and Drainage? Article: Kim DJ et al. Acad Emerg Med. 2023 Jan 10. Epub ahead of print. PMID: 36625850.

Ultrasounds 127

Ultrasounds Radiology Radiology Operations 127

The Skeptics' Guide to EM

FEBRUARY 2, 2019

The Lancet 2018. The Lancet 2018. This study expands upon that investigation to patients with other conditions as well. The Lancet 2018. Comparison: The lower oxygen target (conservative group) * Outcomes: The authors do not report any one outcome as a primary outcomes, but instead listed morbidity and mortality.

Administration 52

Administration Poisoning Hospitals Outcomes 52

The Skeptics' Guide to EM

JUNE 24, 2018

[display_podcast] Date: June 15th, 2018 Reference: Silva et al. 2018 Guest Skeptics: Dr. Sergey Motov is an Emergency Physician in the Department of Emergency Medicine, Maimonides Medical Center in New York City. display_podcast] Date: June 15th, 2018 Reference: Silva et al. Ann Emerg Med. Ann Emerg Med. Reference: Silva et al.

Emergency Department 52

Emergency Department Outcomes Administration Research 52

PulmCCM

JUNE 10, 2024

Background I’m not sure if you’ve noticed this, but patients and families frequently disagree with their physicians about the likely outcomes from critical illness. Time-limited trials were reviewed in 2018 in Intensive Care Medicine by Vink et al , and in 2024 in Chest by Kruser et al. 2024 Apr;165(4):881-891. 2023.12.014.

COPD 45

COPD Outcomes Hospitals EMS 45

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

OCTOBER 9, 2023

percent) do not speak English as a primary language, and 25 million of those speak English less than well (known as “limited English proficiency” or LEP); many indicators show this number will only continue to grow. Published Feb 8, 2018. Census Bureau, 60.6 million Americans (approximately 20.8 These include ASL interpreters.

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Systolic function normal by visual assessment only, unable to visualize well for further characterization. The patient did well and was discharged. Atrial fibrillation is also a predictor of worse outcomes in this case (Alborzi). RV: Cavity size normal. 1900: RBBB and LAFB are almost fully resolved. No cardiac MRI was done.

EKG/ECG 101

EKG/ECG Wellness Fractures Hospitals 101

Sensible Medicine

SEPTEMBER 26, 2023

As background, a 2018 article in Health Affairs tried to look at the issue of how to best communicate with patients after a problem or adverse event; the paper studied what happened before and after a new communications program was implemented at 4 Massachusetts hospitals. Not so, unfortunately.

Research 121

Research Hospitals Documentation/Coding Outcomes 121

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 52

Documentation/Coding Operations Academics Ultrasounds 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. display_podcast] Date: October 30th , 2018 Reference: Raskob GE et al. Edoxaban for the Treatment of Cancer-Associated Venous Thromboembolism.

EMS 52

EMS Outcomes Wellness 52

Pediatric Education

SEPTEMBER 3, 2023

He had no concerns and he was doing well in school and with his friends. He had a sprained ankle the previous year that he says was well-healed. High-quality studies in the SCT population are needed to clarify the health-outcomes as many studies are necessarily smaller or not able to be performed as rigorously. Ann Intern Med.

Dehydration 40

Dehydration Hyperthermia / Hypothermia Pediatrics Military 40

Don't Forget the Bubbles

OCTOBER 7, 2024

The high voltage can cause direct thermal injuries, as well as mechanical injuries from falls or secondary trauma. Prolonged CPR should be considered as outcomes are generally good, even if asystole is the presenting rhythm. In most paediatric cardiac arrests, the primary cause is respiratory – not so in cases of electrocution.

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

ACEP Now

NOVEMBER 16, 2023

There are few data on the outcomes of UGIB when balloon tamponade is used as a temporizing measure. 13 A 2018 meta-analysis found that terlipressin is comparable with somatostatin, octreotide, and vasopressin in the control of bleeding. 2018:36(4):689-698. 3 Platelets should be transfused with a goal of 50,000/μL. Ann Emerg Med.

Best Practices 52

Best Practices Resuscitation Fluid Resuscitation Outcomes 52

Taming the SRU

NOVEMBER 14, 2023

B) on right: hand drawn images of layers of ear demonstrating auricular hematoma The epidemiology and incidence of ED presentation for auricular hematomas has not been well-studied because it is a relatively uncommon condition. Elsevier; 2018. Updated 2018 Dec 16]. Courtesy of wiki commons under CC Attribution 3.0 Stat Pearls.

Emergency Department 92

Emergency Department Pediatrics Wellness Documentation/Coding 92

EMDocs

JULY 3, 2023

Introduction SAH has the potential for rapid progression and devastating outcomes. All patients with concern for SAH need a rapid primary survey to assess the airway, breathing, and circulation as well as a comprehensive neurologic exam to create a baseline for the patient. What are the next steps in the management of this patient?

Seizures 86

Seizures Stroke Outcomes EMS 86

Don't Forget the Bubbles

NOVEMBER 15, 2023

One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. The REVERSE-AKI feasibility trial suggests that fluid restriction can improve outcomes without significant renal consequences. 2018 Apr;44(4):409-417. Epub 2018 Mar 27.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

RebelEM

MARCH 23, 2023

The primary outcome, hospital length of stay, was significantly shorter both before and after propensity score adjustment for the phenobarbital group. A broad range of variables were included that potentially influences treatment decisions and/or outcomes. The protocols used in the study were using symptom-driven medications.

Emergency Department 52

Emergency Department Outcomes Hospitals Burns 52