Pediatric EM Morsels

SEPTEMBER 22, 2023

” Children compensate for blood and volume loss very well… until they don’t. 2018 Oct;14(2):47-54. Epub 2018 Oct 31. Orenstein JB, Klein BL, Gotschall CS, Ochsenschlager DW, Klatzko MD, Eichelberger MR. Age and outcome in pediatric cervical spine injury: 11-year experience. Korean J Neurotrauma. 2018.14.2.47.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

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. 1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Patients whose last known well (LKW) time was within 24 hours of presentation. 1 week after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

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. 4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

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 98

Sepsis Outcomes Administration EMS 98

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

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). DAPT statistically noninferior to alteplase The finding was consistent in the per-protocol and as-treated groups as well Symptomatic ICH at 90d DAPT: 0.3% Alteplase: 91.4%

Stroke 98

Stroke Outcomes EMS Hospitals 98

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 77

Stroke Administration Outcomes Documentation/Coding 77

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

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

Mount Sinai EM

OCTOBER 11, 2024

There was significant heterogeneity among studies and outcomes were not measured consistently. And well before the depth at which it would reach the carotid). A lot of times we consult ENT and they perform the aspiration, but it is well within our scope of practice to do it ourselves! in the medical cohort and 6.2%

Ultrasounds 100

Ultrasounds Wellness Outcomes Hospitals 100

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Heart disease and stroke statistics—2018 update: A report from the American Heart Association.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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 130

Ultrasounds Outcomes COPD Hospitals 130

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

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 91

Stroke Academics Outcomes Shock 91

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. as well as patients less than 18 years old were excluded from analysis. The study’s primary outcomes were the operational impacts of the SQuID protocol on EDLOS and ICU admission rates.

Operations 96

Operations Hospitals Best Practices Wellness 96

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

Emergency Medicine Journal

MAY 23, 2023

A modified GBS (mGBS) and CANUKA score have recently been proposed but have not been well studied. Methods A single-centre retrospective study was performed including patients with suspected UGIB visiting the ED of Saint-Antoine hospital (Paris, France) from January 2016 to December 2018.

Emergency Department 40

Emergency Department Blood Transfusions Hospitals Wellness 40

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., Included traumatic and nontraumatic brain injuries.

CDC 126

CDC Outcomes Radiology Radiology 126

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 120

EKG/ECG EMS Outcomes Wellness 120

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

Sensible Medicine

AUGUST 7, 2024

There is evidence that, for children and adults, elevated cortisol levels and chronic stress can lead to behavioral, mental-health, and mood issues, as well as changes in inflammation and immunity. Research by Collett et al (2018) shows that, despite some improvement in PP by 18 months, the deformations persist beyond 36 months.

CDC 107

CDC Documentation/Coding Research Pediatrics 107

Don't Forget the Bubbles

JULY 22, 2024

The 2018 PREVIEW trial reported a significant reduction in length of stay (LOS) in children given prednisolone in Australia (24-71 months, mean 41 months) compared to placebo. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS).

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

RebelEM

AUGUST 7, 2023

Approximately half of the ICU patients with delirium received haloperidol in a cohort study published in 2018 (5) however the use of haloperidol is not supported by practice guidelines due to evidence of its effect being limited (6). 2018; PMID: 30346242 Salluh JI et al. Intensive Care Med 2018; PMID: 29767323 Devlin JW et al.

Outcomes 52

Outcomes Hospitals EMS Administration 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 Administration 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

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 85

Radiology Radiology Emergency Department Ultrasounds 85

Don't Forget the Bubbles

JUNE 17, 2024

High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. Loss of psychological safety and mental well-being persist long after the episode and can impact future episodes of care. John Wiley & Sons, 2018 Edward KL, Ousey K, Warelow P, Lui S. Australian Health Review.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

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 72

Stroke Outcomes EMS Seizures 72

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 112

EKG/ECG Hospitals Outcomes Wellness 112

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

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

Sensible Medicine

NOVEMBER 21, 2024

Ryan during the monkeypox outbreak, our empirical research found that he was the single most accurate source of information on Twitter/X… Read more a month ago · 267 likes · 62 comments · Benjamin Ryan This is a controversial topic, and it is not usually well covered in medical journals or the lay media.

64

64

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 130

Ultrasounds Radiology Radiology Operations 130

Sensible Medicine

NOVEMBER 14, 2023

Criticism of these programs is both well-deserved and unfair. Despite these well-deserved criticisms, I’ve found that residential treatment programs and therapeutic communities can be essential to my patients, and there’s evidence to support that. These higher quality studies usually achieved better outcomes.

Research 115

Research Psychiatric CDC Best Practices 115

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