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 ). An update was published by Fanaroff et al in JAMA 2019. This is a broader problem in medicine. Tricoci et al.

Military 40

Military Operations Emergency Department Pediatrics 40

PulmCCM

APRIL 24, 2024

Perc trachs do not require operating room time or a surgeon, and can significantly shorten ICU stays. It looks like this: FDA Clearance and Initial Adoption According to Dr. Tropello, the new system was FDA cleared in April 2019 based on animal testing and lab data.

Ultrasounds 52

Ultrasounds Hospitals Operations Outcomes 52

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 96

Ultrasounds Operations Radiology Radiology 96

The Skeptics' Guide to EM

MAY 11, 2019

Date: May 6th, 2019 Reference: Sceats et al. Date: May 6th, 2019 Reference: Sceats et al. This is an example of why things in evidence-based medicine can be “complicated” ( SGEM#115 and SGEM#180 Clinical Question: Operative treatment or non-operative treatment of acute Grade 1 (uncomplicated) appendicitis?

Documentation/Coding 52

Documentation/Coding Operations Academics Ultrasounds 52

The Skeptics' Guide to EM

MARCH 5, 2022

The definitions used for each level of evidence are as follows: An update was published by Fanaroff et al in JAMA 2019. 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

PulmCCM

JANUARY 8, 2024

Twenty-five ICUs in Canada were switched to small-volume blood collection tubes at randomly assigned times (a so-called stepped-wedge cluster design) from 2019-2021. The Red Cross funds a large portion of its operations through its ~$2 billion transfusion business , and would seem to be unlikely to advocate for reducing its size.

Blood Transfusions 96

Blood Transfusions Hospitals Outcomes Operations 96

Don't Forget the Bubbles

JANUARY 17, 2024

They passed away a few days after a second operation. There have been reports of the Orbeez Challenge leading to serious outcomes. A six-month-old infant presented with sub-acute obstruction and needed an enterostomy. Unfortunately, the anastomosis broke down. It’s beads, too! Darracq, M.A., Rentmeester, L., Cantrell, F.L.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Cook County EM Blog

MARCH 20, 2023

2019 Nov 16;8(11):2000. Latex paint-gun injuries of the hand: are the outcomes better? 2019 Dec 18;6(1):153-158. Vitale E, Ledda C, Adani R, Lando M, Bracci M, Cannizzaro E, Tarallo L, Rapisarda V. Management of High-Pressure Injection Hand Injuries: A Multicentric, Retrospective, Observational Study. J Clin Med. Hand (N Y).

Documentation/Coding 52

Documentation/Coding Fractures Operations Research 52

EMDocs

NOVEMBER 18, 2023

Liver Transplantation: Operative Techniques and Medical Management. 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. Published 2019 Dec 27.

EMS 69

EMS Ultrasounds Emergency Department Outcomes 69

Don't Forget the Bubbles

MAY 10, 2023

Then the patient is rapidly moved to the operating theatre. The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre. Communication is closed-loop. with a shared collective mindset. A hole in a ventricle is identified at thoracotomy and occluded with a finger.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

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. 2019 Nov 27;4(Suppl 1):S130-S139. 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. AEM Educ Train.

Academics 64

Academics Leadership Wellness Research 64

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). 2019 Sep;74(9):1186-1190. Epub 2019 Jul 16. Paediatr Anaesth.

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

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 89

Resuscitation Outcomes Operations Hospitals 89

Taming the SRU

MARCH 14, 2023

Ultimately, definitive management is in the operating room with revision or replacement of the VP shunt. Estimated incidence of normal pressure hydrocephalus and shunt outcome in patients residing in assisted-living and extended-care facilities. Lumbar puncture is an option with limited data for success. Bothwell, Janigro, Patabendige.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 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. Exposure to incivility hinders clinical performance in a simulated operative crisis. 2019 May 31:bmjqs-2019.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Emergency Medicine Journal

JULY 22, 2024

Methods Adult patients transported to a single ED by ambulances and subsequently admitted to the hospital between 1 January 2019 and 18 April 2019 were eligible for inclusion. The discriminative ability of the EWS scores was assessed using the area under the receiver operating characteristic curve (AUROC). male, mean age 68.7±17.5

Ambulance Services 52

Ambulance Services Hospitals Emergency Department Operations 52

Emergency Medicine Journal

MAY 23, 2023

We validated the score in a large patient data set and constructed a model that allows early prediction of the probability of clinical outcomes based on the individual’s NEWS+L Score. The outcomes were hospital death or a composite of hospital death and intensive care unit admission at 24 hours, 48 hours and 72 hours.

Outcomes 40

Outcomes Emergency Department Academics Hospitals 40

RebelEM

OCTOBER 2, 2023

The SQuID Protocol (Subcutaneous Insulin in /diabetic Ketoacidosis): Impacts on ED Operational Metrics. No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 A more optimal, and promising, solution may be the use of SQ insulin in mild to moderate DKA.

Operations 100

Operations Academics Outcomes Fluid Resuscitation 100

RebelEM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

Outcomes 74

Outcomes Hospitals Operations Shock 74

RebelEM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Outcomes: Primary Outcome: Reduction of dyspnea measured on a verbal dyspnea scale (VDS) from 0 to 10 recorded at enrollment, then at 2, 4, and 5 hours after arrival.

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. While secrecy surrounds the operations of many PE-owned groups, Envision serves as a case study. Published September 5, 2019. Published July 22, 2019. J Hosp Med. 2020;15(5):318-320. Ayash B, Rastad M.

Hospitals 69

Hospitals Radiology Radiology Administration 69

EB Medicine

JULY 8, 2019

I’m Jeff Nusbaum and I’m back with Nachi Gupta for the 30 th episode of EMplify and the first Post-Ponte Vedra Episode of 2019. Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision. I hope everybody enjoyed a fantastic conference.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

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

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

EMDocs

JUNE 21, 2023

Functional outcomes Severe soft tissue injuries and damage to the bony structures => poor functional outcomes. US : under studied but not routinely recommended A 2019 study evaluating use of US in cadavers found a sensitivity of 65% and specificity of 75%. 2019 Sep;57(3):362-366. 2019 Jun;23(2):59-61.

Soft Tissue Injuries 68

Soft Tissue Injuries Fractures Dislocations Radiology 68

RebelEM

JUNE 8, 2023

Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Emergency Medicine Journal

NOVEMBER 28, 2023

This study aims to investigate the utility of NEWS in predicting short-term morbidity and mortality outcomes in patients presenting to the ED. Method and Design Emergency attendances in 2019 from three East London EDs were included in this study. The primary outcome of mortality within 24-hours was comprised of 205 (0.08%) patients.

Outcomes 40

Outcomes Emergency Department Operations 40

Taming the SRU

AUGUST 30, 2023

The 2019 Journal of Arthroplasty practice guidelines to screen for periprosthetic joint infections recommend using ESR at 30mm/hr and CRP at 10mg/L, citing pooled sensitivities and specificities ranging from 75%-86% and 70-72.3%, respectively, for ESR and 88% and 73-74%, respectively, for CRP [32].

Infectious Diseases 86

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

Taming the SRU

NOVEMBER 3, 2023

The primary outcome in this study was a change in pain score at rest 60 minutes after block. Secondary outcomes were changes in pain scores at rest at 15 minutes, during incentive spirometry at both time points and then change in maximum vital capacity. Mean and median pain score at rest prior to SAPB were 5.4 (SD SD 3.28) and 6.5,

Fractures 97

Fractures Ultrasounds Outcomes Research 97

RebelEM

NOVEMBER 6, 2023

Methylene Blue for Vasoplegic Syndrome After Cardiac Operation: Early Administration Improves Survival. to 1mg/kg/hr) Information regarding the vasopressors used in the study is as follows: Norepinephrine equivalents = norepinephrine mcg/kg/min + (phenylephrine mcg/kg/min/10) + epinephrine mcg/kg/min + (vasopressin units/min x2.5)

Shock 64

Shock Administration Academics Hospitals 64

EMDocs

SEPTEMBER 25, 2023

Still, there are those that believe that FPS is more of a physician-centered endpoint that does not fully reflect important patient-centric outcomes (16). Improved Visualization: Video laryngoscopes allow for the use of standard or hyperangulated geometry, essentially allowing the operator to “look around the corner” on an anterior airway.

Emergency Department 65

Emergency Department Soft Tissue Injuries Operations Airway Management 65

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

EB Medicine

DECEMBER 4, 2019

Nachi: As we are just about to see one of the busiest travel days of the year, that would be the Wednesday before Thanksgiving, we thought there would be no better time to discuss the September 2019 issue of EMP: Assisting With Air Travel Medical Emergencies: Responsibilities and Pitfalls. Nachi: So, I fly about 4 times a month for work.

Dehydration 40

Dehydration Wellness EMS Burns 40

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 54

Fractures Resuscitation Operations EMS 54

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. 2019 Aug; PMID: 30954692 Clinical Question: What is the impact of system factors in the implementation of standard-of-care LPV in critically ill ED patients admitted to the ICU? Paper: Owyang CG, et al.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

Don't Forget the Bubbles

JANUARY 31, 2024

This was compared to a mixed reference standard that included the results of ultrasound by radiologists, intra-operative findings, and clinical follow-up. This retrospective cohort study was conducted in Boston Children’s Hospital and affiliated paediatric outpatient clinics between 2016 and 2019.

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

EMDocs

OCTOBER 30, 2023

Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. Under standard operating protocols, residual contrast materials are usually wasted, according to current CDC and JC standards.

Radiology 73

Radiology Radiology Emergency Department Hospitals 73