PulmCCM

APRIL 1, 2024

Both a 2019 meta-analysis and a large 2022 trial by the ANZICS group raised concerns about increased adverse events among patients receiving intensive physical therapy in the ICU. 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

Dr. Smith's ECG Blog

DECEMBER 19, 2023

Unfortunately, we do not have those images for review, but the operators described a ruptured LAD plaque and they stented this area, which ensures the stability of the plaque. The patient did well afterward without any recurrence of symptoms. Figure-4: I've labeled the first 2 ECGs shown in the November 14, 2019 post ( See text ).

EKG/ECG 113

EKG/ECG EMS Wellness Operations 113

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

RebelEM

FEBRUARY 1, 2024

What they Did : Investigator-initiated, Multicenter, Parallel-ground, Open-label, Registry-linked, Randomized, Controlled, Non-Inferiority trial 22 Canadian Primary and Comprehensive Stroke Centers from December 2019 to January 2022 Eligible ischemic stroke patients randomized 1:1 to receive intravenous tenecteplase (0.25 vs Alteplase 34.8%

Stroke 134

Stroke Blood Transfusions Outcomes EMS 134

Don't Forget the Bubbles

MAY 22, 2023

In 2019, there were 2,383 LTV patients in the UK. These can be operated and maintained by patients and their families at home. Gemma tells you that as well as the physio, Robin’s LTV Consultant has also prescribed some oral antibiotics. Since then, he has been well in himself. There has been a 2.5x

Radiology 98

Radiology Radiology Hospitals Wellness 98

Greater Sydney Area HEMS

APRIL 26, 2023

Both the stuff of legend and go by multiple names including harness hang syndrome and orthostatic intolerance, as well as bigfoot and the abominable snowman, respectively. Although remember, as is observed intra-operatively from tourniquet application, muscle can tolerate hours of hypoxia. 2019, 119:1353-1365. That’s it?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

Intensive Blog

AUGUST 17, 2023

Diagnostic and Interventional Imaging, 2019, 100(6), 337-345, ISSN 2211-5684, [link]. The many causes of anaemia include: Decreased production Malnutrition Bone marrow suppression (e.g., Cannula site bleeding. PMID: 30691971 All case-based scenarios on INTENSIVE are fictional.

Blood Transfusions 52

Blood Transfusions Operations Wellness 52

Don't Forget the Bubbles

JANUARY 17, 2024

Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. They passed away a few days after a second operation. From Mullens et al., Unfortunately, the anastomosis broke down. It’s beads, too!

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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. 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.

Academics 64

Academics Leadership Wellness Research 64

PulmCCM

JANUARY 8, 2024

But apparently, few centers use them, because … well, no one can give a good reason why. 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. In one of those “how has this not been done already?”

Blood Transfusions 96

Blood Transfusions Hospitals Outcomes Operations 96

EM SIM Cases

AUGUST 23, 2022

Because this case can be triggering, especially for individuals having experienced previous microaggressions, careful selection of actors and participants, as well as pre-briefing the resident leading the case far ahead of time are crucial. Chicago: JAMA Surg; 2019 Sep. The other trainees watched the case. 1;154(9):868-872.

Operations 40

Operations Resuscitation Wellness Hospitals 40

Don't Forget the Bubbles

MAY 24, 2023

Crouzon syndrome, Pierre-Robin sequence, Down syndrome, Beckwith-Wiedemann syndrome) I njuries to the face, mandible, pharynx, or neck S leeping issues such as snoring due to adenotonsillar hypertrophy It’s essential to have a well-planned approach to managing the difficult airway. 2019 Oct 1;131(4):818–29 Kanaris C, Murphy PC.

Airway Management 98

Airway Management Teamwork Pediatrics Emergency Department 98

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. doi:10.1136/emermed-2019-208830 The post Learning about human factors in the emergency department appeared first on Don't Forget the Bubbles.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

Dr. No

DECEMBER 1, 2021

The way to get round this slippery data problem, as regular readers of this blog will know only too well, is to look at all cause mortality. Well, Dr No did try a bit of figuring, by looking at all cause deaths by age band in recent years, downloaded from this page. Just as it seems a strand is emerging, it slithers away again.

Forensics 52

Forensics Wellness Operations 52

Pediatric EM Morsels

AUGUST 4, 2023

(Oka, 2023) A systematic review linked SMA syndrome to the immediate post-operative period after surgery for scoliosis in pediatric patients, and found the mean days to onset of symptoms was 9. Positional changes after intake can also be helpful including the lateral decubitus position as well as knee to chest. Ann Vasc Surg.

Pediatrics 246

Pediatrics Burns Operations Ultrasounds 246

ALiEM

AUGUST 9, 2023

F Heart Rate 138 bpm Blood Pressure 102/61 Respiratory Rate 32 Oxygen Saturation (room air) 100% He is well appearing but has increased work of breathing. The lung POCUS is also operator-dependent, and it has a steep learning curve. 2019 Sep;26(9):1074-1088. On arrival, his vital signs are: Vital Sign Finding Temperature 99.7

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

Taming the SRU

MARCH 14, 2023

He appears well and is triaged to an ESI 4. Ultimately, definitive management is in the operating room with revision or replacement of the VP shunt. She was doing well, but recently has had the “stomach flu” with a couple weeks of abdominal pain, nausea and vomiting. More on this below as we work through a few cases….

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

Pediatric EM Morsels

NOVEMBER 3, 2023

Both have a range of detection limits, which can be greatly dependent on operator. With concern for malaria, it is very important to identify who is non-immune and semi-immune as this can affect both the timeframe for illness after departure from the endemic country as well as severity of illness. 2019; 17: 98. 8 Dec 2022.

Seizures 277

Seizures Pediatrics CDC Infectious Diseases 277

Pediatric Education

NOVEMBER 12, 2023

weeks was seen for well-care. Pierre-Robin Sequence) and post-operative congenital heart disease. 2019-1703 Author Donna M. Patient Presentation A former 35 week, appropriate for gestational age male, now 37.5 neuromuscular problems, Down syndrome), micrognathia (e.g. J Perinatol. 2018;38(10):1287-1294. Pediatrics.

Pediatrics 40

Pediatrics Poisoning Hospitals Documentation/Coding 40

Dr. Smith's ECG Blog

MARCH 19, 2019

Although the QT is very long, long QT due to hypocalcemia is rarely associated with Torsades de Pointes. == Comment by K EN G RAUER, MD ( 3/19/2019 ): == There are a number of ECG patterns that should immediately suggest a clinical diagnosis. Here was a repeat ECG: QTc 523. Long ST segment remains. This is one of them!

EKG/ECG 52

EKG/ECG Seizures Stroke Operations 52

Ken Grauer, MD

SEPTEMBER 6, 2024

Depending on which of above considerations is operative — the differential diagnosis of the rhythm in ECG #1 will be between: i ) A reentry SVT rhythm with retrograde atrial conduction; ii ) ATach ( A trial T achycardia ) ; — or — iii ) Junctional Tachycardia. The October 16, 2019 post in Dr. Smith's ECG Blog.

EKG/ECG 248

EKG/ECG Administration Wellness Operations 248

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. Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. I hope everybody enjoyed a fantastic conference.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Dr. Smith's ECG Blog

DECEMBER 13, 2019

On exam the patient was well appearing, with normal vitals signs other than BP 155/82, no murmurs or rubs, normal pulses, no reproducible chest pain. The next morning the patient went for his routine echocardiogram, where the operator noticed a dilated aortic root at 5.47 Here is his triage ECG: What do you think?

EKG/ECG 52

EKG/ECG Operations Ultrasounds Wellness 52

EB Medicine

DECEMBER 4, 2019

Well, with that, let’s get started on our final scheduled episode of EMplify ! Thanks as well to the peer editors, Dr. Knight, and Dr. Hill of the University of Cincinnati. Show More v Jeff: Well, this is a first! In 2019, of the 4 billion passengers expected to fly, there will be an estimated 60,000 medical emergencies.

Dehydration 40

Dehydration Wellness EMS Burns 40

Don't Forget the Bubbles

JUNE 17, 2024

Loss of psychological safety and mental well-being persist long after the episode and can impact future episodes of care. Exposure to incivility hinders clinical performance in a simulated operative crisis. 2019 May 31:bmjqs-2019. 2019 May;27(4):758-64. The lasting effects of incivility cannot be understated.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. This finding was not significantly different among operators with different levels of experience, or between adults and children. They are used clinically to detect pathological inflammation or measure response to treatment [1-2].

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). 2019, 64:617-28. 1985, 25:347-9. 10.1097/00005373-198504000-00013 MacIntyre NR. Physiologic effects of noninvasive ventilation.

Emergency Department 66

Emergency Department Soft Tissue Injuries Operations Airway Management 66

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. These procedures require an experienced operator. These procedures require an experienced operator. These procedures require an experienced operator. 2019 Aug;31(4):683-687. The trauma call goes out. Really, in a 14-year-old?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

RebelEM

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability.

Outcomes 79

Outcomes Hospitals Operations Shock 79

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

Regarding my Systematic assessment of ECG #1: There is significant baseline artifact , as well as baseline wander. since what appears to be a major causative factor ( simultaneous ingestion of 9 herbal preparations ) is no longer operative. Nossen — results of genetic testing for LQTS are pending.

Seizures 98

Seizures EKG/ECG EMS Stroke 98

EB Medicine

AUGUST 1, 2018

Jeff: Because the current DEA controlled substances schedule designations are based on original chemical names, synthetics have gained popularity as manufacturers are able to produce newer compounds and circumvent DEA designation as well as routine urine drug screening tests. Jeff: And the etiology of CHS is not well understood.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

RebelEM

JUNE 8, 2023

Epub 2019 Jul 3. Am J Emerg Med. 2022 2022 Sep 5. PMID: 36108346 Cole JB, et al. Human Errors and Adverse Hemodynamic Events Related to “Push Dose Pressors” in the Emergency Department. J Med Toxicol. PMID: 31270748 Maheshwari K, et al. Intensive Care Med. 2018;44(6):857–67. Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Ken Grauer, MD

FEBRUARY 9, 2024

Awareness of this common association made me instantly suspect that some type of Wenckebach conduction is probably operative in today's rhythm — even though I admittedly do not see any pattern of consistent group beating, or any repetitive PR intervals that typically clue me in to Mobitz I conduction defects.

EKG/ECG 266

EKG/ECG Operations Wellness 266

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. Point-of-care ultrasound (PoCUS) is inherently operator-dependent, which may have led to inconsistencies in the quality and findings of the ultrasound exams across different operators.

Ultrasounds 127

Ultrasounds Outcomes COPD Hospitals 127

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. Figure 5: Pelvic binding with a sheet.

Fractures 54

Fractures Resuscitation Operations EMS 54

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. the pre-hospital setting.

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. On arrival at hospital the child was well with normal observations. The Fontan circulation was an operation initially developed around 50 years ago to treat tricuspid atresia. Family history. What are the important investigations?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98