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 135

Stroke Blood Transfusions Outcomes EMS 135

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 129

Ultrasounds Outcomes COPD Hospitals 129

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

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

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

SheMD

MAY 4, 2023

Women were more likely to be first appointed to educational rather than operational roles (52.6% vs 61.2%, p=0.02) as well as to be in those roles immediately prior to first chair appointment (p=0.01). doi: 10.1136/bmjopen-2019-032232 Farrugia G, Zorn CK, Williams AW, Ledger KK. Why do we care about this article? JAMA Netw Open.

Leadership 52

Leadership Academics Operations Emergency Department 52

Taming the SRU

NOVEMBER 3, 2023

The thought with introducing the serratus anterior plane block was that regional anesthesia is well within the purview of EM physicians and can offer a safe alternative to systemic pain medications. 50% were male, 50% were female and they had a median # of 4 rib fractures with a range 2-8. SD 3.28) and 6.5, respectively.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

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

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 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

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

EMDocs

OCTOBER 30, 2023

Some institutions developed a tier-based system for outpatient imaging as well which was updated in real-time. Under standard operating protocols, residual contrast materials are usually wasted, according to current CDC and JC standards. Published online 2019. 2005;237(1):189-196. doi:10.1148/radiol.2371041432 Proof of Concept.

Radiology 99

Radiology Radiology Emergency Department Hospitals 99

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

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

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

RebelEM

MARCH 27, 2023

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? There may have very well been a policy where only RTs can make changes to a ventilator after an order was placed to ensure accurate documentation. J Crit Care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

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

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

Dr. Smith's ECG Blog

MARCH 2, 2019

And more cases, if you want, at this link. == My Comment, by K EN G RAUER, MD ( 3/2/2019 ): == The importance of this case lies in recognition of a number of findings, and the differential diagnoses that these findings should evoke. Often more than one entity is operative as is likely in this case. ST depression: is it ischemia?

EKG/ECG 52

EKG/ECG Operations Seizures Stroke 52

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

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

NOVEMBER 30, 2022

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. This patient, who is a mid 60s female with a history of hypertension, hyperlipidemia and GERD, called 911 because of chest pain.

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 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

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 281

Seizures Pediatrics CDC Infectious Diseases 281

EMDocs

FEBRUARY 22, 2025

Well keep it short, while you keep that EM brain sharp. 2019 Nov;29(4):581-594. Epub 2019 Aug 26. 2019 Mar;57(2):439-451. A 37-year-old male comes in with facial trauma after his head slammed into the steering wheel during an MVC. He was able to walk away from the scene with no loss of consciousness, nausea, or vomiting.

EMS 65

EMS Fractures Operations Wellness 65

EMDocs

DECEMBER 6, 2024

5 Orogastric lavage may also be considered for GI decontamination but likely to be limited by location, size of tablets, and operator familiarity. McGraw Hill; 2019. 9 Typical dose: Polyethylene glycol (Go-Lytely ) 25 mL/kg/hr in small children and 1.5-2 2 L/hr in adults. 10 Maximum daily dose of 6-8g total of defuroxamine.

Poisoning 97

Poisoning Fluid Resuscitation Seizures Resuscitation 97

PulmCCM

APRIL 18, 2024

The real world success rates by operators experienced with intubation remained unknown. In the relatively few studies comparing video to direct laryngoscopy, intubations were usually performed by inexperienced trainees, and sample sizes were small. The results seem to hold for both major video laryngoscopes (GlideScope and McGrath).

Airway Management 98

Airway Management Operations EMS Research 98

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 91

Emergency Department Soft Tissue Injuries Airway Management Operations 91

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 113

Seizures EKG/ECG EMS Stroke 113

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

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

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 40

Documentation/Coding Operations Academics Ultrasounds 40

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

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

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 81

Outcomes Hospitals Operations Shock 81

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

Northwestern EM Blog

MAY 16, 2022

Follow up CT should depend on the patient and ultrasound operator. Lastly the POCUS operators were ED physicians with training “recommended by ACEP.” J Urol 2019. In this study, 40.7% of those in the POCUS group and 27% in the formal ultrasound group underwent subsequent CT. References 1) Moore et al. 202(3):475-483.

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

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