PulmCCM

FEBRUARY 27, 2025

Does the choice of balanced solution make a difference in patient outcomes from critical illness? Based on their similarities, you might expect no differences in outcomes between patients resuscitated with LR or Normosol-R. There were no significant differences in any outcome: Bicarbonate levels: (-1.2 Buffering capacity (i.e.,

Resuscitation 95

Resuscitation Outcomes Research 95

Pediatric EM Morsels

SEPTEMBER 22, 2023

McGraw Hill Education; 2019:104-109 Dave S, DAHLSTROM JJ. Orenstein JB, Klein BL, Gotschall CS, Ochsenschlager DW, Klatzko MD, Eichelberger MR. Age and outcome in pediatric cervical spine injury: 11-year experience. McGraw Hill Education; 2019:125-138 Ziu E, Mesfin FB. References Coleman-Satterfield, TT. 5 th Edition.

Shock 304

Shock Pediatrics Dislocations Hyperthermia / Hypothermia 304

Pediatric EM Morsels

JUNE 14, 2024

Tavasoli 2018, Wolf 2012) More common in adults; children comprise 20% of total cases (Pidcock 2007, Wang 2019) Bimodal age distribution (Absoud 2016) Children < 5 years Children > 10 years Symptoms evolve over 2-4 days and peak at 5-6 days (Absoud 2016) ATM may occur alone OR as part of another disorders (e.g.

Pediatrics 143

Pediatrics EMS Outcomes 143

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 187

Pediatrics Emergency Department Outcomes Sepsis 187

PulmCCM

MARCH 4, 2025

In 1999, the Transfusion Requirements in Critical Care (TRICC) trial demonstrated that in a mix of patients with critical illness, restricting red blood cell transfusion to those with hemoglobin <7 g/dL did not worsen outcomes. In its evidence review, a U.S. society found no adverse effects of restrictive transfusion strategies (Hb 7.0

Outcomes 52

Outcomes Hospitals 52

RebelEM

SEPTEMBER 7, 2023

BACKGROUND: intracerebral hemorrhage (ICH) makes up 10-15% of all strokes and significantly contributes to overall stroke-related morbidity and mortality ( Hostettler 2019 ). OUTCOMES Primary: Occurrence of at least one clinical or electrographic seizure recorded on continuous EEG within 72 hours after inclusion. OR 0.07, 95% CI 0.01-0.38,

Seizures 129

Seizures Stroke Outcomes Research 129

RebelEM

MAY 25, 2023

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

EM Literature of Note

SEPTEMBER 11, 2023

MARISS tried to ascertain predictors of poor outcome in mild stroke, and intravenous thrombolysis was not associated with an effect on the primary outcome. The population included for analysis is the Austrian Stroke Unit Registry from 2018 until 2019, an original cohort of 53,899 patients.

Stroke 114

Stroke Outcomes Wellness 114

NIOSH Science Blog

SEPTEMBER 27, 2023

As of 2019, more than 18 million people, 11.5 % of the United States workforce, were employed in healthcare settings. Everyday healthcare workers face hazardous work conditions due to exposures to infectious agents and hazardous drugs and chemicals.

Outcomes 108

Outcomes 108

Pediatric EM Morsels

JUNE 9, 2023

Specific Therapies for Variceal Hemorrhage : [ Luoto, 2020 ; Castillo, 2019; Garcia-Tsao, 2007 ] Antibiotic prophylaxis (usually for 7 days) Ceftriaxone is reasonable 1st choice. Castillo, 2019 ] Somatostatin (or its analogues, like Octreotide) Guidelines do recommend this… There is great variability in its administration, though.

Pediatrics 154

Pediatrics Head Injuries Airway Management Administration 154

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 Pediatrics Outcomes 145

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

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 129

Ultrasounds Outcomes COPD Hospitals 129

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. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 143

Administration Outcomes Resuscitation Radiology 143

ACEP Now

MARCH 11, 2025

1 Further, a Cochrane review found that LMWH is associated with improved outcomes compared with UFH including reduced incidence of major hemorrhage (odds ratio [OR]=0.69; 95 percent CI, 0.50-0.95) Trends in the Management and Outcomes of Acute Pulmonary Embolism Analysis from the RIETE Registry. 2012;141(2 Suppl):e419S-e496S.

Hospitals 52

Hospitals Administration Outcomes Stroke 52

EMDocs

DECEMBER 6, 2024

7 Workup other than serum iron concentration at 4 hours after ingestion not shown to accurately predict clinical outcomes or severity of toxicity. McGraw Hill; 2019. If large number of tablets are visualized on abdominal x-ray, it can help guide GI decontamination decisions. 1 Management: Supportive care first and foremost.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

RebelEM

NOVEMBER 30, 2023

Outcomes: Primary Outcome: In-hospital mortality. Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. There was no specified time-frame for the primary outcome, potentially affecting the precision of the findings. May 1, 2019 , A5999-A5999. 2.89, p = 0.01. Hamdon, M.

Sepsis 122

Sepsis Fluid Resuscitation Resuscitation Administration 122

EMDocs

JANUARY 29, 2024

Finally, anticipating and addressing known complications such as seizures, increased intracranial pressure, or cerebral edema with appropriate measures, including antiepileptic drugs or osmotic agents, is essential for improving patient outcomes. Lowering the MAP may mitigate these risks and possibly improve outcomes. Ann Emerg Med.

Stroke 101

Stroke Outcomes EMS Seizures 101

Sensible Medicine

JULY 29, 2024

The background for cash giveaways stem from the association of low income and worse health outcomes. The primary outcome was positive but there were caveats. Importantly, however, there were no differences in health outcome measures, such as BP, BMI, HbA1c or cholesterol level. More than 70% were first-language Spanish speaking.

Outcomes 118

Outcomes Research Sepsis Emergency Department 118

EMDocs

AUGUST 22, 2024

Certified interpreter use can improve communication and patient outcomes. Conducting research regarding best practices for improving health outcomes for NELP patients. Pearls NELP patients have worse health outcomes despite widespread language-access policies. April 2019. 45:446-458. Taira B, et al. 23:1214-1222.

Documentation/Coding 105

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 105

PulmCCM

SEPTEMBER 21, 2023

But there’s been surprisingly little data from randomized trials to identify more precise targets in the middle: The MAPAS trial (2019) suggested rapid lowering of blood pressure in acute ischemic stroke was unhelpful, a target of 161-180 mm Hg might be beneficial, and pressures 181-200 mm Hg resulted in more intracranial hemorrhage.

Stroke 105

Stroke Outcomes 105

Don't Forget the Bubbles

JUNE 30, 2023

Ann Cardiothorac Surg 2019; 8:137–142 But Elsa’s temperature is 30.1⁰C. Extracorporeal life support rewarming rate is associated with survival with good neurological outcome in accidental hypothermia. Ann Cardiothorac Surg 2019; 8:137–142 Saczkowski, R., Mazur P, Kosinski S, Podsiadlo P, et al.: The “sweet spot” is between 0.5-2⁰C

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

The Trauma Pro

OCTOBER 4, 2024

Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. J Ped Surg 54:335-339, 2019.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

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. 2019 May 31:bmjqs-2019. 2019 May;27(4):758-64. BMJ Quality & Safety.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

EMDocs

SEPTEMBER 30, 2024

Primary outcome: Prescription of ICS on ED discharge from the index visit Secondary outcomes: ICS prescription rates in high-risk subgroups Rates of outpatient follow-up within 30 days of an ED visit for asthma Variation in ICS prescription rates among attending ED physicians. The primary outcome was hospital admission rates.

Outcomes 105

Outcomes Academics Documentation/Coding Emergency Department 105

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives The prevalence of multimorbidity, the presence of two or more long-term conditions (LTCs) is increasing, and it is associated with poor health outcomes. This study describes the impact of multimorbidity in patients attending ED on 30-day mortality and other patient-centred outcomes in an ED setting.

Emergency Department 40

Emergency Department Outcomes Hospitals 40

American Medical Compliance

APRIL 16, 2024

Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve healthcare outcomes. A medication safety fact file released by the World Health Organization (WHO) in 2019 shows that medication errors harm millions of patients yearly.

Patient Safety 98

Patient Safety Administration Outcomes 98

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes. 7 (2019): 654-664. Diastolic Shock Index: A clinically relevant predictor of poor outcome in septic shock?

Shock 52

Shock Outcomes Sepsis Resuscitation 52

Broome Docs

OCTOBER 6, 2024

Can acutely ill patients predict their outcomes? 2019 Nov 5;322(17):1722. Mols EM, Haak H, Holland M, Schouten B, Ibsen S, Merten H, Christensen EF, Nanayakkara PWB, Nickel CH, Weichert I, Kellett J, Subbe CP, Kremers MNT; Safer@Home Research Consortium. A scoping review. Emerg Med J. 2024 May 28;41(6):342-349. doi: 10.1001/jama.2018.15583.

Emergency Department 102

Emergency Department EMS Research Outcomes 102

Mind The Bleep

OCTOBER 29, 2024

Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes. 2019 Nov;34(4):276-281. Epub 2019 Nov 29. Specific protocols, such as those for hydrofluoric acid burns, must be followed to address unique complications like hypocalcaemia and cardiac arrhythmias. J Med Toxicol.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

RebelEM

OCTOBER 2, 2023

No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 tests/hr (0.8 Traditional: 1.0 tests/hr (0.8 Pre-Intervention: 1.0 tests/hr (0.9

Operations 103

Operations Academics Fluid Resuscitation Outcomes 103

RebelEM

FEBRUARY 8, 2024

patients with more discrepant readings had NIBP checked more frequently) Some patients were on multiple vasopressors, but for an unclear reason the authors decided to only evaluate the dose of norepinephrine MAP discrepancy is not a patient oriented outcome (i.e. to 1.12; p = 0.03 to 0.99; p <0.01 to 1.09; p = 0.01 to 1.37; p <0.01

Resuscitation 123

Resuscitation Outcomes EMS Sepsis 123

Pediatric EM Morsels

AUGUST 9, 2024

2019, there were 1,875 and this trend has continued to increase (2,157 case in 2020; 2,855 cases in 2021). If not treated early, then increased risk of poor outcomes and death. Worldwide, congenital syphilis complicates about 1 million pregnancies / year. Hussain, 2023 ] Leads to >300,000 perinatal deaths / year globally.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

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

ACEP Now

JUNE 21, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes including successful development of a niche in the specialty. 11 What should we take away?

EMS 114

EMS Academics Telemedicine Operations 114

PulmCCM

JUNE 12, 2023

TTM2 found no improvement in survival or neurologic outcome among patients randomized to cooling to a target of 33 °C, as compared to controls receiving fever prevention (e.g. Elsevier boasted a 40% profit margin in 2019. Elsevier explained that their fees are justified to maintain open access (i.e.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 105

PulmCCM

JANUARY 6, 2025

A cluster randomized trial using all-cause mortality as an outcome was always needed to determine whether EMR alerts improve outcomes for suspected severe infection. Administratively, CMS could convert SEP-1 to a “process”-based or “intermediate outcome measure” or another type.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45