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

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

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) The pervasive maxim quick on, quick off for UFH doesnt hold up as well as touted. 2012;141(2 Suppl):e419S-e496S. Eur Respir J.

Hospitals 52

Hospitals Administration Outcomes Stroke 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 135

Stroke Blood Transfusions Outcomes EMS 135

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. If not, then we still don’t know the answer.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

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

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

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

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. Epub 2019 Nov 29.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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 98

Stroke Administration Documentation/Coding Outcomes 98

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 99

Stroke Outcomes EMS Seizures 99

EMDocs

AUGUST 22, 2024

Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Certified interpreter use can improve communication and patient outcomes. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter.

Documentation/Coding 104

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 104

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

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. The pathologic vasodilation observed in sepsis is thought to result from failure of the vascular smooth muscle to constrict appropriately, leading to hypotension as well as tissue hypoperfusion (2). Ospina-Tascón GA, Teboul J-L, Hernandez G, et al.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

Ken Grauer, MD

FEBRUARY 28, 2023

As a result — IF the 1 lead you are monitoring happens to be one in which P waves are not well seen — then you might assume the irregular rhythm in front of you was AFib. The September 30, 2019 post in Dr. Smith’s ECG Blog — for an example of “MAT”, but without the tachycardia. Remember — 12 leads are better than one!

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

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

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Mount Sinai EM

OCTOBER 10, 2024

He pointed to a retrospective cohort study (Riehm et al, 2019) showing that adolescents who self-reported more than three hours a day on social media experienced double the rate of anxiety and depression symptoms. To make it directly related to our wellness, I’ll focus on studies of adults. Vivek Murthy, the U.S. Lambert et al.,

Wellness 100

Wellness Research Outcomes 100

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. What outcomes did they look at? Which patients were involved?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

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

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

RebelEM

MAY 18, 2023

The secondary outcome of mortality was not statistically different however numerically favored the early use of norepinephrine. This could have influenced care the patients received as well as reporting of adverse events (i.e. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104

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

EMDocs

MAY 25, 2023

Outcome: No statistically significant difference in primary outcome, which was absence of clinically apparent seizures without the need for additional anti-convulsant medications AND improving responsiveness at 60 minutes after the start of trial-drug infusion, as determined by the treating physician. 2019; 381(22): 2103-2113.

Seizures 89

Seizures Administration Anaphylaxis Outcomes 89

ACEP Now

JULY 11, 2024

Deaths from drinking increased 25 percent from 2019 to 2020 and another 10 percent in 2021. This medication has limited outcomes data and multiple contraindications. On the other hand, naltrexone and acamprosate are well-tolerated, affordable medications with promising outcomes data for harm reductions and, in some cases, abstinence.

Emergency Department 98

Emergency Department Psychiatric Outcomes Wellness 98

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 122

CDC Radiology Radiology Head Injuries 122

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% 2019 Oct;106(11):1542-1548. perforation). 623 patients included. in the observational group versus 14.9%

Sepsis 113

Sepsis Best Practices Hospitals Outcomes 113

Dr. Smith's ECG Blog

AUGUST 2, 2024

The LCx and OM branches are not as well seen. the investigators reviewed outcomes in 118 patients presenting with NSTEMI. We've highlighted a considerable number of acute RV MI cases in Dr. Smith's ECG Blog ( See the October 7, 2019 and May 10, 2024 posts , to name just two ). There is non-obstructive disease here.

EKG/ECG 119

EKG/ECG Fluid Resuscitation Academics Resuscitation 119

RebelEM

APRIL 22, 2024

Intervention: Target PaO2 = 60 mm Hg Control: Target PaO2 = 90 mm Hg Outcome (primary): Absolute number of days without life support in 90 days defined as the absence of mechanical ventilation, circulatory support, or kidney replacement. Outcomes (secondary): 90-day all-cause mortality. CI) Secondary Outcomes 90-day Mortality 34.7%

Outcomes 74

Outcomes Best Practices EMS Shock 74

ACEP Now

NOVEMBER 8, 2024

The guidelines, updated most recently in 2019, note that endotracheal intubation is reserved for paramedics. 11 As with LMAs, Combitubes are at risk of balloon rupture as well, and attention is needed to avoid damaging the inflating sections of the device both while in storage and during placement. DOT HS 813 151).

Airway Management 40

Airway Management EMS Hospitals Administration 40

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Date: September 11th, 2019 Reference: Putzu et al. The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Date: September 11th, 2019 Reference: Putzu et al. You wonder if giving vitamin C will affect her outcome?

Sepsis 52

Sepsis Shock Outcomes Stroke 52

EMDocs

JANUARY 3, 2024

10 This procedure has well-described rare complications including infection, blood loss, allergic reaction, arrhythmia, pneumothorax if approaching via the internal jugular vein, embolization of the device, and pulmonary artery perforation or dissection. 2019 Apr;6(2):308-18. 2019 Dec;21(Suppl M):M50-M53. Epub 2019 Dec 31.

Allergic Reactions 113

Allergic Reactions Hospitals EMS Emergency Department 113

Don't Forget the Bubbles

JULY 19, 2023

Olivia, a previously well 13-year-old girl, is referred to the paediatric ED from the Ophthalmology ED. 2019) describe 23% and 13% of children with papilloedema as having significant pathology – an intracranial tumour, hydrocephalus, or intracranial infection. 2019 Dec 1;54(6):653–8. 2020 and Hyde et al. Can J Ophthalmol.

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

Sensible Medicine

AUGUST 4, 2024

The authors obtained incidence data for 34 types of cancer and mortality data for 25 types of cancer for individuals aged 25–84 years for the period Jan 1, 2000, to Dec 31, 2019 from the North American Association of Central Cancer Registries and the US National Center for Health Statistics, respectively.

Academics 100

Academics Outcomes Wellness 100

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. The primary outcome in this study was a change in pain score at rest 60 minutes after block.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

Don't Forget the Bubbles

AUGUST 2, 2023

Early management leads to better outcomes. That being said, younger patients tend to have better outcomes with a multidisciplinary team approach leading to remission in approximately 90% of children. Outcomes of children with complex regional pain syndrome after intensive inpatient rehabilitation. 2019 Dec;35(12):933-940.

Psychiatric 98

Psychiatric Pediatrics Outcomes Academics 98

PulmCCM

JANUARY 22, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

RebelEM

AUGUST 12, 2024

PMID: 36038001 Clinical Question: In patients undergoing cardiac surgery with cardiopulmonary bypass, does the administration of intravenous amino acid therapy lead to lower occurrence of postoperative AKI when compared to placebo?

Outcomes 81

Outcomes Hospitals Operations Shock 81