The Skeptics' Guide to EM

NOVEMBER 21, 2020

Date: November 19th, 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. AEM November 2020. Date: November 19th, 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. AEM November 2020. AEM November 2020. Reference: Pines et al. Reference: Pines et al.

Emergency Department 52

Emergency Department Telemedicine Academics Outcomes 52

The Skeptics' Guide to EM

JULY 30, 2022

Background: Somewhere between two and four percent of patients presenting to US EDs with abdominal pain have a small bowel obstruction (SBO) – those who are managed operatively (who are only 20-30%) account for 60,000 hospitalizations and 565,000 inpatient care days per year. sensitivity and 96.6% specificity with ultrasound [1].

Ultrasounds 52

Ultrasounds Operations Outcomes Documentation/Coding 52

PulmCCM

SEPTEMBER 4, 2024

OP is operating point, the operating point defines the cardiac output on the y-axis and Pra on the x-axis; Rcardiac is cardiac resistance (i.e., OP1 is operating point 1 at baseline. With tamponade, operating point 2 (OP2) is formed. Might this novel measure predict outcome in critically-ill patients [ @ross_prager ]?

Ultrasounds 84

Ultrasounds Operations Research Outcomes 84

SheMD

MAY 4, 2023

What were their outcomes: The median number of years to first appointment to a chair position was 7 years after graduation. Women were more likely to be first appointed to educational rather than operational roles (52.6% Categorical analyses were conducted to compare demographics, qualifications, and achievements by gender.

Leadership 52

Leadership Academics Operations Administration 52

The Skeptics' Guide to EM

NOVEMBER 28, 2020

Date: November 25th, 2020 Guest Skeptic: Dr. Joe Vipond has worked as an emergency physician for twenty years, currently at the Rockyview General Hospital. Date: November 25th, 2020 Guest Skeptic: Dr. Joe Vipond has worked as an emergency physician for twenty years, currently at the Rockyview General Hospital. Should they do it?

Infectious Diseases 52

Infectious Diseases Outcomes Wellness Operations 52

Don't Forget the Bubbles

JUNE 26, 2023

Whilst waiting for an operation, they need to be managed medically. The underlying heart defect determines the precise operation performed – you might have heard of the Norwood procedure , an example used for HLHS specifically. Six hours post-operatively, they become more mottled, with weak pulses – signs of poor systemic perfusion.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

Don't Forget the Bubbles

JANUARY 8, 2024

This led to her death at 19, an outcome ruled as homicide at inquest, indicating others’ contribution to her demise. Verbal de-escalation not only helps in avoiding the need for physical intervention but also fosters a therapeutic relationship, crucial for successful treatment outcomes in these sensitive situations. Mulraney, M.,

Research 105

Research Emergency Department Psychiatric Outcomes 105

Don't Forget the Bubbles

JANUARY 17, 2024

After Meshram et al, 2020 When Orbeez are exposed to water, the water molecules diffuse into the polymer network through osmosis. They passed away a few days after a second operation. There have been reports of the Orbeez Challenge leading to serious outcomes. Unfortunately, the anastomosis broke down. It’s beads, too!

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. A comparison between pre-operative ultrasonography and surgical findings. 2020 Apr 15;28(8):309-315. Injuries discussed are shown in Image 1. Acta Radiol.

Fractures 75

Fractures Dislocations Operations Radiology 75

RebelEM

APRIL 29, 2024

One may speculate that the US-guided CVC placement would have a higher first-pass success rate with fewer complications, however, this may potentially add time to the procedure depending on the operator and institution’s use of ultrasound during emergencies and maintaining sterile technique with the US probe. Resuscitation. 9 Zhang W et al.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

Don't Forget the Bubbles

JANUARY 1, 2024

However, children who had an operation experienced improvements in behaviour, symptoms, and quality of life and had lower blood pressure. During the COVID-19 pandemic (2020-2021), the incidence of IPD reached its lowest level in 20 years. Outcomes From a Randomized Clinical Trial. They enrolled 459 children aged 3 to 12.9

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

The Skeptics' Guide to EM

JANUARY 23, 2021

That SGEMHOP episode asked how the productivity of APPs compare to emergency physicians and what is its impact on ED operations? The SGEM bottom line was that increasing APP coverage has minimal effect on ED flow and safety outcomes based on the data. Intervention: Evaluated by an APP * Comparison: Evaluated a physicial * Outcome:

Research 52

Research Poisoning Documentation/Coding 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

EMDocs

NOVEMBER 18, 2023

OPTN/SRTR 2020 Annual Data Report: Liver. Liver Transplantation: Operative Techniques and Medical Management. Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Pediatr Radiol. 2021;51(2):248-256. Am J Transplant. 2022;22 Suppl 2:204-309. doi:10.1111/ajt.16978

EMS 69

EMS Ultrasounds Emergency Department Outcomes 69

PulmCCM

FEBRUARY 28, 2022

What they did Adult patients admitted to one of 53 intensive care units in New Zealand or Australia between September 2017 and December 2020 were eligible. Death, from any cause, within 90 days of randomization was the primary outcome. The analysis was performed as an intention-to-treat.

Fluid Resuscitation 40

Fluid Resuscitation Resuscitation Outcomes Sepsis 40

Cook County EM Blog

MARCH 20, 2023

2020 Nov;26(6):899-904. Latex paint-gun injuries of the hand: are the outcomes better? Ulus Travma Acil Cerrahi Derg. doi: 10.14744/tjtes.2020.26751. 2020.26751. PMID: 33107958. Rosenwasser MP, Wei DH. High-pressure injection injuries to the hand. J Am Acad Orthop Surg. 2014 Jan;22(1):38-45. doi: 10.5435/JAAOS-22-01-38.

Documentation/Coding 52

Documentation/Coding Fractures Operations Research 52

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. 2020; 42(6):663-672. 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. What should I look for in a coach?

Academics 64

Academics Leadership Wellness Research 64

Taming the SRU

JANUARY 29, 2024

Variations in sensitivity are thought to be related to operator technique, patient habitus, and difficulty evaluating the subclavian vein beneath the clavicle. [12] Phlegmasia Cerulea Dolens in the Upper Extremity: A Case Report and Systematic Review and Outcomes Analysis. Epub 2020 Nov 25. Vasc Endovascular Surg. Phlebology.

Emergency Department 91

Emergency Department Fractures Hospitals Operations 91

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. Fluids and Barriers of the CNS.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

EMDocs

SEPTEMBER 9, 2023

Published 2020 Dec 21. Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation. Effect of Time to Hand Therapy following Zone II Flexor Tendon Repair. Plast Reconstr Surg Glob Open. 2020;8(12):e3278. doi:10.1097/GOX.0000000000003278 Arch Orthop Trauma Surg.

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

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

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. 2020 Aug 20. 2020 Jan 1;35(1):70-6. Conclusion Critical care resuscitation is stressful.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

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

ACEP Now

JULY 7, 2023

2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. Circulation. 2018;137(12). Kimblad H, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. Published March 15, 2020. Published April 20, 2020. Accessed August 25, 2024.

Hospitals 69

Hospitals Radiology Radiology Administration 69

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

RebelEM

DECEMBER 19, 2022

That write up was for the DOSE-VF pilot trial done in March 2020 and can be found here. At REBEL EM, we’ve done an extensive write up that details some of the different types of DED and the electrophysiology behind it. Now that same group has published the results of their full randomized control trial.

EMS 52

EMS CPR Shock Resuscitation 52

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

EMDocs

OCTOBER 17, 2023

World Society of Emergency Surgery guidelines (2020) “What is the best way to make a diagnosis of ALCD? However, no included studies compared patient health outcomes between CT-guided care and care without the use of routine CT for suspected diverticulitis. 2020 May 7;15(1):32. Noncompressible hyperechoic pericolic tissue.

Radiology 68

Radiology Radiology Operations Best Practices 68

EMDocs

JUNE 21, 2023

Functional outcomes Severe soft tissue injuries and damage to the bony structures => poor functional outcomes. Common operator errors Failing to enter joint capsule before injecting STS. Curr Orthop Pract, 31 (5) (2020 Sept), pp. 2020 Sep;29(9):1869-1875. Not injecting enough STS into the joint. PMID: 8836059.

Soft Tissue Injuries 68

Soft Tissue Injuries Fractures Dislocations Radiology 68

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

The Skeptics' Guide to EM

DECEMBER 12, 2020

Date: December 10th, 2020 Reference: Ladde et al. AEM December 2020 Guest Skeptic: Dr. Kirsty Challen (@KirstyChallen) is a Consultant in Emergency Medicine and Emergency Medicine Research Lead at Lancashire Teaching Hospitals Trust (North West England). Date: December 10th, 2020 Reference: Ladde et al.

Operations 52

Operations Outcomes Research Academics 52

EMDocs

OCTOBER 23, 2023

Operative complications requiring surgical intervention or hospitalization occur in about 3-6% of all hysterectomies (5). difficile infection, and post-operative hemorrhage. Abscess and Infected Hematoma : This condition is typically delayed, occurring most commonly 10-14 days post-operatively.

OB/GYN 67

OB/GYN Operations EMS Ultrasounds 67

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. However, these observations have failed to be validated at a larger level and should be taken with caution.

Infectious Diseases 86

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

RebelEM

NOVEMBER 3, 2022

Van Berkel 2017) In 2020 the NEAR study reported peri-intubation hypotension rates of 18.3% April 2020 ) RebelEM recently reviewed The EvK trial , which found a higher 7-day survival rate with ketamine but no difference in 28-day survival. April 2020 NEAR registry study represents 1/3rd the weight of this meta-analysis.

Outcomes 52

Outcomes Emergency Department Sepsis Hospitals 52

The Skeptics' Guide to EM

NOVEMBER 20, 2021

There are three other GEAR 1.0 Reference: Hammouda et al.

Geriatric Emergencies 52

Geriatric Emergencies Elder Abuse Research Academics 52

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. demonstrating that functional outcome at 3 months did not differ between the CTA and MRI groups (38.5% vs. 38.1%) with a good functional outcome.

Stroke 87

Stroke Radiology Radiology Emergency Department 87