Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

EMDocs

NOVEMBER 13, 2024

Older age, recurrent episodes of SBP, hepatorenal syndrome, hepatic encephalopathy, acute kidney injury (AKI), concurrent GI bleeding, and higher MELD scores are predictors of worse outcomes. 2020 Sep-Oct;19(5):451-457. Spontaneous bacterial peritonitis in patients with cirrhosis: incidence, outcomes, and treatment strategies.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 105

ED ECMO

DECEMBER 18, 2020

2020 was a crazy year. This month Zack goes through the biggest ECMO lessons learned in 2020. It’s a reminder of how organization is so critical to the outcome of your ECMO program. 2020 was a crazy year. 2020 was a crazy year. This month Zack goes through the biggest ECMO lessons learned in 2020.

Outcomes 52

Outcomes 52

Emergency Medicine Journal

JULY 24, 2023

Background In England, reported COVID-19 mortality rates increased during winter 2020/21 relative to earlier summer and autumn months. This study aimed to examine the association between COVID-19-related hospital bed-strain during this time and patient outcomes. Bed-strain was categorised into quartiles for modelling.

Outcomes 69

Outcomes Hospitals 69

EMDocs

DECEMBER 1, 2024

The disease is generally mild, but in untreated cases, it can lead to more severe outcomes, especially in patients with underlying conditions such as glucose-6-phosphate dehydrogenase deficiency. Even though the disease often resolves spontaneously, prompt antibiotic therapy is essential for optimal outcomes. pregnant patients).

EMS 105

EMS Infectious Diseases Shock Airway Management 105

PulmCCM

JANUARY 15, 2025

According to a 2023 analysis of applications for FDA approval , as late as 2020 manufacturers were complying with a minimum of effort—e.g., Clinical Outcomes Associated With Overestimation of Oxygen Saturation by Pulse Oximetry in Patients Hospitalized With COVID-19. Nature (news). January 2024. Fawzy et al. Ferryman et al.

Academics 81

Academics Documentation/Coding Administration Research 81

Pediatric EM Morsels

JUNE 9, 2023

Luoto, 2020 ] Increase resistance can be related to pre-hepatic , intra-hepatic , or post-hepatic etiologies. Luoto, 2020 ] Increase resistance can be related to pre-hepatic , intra-hepatic , or post-hepatic etiologies. Banc-Husu, 2023 ; Luoto, 2020; Carneiro de Moura, 2018 ] Basics are best (always)! 2020 May;70(5):628-634.

Pediatrics 154

Pediatrics Head Injuries Airway Management Administration 154

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

Ken Grauer, MD

SEPTEMBER 21, 2024

To quote Dr. Stephen Smith: "The worst risk factor for a bad outcome in acute MI is young age." Sometimes cardiac cath is needed to distinguish between an MI vs myocarditis. PEARL # 3: Acute MI Can Occur in a Younger Patient!

EKG/ECG 296

EKG/ECG Resuscitation Outcomes Hospitals 296

Emergency Medicine Journal

JUNE 20, 2024

Methods A retrospective chart review of ED visits of patients on ICI from 15 December 2016 to 6 December 2020 was performed. Outcome was based on mortality at date of last follow-up. Clinical presentation, cancer characteristics and type of ICI were extracted by a single abstractor.

Outcomes 70

Outcomes Emergency Department 70

Emergency Medicine Journal

JULY 24, 2023

We aimed to determine the association between the 2020 COVID-19 pandemic and OHCA outcomes and bystander resuscitation efforts among the working-age population. We compared characteristics and outcome differences of the arrests between three prepandemic years (2017–2019) and the pandemic year 2020.

Resuscitation 52

Resuscitation Outcomes CPR Hospitals 52

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 initial anticoagulation among US patients hospitalized with acute pulmonary embolism 2011-2020. percent to 56.3 Ann Emerg Med.

Hospitals 52

Hospitals Administration Outcomes Stroke 52

Canadian EM

APRIL 4, 2023

Although some COVID-19 survivors report persistent symptoms months after resolution of the acute infection, we do not know much about their long-term physical and psychological health outcomes. 1​ We used data from 22 CCEDRRN EDs across 5 provinces between March 2020 to July 2021.

Outcomes 52

Outcomes 52

Pediatric EM Morsels

AUGUST 11, 2023

Infections there become complicated very quickly and the outcomes can be very poor. 2020 Oct 24;12(10):e11141. Inpatient Vs Outpatient Therapy No standard approach… but… here is what I say: “ Always Fear Infections in the Hands, Feet, or Face.” ” Those areas have very important and delicate structures.

Burns 130

Burns Pediatrics EMS Outcomes 130

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Three outcomes were evaluated, with none being deemed the primary outcome. Background: Sepsis remains one of the leading causes of morbidity and mortality. to 0.97; p = 0.02 to 2.07; p = 0.91 to 12.33; p = 0.26

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

RebelEM

APRIL 17, 2023

An extensive systematic review with more than 30,000 patients found no difference in the odds of treatment failure for patients with PTA managed with medical intervention alone or surgically (Forner 2020). 2020 Nov;163(5):915-922. Epub 2020 Jun 2. 2020, August 18). Otolaryngol Head Neck Surg. PMID: 32482146. Podcast Blog.

Ultrasounds 130

Ultrasounds Radiology Radiology Operations 130

EMDocs

NOVEMBER 7, 2023

No difference in their primary outcome of complications and need for emergency surgery (1.9% Outcome measures were complicated diverticulitis, recurrent diverticulitis and sigmoid resection at 24 months’ follow up. 2020 Mar 30:S1542-3565(20)30426-2. 623 patients included. in the observational group versus 14.9%

Sepsis 114

Sepsis Best Practices Hospitals Outcomes 114

Emergency Medicine Journal

APRIL 22, 2024

Methods This was a multicentre prospective observational study of adult ED patients presenting to five Australian hospitals between November 2020 and September 2021. The primary outcome was index AMI, including type 1 or 2 non-ST segment elevation MI (NSTEMI) or ST-elevation MI (STEMI) following presentation.

Emergency Department 98

Emergency Department Outcomes EKG/ECG Hospitals 98

Emergency Medicine Journal

JUNE 22, 2023

The primary outcome was intubation or non-invasive ventilation, death or intensive care unit admission at 30 days. Results Of the 446 084 patients, 15 397 (3.45%, 95% CI 34% to 35.1%) experienced the primary outcome. Clinical decision-making for inpatient admission achieved a sensitivity of 0.77 (95% CI 0.76

Outcomes 98

Outcomes 98

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. doi: 10.1136/bcr-2020-240532. Rates of congenital syphilis are increasing. Foles, 2024 ] In the US, from 2013-2018, cases increased from 362 to 1,306.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

EMDocs

AUGUST 3, 2024

He Was Right Spoon Feed This systematic review found that approximately 4%-27% of patients presenting to the ED with presyncope experienced serious outcomes within a 30-day period. Source Serious outcomes among emergency department patients with presyncope: A systematic review. Acad Emerg Med. 2024 Jun 9. doi: 10.1111/acem.14943.

Emergency Department 98

Emergency Department Outcomes Hospitals 98

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. Intensive Care Med 2020. [13]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Vitamin C did not improve outcomes among patients hospitalized with Covid-19.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

EMDocs

JANUARY 25, 2025

0000000000000305 Kazumi Y (2023) The Epidemiology and Outcomes of Leukopenia in Different Populations and Regions. BioMed Research International, 2020, 1-10. An update on the diagnosis and treatment of chronic idiopathic neutropenia. Curr Opin Hematol. 2017;24(1):46-53. doi:10.1097/MOH.0000000000000305 J Blood Disord Transfus.

EMS 96

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 96

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.,

CDC 119

CDC Radiology Radiology Head Injuries 119

EMDocs

SEPTEMBER 8, 2024

Delaying treatment of elevated BP in patients may lead to worse outcomes, and an optimal IV antihypertensive medication will reach the BP goal rapidly while avoiding hypotension and causing end organ injury. Authors extracted proportions dichotomous outcomes (in-hospital mortality) and calculated risk ratios. clevidipine).

Stroke 105

Stroke Outcomes Hospitals 105

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

Don't Forget the Bubbles

MAY 31, 2023

What outcomes did they look at? Was the outcome accurately measured to minimise bias? The inability to test for SARS-CoV-2 antibodies may have led to an underestimation of the impact of the virus on the reported outcomes. Mintegi, S., & Country Leads (2020). Was the follow-up of subjects complete enough? Bressan, S.,

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

PulmCCM

OCTOBER 7, 2024

What’s the evidence for this practice, in terms of efficacy, outcomes, and safety? Randomized Trials of Midodrine in the ICU At least four randomized trials testing midodrine in the ICU were published between 2020 and 2022, as described in a narrative review by Costa-Pinto et al. All but one were retrospective. Read more

Shock 98

Shock Outcomes 98

Dr. Smith's ECG Blog

JUNE 5, 2024

IMPRESSION: The finding of sinus bradycardia with 1st-degree AV block + marked sinus arrhythmia + the change in PR interval from beat #5-to-beat #6 — suggests a form of vagotonic block ( See My Comment in the October 9, 2020 post in Dr. Smith's ECG Blog ).

EKG/ECG 122

EKG/ECG Outcomes 122

ACEP Now

JULY 11, 2024

Deaths from drinking increased 25 percent from 2019 to 2020 and another 10 percent in 2021. The percentage of suicides while intoxicated with alcohol has increased, particularly among women, and traffic fatalities in 2020 were at their highest point in over a decade. 2020:8;279. problem drinking has reached a steady state.

Emergency Department 98

Emergency Department Psychiatric Outcomes Wellness 98

Don't Forget the Bubbles

JUNE 30, 2023

American Thoracic Society, 2020 c) Rewarm and give IV K+ As the infusion is put up, Elsa goes into a VF rhythm due to a rapid shift in potassium and arrests soon after. Extracorporeal life support rewarming rate is associated with survival with good neurological outcome in accidental hypothermia. ” In C44. A5175-A5175.

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

EMDocs

JUNE 12, 2024

HypoCa is common in trauma patients and is associated with poor outcomes. We need RCTs to determine if Ca administration in trauma impacts mortality and other patient-centered outcomes. All are associated with critical illness and severe hemorrhage. However, this triad does not include hypoCa, which has a major role in trauma.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 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. 2020 Feb;8(2):605-617.e6.

Outcomes 105

Outcomes Academics Documentation/Coding Emergency Department 105

The Trauma Pro

OCTOBER 25, 2024

Here are the factoids: The original data were derived from a 17-center study conducted from 2018-2020; this study only included 1,387 patients who had pelvic fractures (as well as other injuries). The primary outcome was the development of VTE during the hospitalization.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

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. Mayo Clin Proc Innov Qual Outcomes. 2.89, p = 0.01.

Sepsis 122

Sepsis Fluid Resuscitation Resuscitation Administration 122

Taming the SRU

MARCH 27, 2024

The parent trial was conducted from October 2020 to July 2022 in the capital region of Denmark. The primary outcome was cumulative norepinephrine use during the first 48 hours of admission. That said, outcomes for these patients are generally poor and the use of steroids as a one-time dose likely has little risk. Hill, J.

Resuscitation 99

Resuscitation CPR Outcomes Hospitals 99