Sensible Medicine

NOVEMBER 5, 2024

Introduction In 2020, the term “Long COVID” was adopted to describe persistent symptoms after a COVID-19 infection. Researchers like Dr. Zayid Al-Aly have been at the forefront of advancing our understanding of the long-term outcomes of COVID-19. Funding Funding was provided by the Department of Veterans Affairs.

Outcomes 103

Outcomes Research Hospitals 103

Pediatric EM Morsels

JULY 26, 2024

Higher titers in both CSF and serum were associated with poor outcomes. Earlier diagnosis leads to better outcomes. Younger Age at Onset Is Associated With Worse Long-term Behavioral Outcomes in Anti-NMDA Receptor Encephalitis. 2020 Feb;75:55-62. It is best to assume the worst and cover for this possibility. 2019.12.016.

Psychiatric 269

Psychiatric Seizures Outcomes Pediatrics 269

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 152

Pediatrics Head Injuries Airway Management Administration 152

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

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

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

The Skeptics' Guide to EM

OCTOBER 12, 2024

June 2024 Population: Children aged 7-17 years and their caregivers who presented to ten Canadian pediatric EDs between 2018 and 2020 Excluded: Children who remained medically unstable during their ED stay, had altered levels of consciousness, were suspected of being abused, or had a caregiver who was not their legal guardian​.

Emergency Department 91

Emergency Department Pediatrics Outcomes EMS 91

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

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 83

Sepsis Stroke Shock Infectious Diseases 83

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 147

Fractures Head Injuries Operations Ultrasounds 147

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

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 74

Emergency Department Outcomes Hospitals 74

Sensible Medicine

JUNE 6, 2024

The first two weeks of March 2020 were jolting. Although he initially rejected it, by April 2020, he recommended community cloth masking to slow the coronavirus (an intervention for which we now have randomized data showing it doesn’t work). In other words, if policies actually work, this method is able to prove that they work.

Infectious Diseases 144

Infectious Diseases Research Outcomes 144

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

PulmCCM

APRIL 29, 2024

Simvastatin has anti-inflammatory properties, and while it isn’t an effective treatment for ARDS overall, it may improve outcomes in the subset of people with ARDS due to increased inflammation.

Outcomes 52

Outcomes 52

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 80

Stroke Outcomes Hospitals 80

Emergency Medicine Journal

MARCH 21, 2024

Pandemic phase-related racial and ethnic disparities in COVID-19 positivity and outcomes among patients presenting to emergency departments during the first two pandemic waves in the USA The COVID-19 pandemic will likely be one of the most significant clinic events for any of us in our professional lives.

Emergency Department 52

Emergency Department Outcomes 52

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 126

CDC Radiology Outcomes Radiology 126

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 152

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 152

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 393

EKG/ECG Resuscitation Outcomes Hospitals 393

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 105

Operations Academics Outcomes Fluid Resuscitation 105

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

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 98

Resuscitation Outcomes CPR Hospitals 98

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 88

Sepsis Best Practices Hospitals Outcomes 88

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 82

Outcomes Academics Documentation/Coding Administration 82

PulmCCM

SEPTEMBER 28, 2023

Systemic corticosteroids (such as intravenous dexamethasone) improve outcomes in severe pneumonia due to SARS-CoV-2 infection. It makes sense that inhaled steroids might improve outcomes from less severe infections. Predominant SARS-CoV-2 strains during that trial’s enrollment (July-December 2020) were Wuhan, Alpha and Delta.

COPD 85

COPD Stroke Academics Urgent Care 85

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

PulmCCM

NOVEMBER 6, 2023

The therapy was approved for emergency use in 2020 by FDA after an observational study of 10 patients showed likely benefit (yes, 10, which should remind us of our collective desperation). patients infected with the Wuhan/Delta variants in 2020-2021). Thromboelastometry (e.g., The balloon generally required 30 minutes to insert.

Blood Transfusions 93

Blood Transfusions Operations Resuscitation Infectious Diseases 93

The Skeptics' Guide to EM

MARCH 18, 2023

Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020. Association of early oseltamivir with improved outcomes in hospitalized children with influenza, 2007-2020.

Pediatrics 40

Pediatrics Infectious Diseases Administration Outcomes 40

Emergency Medicine Journal

JUNE 20, 2024

The associations between where you live and your health outcomes are increasingly understood. In 2020, Quality Watch, a joint venture funded by the Nuffield Trust and the Health Foundation, found that long waits for emergency care were greater in the most deprived areas.

Outcomes 40

Outcomes 40

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 89

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 89

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 81

Outcomes Hospitals Operations Shock 81

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 106

EKG/ECG Outcomes 106

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

Emergency Medicine Journal

NOVEMBER 28, 2023

Methods We conducted a pragmatic randomised controlled feasibility trial in two EDs in England over a 6-month period (7 October 2019 to 6 April 2020). The primary outcome for this study was trial recruitment rate. Other measures were recorded to assess potential future definitive trial outcomes and feasibility.

Fractures 40

Fractures Ultrasounds Outcomes Research 40

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

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