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 300

EKG/ECG Resuscitation Outcomes Hospitals 300

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

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

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 142

Infectious Diseases Research Outcomes 142

RebelEM

DECEMBER 23, 2024

There has been ongoing study about the clinical significance of these effects, as well as whether and for whom LR might provide meaningfully better clinical outcomes ( Myburgh 2013 , Self 2018 , Semler 2018 , Self 2020 ). The enrollment was multicenter, large, and adequately powered for clinically meaningful changes in outcome.

Fluid Resuscitation 123

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 123

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 131

Sepsis Hospitals Administration Outcomes 131

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

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 129

Ultrasounds Radiology Radiology Operations 129

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 114

CDC Radiology Radiology Outcomes 114

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

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

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

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 99

Operations Academics Outcomes Fluid Resuscitation 99

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

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 97

Resuscitation Outcomes CPR Hospitals 97

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

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 90

Emergency Department Pediatrics Outcomes EMS 90

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 95

COPD Stroke Academics Urgent Care 95

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. J Crit Care 2020. to 1.12; p = 0.03 to 0.99; p <0.01 to 2.47; p – 0.04

Resuscitation 119

Resuscitation Outcomes EMS Sepsis 119

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

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

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 119

Sepsis Fluid Resuscitation Resuscitation Administration 119

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 98

Blood Transfusions Operations Infectious Diseases Resuscitation 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 75

Emergency Department Outcomes Hospitals 75

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

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. with acetaminophen) until temperatures reached 37.8 °C who then received external cooling to maintain a target temperature of 37.5 °C.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 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.

Documentation/Coding 81

Documentation/Coding Academics Administration Research 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 103

EKG/ECG Outcomes 103

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 81

Stroke Outcomes Hospitals 81

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

Taming the SRU

SEPTEMBER 25, 2023

Functional outcome of bimalleolar ankle fractures treated with fibular plate for lateral malleolus and C.C. 2020 Feb 12;4(2):e20.00005. 2020 Dec;12(6):1644-1651. Epub 2020 Sep 7. Functional outcome of bimalleolar ankle fractures treated with fibular plate for lateral malleolus and C.C. screws for medial malleolus.

Fractures 100

Fractures Operations Emergency Department EMS 100

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 90

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 90