The Skeptics' Guide to EM

JANUARY 1, 2022

Prospective, multicenter, controlled trial of mobile stroke units. Date: December 21st, 2021 Guest Skeptic: Dr. Prospective, multicenter, controlled trial of mobile stroke units. Background: No one who has listened to the SGEM will be surprised we are covering another paper looking at stroke. Reference: Grotta JC et al.

Stroke 52

Stroke EMS Outcomes Administration 52

Don't Forget the Bubbles

NOVEMBER 27, 2023

The amount of blood that comes from the heart with each contraction is the stroke volume (SV). The stroke volume is the difference between how full it is at the start and how full it is after a contraction. The next element of stroke volume is the emptying. Adrenaline and noradrenaline both work at α and β receptors.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Taming the SRU

NOVEMBER 3, 2023

Broad strokes In this prospective, non-randomized study published by Kring et al in January 2022 out of Maine Medical Center, researchers compared mean pain scores at rest and during incentive spirometry before, at 15 minutes after, and then 60 minutes after treatment with a serratus anterior plane block. Ultrasound Med. 41, 2695–2701 (2022).

Fractures 98

Fractures Ultrasounds Research Outcomes 98

ALiEM

JANUARY 29, 2024

It requires immediate consultation with ophthalmology as well as neurology as it is considered a stroke equivalent. Case Question: What treatments can you perform in the ED for this diagnosis and do they improve outcomes? 39,1 (2020): 197-202. This has the potential to expedite consultations with specialty teams and treatment.

Stroke 64

Stroke Ultrasounds Academics Outcomes 64

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Here is that last post: A 90-something with acute stroke. Outcome: All 4 serial hs troponin I, out to 6 hours, were undetectable. For examples of this phenomenon — See My Comment in the February 14, 2018 — July 21, 2020 — and December 22, 2022 posts in Dr. Smith's ECG Blog ). She has no chest symptoms. What is the diagnosis?

EKG/ECG 116

EKG/ECG EMS Stroke Outcomes 116

The Skeptics' Guide to EM

DECEMBER 5, 2020

Date: November 30th, 2020 Reference: Ohle R et al. AEM 2020 Guest Skeptic: Dr. Mary McLean is an Assistant Program Director at St. Date: November 30th, 2020 Reference: Ohle R et al. AEM 2020 Guest Skeptic: Dr. Mary McLean is an Assistant Program Director at St. A Systematic Review and Meta-analysis. How hard can it be?”

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

Dr. Smith's ECG Blog

MAY 30, 2023

IV fluids for more preload are indicated, but not too much, as the RV can be overloaded with fluid, cause the septum to bow into the LV, and then harm LV stroke volume and cardiac output, leading to worsening hypotension, worse RV perfusion, worse RV function, and more RV failure. The February 11, 2020 post ( LA-RA reversal ).

Shock 97

Shock EKG/ECG Academics Stroke 97

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]. 2020 Nov 20;99(47):e23315. Compared to CRP, FC has similar sensitivity but nearly double the specificity [42-43].

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Stroke-volume:50 ml. Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. To paraphrase Dr. Smith's comments in the May 19, 2020 post : — Non-obstructive coronary disease does not necessarily imply no plaque rupture with thrombus.

EKG/ECG 109

EKG/ECG Ultrasounds Wellness Stroke 109

PulmCCM

APRIL 10, 2025

Among 166 patients with “sepsis” who were randomized to aspirin 200 mg or placebo at five ICUs in Brazil, those receiving aspirin had no improvement in organ failure scores or other outcomes. Only about one-quarter of 5,300 patients with septic shock received corticosteroids at 26 ICUs at nine UPMC hospitals between 2018 and 2020.

CDC 40

CDC Stroke Sepsis Radiology 40

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

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 3, 6 Among patients with stroke or traumatic brain injury (TBI), the risk may be as high as 28%-76% and 23%-60%, respectively. 4, 8 Paper: Dahyot-Fizelier, C., 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 122

CDC Radiology Radiology Head Injuries 122

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 104

Stroke Outcomes Hospitals 104

EMDocs

DECEMBER 16, 2023

Both can result in heat exhaustion and heat stroke and have many overlapping symptoms. Patients with heat stroke have hot, dry skin and altered mental status (e.g., C, and heat stroke occurs at a core temperature > 40°C. C, and heat stroke occurs at a core temperature > 40°C. Temps greater than 41.5C Bendall, J.

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

EMDocs

MAY 15, 2024

Causes and outcomes of the acute chest syndrome in sickle cell disease. American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Published 2020 Feb 12. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Am J Emerg Med. 2022 Aug;58:235-244. Epub 2022 Jun 11. PMID: 35717760.

Blood Transfusions 103

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 103

EMDocs

MAY 28, 2024

Causes and outcomes of the acute chest syndrome in sickle cell disease. American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Published 2020 Feb 12. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Underestimates alveolar hypoxemia. Am J Emerg Med. 2022 Aug;58:235-244.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

PulmCCM

JULY 10, 2023

At 28 days, there were no observed differences in the primary outcome (an odd composite of mortality and emergence of antibiotic resistance), and no difference in survival at 90 days. There’s a period of time after ischemic stroke when damaged cerebral blood vessels are susceptible to bleeding. access, etc., detailed here.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

The Skeptics' Guide to EM

APRIL 3, 2021

mg/kg) was beneficial for unknown onset stroke above a certain core size. Stroke 2021 Case: A 74-year-old man presents to the emergency department after waking up with left sided weakness. Background: We have talked about stroke management a number of times recently including SGEM#297 on the reanalysis of ECASS-3 by Alper et al 2020.

Stroke 52

Stroke Research Outcomes Emergency Department 52

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Date: September 16th, 2020 Guest Skeptics: Dr. Robert Goulden and Dr. Audrey Marcotte are Chief Residents from the Royal College of Emergency Medicine Program at McGill University. The Lancet 2020 This was an SGEM Journal Club episode recorded live at McGill University Grand Rounds. The CRASH-2 trial showed a 1.5%

Academics 52

Academics Resuscitation EMS Stroke 52

The Skeptics' Guide to EM

MAY 30, 2020

Date: May 29th, 2020 Reference: Erramouspe et al. AEM May 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Date: May 29th, 2020 Reference: Erramouspe et al. AEM May 2020 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. TXA vs. 19.8%

Head Injuries 52

Head Injuries Academics EMS Stroke 52

Taming the SRU

MAY 3, 2023

Furthermore, these rapid changes in pulmonary vascular resistance can lead to significant reduction in RV stroke volume and subsequent RV dilation & tricuspid regurgitation (16). StatPearls Publishing; 2020. Inhaled Pulmonary Vasodilators July 29, 2020, 2020. 2018;6(2):38. Lau KE, Lui F. Physiology, prostaglandin I2.

Wellness 52

Wellness Hospitals Shock Outcomes 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. While both conditions rely on supportive care as the mainstay of treatment, plastic surgery literature suggests better outcomes with microscopic fat embolism. Aesthetic Plastic Surgery National Databank Statistics 2020–2021. Accessed March 6, 2024. Aesthet Surg J.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

EMDocs

JULY 3, 2023

National Institutes of Health Stroke Scale (NIHSS) is 13; vital signs include pulse 86 beats/minute (bpm), blood pressure 164/94 mmHg, and saturation of 98% on room air. Introduction SAH has the potential for rapid progression and devastating outcomes. On arrival, the patient is taken directly to CT scan due to concerns for CVA.

Seizures 98

Seizures Stroke Outcomes EMS 98

EMDocs

NOVEMBER 4, 2024

80 It can be caused by traumatic nerve, spinal cord, or brain injury (including stroke) or can be a sequela of conditions like diabetes, HIV/AIDS, postherpetic neuropathies, multiple sclerosis, cancer, or chemotherapies. Cause and outcome of atypical chest pain in patients admitted to hospital. Epub 2020 Oct 31. Am J Emerg Med.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

Don't Forget the Bubbles

FEBRUARY 7, 2024

This week, NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) produced a much-anticipated report on how we manage acute testicular torsion in young people. “Time is brain” urges us to think about thrombolysis or clot retrieval in acute strokes. Ghadban, T., Wenskus, J., Herrmann, J., Junge, C.M.,

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

ACEP Now

DECEMBER 11, 2023

These included oral and nasal spray formulations of these two decongestants, but a third, phenylpropanolamine, was excluded due to safety concerns relating to hemorrhagic strokes. Recently, the 2020 Coronavirus Aid, Relief, and Economic Security Act provided resources and processes to relieve some of the burden for review of these monographs.

Administration 64

Administration Outcomes Research Stroke 64

RebelEM

FEBRUARY 22, 2024

Background : Concurrent anemia worsens outcomes in patients that present with acute myocardial infarctions. The Myocardial Ischemia and Transfusion (MINT) trial is the largest study to date examining the impact of a liberal versus restrictive transfusion strategy on outcomes in this patient population. 2012;126(16):2020-2035.

Blood Transfusions 58

Blood Transfusions Outcomes Wellness Research 58

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% 8 The data in Mayer et al.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

PulmCCM

FEBRUARY 26, 2024

Tenecteplase for acute ischemic stroke presenting after 4.5 Because it can be infused more rapidly than alteplase, TNK is gaining prominence as thrombolytic treatment for acute ischemic stroke, in patients presenting within 4.5 hours post-stroke, but those trials were conducted before mechanical thrombectomy (performed a.s.a.p.

Stroke 40

Stroke Psychiatric CDC Hospitals 40

PulmCCM

NOVEMBER 18, 2021

What they did Budesonide was added as a therapy to the PRINCIPLE platform investigation in late November 2020. heart disease, hypertension, asthma or lung disease, diabetes, hepatic impairment, stroke or neurological problems, immunocompromise, self-reported obesity or body-mass index of at least 35 kg/m² were enrolled.

Urgent Care 40

Urgent Care Hospitals Stroke Wellness 40

EMDocs

DECEMBER 28, 2024

Vertical nystagmus (D) is a finding that is concerning for a central process, such as a posterior stroke. Patients with posterior stroke often present with diplopia, dizziness, dysarthria, dysmetria, dysphagia, and vomiting but typically without eye pain and headache. Published online March 27, 2020. McGraw-Hill Education; 2020.

EMS 98

EMS Stroke Outcomes Risk Management 98

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