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

Pediatric EM Morsels

AUGUST 11, 2023

Having authored 575 ( well, now 576 ) of them, I am often quite convinced that there are no new topics to discuss. Infections there become complicated very quickly and the outcomes can be very poor. 2020 Oct 24;12(10):e11141. This is the 601st Ped EM Morsel ! ” Those areas have very important and delicate structures.

Burns 130

Burns Pediatrics EMS Outcomes 130

RebelEM

APRIL 17, 2023

However, It is unclear how well POCUS performs in ruling in or ruling out the diagnosis of PTA. Question: How well does the US perform in diagnosing PTA compared to CT, needle aspiration, or Incision and Drainage? 2020 Nov;163(5):915-922. Epub 2020 Jun 2. 2020, August 18). Article: Kim DJ et al. Acad Emerg Med.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

The Trauma Pro

OCTOBER 25, 2024

Authors from several well-known trauma centers collaborated to re-analyze data from the CLOTT study. 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).

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. What outcomes did they look at? Which patients were involved?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

The Skeptics' Guide to EM

FEBRUARY 15, 2020

Date: February 11th, 2020 Reference: Yeh et al. Case: A 32-year-old woman with no previous medical history calls you while a passenger on a […] The post SGEM#284: Might as Well Jump, but We would Recommend a Parachute first appeared on The Skeptics Guide to Emergency Medicine. Date: February 11th, 2020 Reference: Yeh et al.

Wellness 52

Wellness Outcomes Emergency Department Research 52

Dr. Smith's ECG Blog

DECEMBER 13, 2023

And she learned it well: She is not highly confident, but she does diagnose OMI. Outcome: 100% LAD Occlusion Here the Queen explains why: The dark blue tells us that she is looking especially at the QRS in V3 and the T-wave in V2 and V3. Not OMI, and we (Pendell and I) always take proportionality into account.

EKG/ECG 123

EKG/ECG COPD Wellness Outcomes 123

EMDocs

NOVEMBER 7, 2023

Antibiotics are recommended for those with complicated diverticulitis, as well as surgical specialist consult if necessary (e.g., No difference in their primary outcome of complications and need for emergency surgery (1.9% 2020 Mar 30:S1542-3565(20)30426-2. perforation). 623 patients included. 5.0%; p = 0.085).

Sepsis 113

Sepsis Best Practices Hospitals Outcomes 113

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

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

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 122

CDC Radiology Radiology Head Injuries 122

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Queen of hearts interpretations: Patient 1, ECG1: Patient 2, ECG1: Patient 1 Clinical Course and Outcome: The EM physician did not see that the S wave voltage has been truncated and squared off at 10 mm, thereby greatly limiting the assessment of proportionality. But he did well.

EKG/ECG 125

EKG/ECG EMS Outcomes Wellness 125

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). Only it turns out, it did help. Or could, anyway. Thromboelastometry (e.g.,

Blood Transfusions 98

Blood Transfusions Operations Resuscitation Infectious Diseases 98

The Skeptics' Guide to EM

JULY 8, 2023

She looks well enough to go home but asks if she should be prescribed oseltamivir (Tamiflu) because some of her friends have been given it recently by their doctors. Safety issues popped up soon after widespread use of the drug including neuropsychiatric effects as well as the more common adverse effects of nausea and vomiting.

CDC 108

CDC Hospitals EMS Emergency Department 108

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

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

Ken Grauer, MD

FEBRUARY 28, 2023

As a result — IF the 1 lead you are monitoring happens to be one in which P waves are not well seen — then you might assume the irregular rhythm in front of you was AFib. These cases provide insight to assessment for MAT: The January 5, 2020 post in Dr. Smith’s ECG Blog — for an example of MAT. Remember — 12 leads are better than one!

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. Acute Crit Care.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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

Don't Forget the Bubbles

JUNE 17, 2024

High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. Loss of psychological safety and mental well-being persist long after the episode and can impact future episodes of care. 2020 Aug 20. Civility Saves Lives The impact of incivility in healthcare cannot be understated.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Don't Forget the Bubbles

JULY 19, 2023

Olivia, a previously well 13-year-old girl, is referred to the paediatric ED from the Ophthalmology ED. This data was collected over a five-year period (2016-2020) had true papilloedema. 2020 and Hyde et al. Outcome of pediatric patients referred for papilledema. 2020 Oct [cited 2023 May 14];10:966–7.

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. Using the EQUAL model will hopefully improve our care of patients living with disabilities, as well as their experience in the ED and accessing healthcare.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

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 Operations Outcomes Wellness 52

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. Circulation. 2018;137(12).

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

ACEP Now

DECEMBER 6, 2024

1 Relatively little literature on the clinical characteristics and outcomes of out-of-hospital cardiac arrest (OHCA) patients complicated by coronary vasospasm exists beyond anecdotal reports, however. Cardiac arrest secondary to myocardial ischemia from coronary vasospasm is well documented. N Engl J Med. 1992;326(22):1451-1455.

Resuscitation 98

Resuscitation EKG/ECG Documentation/Coding COPD 98

EMDocs

OCTOBER 19, 2024

Leukocytosis, as well as mild leukopenia, are common. 2][3][9] Glucocorticoid were not shown to alter clinical course or patient outcomes. [2][3] Published 2020. Care Variations and Outcomes for Children Hospitalized With Bacterial Tracheostomy-Associated Respiratory Infections. Georgiaemsacademy.com. Published 2023.

EMS 110

EMS Pediatrics Sepsis Airway Management 110

Taming the SRU

NOVEMBER 3, 2023

The thought with introducing the serratus anterior plane block was that regional anesthesia is well within the purview of EM physicians and can offer a safe alternative to systemic pain medications. The primary outcome in this study was a change in pain score at rest 60 minutes after block.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

Don't Forget the Bubbles

AUGUST 2, 2023

Early management leads to better outcomes. That being said, younger patients tend to have better outcomes with a multidisciplinary team approach leading to remission in approximately 90% of children. Outcomes of children with complex regional pain syndrome after intensive inpatient rehabilitation. Published 2020 Nov 20.

Psychiatric 98

Psychiatric Pediatrics Outcomes Academics 98

Sensible Medicine

JANUARY 16, 2024

The journal asks that submissions be “well focused, scholarly, and clearly presented but should not include the findings of new research or data that have not been previously published.” If you appreciate our work (and would like to comment on this post) become a paid subscriber. Not getting these vaccines is a terrible decision.”

Research 138

Research Outcomes Wellness 138

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

Don't Forget the Bubbles

AUGUST 7, 2023

The study also did not assess outcomes for each patient, and as such, the impact on deviation from the normal range was not explored. Yes Was the outcome accurately measured to minimize bias? 2020 Sep 17;8:548154. CASP checklist for Cohort studies Does this address a clearly focused issue? Front Pediatr.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

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

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% to 1.02]).

Head Injuries 52

Head Injuries Academics EMS Stroke 52

The Skeptics' Guide to EM

OCTOBER 17, 2020

Date: October 14th, 2020 Guest Skeptic: Dr.Salim Rezaie is a community emergency physician at Greater San Antonio Emergency Physicians (GSEP), where he is the director of clinical education. The authors reported no statistical superiority of TXA compared to placebo for the primary outcome of head injury-related deaths within 28 days.

EMS 52

EMS Head Injuries Outcomes Hospitals 52

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. Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. From Mullens et al.,

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Dr. Smith's ECG Blog

AUGUST 6, 2024

There may be hyperacute T waves from V2-V5, as well as in leads I and II. As a result, this 45-year old man did not experince any delay in treatment — and a large diagonal branch of the LAD was stented with good outcome. The ECG shows ST depression in lead V3. Compared to the QRS amplitude, the ST change in aVL is very abnormal.

EKG/ECG 104

EKG/ECG Wellness Hospitals EMS 104

EMDocs

AUGUST 22, 2024

Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Certified interpreter use can improve communication and patient outcomes. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter.

Documentation/Coding 104

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 104