The Skeptics' Guide to EM

FEBRUARY 20, 2021

Date: February 19th, 2021 This is an SGEM Xtra episode. I had the honour of presenting at the Lehigh Valley Health Network Grand Rounds on February 4th, 2021. Date: February 19th, 2021 This is an SGEM Xtra episode. I had the honour of presenting at the Lehigh Valley Health Network Grand Rounds on February 4th, 2021.

Fractures 52

Fractures Outcomes Hospitals 52

RebelEM

SEPTEMBER 7, 2023

However, guidelines offer no strong recommendations for its use, specifically in spontaneous ICH ( Fang 2021 ). OUTCOMES Primary: Occurrence of at least one clinical or electrographic seizure recorded on continuous EEG within 72 hours after inclusion. The primary outcome was patient-oriented. OR 0.07, 95% CI 0.01-0.38,

Seizures 130

Seizures Stroke Outcomes Research 130

RebelEM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Outcomes: Primary Outcome: Reduction of dyspnea measured on a verbal dyspnea scale (VDS) from 0 to 10 recorded at enrollment, then at 2, 4, and 5 hours after arrival.

Ultrasounds 128

Ultrasounds Outcomes COPD Hospitals 128

PulmCCM

JUNE 3, 2024

The ASTER Trial Ware et al conducted a phase 2b randomized trial from 2021 to 2023 among 447 patients admitted with sepsis and organ failure at 40 US academic hospitals. Patients received either 1 g of acetaminophen IV every six hours or placebo for five days.

Sepsis 52

Sepsis Outcomes Academics Hospitals 52

Don't Forget the Bubbles

JANUARY 31, 2024

As a Trauma Unit within the Thames Valley Trauma Network, Wexham Park Hospital hosts trainees from across the spectrum of acute specialties. Two really important patient groups were excluded – those who were admitted to hospital and families who were not fluent in English. the pre-hospital setting. Why does it matter?

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

Emergency Medicine Journal

JANUARY 22, 2024

Methods This was an open-label randomised control trial conducted in a tertiary care teaching hospital in India from 11 November 2021 to 30 November 2022. The primary outcome was symptom resolution at 6 hours and 12 hours. The low-dose group had longer median hospital stay (12 hours vs 72 hours), more frequent MACE (3.8%

Outcomes 75

Outcomes Hospitals 75

ACEP Now

NOVEMBER 8, 2024

Historically, the endotracheal tube (ETT) has been considered the definitive airway of choice in both the prehospital and in-hospital setting. 1 Prehospital endotracheal intubation and EGAs are typically placed without paralytics and are reserved for unconscious, apneic, and out-of-hospital cardiac arrest patients. DOT HS 813 151).

Airway Management 40

Airway Management EMS Hospitals Administration 40

EM Literature of Note

JANUARY 9, 2022

The Annals of Emergency Medicine Podcast continues apace, with free monthly updates from the original research published in the journal: iTunes Link SoundCloud Link Likewise, the Annals of Emergency Medicine Journal Club has published several monthly installments: Predicting Outcomes in Pediatric Pneumonia: Are We Omnipotent or Incompetent?

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 40

EMDocs

AUGUST 22, 2024

3,4 Notably, institutions receiving federal funding (such as hospitals receiving Medicare reimbursement) must abide by Title VI of the 1964 Civil Rights Act, which entitles persons with NELP to language assistance. Certified interpreter use can improve communication and patient outcomes. Lion KC, et al. Pediatrics. 135:e709-e716.

Documentation/Coding 104

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

RebelEM

APRIL 17, 2023

A repeat search was completed in May 2021 & November 2022. 2021 May 12:34894211015590. Published on October 25, 2021. Accessed on December 3, 2021. Two investigators independently assessed and screened all studies for eligibility. AJR Am J Roentgenol. 2015 May;204(5):1064-8. PMID: 25905942. Ann Otol Rhinol Laryngol.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

RebelEM

OCTOBER 2, 2023

Mild to moderate DKA represents a subgroup of patients that often require admission to the ICU due to hospital policies not allowing insulin infusions outside of this clinical setting. 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

Operations 102

Operations Academics Fluid Resuscitation Outcomes 102

Emergency Medicine Journal

FEBRUARY 20, 2024

The objective of this study is to evaluate outcomes of reversal with these agents in patients with isolated traumatic brain injuries (TBI). Methods This is a retrospective review of 35 trauma centres from 2014 to 2021. Primary outcome includes rate of mortality/hospice at hospital discharge.

Hospice 74

Hospice Outcomes Hospitals 74

PulmCCM

JUNE 12, 2023

But the most recent TTM2 trial (NEJM 2021, n=1850) , which was included in the analysis, by itself cast significant doubt on any benefit of temperature management below normothermia. 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

ACEP Now

AUGUST 25, 2023

The Pediatric Pain Management Standard 1 for children was published this year to provide guidance to health organizations on how to deliver equitable and quality pain management across hospital settings. Primary Outcome: Discharged home from the ED Secondary Outcomes: There were several secondary outcomes. Am J Hematol.

Administration 97

Administration Pediatrics Emergency Department Outcomes 97

Taming the SRU

MARCH 12, 2024

ED visits per 1000 adults with diabetes based on 2018 data resulting in over 500,000 annual hospital days. This amounts to annual hospital costs of $5.1 The study’s primary outcomes were the operational impacts of the SQuID protocol on EDLOS and ICU admission rates. Acad Emerg Med 2023;30(8):800–8. 10.1111/acem.14685

Operations 98

Operations Hospitals Best Practices Wellness 98

The Skeptics' Guide to EM

NOVEMBER 13, 2021

Date: November 10th, 2021 Reference: Andersen, et al: Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest. JAMA Sept 2021. JAMA Sept 2021. Epinephrine is provided and you quickly place an advanced airway.

Advances Cardiac Life Support (ACLS) 40

Advances Cardiac Life Support (ACLS) Hospitals Emergency Department Resuscitation 40

ACEP Now

JUNE 21, 2023

2,3 In the 2021-2022 academic year, categorical (non-combined) EM residency lengths included 221 (80 percent) PGY 1-3 and 55 (20 percent) PGY 1-4 programs. The lack of differences in the observed outcomes do not suggest one EM training length is superior. 1 Curricula with non-EM internships (i.e., 11 What should we take away?

EMS 114

EMS Academics Telemedicine Operations 114

RebelEM

AUGUST 22, 2024

hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Finally, most hospitals lack the necessary protocols and processes to coordinate the complex interdisciplinary care patients with RAO may require. Paper: Lema GMC, De Leacy R, Fara MG, et al.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

PulmCCM

JANUARY 22, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

RebelEM

APRIL 29, 2024

Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure. Intravenous vs.intraosseous vascular access during out-of-hospital cardiac arrest – protocol for a randomized clinical trial. 2021 PMID: 34273470 12 Petitpas F et al. Resusc Plus. Resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

The Skeptics' Guide to EM

DECEMBER 25, 2021

Date: December 21st, 2021 Guest Skeptic: Dr. Spencer Greaves is an Emergency Medicine resident at Florida Atlantic University. Date: December 21st, 2021 Guest Skeptic: Dr. Spencer Greaves is an Emergency Medicine resident at Florida Atlantic University. Spencer completed his medical doctorate at the Medical College of Wisconsin.

CPR 52

CPR Administration Outcomes Hospitals 52

Taming the SRU

APRIL 17, 2024

The primary outcome was defined as agreement of less than 10 % of the mean arterial pressure (MAP) between simultaneously recorded IABP and NIBP measurements. Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. 1) Data comparing the accuracy between IABP and NIBP measurements are limited.

Sepsis 95

Sepsis Research Stroke Academics 95

The Skeptics' Guide to EM

JANUARY 1, 2022

Date: December 21st, 2021 Guest Skeptic: Dr. Howard “Howie” Mell began his career as a firefighter / paramedic in Chicago. NEJM 2021 […] The post SGEM#354: Everybody Walk the Dinosaur and Not Take the MSU first appeared on The Skeptics Guide to Emergency Medicine. Howie also has a Master of Public Health. Reference: Grotta JC et al.

Stroke 52

Stroke EMS Outcomes Administration 52

The Skeptics' Guide to EM

MAY 8, 2021

Date: May 7th, 2021 Guest Skeptic: Dr. Ryan Stanton is a community emergency physician with Central Emergency Physicians in Lexington, KY. Date: May 7th, 2021 Guest Skeptic: Dr. Ryan Stanton is a community emergency physician with Central Emergency Physicians in Lexington, KY. first appeared on The Skeptics Guide to Emergency Medicine.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

The Skeptics' Guide to EM

JULY 3, 2021

Date: July 1st, 2021 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called First10EM.com. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. NEJM 2021 Case: A 58-year-old man collapsed in front of his family. This gives a NNT of 4.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Outcomes Wellness 52

ED ECMO

FEBRUARY 23, 2021

Outcome in refractory out-of-hospital cardiac arrest before and after implementation of an ECPR protocol. 2021 Feb 10;162:35-42. Prognostic value of signs of life throughout cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest. 2021 Feb 17:S0300-9572(21)00077-0. 2021 Feb 10;162:35-42.

CPR 52

CPR Resuscitation Hospitals Outcomes 52

Emergency Medicine Journal

JUNE 22, 2023

Methods This is a retrospective review of medical records of the ED of three public hospitals in Sydney, New South Wales, Australia from January 2016 to October 2021. The main outcome measures were ambulance transport, lumbar imaging, opioid administration and hospital admission. to 0.73) than Australian-born patients.

Emergency Department 40

Emergency Department Administration Hospitals Outcomes 40

Emergency Medicine Journal

NOVEMBER 28, 2023

This audit aims to investigate the relationship between time delay to treatment and its effect on HBOT efficacy and novelly, 30-day patient outcomes, to better support recommendations for healthcare providers. Method and Design The audit included 33 DCS patients treated at Whipps Cross Hospital, London (May 2021-December 2022).

Outcomes 40

Outcomes Hospitals 40

EMDocs

JANUARY 3, 2024

The goal of these devices is to detect a heart failure decompensation early and to reduce hospital admissions. 2 These implantable devices offer physiological parameters to direct therapies and reduce hospitalizations. The device group experienced 39% fewer HF hospitalizations over the study period.

Allergic Reactions 112

Allergic Reactions Hospitals EMS Emergency Department 112

RebelEM

NOVEMBER 6, 2023

So with yet another confounding variable added (sicker patients at baseline in methylene blue group), the comparison of these two medications is yet again even more difficult There was no difference in ICU and hospital length of stays or hospital mortality between the two groups.

Shock 71

Shock Administration Academics Hospitals 71

The Skeptics' Guide to EM

JUNE 5, 2021

Date: May 25th, 2021 Guest Skeptic: Dr. Garreth Debiegun is an emergency physician at Maine Medical Center in Portland, ME and clinical assistant professor with Tufts University School of Medicine. He also works at an urgent care and a rural critical access hospital. He also works at an urgent care and a rural critical access hospital.

Stroke 52

Stroke Urgent Care Critical Access Outcomes 52

EMDocs

SEPTEMBER 27, 2023

In years previous, the conversion factor has largely stayed the same resulting in physician pay falling 22% from 2001 to 2021 when adjusted for inflation (3). This would be similar to how all other Medicare providers (long-term care facilities, hospital payments, etc.) are already reimbursed (5). link] American Medical Association.

Emergency Department 86

Emergency Department Research Outcomes Hospitals 86

The Skeptics' Guide to EM

AUGUST 14, 2021

Date: August 12th, 2021 Reference: Daya et al. Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Date: August 12th, 2021 Reference: Daya et al. Missy is also now the director […] The post SGEM#340: Andale, Andale Get An IO, IO for Adult OHCA?

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. Date: September 8th, 2021 Reference: Desch et al. Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. The TOMAHAWK Investigators. The TOMAHAWK Investigators.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

AENJ: Current Issue

DECEMBER 19, 2024

Methods: This initiative was implemented at a community hospital in Southern California in response to previous undesirable sepsis outcomes. In fiscal year 2021, the ED Sepsis Nursing Team was launched with the goal of improving sepsis-related outcomes. at a rate of 0.5.

Documentation/Coding 40

Documentation/Coding Sepsis Outcomes Emergency Department 40

Emergency Medicine Journal

NOVEMBER 28, 2023

Background The regional emergency medical service (EMS) in Lombardy (Italy) developed clinical algorithms based on operator-based interviews to detect patients with COVID-19 and refer them to the most appropriate hospitals.

Operations 52

Operations EMS Hospitals Outcomes 52

ALiEM

OCTOBER 30, 2024

Clinical impact: Rather than arguing with the patient about the likelihood of this phenomenon occurring and whether this is a true allergy, the patient is informed that they do not need to immediately start treatment to receive care in the hospital. 2021 Aug 1;94:103086. I am happy to help how I can. 2023 Jan 1;53(1):140-2.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64