Don't Forget the Bubbles

JUNE 30, 2023

In 2021, Evans and colleagues (1) compared adolescent mortality rates in adult, children’s and mixed major trauma centres across the UK. In 2021, Kulvatunyou, Bauman and colleagues compared the insertion of traditional 28-32Fr chest tubes with 14Fr pigtail catheters for drainage of traumatic haemothorax. Is he going to be OK?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Taming the SRU

MARCH 12, 2024

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. The study’s primary outcomes were the operational impacts of the SQuID protocol on EDLOS and ICU admission rates. Secondary outcomes included fidelity to and safety of the intervention. Acad Emerg Med 2023;30(8):800–8.

Operations 97

Operations Hospitals Best Practices Wellness 97

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 129

Ultrasounds Outcomes COPD Hospitals 129

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

PulmCCM

NOVEMBER 6, 2023

patients infected with the Wuhan/Delta variants in 2020-2021). I recall very well my (unjustified) negative view on convalescent plasma in 2020 and 2021 — it was probably minimally effective, and I would never spontaneously offer it. Thromboelastometry (e.g., The balloon generally required 30 minutes to insert.

Blood Transfusions 98

Blood Transfusions Operations Resuscitation Infectious Diseases 98

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. Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Documented at the following time points: Before treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

JournalFeed

OCTOBER 23, 2021

It’s the JournalFeed Podcast for the week of October 18-22, 2021. We cover intubating angioedema patients, inhaled steroids for COVID-19, non-operative management of appendicitis, part-time physician outcomes, and ECG diagnosis of wide complex tachycardia.

Operations 52

Operations EKG/ECG Outcomes 52

ALiEM

OCTOBER 30, 2024

Your patient ultimately is diagnosed with a spinal epidural abscess requiring operative care. 2021 Aug 1;94:103086. Emergency department-initiated buprenorphine for opioid dependence with continuation in primary care: outcomes during and after intervention. I am happy to help how I can. References Reuter P, Pardo B, Taylor J.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

PulmCCM

APRIL 18, 2024

The real world success rates by operators experienced with intubation remained unknown. This outcome measure was less robust than intubation attempts, because the “failure” definition included simply switching devices, which the intubator was permitted to do at any time for any reason.

Airway Management 98

Airway Management Operations EMS Research 98

Don't Forget the Bubbles

JANUARY 17, 2024

2021 A plain abdominal X-ray shows multiple dilated loops of bo wel. 2021 These beads, once hydrated inside the body, reached considerable sizes. They passed away a few days after a second operation. There have been reports of the Orbeez Challenge leading to serious outcomes. His abdominal X-ray looked a lot like this.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Taming the SRU

OCTOBER 23, 2023

At this point, the patient is taken to the operating room for a diagnostic laparoscopy. Discrimination between an IUP and an interstitial pregnancy is critical as interstitial pregnancies can have devastating outcomes. She was taken to the operating room and found to have a right tubal ectopic pregnancy with a pseudogestational sac.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

The Skeptics' Guide to EM

NOVEMBER 20, 2021

Date: November 16th, 2021 Reference: Hammouda et al. AEM November 2021 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: November 16th, 2021 Reference: Hammouda et al.

Geriatric Emergencies 52

Geriatric Emergencies Elder Abuse Research Academics 52

EMDocs

SEPTEMBER 25, 2023

Still, there are those that believe that FPS is more of a physician-centered endpoint that does not fully reflect important patient-centric outcomes (16). Improved Visualization: Video laryngoscopes allow for the use of standard or hyperangulated geometry, essentially allowing the operator to “look around the corner” on an anterior airway.

Emergency Department 92

Emergency Department Soft Tissue Injuries Airway Management Operations 92

The Skeptics' Guide to EM

JANUARY 23, 2021

Date: January 20th, 2021 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate. AEM January 2021 Case: A 50-year-old male presents to the Emergency Department (ED) with left lower quadrant abdominal pain. Reference: Pines et al.

Poisoning 52

Poisoning Research Documentation/Coding Operations 52

RebelEM

APRIL 29, 2024

One may speculate that the US-guided CVC placement would have a higher first-pass success rate with fewer complications, however, this may potentially add time to the procedure depending on the operator and institution’s use of ultrasound during emergencies and maintaining sterile technique with the US probe. Resusc Plus. Resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Don't Forget the Bubbles

MAY 10, 2023

A study in Denmark in 2021 explored barriers to effective resuscitation in over 900 in-hospital resuscitations across six hospitals in Denmark. Then the patient is rapidly moved to the operating theatre. 2021; 164: 70-78. StatPearls Publishing, Treasure Island (FL) ; 2021. But crowd control can still be an issue.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

PulmCCM

SEPTEMBER 4, 2024

OP is operating point, the operating point defines the cardiac output on the y-axis and Pra on the x-axis; Rcardiac is cardiac resistance (i.e., OP1 is operating point 1 at baseline. With tamponade, operating point 2 (OP2) is formed. Might this novel measure predict outcome in critically-ill patients [ @ross_prager ]?

Ultrasounds 84

Ultrasounds Operations Research Outcomes 84

The Skeptics' Guide to EM

APRIL 16, 2022

BMJ 2021 Guest Skeptic: Dr. Matt Schmitz, Pediatric Orthopedics, Adolescent Sports Medicine and Young Adult Hip Preservation Surgeon at San Antonio Military Medical Center in Texas. Clinical Question: What is the effectiveness of common elective orthopaedic procedures compared with no treatment, placebo, or non-operative care?

Military 40

Military Operations Emergency Department Pediatrics 40

RebelEM

NOVEMBER 6, 2023

Methylene Blue for Vasoplegic Syndrome After Cardiac Operation: Early Administration Improves Survival. to 1mg/kg/hr) Information regarding the vasopressors used in the study is as follows: Norepinephrine equivalents = norepinephrine mcg/kg/min + (phenylephrine mcg/kg/min/10) + epinephrine mcg/kg/min + (vasopressin units/min x2.5)

Shock 71

Shock Administration Academics Hospitals 71

PulmCCM

JANUARY 8, 2024

Twenty-five ICUs in Canada were switched to small-volume blood collection tubes at randomly assigned times (a so-called stepped-wedge cluster design) from 2019-2021. The Red Cross funds a large portion of its operations through its ~$2 billion transfusion business , and would seem to be unlikely to advocate for reducing its size.

Blood Transfusions 96

Blood Transfusions Hospitals Outcomes Operations 96

ACEP Now

MAY 9, 2024

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon. These questionable practices led to a rash of bad outcomes. Aesthetic Plastic Surgery National Databank Statistics 2020–2021.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Taming the SRU

JANUARY 29, 2024

Variations in sensitivity are thought to be related to operator technique, patient habitus, and difficulty evaluating the subclavian vein beneath the clavicle. [12] 2021 Oct;76:601.e7-601.e11. Epub 2021 Jun 25. Phlegmasia Cerulea Dolens in the Upper Extremity: A Case Report and Systematic Review and Outcomes Analysis.

Emergency Department 94

Emergency Department Fractures Hospitals Operations 94

ACEP Now

NOVEMBER 16, 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. Residency length has varied since the inception of the specialty of EM.

Academics 52

Academics EMS Telemedicine Research 52

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. Published May 31, 2021. References Pomorski C. The death of Hahnemann Hospital.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

EMDocs

NOVEMBER 18, 2023

Liver Transplantation: Operative Techniques and Medical Management. McGraw Hill; 2021. Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Sonographic diagnosis and outcome of hepatic artery thrombosis after orthotopic liver transplantation in adults.

EMS 95

EMS Ultrasounds Emergency Department Outcomes 95

PulmCCM

APRIL 1, 2024

Physical therapy is probably under-provided to critically ill patients, and improving this might improve outcomes for many. That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

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]. 2021; 93: 4358–4369. 2021 Jan;25(1):466-479. Epub 2021 Oct 1. J Med Virol. Medicine (Baltimore).

Infectious Diseases 89

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

RebelEM

NOVEMBER 3, 2022

What They Did: Performed a search of the following databases: Pubmed, Embase, Cochrane, and ClinicalTrials.gov up to and including June 1, 2021. Articles removed were duplicates, contained irrelevant outcomes, or had a significant risk for bias. Patients were excluded with pre-induction hypotension defined as SBP <100 mmHg.

Emergency Department 52

Emergency Department Outcomes Sepsis Operations 52

Don't Forget the Bubbles

JANUARY 31, 2024

This was compared to a mixed reference standard that included the results of ultrasound by radiologists, intra-operative findings, and clinical follow-up. Scand J Trauma Resusc Emerg Med 29, 170 (2021) What’s it about? The index test was POCUS by a clinician. to 99.8%) and specificity 97.2% (95% CI 87.2% Hetmann, F.,

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

ALiEM

OCTOBER 30, 2023

The same goes for clinical operations and research – interesting, but there hasn’t been any “a ha” moment to illuminate her calling. 2021; 43(10):1210-1213. Garcia finds herself at a bit of a crossroad. She likes teaching, but are not sure residency or medical student education leadership is for her. What should I look for in a coach?

Academics 64

Academics Leadership Wellness Research 64

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. 12) Axillary While axillary arterial line placement has been uncommon, in the age of facile ultrasound operators it may become a more advantageous and accessible site particularly in patients with high BMIs. But are they good enough? Gelmann, D.,

Shock 59

Shock Resuscitation Ultrasounds Research 59

Taming the SRU

MARCH 14, 2023

Ultimately, definitive management is in the operating room with revision or replacement of the VP shunt. Estimated incidence of normal pressure hydrocephalus and shunt outcome in patients residing in assisted-living and extended-care facilities. Lumbar puncture is an option with limited data for success. Lancet Neurol. Neurosurg Focus.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

EMDocs

NOVEMBER 16, 2024

4 Pain is the most common reason for presentation in the early post operative period. 5 Highest risk of dislocation early in the post operative course due to laxity of the soft tissue after surgery. 6 Hip flexion or adduction in the early post-operative period can cause atraumatic dislocations (typically avoided for 6 weeks post-op).

EMS 98

EMS Dislocations Fractures Operations 98

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. References: 1.

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

Don't Forget the Bubbles

OCTOBER 28, 2024

In adults, TXA has been shown to reduce transfusion requirements and improve outcomes. Although TXA improved outcomes in combat settings, it did not significantly improve survival in civilian settings. doi:10.1136/bmjopen-2021-057780 Hibberd O, Price J, Thomas SH, Harris T, Barnard EBG. Published 2021 Apr 29.

Blood Transfusions 72

Blood Transfusions Hyperthermia / Hypothermia Shock Pediatrics 72

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. One systematic review of 1283 patients showed that if you got to the operating room within 6 hours, you had a 97% chance of saving the testicle. Barbosa, J.A.,

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

EMDocs

DECEMBER 18, 2023

The most recent surviving sepsis campaign (SSC) guidelines were released in 2021, which provided 93 recommendations for evidence-based sepsis management. 1 Since 2021, attempts to identify a single screening tool with optimal sensitivity and specificity to predict which patients will develop sepsis or septic shock have been ongoing.

Sepsis 91

Sepsis Fluid Resuscitation Resuscitation Shock 91