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

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 Infectious Diseases Resuscitation 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

RebelEM

NOVEMBER 25, 2024

1 Conversely, the 2021 BOUGIE trial—a larger, multicenter randomized clinical trial conducted by the same investigators—found no significant difference in first-attempt intubation success between the bougie and an endotracheal tube with stylet among critically ill adults. Intervention: Intubation performed using a bougie. in another study).

Outcomes 76

Outcomes Emergency Department Operations Hospitals 76

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

Don't Forget the Bubbles

JANUARY 1, 2024

However, children who had an operation experienced improvements in behaviour, symptoms, and quality of life and had lower blood pressure. Data collected from 2002 to 2021 revealed a 72% decline in IPD incidence among children (<18 years), with continued reductions after the transition from PCV7 to PCV13. Lock JD, et al.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

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 97

Ultrasounds Operations Radiology Radiology 97

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

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 Outcomes 52

EMDocs

JANUARY 11, 2025

Operative management is necessary for signs of peritonitis, evidence of perforation, extensive bowel involvement >40cm, or after failed medical management. 2-4, 6, 8, 9, 12, 13, 14 Operative intervention typically consists of emergency laparotomy with bowel resection, colostomy formation, and Hartmann pouch creation. (May

EMS 72

EMS Sepsis Shock Fluid Resuscitation 72

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

EMDocs

JULY 17, 2023

7 While post-operative adhesive disease is also a risk factor, it is far less commonly implicated in LBO compared to SBO. Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients. Published 2021 Apr 22.

Operations 77

Operations EMS Fluid Resuscitation Resuscitation 77

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

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

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

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. A comparison between pre-operative ultrasonography and surgical findings. This post will cover some of the most common and important injuries, but is not comprehensive.

Fractures 76

Fractures Dislocations Operations Radiology 76

PulmCCM

JANUARY 6, 2025

A 2021 analysis of Epic’s sepsis model revealed atrocious false positive and negative rates. A cluster randomized trial using all-cause mortality as an outcome was always needed to determine whether EMR alerts improve outcomes for suspected severe infection. And have they fired. But for whom, and to what end?

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

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 92

Emergency Department Fractures Hospitals Operations 92

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 Hospitals 52

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

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 66

Emergency Department Soft Tissue Injuries Airway Management Operations 66

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 Administration 113

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 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

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.

Outcomes 52

Outcomes Emergency Department 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

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

EMDocs

SEPTEMBER 9, 2023

McGraw Hill; 2021. Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation. Rosh Review Website Link References Park CW, Juliano ML, Woodhall D. Tendon Lacerations. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. The Atlas of Emergency Medicine, 5e. Accessed June 24, 2023.

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

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

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 69

EMS Ultrasounds Emergency Department Outcomes 69

EMDocs

JUNE 3, 2023

4 This is the framework the ED resuscitationist should be operating under, as hemodynamically unstable pelvic trauma patients require a different approach compared to stable patients who will undergo CT, routine pelvic fixation, and definitive surgical repair. An x-ray in the trauma bay demonstrated an AP grade III fracture.

Fractures 54

Fractures Resuscitation Operations EMS 54

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

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

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 76

EMS Dislocations Fractures Operations 76