The Skeptics' Guide to EM

MAY 1, 2021

Date: April 30th, 2021 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the excellent #FOAMed project called First10EM.com. Date: April 30th, 2021 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the excellent #FOAMed project called First10EM.com.

Stroke 52

Stroke Outcomes Wellness 52

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. Do inhaled steroids improve Covid pneumonia? This study included a true blinded placebo control arm.

COPD 95

COPD Stroke Academics Urgent Care 95

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

JANUARY 29, 2024

This article will discuss blood pressure goals and preferred pharmacotherapy for non-traumatic ischemic and hemorrhagic strokes. Ischemic Strokes: Ischemic stroke is characterized by a blockage of a blood vessel in the brain. The BP targets for patients with ischemic strokes depend on the available therapeutic options.

Stroke 73

Stroke Outcomes EMS Seizures 73

RebelEM

FEBRUARY 8, 2024

patients with more discrepant readings had NIBP checked more frequently) Some patients were on multiple vasopressors, but for an unclear reason the authors decided to only evaluate the dose of norepinephrine MAP discrepancy is not a patient oriented outcome (i.e. to 1.12; p = 0.03 to 0.99; p <0.01 to 1.09; p = 0.01 to 1.37; p <0.01

Resuscitation 119

Resuscitation Outcomes EMS Sepsis 119

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. Prospective, multicenter, controlled trial of mobile stroke units. NEJM 2021 […] The post SGEM#354: Everybody Walk the Dinosaur and Not Take the MSU first appeared on The Skeptics Guide to Emergency Medicine.

Stroke 52

Stroke EMS Outcomes Administration 52

Emergency Medicine Cases

JANUARY 18, 2022

The post EM Quick Hits 35 – 10 Best Papers of 2021, Peripartum Cardiomyopathy, Crashing Asthmatic, Febrile Neutropenia, Anaphylaxis update appeared first on Emergency Medicine Cases.

Anaphylaxis 52

Anaphylaxis EMS Outcomes Hyperthermia / Hypothermia 52

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. JAMA 2021 * Zi et al. JAMA 2021 Case: A 74-year-old woman presents to your emergency department with 1.5

Urgent Care 52

Urgent Care Stroke Critical Access Outcomes 52

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

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. Published 2021 Apr 16. 2021;25(1):146. link] Roland D.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Dr. Smith's ECG Blog

APRIL 2, 2024

Angiogram in 2021 was normal. No wall motion abnormality Decreased left ventricular systolic performance, severe Left ventricular enlargement, marked Dilated cardiomyopathy severe Est. stroke volume 52 cc at HR 70 = 3.64 The patient awoke and had a good outcome! "Old records still had not appeared. Initial trop ~200.

EKG/ECG 126

EKG/ECG Shock CPR Stroke 126

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. References Evans L, Rhodes A, Alhazzani W, et al. Crit Care Med.

Sepsis 92

Sepsis Research Stroke Academics 92

Downeast Emergency Medicine

OCTOBER 1, 2021

This lecture was presented at the 2021 Maine Medical Center Winter Symposium. TNK is easier to prepare and administer (a rapid, single-bolus) which may mean faster door-to-needle times and faster door-in-door-out times for transport (and hopefully translate into less disability after stroke). 2019 Aug;50(8):2156-2162.[ Full Print ]

Stroke 52

Stroke Administration Outcomes 52

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

PulmCCM

JANUARY 24, 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 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

EMDocs

JANUARY 11, 2025

A 75-year-old woman who is bedridden after a stroke presents to the ED from a nursing facility with abdominal pain and constipation. Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Fecal Impaction and Nonperforated Stercoral Colitis: Red Flags for Poor Outcomes.

EMS 72

EMS Sepsis Shock Fluid Resuscitation 72

PulmCCM

MARCH 18, 2024

PROPHY-VAP) Patients with strokes and traumatic brain injuries who require mechanical ventilation due to coma are at very high risk for developing ventilator associated pneumonia. These results line up with a 2021 meta-analysis, which found both midlines and PICCs had a CRBSI rate of about 0.5%.

Stroke 40

Stroke Outcomes Research Hospitals 40

The Skeptics' Guide to EM

MARCH 13, 2021

Date: March 11th, 2021 Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Ohio. Lancet 2021 Case: You’re […] The post SGEM#322: TXA for SAH – Won’t Stop Me Now first appeared on The Skeptics Guide to Emergency Medicine. Reference: Post et al. Reference: Post et al.

Stroke 40

Stroke Emergency Department EMS Outcomes 40

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. 2021 Jan 1;32(1):37-43.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

ACEP Now

MAY 9, 2024

The procedure has soared in popularity as beauty standards have shifted and cosmetic surgery has become increasingly transparent on social media platforms, with reported cases in the United States increasing from 614 in 2002 to 61,387 by 2021, a nearly 10,000 percent increase. These questionable practices led to a rash of bad outcomes.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Don't Forget the Bubbles

NOVEMBER 18, 2024

Research and guidelines from Australian centres, like those published by the Australian and New Zealand Neonatal Network (ANZNN), emphasize early detection and management to improve outcomes. CO = SV x HR SV is Stroke Volume (the amount of blood ejected with each heartbeat). After any stressful situation, don’t forget to debrief.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

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. Figure-2: Classification of Underlying Diagnoses in Patients with MINOCA ( Adapted from Table-1 in Sykes et al: Interventional Cardiology Review: 16:e10, 2021 ).

EKG/ECG 97

EKG/ECG Ultrasounds Wellness 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]. 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

PulmCCM

NOVEMBER 18, 2021

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. Inclusion criteria were outpatients at least 65 years of age, or at least 50 years of age with comorbidities [i.e.,

Urgent Care 40

Urgent Care Hospitals Stroke Wellness 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 November 27, 2021 post ( LA-RA reversal ).

Shock 75

Shock EKG/ECG Academics Stroke 75

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. Pediatric radiology , 48 , pp.735-744. Barbosa, J.A.,

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

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. Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage.

Seizures 86

Seizures Stroke Outcomes EMS 86

Don't Forget the Bubbles

AUGUST 21, 2023

Stimulation of baroreceptors results in a catecholamine-mediated increase in heart rate , stroke volume, contractility, and systemic vascular resistance (SVR). What are the long-term outcomes for children with dilated cardiomyopathy? Outcomes at 1 year seem to be influenced by the severity of illness at presentation.

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98

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 68

Hyperthermia / Hypothermia EMS Stroke Seizures 68

The Skeptics' Guide to EM

APRIL 3, 2021

Date: March 31st, 2021 Guest Skeptic: Prof Daniel Fatovich is an emergency physician and clinical researcher based at Royal Perth Hospital, Western Australia. Date: March 31st, 2021 Guest Skeptic: Prof Daniel Fatovich is an emergency physician and clinical researcher based at Royal Perth Hospital, Western Australia. THAWS RCT Substudy.

Stroke 52

Stroke Research Outcomes Hospitals 52

ACEP Now

AUGUST 25, 2023

Primary Outcome: Discharged home from the ED Secondary Outcomes: There were several secondary outcomes. Another interesting secondary outcome that could confound the results is that children who received IN fentanyl received higher overall total parenteral opioid morphine equivalents. link] Published May 2021.

Administration 97

Administration Pediatrics Emergency Department Outcomes 97

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 Hospitals CDC 40

The Skeptics' Guide to EM

NOVEMBER 6, 2021

Date: November 1st, 2021 Reference: Katsanos et al. Utility of Intravenous Alteplase Prior to Endovascular Stroke Treatment: A Systematic Review and Meta-analysis of RCTs. Neurology 2021 Guest Skeptic: Dr. Michal Krawczyk is in his fifth year of neurology residency at Western University in London, Ontario, Canada.

Stroke 52

Stroke Outcomes 52

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 87

Stroke Radiology Radiology Emergency Department 87

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. 2021 Apr;28(4):444-454. Epub 2021 Jan 2. 2021 Feb;60(2):165-174. 2021 Feb;60(2):165-174.

Emergency Department 99

Emergency Department Fractures Burns EMS 99