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? A repeat search was completed in May 2021 & November 2022. 2021 May 12:34894211015590. Acad Emerg Med.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

Northwestern EM Blog

DECEMBER 27, 2021

Congratulations to all of the authors with the most popular posts of 2021! Despite previous black box warnings on droperidol causing it to fall out of favor, it is safe and well-tolerated at the doses typically used in an emergency department setting. The expert review of Dr. Matthew Levine, Dr. Daniel Levine (NUEM '23), and Dr.

Dislocations 52

Dislocations Emergency Department Burns Shock 52

Sensible Medicine

AUGUST 12, 2024

Surely you do as well. You can improve your chances by eating well, exercising, avoiding smoking and too much alcohol. And that was the result of screening for just 5 cancers (breast, cervical, colorectal, lung and prostate) in the year 2021. My thinking aligns well with his. I would like to live a long life.

Outcomes 117

Outcomes Research Wellness Hospitals 117

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

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 126

Ultrasounds Outcomes COPD Hospitals 126

Sensible Medicine

NOVEMBER 6, 2023

Today I will tell you about one-year results of the SWISS-APERO trial—which compared outcomes with the two most common types of closure devices. The original SWISS APERO trial results came in 2021. This study report included only 45-day outcomes. They main outcome measure was patency of the left atrial appendage.

Stroke 118

Stroke Outcomes Ultrasounds Wellness 118

The Trauma Pro

NOVEMBER 21, 2023

A group of investigators from Jackson Memorial in Miami and Denver Health published a paper earlier this month that critically reviewed 187 trauma surgery RCTs published from 2000 to 2021. Among 30 studies that had a statistically significant binary outcome, the mean fragility index was 2. Bottom line: What does it all mean?

Research 113

Research Outcomes Wellness 113

RebelEM

AUGUST 21, 2023

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Paper: Eastwood G, et al.

Hospitals 93

Hospitals Resuscitation Outcomes CPR 93

The Skeptics' Guide to EM

JUNE 3, 2023

One aspect that has not been well covered on the SGEM is the choice of induction agent when intubating patients. The primary outcome was an 8% absolute increase in all-cause mortality at seven days for patients allocated to the etomidate group. This outcome was no longer statistically different at 28 days.

Outcomes 98

Outcomes Wellness 98

RebelEM

SEPTEMBER 21, 2023

Troponins are highly specific to cardiac myocytes but do exist in other muscle types as well. The available literature shows that SVT is not associated with ACO, Type I MI or serious outcomes either in the short term or after prolonged follow up ( Gabrielli 2022 ). Who should have troponins sent?

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

Taming the SRU

MARCH 12, 2024

In the context of increasing ED and hospital crowding as well as limited ICU availability, this study aimed to evaluate the impact of a subcutaneous insulin (SQuID) protocol in the treatment of DKA on emergency department length-of-stay (EDLOS) and ICU admissions. as well as patients less than 18 years old were excluded from analysis.

Operations 96

Operations Hospitals Best Practices Wellness 96

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. 1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Patients whose last known well (LKW) time was within 24 hours of presentation. 1 week after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

Don't Forget the Bubbles

JUNE 30, 2023

Extracorporeal life support rewarming rate is associated with survival with good neurological outcome in accidental hypothermia. The THAPCA-OH trial found that hypothermia did not result in a statistically significant benefit for survival with good functional outcomes at one year compared to normothermia. Saczkowski, R.,

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

Sensible Medicine

APRIL 14, 2024

For instance, CAR-T was given to myeloma patients in 2014, but we only learned it can cause Parkinsonism in 2021. Medicine has become a financial commodity with the rare adverse event of better health outcomes. A few companies will get rich doing this, and many well-intentioned people will be cheering us over the cliff.

Patient Safety 135

Patient Safety Academics Outcomes Wellness 135

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

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

ACEP Now

NOVEMBER 7, 2024

Wound management in the ED is only a starting point, and appropriate referral and follow-up are key to an improved outcome. Conclusion Poorly healing wounds pose a significant burden on health care systems and personal well-being, and their presence as a harbinger of severe morbidity and mortality must be appreciated. Mayo Clin Proc.

Burns 97

Burns Outcomes Documentation/Coding Emergency Department 97

PulmCCM

NOVEMBER 6, 2023

Intuitively, plasma seemed even less likely to help the very sickest of the sick— those mechanically ventilated with ARDS from Covid-19, whose mortality rate was well over 50% at many centers. 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 Infectious Diseases Resuscitation 98

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

PulmCCM

AUGUST 7, 2023

In early 2021, as hospitals overflowed, deaths mounted, and the economy languished, these felt like vital national goals. We didn’t know all this in 2021. But well after it became clear in 2022, Covid vaccine mandates persisted, and continue at a large number of U.S. university campuses. Can this be justified?

CDC 98

CDC Hospitals Administration Research 98

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

ACEP Now

JULY 11, 2024

Deaths from drinking increased 25 percent from 2019 to 2020 and another 10 percent in 2021. This medication has limited outcomes data and multiple contraindications. On the other hand, naltrexone and acamprosate are well-tolerated, affordable medications with promising outcomes data for harm reductions and, in some cases, abstinence.

Emergency Department 98

Emergency Department Psychiatric Outcomes Wellness 98

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. In 2021, Evans and colleagues (1) compared adolescent mortality rates in adult, children’s and mixed major trauma centres across the UK. All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

RebelEM

AUGUST 14, 2023

days 2 most common sites of infection were lung (44.8%) and inta-abdominal (32.1%) Majority of infections were community-acquired (≈84%) Over half the patients were on mechanical ventilation (≈53%) Primary Outcome Results: 28-day mortality rate: Placebo 26.1% (230/882) vs. XBJ 18.8% (165/878); P<0.001 The risk difference was 7.3% (95% CI, 3.4-11.2)

Sepsis 98

Sepsis Outcomes Administration EMS 98

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% No statistical difference in the primary outcome of hospital length of stay (40 vs 46 hours). perforation).

Sepsis 88

Sepsis Best Practices Hospitals Outcomes 88

RCEM Learning

JANUARY 23, 2024

This can include randomisation procedures, recruitment and follow-up response rates, what outcome measures patients will prefer, whether patients agree to complete the intervention (in this case the exercise programme) and so on. The ELECT2 Trial as it was to be called, was to start on October 2021.

Research 72

Research Wellness Outcomes Documentation/Coding 72

Don't Forget the Bubbles

NOVEMBER 27, 2024

They look well and, apart from fever, have no other symptoms. Although they look well, you don’t want to miss a serious diagnosis, so what do you do? The AAP guideline is not alone in using PCT – several other, well-validated tools use PCT, including StepByStep and PECARN. What were the outcomes measured?

Outcomes 81

Outcomes Wellness Hospitals Emergency Department 81

RebelEM

FEBRUARY 12, 2024

Chang 2021 ) This systematic review was used as the basis for a 9 member panel to develop consensus guidelines on CT imaging for patients with suspected renal colic in 29 scenarios. 2021 Sep;47:70-73. Epub 2021 Mar 22. CT in Detecting Urinary Tract Calculi: Influence on Patient Imaging and Clinical Outcomes Radiology.

Radiology 69

Radiology Radiology Emergency Department Ultrasounds 69

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. He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR […] The post SGEM#329: Will Corticosteroids Help if…I Will Survive a Cardiac Arrest? Reference: Shah and Mitra.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

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 82

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 82

ED ECMO

FEBRUARY 23, 2021

Zack invited Brian Grunau to discuss these topics as well as a recent ECPR paper out of Norway and study dealing with signs of life during CPR. Outcome in refractory out-of-hospital cardiac arrest before and after implementation of an ECPR protocol. 2021 Feb 10;162:35-42. 2021 Feb 17:S0300-9572(21)00077-0. Resuscitation.

CPR 52

CPR Resuscitation Hospitals Outcomes 52

PulmCCM

NOVEMBER 11, 2024

Severe bleeding, limb ischemia, and sepsis with bacteremia were also increased in the Impella group, with the composite outcome of adverse events occurring four times more often in Impella patients (24% vs 6%). Will we get to see those secondary analyses, as well? Patients in the Impella arm had 2.8 Circulation. 2024 Oct 27.

Shock 98

Shock Sepsis Outcomes Research 98

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. Exclusion criteria: Manikin and cadaver studies. in another study).

Outcomes 76

Outcomes Emergency Department Operations Hospitals 76

Core Ultrasound

MARCH 25, 2024

Old IVC Vid (2021) TEE VTI Here are Dr. Spiegel’s Notes: 1. If one is going to access the collapsibility of the IVC one should probably look at it in the transverse plane as well 3. It is our job as clinicians to interpret what that means. There is no one dichotomous test that will tell you whether to give fluid or not.

Administration 75

Administration Sepsis Ultrasounds Outcomes 75

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

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? 2021 Feb;38(2):132–8. CASP checklist for Cohort studies Does this address a clearly focused issue? Emerg Med J. Resuscitation Council UK.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

Don't Forget the Bubbles

JANUARY 17, 2024

2021 A plain abdominal X-ray shows multiple dilated loops of bo wel. 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. 2021 These beads, once hydrated inside the body, reached considerable sizes.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111