RebelEM

NOVEMBER 6, 2024

2022 Aug 2. PMID: 31082090 Post Peer Reviewed By: Anand Swaminathan MD, MPH (Insta @EMSwami) The post Elbow Dislocations appeared first on REBEL EM - Emergency Medicine Blog. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998 Jan-Feb;6(1):15-23. doi: 10.5435/00124635-199801000-00002. Shoulder Elbow.

Dislocations 116

Dislocations Fractures Soft Tissue Injuries Outcomes 116

Pediatric EM Morsels

JULY 26, 2024

Higher titers in both CSF and serum were associated with poor outcomes. Earlier diagnosis leads to better outcomes. Younger Age at Onset Is Associated With Worse Long-term Behavioral Outcomes in Anti-NMDA Receptor Encephalitis. 2022 Jul 6;9(5):e200013. It is best to assume the worst and cover for this possibility.

Psychiatric 271

Psychiatric Seizures Outcomes Pediatrics 271

EMDocs

OCTOBER 30, 2023

Pillai, MBBS (@sspillai01, EM Resident Physician, University of Kentucky) and Christopher N. ” – Musings of an American ED resident in July 2022 when US healthcare was affected simultaneously by supply chain issues from GE Healthcare (contrast media) and Abbott Laboratories (Similac baby formula). Authors: Saran S.

Radiology 99

Radiology Radiology Emergency Department Hospitals 99

EMDocs

OCTOBER 21, 2023

We’ll keep it short, while you keep that EM brain sharp. The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Basilar artery occlusion remains a challenging diagnosis to make, and the delays in reaching the diagnosis can have considerable impact on health outcomes.

EMS 97

EMS Stroke Outcomes Hospitals 97

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Here is the case: Report from EMS was witnessed syncope, his son did CPR, but the patient had pulses when EMS arrived. When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. Smith : "What was the outcome?" Hope you’re doing well! No Chest Pain, but somnolent.

EMS 114

EMS CPR EKG/ECG Wellness 114

RebelEM

FEBRUARY 1, 2024

What they Did : Investigator-initiated, Multicenter, Parallel-ground, Open-label, Registry-linked, Randomized, Controlled, Non-Inferiority trial 22 Canadian Primary and Comprehensive Stroke Centers from December 2019 to January 2022 Eligible ischemic stroke patients randomized 1:1 to receive intravenous tenecteplase (0.25 vs Alteplase 34.8%

Stroke 135

Stroke Blood Transfusions Outcomes EMS 135

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. 2022 May 11;10:864766. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). 2022 Apr;29(4):406-414. Epub 2022 Jan 12.

Pediatrics 187

Pediatrics Emergency Department Outcomes Sepsis 187

Pediatric EM Morsels

JULY 28, 2023

Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. 2022; 23( 7): 835- 856. Is your patient hyperglycemic, acidotic, with ketonuria? Then we’ve likely got DKA.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

Pediatric EM Morsels

AUGUST 11, 2023

This is the 601st Ped EM Morsel ! Infections there become complicated very quickly and the outcomes can be very poor. 2022 Sep;68(9):661-663. The post Perichondritis of the Ear in Children appeared first on Pediatric EM Morsels. ” Those areas have very important and delicate structures. Can Fam Physician.

Burns 130

Burns Pediatrics EMS Outcomes 130

Pediatric EM Morsels

AUGUST 9, 2024

If not treated early, then increased risk of poor outcomes and death. Early Congenital Syphilis Present before 2 years of age [ Hussain, 2023 ; Foles, 2024; Fang, 2022; Morrisroe, 2021 ] Only ~33% of newborns present with symptoms at birth and can be subtle. 2022 Dec 27;14(12):e33009. Most will develop signs by 3 months of age.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Health Sci Rep 2022. Three outcomes were evaluated, with none being deemed the primary outcome. Health Sci Rep 2022. appeared first on REBEL EM - Emergency Medicine Blog. Paper: Varney J et al.

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

The Skeptics' Guide to EM

JANUARY 6, 2024

She is an executive lead for the EMS for Children Innovation and Improvement Center. She is the co-Principal Investigator for the EMS for Children Data Center. She is nationally known for her work as an EMS researcher and educator. Background: Back in August of 2022, we announced the start of #SGEMPeds for SGEM Season 11.

Emergency Department 136

Emergency Department Pediatrics Anaphylaxis Leadership 136

RebelEM

MAY 25, 2023

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

SEPTEMBER 7, 2023

About 30% of patients experience early seizures within seven days following the onset of a stroke ( Peter-Derex 2022 ). Lancet Neurology 2022; 21:781-91. OUTCOMES Primary: Occurrence of at least one clinical or electrographic seizure recorded on continuous EEG within 72 hours after inclusion. PMID: 35963261. OR 0.07, 95% CI 0.01-0.38,

Seizures 132

Seizures Stroke Outcomes Research 132

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" 25 minutes later, EMS called back with this new ECG: Super obvious STEMI(+) OMI.

EKG/ECG 125

EKG/ECG EMS Outcomes Wellness 125

RebelEM

SEPTEMBER 21, 2023

Up to 80% of patients will have at least one troponin sent ( Gabrielli 2022 ). 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 ). appeared first on REBEL EM - Emergency Medicine Blog. Cardiol Rev.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

RebelEM

SEPTEMBER 19, 2022

Background: There are only two interventions that have been proven in the medical literature to improved outcomes in cardiac arrest: high-quality CPR and early defibrillation. Over the years, we as a scientific community have worked extensively to find other interventions that improve outcomes. Resuscitation 2022; 179: 9-17.

CPR 52

CPR Outcomes Resuscitation EMS 52

RebelEM

MAY 27, 2024

What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy. The unblinded nature of the study could influence outcomes due to observer bias.

Outcomes 137

Outcomes Research Operations Hospitals 137

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. 2009;338:b2085.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

The Skeptics' Guide to EM

AUGUST 10, 2024

Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table. INTERACT-3 reported the odds of a poor functional outcome were lower in the goal-directed intensive care bundle group compared to usual care (SGEM#413).

Stroke 89

Stroke Airway Management Documentation/Coding Outcomes 89

RebelEM

MAY 29, 2023

What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

RebelEM

SEPTEMBER 2, 2024

Published 2022 Sep 10. Device-Oriented Outcomes : While suction rate improvements were significant, the clinical relevance of these findings remains uncertain. While the suction rates observed are impressive, it is unclear whether using the DuCanto catheter would lead to improved clinical outcomes. Published 2022 Sep 10.

Airway Management 115

Airway Management Outcomes EMS Research 115

Broome Docs

OCTOBER 6, 2024

Mols EM, Haak H, Holland M, Schouten B, Ibsen S, Merten H, Christensen EF, Nanayakkara PWB, Nickel CH, Weichert I, Kellett J, Subbe CP, Kremers MNT; Safer@Home Research Consortium. Can acutely ill patients predict their outcomes? doi: 10.1136/emermed-2022-213000. Can patients predict the future? A scoping review. Emerg Med J.

Emergency Department 102

Emergency Department EMS Research Outcomes 102

Dr. Smith's ECG Blog

JUNE 23, 2024

His daughter immediately started CPR and another family member called EMS. When EMS arrived the patient was in ventricular fibrillation. The above said — it may prove insightful to take another look at the Wellens' Syndrome case instantly recognized by Dr. Smith in the August 12, 2022 post in Dr. Smith’s ECG Blog.

EKG/ECG 118

EKG/ECG CPR EMS Hospitals 118

EMDocs

JANUARY 29, 2024

Authors: Sameer Desai, MD (EM Attending Physician, University of Kentucky); Omar Abbas Ahmed Malik, MBBS (Patients’ Aid Foundation, Jinnah Postgraduate Medical Center) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine in St.

Stroke 99

Stroke Outcomes EMS Seizures 99

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

Pediatric EM Morsels

JUNE 9, 2023

Epub 2022 Dec 26. Long-term Outcomes and Health Perceptions in Pediatric-onset Portal Hypertension Complicated by Varices. The post Acute Esophageal Variceal Bleeding in Children appeared first on Pediatric EM Morsels. Beyond Varices: Complications of Cirrhotic Portal Hypertension in Pediatrics. Semin Liver Dis. PMID: 36572031.

Pediatrics 154

Pediatrics Head Injuries Airway Management Resuscitation 154

ACEP Now

OCTOBER 10, 2023

Both INTERACT-2 and ATACH-2 showed no statistical difference in their primary outcome between intensively lowering the BP and a less-intensive strategy. 1,2 The 2022 AHA/ASA Guidelines give several recommendations on this topic. 3 The class (strength) of their recommendation is 2a/2b based upon Level B and Level C quality of evidence.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

RebelEM

JULY 24, 2023

This approach has been shown to benefit patients when agents like propofol and midazolam are used. ( Russotto 2022 , Choi 2004 ). Outcomes: Primary: Postintubation hypotension (SBP < 100 mm Hg) 15 minutes post-intubation. appeared first on REBEL EM - Emergency Medicine Blog. Paper: Driver BE et al. mg/kg 1.33 mg/kg 1.33

Resuscitation 98

Resuscitation Outcomes Emergency Department EMS 98

RebelEM

JULY 27, 2023

In this group of patients, the use of alteplase poses a fine line of potential benefit (functional outcomes) vs potential harm (symptomatic intracranial hemorrhage). Many patients, however, will have minor strokes (defined as an NIHSS score ≤5). Alteplase: 91.4% Risk Diff: 2.3%; 95% CI -1.5 Alteplase: 0.9% Any Bleeding Events: DAPT: 1.6%

Stroke 98

Stroke Outcomes EMS Hospitals 98

Taming the SRU

FEBRUARY 24, 2024

ENRICH Trial - the leadership journey - EMS grand rounds - r4 capstone - r1 clinical knowledge - pediatric lecture ENRICH Trial WITH visiting professor Dr. david wright ICH makes up only 10-15% of all strokes yet has a higher mortality than ischemic strokes and SAH Current 2022 AHA/ASA guidelines for spontaneous ICH (prior to ENRICH Trial) minimally-invasive (..)

Leadership 94

Leadership EMS Pediatrics Stroke 94

ALiEM

OCTOBER 30, 2024

Case A patient arrives via EMS from the bus station complaining of fever, vomiting, and back pain. Our experience: It was not long ago that we instructed our staff that: ‘COWS >8, give ’em 8 (mg of buprenorphine).’ Drug Checking Quarterly Report (Q3 2022). 2022; 06/26/2023. 2022 May;14(5). 2011 Dec;6:1-4.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

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

ACEP Now

OCTOBER 3, 2023

These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations. This document is an update of guidelines first published in 2000, and then updated in 2007.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

RebelEM

AUGUST 24, 2023

Historical practice recommends rest to prevent adverse outcomes; however, evidence suggests strict rest is harmful. What They Did: The authors performed a systematic review up to October of 2022, meta-analyses were conducted where appropriate for RCTs included in the review. PMID: 37073681. to 5.94]; I2, 0%; P 5.79).

Pediatrics 95

Pediatrics Outcomes Research Hospitals 95

Taming the SRU

NOVEMBER 3, 2023

41, 2695–2701 (2022). Broad strokes In this prospective, non-randomized study published by Kring et al in January 2022 out of Maine Medical Center, researchers compared mean pain scores at rest and during incentive spirometry before, at 15 minutes after, and then 60 minutes after treatment with a serratus anterior plane block.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

RebelEM

JUNE 8, 2023

2022 Sep 5. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose. Prior literature primarily focused on safety and medication errors, and while this study did the same, they also assessed variables associated with PDP response.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98