Don't Forget the Bubbles

JUNE 30, 2023

She has a right parietal-occipital region haematoma, and you think you might be able to feel a step – you’re pretty convinced she has a palpable skull fracture. The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Two IVs go in, one in each antecubital fossa.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

The Skeptics' Guide to EM

JULY 23, 2022

Date: July 22nd, 2022 Reference: Perry et al. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Date: July 22nd, 2022 Reference: Perry et al. The X-ray shows a buckle fracture of his right distal radius. He has bony tenderness at the distal radius.

Fractures 52

Fractures Pediatrics Emergency Department Outcomes 52

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

The Skeptics' Guide to EM

DECEMBER 10, 2022

Date: November 30th, 2022 Reference: Johnson et al. One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture: A meta-analysis of randomized controlled trials. Date: November 30th, 2022 Reference: Johnson et al.

Operations 52

Operations Fractures Military Emergency Department 52

Don't Forget the Bubbles

OCTOBER 19, 2023

Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. This is what they found: Length of hospital stay (time from randomisation to the time of hospital discharge or death), the primary outcome, was significantly longer in the high-flow group at 1.77

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

Don't Forget the Bubbles

MARCH 4, 2024

This was a secondary outcome embedded in the Travel Fever study – a multi-centre, retrospective diagnostic accuracy study for imported malaria. Safety and efficacy of a nitrous oxide procedural sedation programme in a paediatric emergency department: a decade of outcomes. doi: 10.1136/emermed-2022-212931. Emerg Med J.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives Rib fractures account for over 15% of all trauma attendances in the Emergency Department. Among patients with multiple rib fractures, the mortality rate can reach a staggering 33%, and this risk doubles for individuals above the age of 65. Abstract 2268 Table 1 Rib-fracture Data Set March 2022 – June 2023

Fractures 40

Fractures Anaphylaxis Emergency Department Ultrasounds 40

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Trauma CTs showed a "mildly displaced sternal fracture and a small retrosternal hematoma." Atrial fibrillation is also a predictor of worse outcomes in this case (Alborzi). Retrieved July 2, 2022, from [link] Moyé, D. Retrieved July 2, 2022, from [link] Sybrandy, K. References Alborzi, Z., Zangouri, V., Ghahramani, Z.,

EKG/ECG 115

EKG/ECG Wellness Fractures Emergency Department 115

ALiEM

OCTOBER 30, 2024

A trans-esophageal echocardiogram showed a normal ejection fracture, normal right ventricular function, and no vegetations. Drug Checking Quarterly Report (Q3 2022). 2022; 06/26/2023. 2022 May;14(5). Clinical impact: The patient’s DVT ultrasounds were negative. Xylazine (veterinary sedative) use in Puerto Rico.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

Taming the SRU

JANUARY 10, 2024

Phenobarbital has been proven to be equivalent to benzodiazepines with regard to clinical, pharmacologic and utilization outcomes. Physicians believe the biggest factors contributing to ED violence are a lack of adequate punitive consequences toward the attacker and the absence of adequate protective mechanisms for staff.

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

RebelEM

APRIL 29, 2024

Given AHA guidelines recommend early epinephrine administration in cardiac arrest, obtaining access is imperative for resuscitative efforts ( 9) When evaluating over 300,000 out-of-hospital cardiac arrests, a meta-analysis found no significant change in primary outcomes when IV and IO access were compared ( 10 ). 2022 PMID: 35206981 2.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

The Skeptics' Guide to EM

DECEMBER 17, 2022

Date: December 16th, 2022 Reference: Hohle et al. AEM December 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: December 16th, 2022 Reference: Hohle et al. Massive Blood Transfusion Following Older Adult Trauma: the Effect of Blood Ratios on Mortality.

Blood Transfusions 52

Blood Transfusions Fractures EMS Emergency Department 52

ACEP Now

OCTOBER 30, 2023

One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. With this model, there will hopefully be improved patient satisfaction and better outcomes. 2022; 14: 441–456. AEM Education Train. EM Resident.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

Taming the SRU

FEBRUARY 24, 2024

non-invasive positive pressure ventilation and IV nitroglycerin infusion have been shown to reduce morbidity (intubation rates, ICU admission) & mortality.

Leadership 94

Leadership EMS Pediatrics Stroke 94

Don't Forget the Bubbles

MAY 17, 2023

2023 Apr 20:fetalneonatal-2022-324835. Early Antibiotic Use and Neonatal Outcomes Among Preterm Infants Without Infections. 2023 Apr 4:archdischild-2022-325281. Distribution and pattern of hand fractures in children and adolescents. Kuypers KLAM, et al. Arch Dis Child Fetal Neonatal Ed. Hegeman EM, et al. 2023 Apr 18.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. Blunt trauma can cause rib fracture or dislocation that may injure the visceral pleura. Treasure Island (FL): StatPearls Publishing; November 28, 2022.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Emergency Medicine Journal

JULY 24, 2023

Although fractures can be ruled out using the Ottawa Ankle Rules, the specificity is low, which means many patients may still receive unnecessary radiographs. Ultrasound could be a reliable, cheap and radiation free alternative to diagnose fractures and ligamentous injuries. No restrictions were applied for date and language.

Ultrasounds 40

Ultrasounds Fractures Outcomes 40

Broome Docs

APRIL 6, 2023

2022 Dec 16:emermed-2021-211946. Epub 2022 Nov 21. Epub 2022 Nov 21. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. 2022 Jul 2;400(10345):39-47. 2022 Oct;51(10):595-604. 2022 Dec 20;328(23):2296.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

RebelEM

JANUARY 30, 2023

Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis [published online ahead of print, 2022 Oct 1]. Heterogeneity (I 2 ) for the primary outcome was 69%, representing a moderate value. hours less in the ED.

Dislocations 58

Dislocations Emergency Department Outcomes Research 58

The Skeptics' Guide to EM

APRIL 8, 2023

In Ontario alone there have been approximately 160 emergency departments (ED) temporarily closed since the beginning of 2022. The main outcome was the adjusted odds ratio for in-hospital mortality and hazard ratio for 30-day mortality with some pre-specified subgroups.

Stroke 56

Stroke Emergency Department COPD Academics 56

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. Unfortunately, at least 13 deaths were subsequently reported in Miami-Dade County from 2019–2022, the three years immediately following the implementation of the subcutaneous injection regulation. Published May 11, 2022. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

PulmCCM

JANUARY 16, 2024

This looks like the major fracture between the two expert panels. Their effects on meaningful patient outcomes are unclear, though, and their appropriate use continues to be debated. This would trigger routine steroid treatment in an enormous number of ICU patients—a big practice change.

Research 87

Research Documentation/Coding Outcomes Fractures 87

Don't Forget the Bubbles

OCTOBER 2, 2024

He is diagnosed with a traumatic brain injury and a fracture to his right tibia and fibula. Significantly, it should be noted that the study does not cover long-term outcomes, including survival. Results: The pooled data showed no statistical difference in survival or neurological outcomes. 2022 Mar 10;5(3). Voellger, B.,

Administration 49

Administration Pediatrics Outcomes Research 49

Taming the SRU

JANUARY 29, 2024

Notable Diagnostics CBC : unremarkable, BMP : unremarkable X-ray imaging of the left hand, wrist, and forearm: chronic degenerative changes without acute fracture or bony abnormality. 2022 Apr 26. Phlegmasia Cerulea Dolens in the Upper Extremity: A Case Report and Systematic Review and Outcomes Analysis. Clin Exp Med.

Emergency Department 94

Emergency Department Fractures Hospitals Operations 94

American Medical Compliance

FEBRUARY 28, 2023

Physical abuse can range from minor bruises to severe fractures, and can even be deadly in some cases. Children need adequate support to develop fully, and a lack of parental presence can have detrimental impacts of child outcomes. Types of physical abuse include punching, beating, and kicking.

Burns 52

Burns Patient Safety Fractures Outcomes 52

Cook County EM Blog

MARCH 20, 2023

X-rays showed radiopaque foreign bodies confined to the distal thumb without fracture. Latex paint-gun injuries of the hand: are the outcomes better? There were no signs of infection, compartment syndrome, tissue necrosis, or limb ischemia. Orthopedics was consulted and recommended outpatient follow up in several days. ISSN 0736-4679.

Fractures 52

Fractures Documentation/Coding Operations Research 52

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]. 2022 Jul 11;11(14):2163. Identifying serious causes of back pain: cancer, infection, fracture. 2021.09.025.

Infectious Diseases 89

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

Taming the SRU

MARCH 14, 2023

Obtain shunt imaging (“shunt series,” CTH non-con) Shunt series shows no migration of the shunt catheters or fractures of the tubing. Estimated incidence of normal pressure hydrocephalus and shunt outcome in patients residing in assisted-living and extended-care facilities. Lancet Neurol. Marmarou, Young, Aygok. Neurosurg Focus.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

EMDocs

NOVEMBER 16, 2024

6 Periprosthetic fracture Occurs at an estimated rate of 3.5-4.1%. 5 CT if concern for occult fracture. Periprosthetic Fractures Pain prior to injury may point toward underlying pathology like infection, implant loosening, etc. Unified classification system used to describe periprosthetic hip fractures. 10% of patients.

EMS 98

EMS Dislocations Fractures Operations 98

EMDocs

JUNE 3, 2023

How should pelvic fractures be identified in unstable trauma patients? Pelvic fractures can involve disruptions in any of the bony or ligamentous structures of the pelvic ring. Due to the round shape of the pelvic ring, multiple fractures typically occur concurrently. 2 Vertical shear fractures are also unstable.

Fractures 66

Fractures Resuscitation Operations EMS 66

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

Don't Forget the Bubbles

DECEMBER 2, 2024

The majority of them focused on the care process (86.8%), while a smaller percentage focused on care outcomes (9.3%) and structural aspects (3.9%). Most QIs focus on the care process; however, there is a lack of QIs that assess clinical outcomes. Expert panel studies and observational studies proposed 129 QIs. 95% CI 1.01

Documentation/Coding 98

Documentation/Coding Pediatrics Emergency Department Fractures 98

EMDocs

JUNE 21, 2023

Functional outcomes Severe soft tissue injuries and damage to the bony structures => poor functional outcomes. Labs do not play a significant role Imaging X-ray : Start with plain films to look for fracture near laceration, intra-articular free air, radiopaque foreign body. 2022 Jan 21;54:41-45. Am J Emerg Med.

Soft Tissue Injuries 96

Soft Tissue Injuries Fractures Dislocations Radiology 96

EMDocs

JULY 3, 2023

Introduction SAH has the potential for rapid progression and devastating outcomes. 3 Common associated injuries may include skull fractures, intracerebral contusion, cervical spine injuries, and vascular injuries of the head and neck. 2022 Jan;39(1-2):35-48. What are the next steps in the management of this patient?

Seizures 98

Seizures Stroke Outcomes EMS 98

PHEM Cast

SEPTEMBER 14, 2022

A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped. Do entrapment, injuries, outcomes and potential for self-extrication vary with age? Scand J Trauma Resusc Emerg Medicine 30 , 14 (2022). Nutbeam, T.

Fractures 52

Fractures Operations Outcomes Academics 52

RebelEM

MAY 22, 2023

saline Outcomes: Primary: Improvement in pain, measured on a 0 to 10 pain scale from baseline to 60 minutes later Secondary: Use of additional medication for the treatment of pain at any time during the ED course Percentage of patients who failed to achieve clinically important improvement in pain (<1.3) Published online 2022:339-355.

Emergency Department 94

Emergency Department Administration Dislocations Hospitals 94

Don't Forget the Bubbles

JULY 17, 2023

Original clinical studies Distribution and pattern of hand fractures in children and adolescents. Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases. 2023 Jun Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5-year experience. McClellan JM, et al.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98