Taming the SRU

SEPTEMBER 22, 2023

million adults undergo tracheal intubation outside of the operating room each year in the United States. Several single-center and moderately-sized studies have compared the outcomes of these two methods with varying results. The operator reported a subjective assessment of the anticipated difficulty. Background More than 1.5

Operations 105

Operations Outcomes Emergency Department Academics 105

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

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

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

ALiEM

OCTOBER 30, 2024

Your patient ultimately is diagnosed with a spinal epidural abscess requiring operative care. Drug Checking Quarterly Report (Q3 2022). 2022; 06/26/2023. 2022 May;14(5). Emergency department-initiated buprenorphine for opioid dependence with continuation in primary care: outcomes during and after intervention.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

PulmCCM

OCTOBER 16, 2024

Animal studies have suggested that the body could be prepped or trained to better withstand ischemic-reperfusion injury, by inducing mild ischemia in another tissue bed before the operation. This is a remarkable example of the differences between societies, which might influence the processes of clinical trials and their outcomes.

Outcomes 52

Outcomes Operations Research Hospitals 52

Taming the SRU

MARCH 12, 2024

The SQuID protocol (subcutaneous insulin in diabetic ketoacidosis): Impacts on ED operational metrics. The study’s primary outcomes were the operational impacts of the SQuID protocol on EDLOS and ICU admission rates. Secondary outcomes included fidelity to and safety of the intervention. Acad Emerg Med 2023;30(8):800–8.

Operations 97

Operations Hospitals Best Practices Wellness 97

RebelEM

APRIL 17, 2023

A repeat search was completed in May 2021 & November 2022. While operator dependent, the dynamic ability of POCUS augments bedside diagnosis and can assist with drainage. Two investigators independently assessed and screened all studies for eligibility. Ultrasound has become an extended part of our physical exam.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes. These procedures require an experienced operator.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Taming the SRU

SEPTEMBER 25, 2023

Specifically, EM physicians should be able to recognize fractures that will likely require operative management and facilitate close follow up, such as a Maisonneuve fracture. Disruption of these structures yields an unstable ankle fracture, thus making close follow up for operative management imperative. 2022 May 16;10(14):4684-4690.

Fractures 101

Fractures Operations Emergency Department EMS 101

ACEP Now

JULY 7, 2023

2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity. Heart disease and stroke statistics-2022 update: A report from the American Heart Association. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

RebelEM

AUGUST 12, 2024

Epub 2022 Aug 28. Intravenous amino acid therapy for kidney protection in cardiac surgery a protocol for a multi-centre randomized blinded placebo controlled clinical trial. The PROTECTION trial. Contemp Clin Trials.

Outcomes 81

Outcomes Hospitals Operations Shock 81

PulmCCM

NOVEMBER 6, 2023

open label) at 17 sites in Belgium in 2020-2022, 35% of those receiving plasma died at 28 days, vs. 45% of the usual care patients — a number needed to treat of 10 to save one life. Among 475 patients with ARDS due to Covid-19, randomized within 5 days of ventilation to receive convalescent plasma or usual care (i.e.,

Blood Transfusions 98

Blood Transfusions Operations Resuscitation Infectious Diseases 98

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

PulmCCM

APRIL 18, 2024

The real world success rates by operators experienced with intubation remained unknown. This outcome measure was less robust than intubation attempts, because the “failure” definition included simply switching devices, which the intubator was permitted to do at any time for any reason.

Airway Management 98

Airway Management Operations EMS Research 98

The Skeptics' Guide to EM

JULY 30, 2022

Date: July 28th, 2022 Reference: Brower et al. AEM July 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Date: July 28th, 2022 Reference: Brower et al. Charles Brower is a second-year resident training in Emergency Medicine at the University of Cincinnati.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

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. 2022 PMID: 35206981 2.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

American Medical Compliance

NOVEMBER 30, 2022

In operating rooms, HAIs can cause surgical site infections, which threaten the health and safety of patients. According to the Emergency Care Research Institute, staffing shortages posed the greatest threat to patient safety in 2022. Many care providers are forced to operate without the necessary materials to do their jobs.

Patient Safety 52

Patient Safety CDC Operations Outcomes 52

Don't Forget the Bubbles

JUNE 17, 2024

High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. At its heart lies an unpleasant reality- a critically unwell child with an anxious carer hoping for a positive outcome. 2022 May 12;46(3):319-24. Civility Saves Lives The impact of incivility in healthcare cannot be understated.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

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. 2022:3(9):e222886. Published December 14, 2022. JAMA Health Forum.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

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.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

SheMD

MAY 4, 2023

What were their outcomes: The median number of years to first appointment to a chair position was 7 years after graduation. Women were more likely to be first appointed to educational rather than operational roles (52.6% Dig Dis Sci 67, 364–366 (2022). Female chairs obtained more advanced degrees (47.4% vs 31.6%, p=0.12).

Leadership 52

Leadership Academics Operations Emergency Department 52

The Skeptics' Guide to EM

APRIL 16, 2022

Date: April 16th, 2022 Reference: Blom et al. Date: April 16th, 2022 Reference: Blom et al. Before we answer that question, let’s remind everyone that only a small number (2.8%) of interventions published in SRMA and relevant to emergency medicine have unbiased and strong evidence for improved outcomes ( SGEM#361 ).

Military 40

Military Operations Emergency Department Pediatrics 40

Don't Forget the Bubbles

MAY 17, 2023

Post-operative pain in children: Comparison of pain scores between parents and children. 2023 Apr 20:fetalneonatal-2022-324835. Early Antibiotic Use and Neonatal Outcomes Among Preterm Infants Without Infections. 2023 Apr 4:archdischild-2022-325281. J Pediatr Gastroenterol Nutr. 2023 Apr 24. Cetinkaya PG, et al.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Taming the SRU

JUNE 11, 2023

Utilized in the pre-hospital setting, ICU and the Operating Room, it is a non-invasive measurement that reflects a patient’s current state of metabolism, circulation and ventilation. The primary outcome was in-hospital mortality. The secondary outcome focused on ICU admissions. 2023;(December 2022):1-10. Acad Emerg Med.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

RebelEM

DECEMBER 19, 2022

2022 Nov 6 PMID: 36342151 Clinical Question: How does double defibrillation and vector change defibrillation compare to standard therapy in OHCA patients with refractory ventricular fibrillation? Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med.

EMS 52

EMS CPR Shock Resuscitation 52

RebelEM

NOVEMBER 6, 2023

Methylene Blue for Vasoplegic Syndrome After Cardiac Operation: Early Administration Improves Survival. 2022 Aug 22. PMID: 37586951 Mehaffey JH, et al. Ann Thorac Surg. Epub 2017 May 24. PMID: 28551045 Bak MA, et al. High-Dose Hydroxocobalamin for Refractory Vasoplegia Post Cardiac Surgery.

Shock 71

Shock Administration Academics Hospitals 71

Emergency Medicine Journal

NOVEMBER 28, 2023

There is little research in the Irish setting, specifically regarding the outcomes of patients who receive chest drains in Irish EDs. This study was conducted by the Irish Trainee Research Network (ITERN) from May 2022 until February 2023. No association was found between drain type, indication or operator and first past success.

Emergency Department 40

Emergency Department EMS Research Operations 40

Dr. No

JANUARY 3, 2022

We must avoid at all costs that most awful of medical outcomes: the operation — all the counter-measures — was a great success, but unfortunately the patient — society — died. This brings Dr No to his final, and perhaps most important point, in this first post of 2022.

Operations 52

Operations Shock Outcomes 52

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. This is a critical error that leads to poorer outcomes for patients in need of critical care. More pertinent and relevant takeaway messages have to do with staffing and operations.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 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

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

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Don't Forget the Bubbles

MAY 10, 2023

In May 2022, Holly and Joe, two students on the joint QMUL and DFTB PEM MSc , created video presentations on human factors. Then the patient is rapidly moved to the operating theatre. The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre. Resuscitation.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

RebelEM

AUGUST 31, 2023

Primary Outcome – Bleeding (Grade 2 to 4) Transfusion 4.8% Primary Outcome – Bleeding (Grade 2 to 4) Transfusion 4.8% Key Secondary Outcome – Severe Bleeding (Grade 3 to 4) Transfusion 2.1% Key Secondary Outcome – Severe Bleeding (Grade 3 to 4) Transfusion 2.1% Median hemoglobin: 8.2 g/dl vs 8.5

Ultrasounds 58

Ultrasounds Outcomes Wellness Research 58

Don't Forget the Bubbles

JANUARY 17, 2024

They passed away a few days after a second operation. There have been reports of the Orbeez Challenge leading to serious outcomes. A six-month-old infant presented with sub-acute obstruction and needed an enterostomy. Unfortunately, the anastomosis broke down. It’s beads, too! BMC Pediatrics , 21 (1), Jackson, J., Randell, K.A.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111