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 96

Operations Hospitals Best Practices Wellness 96

RebelEM

NOVEMBER 25, 2024

2 Moreover, the American Society of Anesthesiologists’ 2022 Practice Guidelines for Management of the Difficult Airway recommend the use of adjuncts like bougies in anticipated difficult airways but stop short of endorsing their routine universal use. Randomized controlled trials or comparative non-randomized observational studies.

Outcomes 93

Outcomes Emergency Department Operations Hospitals 93

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

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

RebelEM

NOVEMBER 6, 2024

2022 Aug 2. Acute elbow dislocation: evaluation and management. J Am Acad Orthop Surg. 1998 Jan-Feb;6(1):15-23. doi: 10.5435/00124635-199801000-00002. PMID: 9692937 Decker N, Norse A. Anterior Elbow Dislocation. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Simple elbow dislocation. Shoulder Elbow.

Dislocations 103

Dislocations Fractures Soft Tissue Injuries Outcomes 103

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 Outcomes Research 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 97

Administration Emergency Department Outcomes Documentation/Coding 97

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

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. Updated 2022 Nov 23]. A comparison between pre-operative ultrasonography and surgical findings. Updated 2022 Apr 7]. Updated 2022 Mar 16]. Acta Radiol.

Fractures 77

Fractures Dislocations Operations Radiology 77

Don't Forget the Bubbles

JANUARY 1, 2024

Data from the Nurse-Family Partnership program involving 60,171 families were analysed across four cohorts, including pre-pandemic and three pandemic cohorts (from July 2022 to October 2023). However, children who had an operation experienced improvements in behaviour, symptoms, and quality of life and had lower blood pressure.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

EMDocs

JANUARY 11, 2025

Operative management is necessary for signs of peritonitis, evidence of perforation, extensive bowel involvement >40cm, or after failed medical management. 2-4, 6, 8, 9, 12, 13, 14 Operative intervention typically consists of emergency laparotomy with bowel resection, colostomy formation, and Hartmann pouch creation. Mathis, K.

EMS 88

EMS Sepsis Shock Fluid Resuscitation 88

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 Administration 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 87

Hospitals Emergency Department EMS Outcomes 87

Taming the SRU

MAY 23, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. Updated 2022 Nov 23]. Updated 2022 May 14]. This post will cover some of the most common and important injuries, but is not comprehensive. Foot & Ankle Int.

Fractures 57

Fractures Dislocations Operations EMS 57

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

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

PulmCCM

APRIL 1, 2024

Both a 2019 meta-analysis and a large 2022 trial by the ANZICS group raised concerns about increased adverse events among patients receiving intensive physical therapy in the ICU. Physical therapy is probably under-provided to critically ill patients, and improving this might improve outcomes for many. Is this safe?

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

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

RebelEM

NOVEMBER 3, 2022

Matchett 2022). Indian J Crit Care Med 2022. Outcomes: Primary Outcome: Incidence of post-induction hypotension Secondary Outcome : First-pass success rate of endotracheal intubation Primary Results: 84 articles were identified for potential inclusion. in the ketamine cohort compared to 12.4%

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

ACEP Now

DECEMBER 10, 2023

Though the health educators often stay only two or three years, Dr. Calderon thinks that turnover rate is ideal because they can operate with full emotional commitment to the program and then move on to new roles in public health. It also allows her to get more underrepresented individuals involved in the program.

Research 52

Research Point-of-Care Testing Burns Academics 52

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. 12) Axillary While axillary arterial line placement has been uncommon, in the age of facile ultrasound operators it may become a more advantageous and accessible site particularly in patients with high BMIs. 2022 Jul;45(7):1183-1192. Gelmann, D.,

Shock 59

Shock Resuscitation Ultrasounds Research 59

Taming the SRU

MARCH 14, 2023

Ultimately, definitive management is in the operating room with revision or replacement of the VP shunt. Estimated incidence of normal pressure hydrocephalus and shunt outcome in patients residing in assisted-living and extended-care facilities. Lumbar puncture is an option with limited data for success. Lancet Neurol. Neurosurg Focus.

Seizures 52

Seizures Emergency Department Pediatrics Critical Access 52

EMDocs

OCTOBER 30, 2023

” – 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). A baby formula milk shortage for adults.” 11 Table 1.

Radiology 84

Radiology Radiology Emergency Department Hospitals 84

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

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 183

Pediatrics Emergency Department Outcomes Sepsis 183