EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Admission allows for close monitoring, given the risks of perforation, ischemic bowel, and ulceration, as well as appropriate management of the condition and patient symptoms. Fecal Impaction and Nonperforated Stercoral Colitis: Red Flags for Poor Outcomes. Mathis, K.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

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. Background: Sepsis remains one of the leading causes of morbidity and mortality.

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

The Trauma Pro

JANUARY 5, 2024

The group at the Medical College of Wisconsin performed a trial of thoracic cavity irrigation and compared the outcomes with patients who did not undergo irrigation. Bottom line: Well, this was a new one for me. The only prior study I could find was published in 2022 by a group at the University of Nevada at Las Vegas.

Hospitals 133

Hospitals Wellness Outcomes 133

Sensible Medicine

MAY 28, 2024

The adoption of depression screening is, of course, well-intentioned. In October 2022 , the USPSTF recommended childhood anxiety screening starting at eight years old. A 2008 Cochrane review found adult depression screening does not improve outcomes. Sensible Medicine is a reader-supported publication.

Military 144

Military Outcomes Psychiatric Wellness 144

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

Don't Forget the Bubbles

MAY 31, 2023

2023 May 17:archdischild-2022-325280. doi: 10.1136/archdischild-2022-325280. 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.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Pediatric EM Morsels

AUGUST 11, 2023

Having authored 575 ( well, now 576 ) of them, I am often quite convinced that there are no new topics to discuss. Infections there become complicated very quickly and the outcomes can be very poor. 2022 Sep;68(9):661-663. This is the 601st Ped EM Morsel ! ” Those areas have very important and delicate structures.

Burns 130

Burns Pediatrics EMS Outcomes 130

RebelEM

SEPTEMBER 21, 2023

Up to 80% of patients will have at least one troponin sent ( Gabrielli 2022 ). Troponins are highly specific to cardiac myocytes but do exist in other muscle types as well. What The Evidence Says: Gabrielli and colleagues demonstrated that troponin testing in patients with SVT is common. Cardiol Rev. PMID: 35148534 Allen R, deSouza IS.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

Don't Forget the Bubbles

OCTOBER 2, 2023

doi: 10.1136/bmjpo-2022-001842 What’s it about? This American single-centre retrospective review of 145 previously-well children referred to endocrinology to evaluate hypoglycaemia (<3.9 Previously well children presenting with acute illness are often thought hypoglycaemic due to prolonged fasting.

Outcomes 138

Outcomes Research Wellness Emergency Department 138

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

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

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Hope you’re doing well! Smith : "What was the outcome?" You taught us well!" Most of these Q waves are unusually wide with respect to QRS amplitude in the lead being looked at — as well as fragmented in multiple leads, including lead V3 ( BLUE arrow ) and leads III, aVF, V2 and V4. No Chest Pain, but somnolent.

EMS 114

EMS CPR EKG/ECG Wellness 114

Don't Forget the Bubbles

MARCH 31, 2025

This was a secondary analysis of the Management and Outcome of Fever in Children in Europe (MOFICHE) study. The primary outcome measure was SBI, and 1854 children included were diagnosed with an SBI. However, excessive fluid administration can lead to fluid overload, which has been linked to worse clinical outcomes.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. 2022 Mar 2;83(3):1-12.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Sensible Medicine

AUGUST 7, 2024

There is evidence that, for children and adults, elevated cortisol levels and chronic stress can lead to behavioral, mental-health, and mood issues, as well as changes in inflammation and immunity. In 2022 the CDC paid the AAP to form an expert working group to revise its developmental surveillance checklists.

CDC 114

CDC Documentation/Coding Research Pediatrics 114

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

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 113

Sepsis Best Practices Hospitals Outcomes 113

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. The “usual care intervention” was not well-defined.

Pediatrics 95

Pediatrics Outcomes Research Hospitals 95

Taming the SRU

MARCH 27, 2024

The parent trial was conducted from October 2020 to July 2022 in the capital region of Denmark. The primary outcome was cumulative norepinephrine use during the first 48 hours of admission. That said, outcomes for these patients are generally poor and the use of steroids as a one-time dose likely has little risk. Hill, J.

Resuscitation 99

Resuscitation CPR Outcomes Hospitals 99

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Systolic function normal by visual assessment only, unable to visualize well for further characterization. The patient did well and was discharged. Atrial fibrillation is also a predictor of worse outcomes in this case (Alborzi). Retrieved July 2, 2022, from [link] Moyé, D. RV: Cavity size normal. No cardiac MRI was done.

EKG/ECG 115

EKG/ECG Wellness Fractures Emergency Department 115

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). DAPT statistically noninferior to alteplase The finding was consistent in the per-protocol and as-treated groups as well Symptomatic ICH at 90d DAPT: 0.3% Alteplase: 91.4%

Stroke 98

Stroke Outcomes EMS Hospitals 98

Sensible Medicine

JUNE 11, 2024

In November 2022, OpenAI launched ChatGPT-3.5. The innovation of such a tool is well described by the rapid adoption of ChatGPT, which reached 1 million users in just five days and 100 million users in two months. One of the most striking examples of this acceleration is the release of Large Language Models (LLMs).

Documentation/Coding 90

Documentation/Coding Wellness Outcomes Research 90

EMDocs

JANUARY 29, 2024

However, other sources suggest that the optimal blood pressure target is not well established and may vary depending on the individual patient’s characteristics and the type of hemorrhagic transformation [7]. Lowering the MAP may mitigate these risks and possibly improve outcomes.

Stroke 99

Stroke Outcomes EMS Seizures 99

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

Emergency Medicine Ireland

MAY 13, 2024

The definition of PH since the 2022 ESC guidelines is a mean PAP of 20mmHg on a right heart catheter. You dig a little deeper and see an echo report that says the left heart works well but the right side is dilated. 2022 ESC Guidance Welcome back to the tasty morsels of critical care podcast. This is by far the commonest.

Wellness 98

Wellness Outcomes 98

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Queen of hearts interpretations: Patient 1, ECG1: Patient 2, ECG1: Patient 1 Clinical Course and Outcome: The EM physician did not see that the S wave voltage has been truncated and squared off at 10 mm, thereby greatly limiting the assessment of proportionality. But he did well.

EKG/ECG 125

EKG/ECG EMS Outcomes Wellness 125

Don't Forget the Bubbles

JUNE 19, 2023

Fetal Growth Restriction (FGR) and dysmaturity are common in neonatology and are a leading cause of morbidity during the neonatal period, as well as later in life. Prescriptive birthweight charts can improve the prediction of adverse outcomes in very preterm infants who are small for gestational age. Hoftiezer L et al.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Heart disease and stroke statistics-2022 update: A report from the American Heart Association.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Sensible Medicine

AUGUST 27, 2024

One of our early series (fall 2022) featured these two pieces. The criteria for getting accepted to a top-tier residency or competitive specialty is equally transparent: excel in classes, publish research, crush your Step exams, and do well on rotations. Today we have a current trainee extending Dr. Prasad’s most recent critique.

Outcomes 114

Outcomes Research Wellness 114

Dr. Smith's ECG Blog

DECEMBER 13, 2023

And she learned it well: She is not highly confident, but she does diagnose OMI. Outcome: 100% LAD Occlusion Here the Queen explains why: The dark blue tells us that she is looking especially at the QRS in V3 and the T-wave in V2 and V3. Not OMI, and we (Pendell and I) always take proportionality into account.

EKG/ECG 123

EKG/ECG COPD Wellness Outcomes 123

Sensible Medicine

NOVEMBER 14, 2023

Criticism of these programs is both well-deserved and unfair. Despite these well-deserved criticisms, I’ve found that residential treatment programs and therapeutic communities can be essential to my patients, and there’s evidence to support that. These higher quality studies usually achieved better outcomes.

Psychiatric 134

Psychiatric Research CDC Best Practices 134

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. Article: Kim DJ et al. Acad Emerg Med. 2023 Jan 10.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

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

ALiEM

OCTOBER 11, 2023

Pufferfish, also known as fugu, is served as a delicacy and perioral numbness is a well-known effect [4]. 2022 Feb 8;14(2):123. Treasure Island (FL): StatPearls Publishing; August 8, 2022. 2022 Feb;60(2):262-266. 2022 Nov 8;19(22):146-8. Treasure Island (FL): StatPearls Publishing; November 3, 2022.

Poisoning 81

Poisoning Burns Wellness Outcomes 81

ACEP Now

JULY 11, 2024

The United States Preventive Services Task Force (USPSTF) recommends screening for problem drinking in the primary setting, but we know that patients who present to the ED are twice as likely to engage in dangerous drinking, so arguably the ED is an important venue for screening as well. American Psychiatric Association Publishing; 2022.

Emergency Department 98

Emergency Department Psychiatric Outcomes Wellness 98