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

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

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

ACEP Now

MARCH 10, 2025

In a 2022 interview about his performance of the yumitori-shiki, Satonofuji said, Every single gesture has a meaning, so I put my heart into it. A sense of purpose is an integral part of well-being. Ikigai and subsequent health and wellbeing among Japanese older adults: longitudinal outcome-wide analysis. 2022;21:100391.

Academics 85

Academics Wellness CPR Hospitals 85

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

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

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

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

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 113

CDC Documentation/Coding Research Pediatrics 113

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

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 Outcomes CPR 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

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 88

Documentation/Coding Wellness Outcomes Research 88

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

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

Mind The Bleep

APRIL 10, 2025

Examples of LLMs used in healthcare are: The main aims of using AI in healthcare would be to reduce costs, improve patient outcomes and medical education. Well, it could be argued AI would be faster and hence more efficient. They performed consistently well with or without AI. One of the most famous LLMs is ChatGPT.

Documentation/Coding 52

Documentation/Coding Research Outcomes Administration 52

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 112

Outcomes Research Wellness 112

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

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 Outcomes Research 98

ALiEM

OCTOBER 30, 2024

The Wounds Common among patients who use xylazine, the necrotic and exudative wounds are still not fully understood [5-8], but are likely due in part to direct cytotoxic effects of the drug and its impurities, as well as possible nutritional deficiencies common in those with dependence. Drug Checking Quarterly Report (Q3 2022).

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

Mount Sinai EM

OCTOBER 10, 2024

In light of this and Dr. Murthy’s recommendation, I wanted this post to touch on technology and wellness: screen time and mental health. To make it directly related to our wellness, I’ll focus on studies of adults. 2021 looked at smartphone addiction and associated health outcomes in adults. A systematic review by Ratan et al.,

Wellness 100

Wellness Research Outcomes 100

Taming the SRU

MARCH 12, 2024

In the context of increasing ED and hospital crowding as well as limited ICU availability, this study aimed to evaluate the impact of a subcutaneous insulin (SQuID) protocol in the treatment of DKA on emergency department length-of-stay (EDLOS) and ICU admissions. as well as patients less than 18 years old were excluded from analysis.

Operations 97

Operations Hospitals Best Practices Wellness 97

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. 2022 PMID: 35206981 2. Labs can be drawn from an IO to help with rapid diagnosis in emergencies.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Don't Forget the Bubbles

JULY 19, 2023

Olivia, a previously well 13-year-old girl, is referred to the paediatric ED from the Ophthalmology ED. 2022 May 18;16:1525-1528. 2022 [cited 2023 May 14];16:1525–8. Outcome of pediatric patients referred for papilledema. She went to the optician today to get a new pair of glasses. Clin Ophthalmol. Can J Ophthalmol.

Pediatrics 98

Pediatrics Emergency Department Outcomes Wellness 98

Dr. Smith's ECG Blog

MAY 23, 2023

And they of course activated the cath lab immediately, where he was found to have acute thrombotic occlusion (TIMI 0) of the proximal LAD, as well as embolic D1 occlusion. LAD and D1 were stented, but flow unfortunately could not be well restored despite efforts (they list the post intervention TIMI flow still as 0). Epub 2022 Mar 17.

EKG/ECG 98

EKG/ECG Wellness Emergency Department EMS 98

Don't Forget the Bubbles

JUNE 17, 2024

High levels of incivility correlate with adverse outcomes for patients, staff, and the organisation. Loss of psychological safety and mental well-being persist long after the episode and can impact future episodes of care. 2022 May 12;46(3):319-24. The lasting effects of incivility cannot be understated. Edmondson, Amy C.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Brief aside: "Early repolarization" is a frequently proclaimed and poorly understood electrocardiographic phenomenon which mostly serves to reassure clinicians that not all ST elevations are ischemic (something readers of this blog know well). linking the finding with long term risk of idiopathic ventricular fibrillation. Stuckey, T.,

EKG/ECG 131

EKG/ECG Documentation/Coding Wellness Emergency Department 131

Sensible Medicine

JUNE 6, 2023

Two nearly identical trials of the monoclonal drug aducanumab, ENGAGE and EMERGE, had disparate outcomes: ENGAGE showed no benefit and EMERGE showed that the drug slowed decline. In late 2022 we learned that a large RCT found that the monoclonal lecanemab appeared to slow progression in AD. This makes the results hard to interpret.

Outcomes 97

Outcomes Infectious Diseases Research Academics 97

EMDocs

AUGUST 22, 2024

Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Certified interpreter use can improve communication and patient outcomes. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter.

Documentation/Coding 104

Documentation/Coding Emergency Department Federal Emergency Management Agency Best Practices 104

Dr. Smith's ECG Blog

AUGUST 19, 2023

Contemporary trends and outcomes in patients with ST-segment elevation myocardial infarction and end-stage renal disease on dialysis: insights from the National Inpatient Sample. Problem #1: As I emphasized in My Comment in the December 6, 2022 post — Not all patients with acute MI report chest pain. Circulation 2007 2. Khan et al.

EKG/ECG 98

EKG/ECG Wellness Outcomes Hospitals 98