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

RebelEM

DECEMBER 23, 2024

There has been ongoing study about the clinical significance of these effects, as well as whether and for whom LR might provide meaningfully better clinical outcomes ( Myburgh 2013 , Self 2018 , Semler 2018 , Self 2020 ). The enrollment was multicenter, large, and adequately powered for clinically meaningful changes in outcome.

Fluid Resuscitation 121

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 121

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 117

EMS CPR EKG/ECG Wellness 117

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 122

Ultrasounds Outcomes COPD Hospitals 122

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 98

Resuscitation Outcomes CPR Hospitals 98

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

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 106

CDC Documentation/Coding Research Pediatrics 106

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 97

Stroke Outcomes EMS Hospitals 97

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 89

Documentation/Coding Wellness Outcomes Research 89

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 128

EKG/ECG EMS Outcomes Wellness 128

PulmCCM

SEPTEMBER 28, 2023

Systemic corticosteroids (such as intravenous dexamethasone) improve outcomes in severe pneumonia due to SARS-CoV-2 infection. It makes sense that inhaled steroids might improve outcomes from less severe infections. Do inhaled steroids improve Covid pneumonia? This study included a true blinded placebo control arm.

COPD 95

COPD Stroke Academics Urgent Care 95

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

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

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 100

Sepsis Best Practices Hospitals Outcomes 100

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

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

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

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

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 96

Operations Hospitals Best Practices Wellness 96

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 80

Pediatrics Outcomes Research Hospitals 80

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

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

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 107

Outcomes Research Wellness 107

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.

Research 129

Research Psychiatric CDC Best Practices 129

PulmCCM

JULY 3, 2023

”) It’s also worth mentioning that anesthesiology residents (not well represented in this study) typically perform hundreds of intubations in their first year —more than most ED residents and CCM fellows perform in three-year programs. Yes, mostly in the O.R. on stable patients, but a striking comparison nonetheless.

Airway Management 105

Airway Management Outcomes Hospitals Emergency Department 105

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

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. Using the EQUAL model will hopefully improve our care of patients living with disabilities, as well as their experience in the ED and accessing healthcare.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

RebelEM

AUGUST 14, 2023

days 2 most common sites of infection were lung (44.8%) and inta-abdominal (32.1%) Majority of infections were community-acquired (≈84%) Over half the patients were on mechanical ventilation (≈53%) Primary Outcome Results: 28-day mortality rate: Placebo 26.1% (230/882) vs. XBJ 18.8% (165/878); P<0.001 The risk difference was 7.3% (95% CI, 3.4-11.2)

Sepsis 96

Sepsis Outcomes Administration EMS 96

EMDocs

JANUARY 25, 2025

Well keep it short, while you keep that EM brain sharp. 0000000000000305 Kazumi Y (2023) The Epidemiology and Outcomes of Leukopenia in Different Populations and Regions. 10^9/L) Moderate (0.50.9 10^9/L) Severe (< 0.5 10^9/L) Generalized leukopenia (i.e. Most common causes of leukopenia Infections: 36.4% Medications: 25.6%

EMS 80

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 80

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

Leadership 93

Leadership EMS Pediatrics Stroke 93

Don't Forget the Bubbles

NOVEMBER 27, 2024

They look well and, apart from fever, have no other symptoms. Although they look well, you don’t want to miss a serious diagnosis, so what do you do? The AAP guideline is not alone in using PCT – several other, well-validated tools use PCT, including StepByStep and PECARN. What were the outcomes measured? No infants died.

Outcomes 81

Outcomes Wellness Hospitals Emergency Department 81

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

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

PulmCCM

NOVEMBER 6, 2023

Intuitively, plasma seemed even less likely to help the very sickest of the sick— those mechanically ventilated with ARDS from Covid-19, whose mortality rate was well over 50% at many centers. Only it turns out, it did help. Or could, anyway. patients infected with the Wuhan/Delta variants in 2020-2021). Thromboelastometry (e.g.,

Blood Transfusions 98

Blood Transfusions Operations Resuscitation Infectious Diseases 98

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