RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7% Prehospital Tranexamic Acid for Severe Trauma.

Outcomes 102

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 102

Critical Care Now

JULY 7, 2024

2023;e2320850. The primary outcome showed higher mortality in the REBOA+SC group (54%) compared to the SCA group (42%), with an odds ratio (OR) of 1.58 (95% CI 0.72 – 3.52) and a posterior probability of OR > 1 at 86.9%.

Resuscitation 52

Resuscitation Military Outcomes Hospitals 52

RebelEM

APRIL 17, 2023

2023 Jan 10. Furthermore, another small retrospective study found that approximately 30% of patients with CT-diagnosed PTA lacked purulence on drainage attempts (Eliason 2023). While operator dependent, the dynamic ability of POCUS augments bedside diagnosis and can assist with drainage. 2023 Feb 9;15(2):e34820.

Ultrasounds 123

Ultrasounds Radiology Radiology Operations 123

RebelEM

AUGUST 7, 2023

Anesth Analg 2023. Anesth Analg 2023. Peri-Intubation Hypoxia After Delayed Versus Rapid Sequence Intubation in Critically Injured Patients on Arrival to Trauma Triage: A Randomized Controlled Trial. Re-oxygenation with BMV can increase airway-related adverse events (i.e.

Head Injuries 98

Head Injuries Outcomes Airway Management Burns 98

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. Accessed March 5, 2023. Updated 2023 Apr 22]. A comparison between pre-operative ultrasonography and surgical findings. Updated 2023 Feb 26].

Fractures 75

Fractures Dislocations Operations Radiology 75

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

EMDocs

SEPTEMBER 7, 2024

In this patient with a penetrating posterior flank injury, trace-free fluid in the pelvis on eFAST, and ongoing signs of hemorrhagic shock despite fluid and blood product administration, transferring to the operating room for exploration is indicated, especially with high probability of zone III injury-related retroperitoneal bleeding.

EMS 73

EMS Fluid Resuscitation Resuscitation Radiology 73

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 2023 Apr 22]. Updated 2023 Mar 30]. Updated 2023, Apr 14]. Updated 2023 Feb 3]. May 23, 2023) Foot Injuries in the ED. Weatherford B.

Fractures 57

Fractures Dislocations Operations EMS 57

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 Hospitals 52

PulmCCM

APRIL 1, 2024

Physical therapy is probably under-provided to critically ill patients, and improving this might improve outcomes for many. That could (and should) change if improved functional outcomes, persisting for months after hospital discharge, are ever confirmed in large, well-conducted trials.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

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. Healthcare. Resusc Plus.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

PulmCCM

JUNE 5, 2023

There was no significant difference in survival with a favorable neurologic outcome at 30 days (20% vs 16% nominally favoring the ECMO group, P=0.52) or at 6 months. Read in AJRCCM In The News The Hospitalist and the Resuscitationist 2023 Conference will take place September 27-30 in Montreal. In the U.S.,

Advances Cardiac Life Support (ACLS) 96

Advances Cardiac Life Support (ACLS) Documentation/Coding CPR Shock 96

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% Paper: van Baarle FLF et al.

Ultrasounds 55

Ultrasounds Outcomes Wellness Research 55

ACEP Now

NOVEMBER 16, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes, including successful development of a niche in the specialty. Accessed October 9, 2023.

Academics 52

Academics EMS Research Telemedicine 52

Taming the SRU

OCTOBER 23, 2023

At this point, the patient is taken to the operating room for a diagnostic laparoscopy. Discrimination between an IUP and an interstitial pregnancy is critical as interstitial pregnancies can have devastating outcomes. She was taken to the operating room and found to have a right tubal ectopic pregnancy with a pseudogestational sac.

Ultrasounds 96

Ultrasounds Operations Radiology Radiology 96

EMDocs

SEPTEMBER 9, 2023

Accessed June 24, 2023. Accessed June 8, 2023. Accessed June 6, 2023. Accessed June 7, 2023. Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation. Accessed June 9, 2023. Accessed June 7, 2023. Tendon Lacerations. McGraw Hill; 2021.

EMS 78

EMS Fractures Soft Tissue Injuries Ultrasounds 78

EMDocs

NOVEMBER 18, 2023

Liver Transplantation: Operative Techniques and Medical Management. Accessed April 21, 2023. UpToDate; 2023. Accessed May 7, 2023 5) Oh SY, Lee JM, Lee H, et al. Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. 2023; [link].

EMS 69

EMS Ultrasounds Emergency Department Outcomes 69

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! Sterling M, Murnick J, Mudd P. and Mudd, P.,

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

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. 2/19/2023 REFERENCES Sharman, J.E.,

Shock 59

Shock Resuscitation Ultrasounds Research 59

ALiEM

OCTOBER 30, 2023

The same goes for clinical operations and research – interesting, but there hasn’t been any “a ha” moment to illuminate her calling. 2023 Feb 7;18(2):e0281406. Garcia finds herself at a bit of a crossroad. She likes teaching, but are not sure residency or medical student education leadership is for her. 2021; 43(10):1210-1213.

Academics 64

Academics Leadership Wellness Research 64

RebelEM

NOVEMBER 20, 2023

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial [published online ahead of print, 2023 Oct 12]. 2023;e2320850. Outcome: Primary Outcome: All-cause mortality at 90 days.

Resuscitation 89

Resuscitation Outcomes Operations Hospitals 89

Pediatric EM Morsels

NOVEMBER 17, 2023

Differences in intubation outcomes for pediatric patients between pediatric and general Emergency Departments. Intubation practice and outcomes among pediatric emergency departments: A report from National Emergency Airway Registry for Children (NEAR4KIDS). 2023 Apr 28;24(3):579-587. That sounds reasonable, so what has changed?

Pediatrics 183

Pediatrics Emergency Department Outcomes Sepsis 183

RebelEM

MAY 27, 2024

The primary outcomes are patient-centered and objectively measured, potentially ensuring relevance and reliability. The unblinded nature of the study could influence outcomes due to observer bias. Employing P-values to compare demographics between groups could mislead interpretations of the data’s relevance to the primary outcomes.

Outcomes 134

Outcomes Research Hospitals Operations 134

RebelEM

JULY 31, 2023

Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults [published online ahead of print, 2023 Jun 16]. Outcomes: Primary Outcome: Successful intubation on the first attempt. Secondary Outcomes: Severe complications of tracheal intubation. N Engl J Med. 2023;10.1056/NEJMoa2301601. PMID: 37326325.

Operations 98

Operations Outcomes Emergency Department Airway Management 98

RebelEM

AUGUST 22, 2024

hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Paper: Lema GMC, De Leacy R, Fara MG, et al. Ophthalmology.

Stroke 80

Stroke Administration Outcomes Documentation/Coding 80

RebelEM

OCTOBER 2, 2023

The SQuID Protocol (Subcutaneous Insulin in /diabetic Ketoacidosis): Impacts on ED Operational Metrics. Acad Emerg Med 2023. No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 Paper: Griffey RT et al. tests/hr (0.8 Traditional: 1.0 tests/hr (0.8

Operations 100

Operations Academics Outcomes Fluid Resuscitation 100

Taming the SRU

SEPTEMBER 22, 2023

389, 418–429 (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.

Operations 103

Operations Outcomes Emergency Department Academics 103

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. Published July 10, 2023. 28 Dr. Sheffler RM, Alexander L, Fulton BD, et al.

Hospitals 69

Hospitals Radiology Radiology Administration 69

ACEP Now

AUGUST 28, 2024

John’s emergency department, including about 43 doctors, nurse practitioners, and physician assistants not working as supervisors or residents, nearly unanimously voted to form a union in 2023. With plenty of warning from the union, TeamHealth and the hospital implemented contingency staffing plans to keep the ED fully operational.

Emergency Department 85

Emergency Department Hospitals Patient Safety Leadership 85

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. Exposure to incivility hinders clinical performance in a simulated operative crisis. 2023 Mar 13.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

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

EMDocs

JUNE 3, 2023

4 This is the framework the ED resuscitationist should be operating under, as hemodynamically unstable pelvic trauma patients require a different approach compared to stable patients who will undergo CT, routine pelvic fixation, and definitive surgical repair. An x-ray in the trauma bay demonstrated an AP grade III fracture.

Fractures 54

Fractures Resuscitation Operations EMS 54

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. Accessed June 16, 2023. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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 11, 2024

Reducing the total ischemic time in patients with vascular injury is the single most important variable in improving outcomes and reducing the risk of amputation; an ischemic time of >8 hours is associated with amputation rates of up to 85%, compared with <20% in those with ischemic time of <8 hours (2). JBJS Reviews. StatPearls.

Dislocations 106

Dislocations Emergency Department Fractures Operations 106

Taming the SRU

AUGUST 30, 2023

Specific Evidence: Septic arthritis: According to the European Journal of Bone and Joint Infection’s 2023 guidelines for septic arthritis of native joints (SANJO), no blood tests have adequate sensitivity or specificity to either diagnose or exclude SANJO. 2023 Feb 2;388(5):439-452. Updated 2023 Apr 24]. 2022 Jul 11;11(14):2163.

Infectious Diseases 86

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 86

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. 2023 Nov; doi:10.1016/j.annemergmed.2023.10.008

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78