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 93

Operations Academics Outcomes Fluid Resuscitation 93

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

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 104

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 104

ACEP Now

MARCH 6, 2024

The Sisyphean task remains to try to keep up—and, in that vein—here is a light round of the emergency medicine literature from 2023. 4 Repeated trials have not shown alteplase to have any signal of better outcomes, nor tenecteplase to have an association with increased adverse events. How Best to Stop the Bleeding in Trauma?

Research 52

Research Airway Management Stroke Outcomes 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 122

Ultrasounds Outcomes COPD Hospitals 122

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 91

Resuscitation Operations Outcomes Hospitals 91

RebelEM

NOVEMBER 25, 2024

A medical librarian with expertise in systematic reviews, searched Cochrane, Embase, Medline, Scopus, and Web of Science for relevant randomized controlled trials and comparative observational studies from inception to June 2023. Included patients from out-of-hospital, emergency department, intensive care unit, and operating-room intubations.

Outcomes 93

Outcomes Emergency Department Operations Hospitals 93

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 94

Head Injuries Airway Management Outcomes Burns 94

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 85

Stroke Administration Outcomes Documentation/Coding 85

Don't Forget the Bubbles

OCTOBER 10, 2024

Reviewed by: Isabella Davenport Article 2: Does it improve outcomes if you replace the nail in nail bed repair? 2023 Mar 30;110(4):432-438. Children with nail bed injuries were randomly assigned to nail replacement or discarding , with the primary outcomes being secondary infection in 7 days and cosmetic outcome in four months.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

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. In StatPearls.

EMS 88

EMS Sepsis Shock Fluid Resuscitation 88

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 77

Fractures Dislocations Operations Radiology 77

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

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 105

Resuscitation Administration Emergency Department Ultrasounds 105

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

Taming the SRU

NOVEMBER 3, 2023

The primary outcome in this study was a change in pain score at rest 60 minutes after block. Secondary outcomes were changes in pain scores at rest at 15 minutes, during incentive spirometry at both time points and then change in maximum vital capacity. 11/3/2023 Mean and median pain score at rest prior to SAPB were 5.4 (SD

Fractures 98

Fractures Ultrasounds Outcomes Research 98

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 107

Dislocations Emergency Department Fractures Operations 107

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 98

Ultrasounds Operations Radiology Radiology 98

Taming the SRU

JUNE 11, 2023

Acad Emerg Med 2023; 10.1111/acem.14703 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.

Hospitals 87

Hospitals Emergency Department EMS Outcomes 87

ACEP Now

JULY 7, 2024

2,3 In this case, aortic dissection was visualized neither on initial bedside nor on repeat inpatient TTE, despite operator knowledge of a known lesion and extensive operator training. 1,3 Temporizing measures are not always possible for critically ill Grade IV patients, and outcomes are usually much worse. Click to enlarge.)

Operations 59

Operations Hospitals Administration Outcomes 59

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 87

EMS Fluid Resuscitation Resuscitation Radiology 87

ACEP Now

OCTOBER 15, 2023

Diabetes care in the hospital: standards of care in diabetes-2023. Evaluation of outcomes following hospital-wide implementation of a subcutaneous insulin protocol for diabetic ketoacidosis. Evaluation of outcomes following hospital-wide implementation of a subcutaneous insulin protocol for diabetic ketoacidosis. Diabetes Care.

Hospitals 80

Hospitals Operations Emergency Department Research 80

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

JournalFeed

MAY 13, 2023

The JournalFeed podcast for the week of May 8-12, 2023. PTU vs MMI Spoon Feed This comparative effectiveness study showed no significant difference in clinical outcomes or adverse effects when comparing use of propylthiouracil (PTU) and methimazole (MMI) for thyroid storm.

Operations 40

Operations Pediatrics Outcomes 40

RebelEM

NOVEMBER 6, 2023

2023 Jul 19. 2023 Jul 19. Methylene Blue for Vasoplegic Syndrome After Cardiac Operation: Early Administration Improves Survival. Paper: Hiruy A, et al. Hydroxocobalamin Versus Methylene Blue for the Treatment of Vasoplegic Shock Associated With Cardiopulmonary Bypass. J Cardiothorac Vasc Anesth. Epub ahead of print.

Shock 71

Shock Administration Academics Hospitals 71

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

Medagadget

AUGUST 25, 2023

During operation, the space to be disinfected must be evacuated since germicidal UV light is harmful, causing damage to nucleic acids, and generates Ozone, which can be a harmful gas by itself. There are two types of equipment: High intensity, high power Germicidal UV ‘robots’ — a very expensive and power-consuming type of technology.

CDC 76

CDC Operations Hospitals Wellness 76

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 58

Ultrasounds Outcomes Wellness Research 58

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

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

Sensible Medicine

MARCH 14, 2024

These suspicions are not baseless as a 2023 Elsevier survey suggests a majority of trainees are struggling to imagine themselves shouldering a career in direct patient care. I’ve heard arguments that frame this discussion in terms of trainee wellness, physician burnout, social contract, and patient outcomes.

Hospitals 98

Hospitals Wellness Academics Fractures 98

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

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 Telemedicine Research 52

PulmCCM

JANUARY 6, 2025

A follow-up study in 2023 showed the Epic model performed badly in complex patients. A cluster randomized trial using all-cause mortality as an outcome was always needed to determine whether EMR alerts improve outcomes for suspected severe infection. 2023 Jun 1;183(6):611-612. But for whom, and to what end?

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

Don't Forget the Bubbles

JANUARY 31, 2024

Edelman J, Taylor H, Goss A, et al Point-of-care ultrasound as a diagnostic tool in respiratory assessment in awake paediatric patients: a comparative study Archives of Disease in Childhood Published Online First: 14 December 2023 What’s it about? Article 1: What predicts parental anxiety in the Paediatric Emergency Department? Martin, S.R.,

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

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

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