PulmCCM

NOVEMBER 22, 2024

At the end of 2023, 26 attendings and 24 residents (mostly in internal medicine at Stanford, Beth Israel/Harvard, and the University of Virginia) read clinical case vignettes and were randomized to answer them either with conventional resources like decision support tools (e.g., Google search, UpToDate™), or to use ChatGPT-4.

Academics 81

Academics Operations Outcomes 81

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

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

Dislocations 59

Dislocations Fractures Soft Tissue Injuries Outcomes 59

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

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 137

Outcomes Research Hospitals Operations 137

ACEP Now

JUNE 21, 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. 11 What should we take away?

EMS 114

EMS Academics Telemedicine Research 114

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

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

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 130

Ultrasounds Radiology Radiology Operations 130

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 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

PulmCCM

SEPTEMBER 4, 2024

OP is operating point, the operating point defines the cardiac output on the y-axis and Pra on the x-axis; Rcardiac is cardiac resistance (i.e., OP1 is operating point 1 at baseline. With tamponade, operating point 2 (OP2) is formed. Might this novel measure predict outcome in critically-ill patients [ @ross_prager ]?

Ultrasounds 84

Ultrasounds Operations Research Outcomes 84

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 130

Ultrasounds Outcomes COPD Hospitals 130

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

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 76

Fractures Dislocations Operations Radiology 76

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

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

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

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

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

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

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

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 74

EMS Fluid Resuscitation Resuscitation Radiology 74

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 97

Fractures Ultrasounds Outcomes Research 97

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

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 Hospitals 105

EMDocs

OCTOBER 30, 2023

Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. Production levels increased steadily back to baseline, achieving normal supply levels in February 2023.

Radiology 73

Radiology Radiology Emergency Department Hospitals 73

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 72

Shock Administration Academics Hospitals 72

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 59

Ultrasounds Outcomes Wellness Research 59

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 104

Hospitals Operations Emergency Department Research 104

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

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) 91

Advances Cardiac Life Support (ACLS) Documentation/Coding CPR Shock 91

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 97

Ultrasounds Operations Radiology Radiology 97

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

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

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