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

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Vitamin C did not improve outcomes among patients hospitalized with Covid-19.

Sepsis 76

Sepsis Stroke Shock Infectious Diseases 76

Total Medical ComplianceHIPAA

APRIL 14, 2023

On April 11, 2023, the HHS published a notice on upcoming new rules to add greater protection to reproductive health care because of new state laws passed due to the outcome of the Supreme Court ruling on Roe v. You should always keep the “minimum necessary” rule in mind whenever you are giving out information.

Documentation/Coding 83

Documentation/Coding Outcomes Wellness 83

Pediatric EM Morsels

JULY 26, 2024

Higher titers in both CSF and serum were associated with poor outcomes. Earlier diagnosis leads to better outcomes. Younger Age at Onset Is Associated With Worse Long-term Behavioral Outcomes in Anti-NMDA Receptor Encephalitis. 2023 Jul 17. It is best to assume the worst and cover for this possibility. doi: 10.1212/NXI.0000000000200013.

Psychiatric 269

Psychiatric Seizures Outcomes Pediatrics 269

Stop and Think

JANUARY 10, 2024

Let’s do two topics on the RCT that I covered in my Top Ten Stories of 2023 piece. They found no significant improvement in the primary endpoint of survival with a favorable neurologic outcome. The primary outcome of all-cause death occurred in 48% and 49% of the ECLS and control group, respectively (RR, 0.98; 95% CI, 0.80-1.19;

CPR 43

CPR Shock Outcomes Resuscitation 43

Broome Docs

JANUARY 30, 2023

Association of Chest Pain Protocol-Discordant Discharge With Outcomes Among Emergency Department Patients With Modest Elevations of High-Sensitivity Troponin. Does wound eversion improve cosmetic outcome?: Outcomes of patients discharged from the pediatric emergency department with abnormal vital signs. Epub 2021 Apr 29.

Emergency Department 52

Emergency Department Outcomes Ultrasounds Pediatrics 52

AENJ: Current Issue

MAY 8, 2024

The article titled “Using Artificial Intelligence to Predict Adverse Outcomes in Emergency Department Patients With Hyperglycemic Crises in Real Time,” authored by C.

Emergency Department 40

Emergency Department Outcomes Sepsis Research 40

ALiEM

JULY 17, 2023

sought to identify program factors associated with unfilled post-graduate year 1 (PGY-1) emergency medicine (EM) positions in the 2023 Match [1]. as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4]. A staggering 131 (47%) EM residency programs had unfilled PGY-1 positions among in 2023 [7].

EMS 52

EMS Burns Emergency Department Shock 52

PulmCCM

DECEMBER 18, 2023

In a large, complicated pragmatic cluster-crossover study at a single academic center, there was no difference in any meaningful outcome (death, ventilator-free days, or severe complications) between patients randomized to an oxygen saturation target of 90%, 94%, or 98%. If replicated, the finding would be remarkable and practice-changing.

Outcomes 52

Outcomes Academics Wellness 52

Pediatric EM Morsels

AUGUST 9, 2024

Hussain, 2023 ] Leads to >300,000 perinatal deaths / year globally. Congenital syphilis differs from syphilis contracted by an “adult” in that: [ Hussain, 2023 ] T. Hussain, 2023 ] Excellent prognosis if treated early. If not treated early, then increased risk of poor outcomes and death. Epub 2023 Aug 18.

Hyperthermia / Hypothermia 152

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 152

Don't Forget the Bubbles

NOVEMBER 11, 2024

One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. The aim of TTM is to control the body and brain’s temperature, thus reducing secondary brain injury and improving the neurological outcome. Kochanek et al.

Hyperthermia / Hypothermia 110

Hyperthermia / Hypothermia Outcomes Pediatrics Resuscitation 110

PulmCCM

FEBRUARY 8, 2024

ATS and ESICM each separately issued its own updated ARDS guideline in 2023, and SCCM did not lend its name to either. Their effects on meaningful patient outcomes are unclear, though, and their appropriate use continues to be debated. 2023 ATS guideline on ARDS 2023 ESICM guideline on ARDS

Research 52

Research Documentation/Coding Fractures Outcomes 52

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes. March 30, 2023). Diastolic Shock Index: A clinically relevant predictor of poor outcome in septic shock? TamingtheSRU.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

RebelEM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. Resus 2023.

CPR 145

CPR EMS Documentation/Coding Outcomes 145

Pediatric EM Morsels

JUNE 9, 2023

Banc-Husu, 2023 ] Cholestastis Inflammatory conditions Genetic and Metabolic diseases Pediatric cirrhotic liver disease has many complications. Banc-Husu, 2023 ; Luoto, 2020; Carneiro de Moura, 2018 ] Basics are best (always)! 2023 Feb;43(1):100-116. Portal Hypertension in children is a heterogenous disease ]. Semin Liver Dis.

Pediatrics 152

Pediatrics Head Injuries Airway Management Administration 152

The Skeptics' Guide to EM

SEPTEMBER 9, 2023

New England Journal of Medicine June 2023 Date: July 19, 2023 Guest Skeptic: Dr. Casey Parker is a Rural Generalist that includes in his practice emergency medicine, anesthesia, and critical care. New England Journal of Medicine June 2023 Reference: Snelling et al. He is also a fully-fledged ultrasonographer.

Fractures 121

Fractures Ultrasounds Pediatrics Outcomes 121

Pediatric EM Morsels

SEPTEMBER 22, 2023

Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Orenstein JB, Klein BL, Gotschall CS, Ochsenschlager DW, Klatzko MD, Eichelberger MR. Age and outcome in pediatric cervical spine injury: 11-year experience. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 5 th Edition. Neurogenic Shock. Updated 2022 Feb 10].

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

The Skeptics' Guide to EM

DECEMBER 16, 2023

AEM Dec 2023 Date: December 14, 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. AEM Dec 2023 Date: December 14, 2023 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary.

Emergency Department 115

Emergency Department Research Outcomes 115

Don't Forget the Bubbles

JULY 17, 2023

2023 Jun;38(6):1733-1751. 2023 May 16;28(3):172-183. 2023 Jun 6;28(4):205-251. 2023 Jun 6;28(4):252-266. 2023 Jun 1;177(6):559-560. 2023 Jun;182(6):2785-2792. 2023 May 16;28(3):184-202. 2023 Jun 15. 2023 Jun 1;42(6):456-460. 2023 Jun;182(6):2567-2575. 2023 Jun 29.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

The Skeptics' Guide to EM

JULY 2, 2023

Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Date: July 1, 2023 Reference: PATCH-Trauma Investigators and ANZICS Clinical Trial Group. Most of the times the RCTs we critically appraised did not demonstrate superiority for their primary outcome.

EMS 118

EMS Outcomes Hospitals Research 118

PulmCCM

SEPTEMBER 21, 2023

A 2015 meta-analysis of 13 randomized trials enrolling >12,000 patients suggested that active blood pressure management after ischemic strokes had little effect on eventual outcomes, and that delaying blood pressure control for three days did not lead to worse outcomes (death or disability).

Stroke 105

Stroke Outcomes 105

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). 2023 Dec 22. 2023 Dec 21. 2023 Dec 19. 2023 Dec 12 Pediatric Sepsis Diagnosis, Management, and Sub-phenotypes. Pediatrics.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

EMDocs

SEPTEMBER 30, 2024

2023 May;64(5):555-563. Primary outcome: Prescription of ICS on ED discharge from the index visit Secondary outcomes: ICS prescription rates in high-risk subgroups Rates of outpatient follow-up within 30 days of an ED visit for asthma Variation in ICS prescription rates among attending ED physicians. J Emerg Med.

Outcomes 83

Outcomes Documentation/Coding Academics Administration 83

Intensive Blog

MARCH 13, 2024

This showed a similar rate of survival to discharge (27%), of whom approximately 50% had a favourable neurological outcome on discharge (CPC 1 or 2). Multiple meta-analyses 9,10 found that ECPR, when compared to conventional CPR (CCPR), was associated with improved 30-day mortality and neurological outcomes. More recently ….

CPR 130

CPR Resuscitation Outcomes Hospitals 130

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

EMDocs

JANUARY 13, 2024

Spoon Feed High-dose nitroglycerin improves outcomes in patients with sympathetic crashing acute pulmonary edema (SCAPE) without significant side effects when compared to low-dose nitroglycerin. 2023 Nov 28:emermed-2023-213285. doi: 10.1136/emermed-2023-213285. 2023 Nov 28:emermed-2023-213285. Emerg Med J.

Stroke 62

Stroke Shock Pediatrics Resuscitation 62

EM Ottawa

NOVEMBER 6, 2023

Lancet 2023 Jul 1;402(10395):27-40. Question and Methods: Do 6 month outcomes improve after implementation of a goal-directed care bundle that corrects prognostically poor physiological abnormalities (systolic hypertension, fever, hyperglycemia, abnormal anticoagulation) for acute intracranial hemorrhage?

Outcomes 104

Outcomes 104

EMDocs

NOVEMBER 29, 2023

2023 May 25;388(21):1931-1941. Included 584 patients > 18 years admitted to ICU with severe PNA based on IDSA/ATS criteria Primary Outcome: 60-day all-cause mortality Hydrocortisone 16% vs. placebo 18%, adjusted OR 0.90 (95% CI 0.57-1.40) 2023 Jul 8;27(1):274. 2023 May 31;27(1):212. #4: 2023 Jul;188:109785.

Resuscitation 80

Resuscitation Outcomes EKG/ECG 80

RebelEM

JUNE 1, 2023

Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. In theory, rapid identification of the underlying cause should improve outcomes by allowing clinicians to tailor management. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study.

Outcomes 145

Outcomes Resuscitation Hospitals CPR 145

ACEP Now

AUGUST 13, 2024

Studies consistently show that having a diverse physician workforce leads to improved patient outcomes, lower mortality, reduced morbidity rates, and, ultimately, a more robust health care system. Published June 6, 2023. Published April 20, 2023. Diversity improves performance and outcomes. Published June 29, 2023.

Leadership 111

Leadership Outcomes Academics Emergency Department 111

RebelEM

FEBRUARY 15, 2024

not a patient oriented outcome) Single country study which may limit generalizability Excluded pregnancy where risk of emesis is increased due to gravid uterus Alcohol was the implicated in the overwhelming majority of patients. Paper: Freund Y et al. References: Freund Y et al.

Poisoning 141

Poisoning Airway Management Seizures Shock 141

EM Ottawa

MAY 20, 2024

2023 Jun 29;388(26):2411-2421. Question and Methods: RCT at 103 sites to compare outcomes at 30 days for early versus late DOAC initiation among patients with ischemic stroke and atrial fibrillation. Methodology: 3/5 Usefulness: 2/5 Fischer U, et al. N Engl J Med.

Stroke 56

Stroke Outcomes 56

The Skeptics' Guide to EM

JUNE 3, 2023

Date: June3, 2023 Reference: Kotani et al. Journal of Critical Care April 2023 Guest Skeptic: Dr. Amber Gombash is an emergency physician in Concord, NC. Date: June3, 2023 Reference: Kotani et al. Journal of Critical Care April 2023 Guest Skeptic: Dr. Amber Gombash is an emergency physician in Concord, NC.

Outcomes 97

Outcomes Wellness 97

Pediatric EM Morsels

NOVEMBER 15, 2024

There are associated co-morbiditiested [Lee 2017, Steinrueke 2023] BECTS Seizures / Benign Rolandic Epilepsy- Moral of the Morsel It’s not a stroke, it’s a seizure. Updated 2023 Aug 7]. Care and three-year outcomes of children with Benign Epilepsy with Centro-Temporal Spikes in England. References : Hernandez, A., Holmes, G.L.

Seizures 152

Seizures Stroke Pediatrics Wellness 152

RebelEM

JUNE 22, 2023

Lancet Infect Dis 2023 PMID: 37302406 Clinical Question: Does outpatient treatment with ivermectin, fluvoxamine or metformin soon after SARS-CoV-2 infection reduce the risk of developing long-COVID in overweight patients? Outcomes: Primary: The development of long-COVID up to 300 days after enrollment. Lancet Infect Dis 2023.

Outcomes 145

Outcomes Research Documentation/Coding Wellness 145

EMDocs

AUGUST 5, 2023

Source Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. 2023 Jul;188:109785. Epub 2023 Apr 3. #2: Source Adverse Clinical Outcomes Among Patients With Acute Low-risk Pulmonary Embolism and Concerning Computed Tomography Imaging Findings.

Resuscitation 64

Resuscitation Outcomes Hospitals 64

The Skeptics' Guide to EM

JANUARY 20, 2024

Aug 2023 Date: October 30, 2023 Guest Skeptic: Dr. Ellie Hill is a pediatric emergency medicine physician at Children’s National Hospital in Washington, DC and Assistant Professor of Pediatrics and Emergency Medicine at George Washington University School of Medicine and Health Sciences. Reference: Zaoutis T, et al. JAMA Pediatr.

Pediatrics 71

Pediatrics Anaphylaxis Emergency Department Outcomes 71