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 144

CPR EMS Documentation/Coding Outcomes 144

Ken Grauer, MD

SEPTEMBER 21, 2024

To quote Dr. Stephen Smith: "The worst risk factor for a bad outcome in acute MI is young age." . = PEARL # 3: Acute MI Can Occur in a Younger Patient! Smith's ECG Blog — with links at the bottom of this post to a series of more cases illustrating this phenomenon ). That said — acute MI does occur in younger patients.

EKG/ECG 300

EKG/ECG Resuscitation Outcomes Hospitals 300

Stop and Think

DECEMBER 26, 2023

My Choice for Top Cardiology Story of 2023 Obesity Treatments: Here is what I wrote : Hyperbole is almost impossible when describing the potential benefits of the glucagon-like peptide-1 (GLP-1) receptor agonists. Semaglutide reduced cardiovascular outcomes in patients with established cardiovascular disease and obesity but without diabetes.

Outcomes 75

Outcomes 75

The Trauma Pro

DECEMBER 22, 2023

The reality is that no one will ever be able to design a study that definitively evaluates the very soft outcomes that result from using this technique. 1485, Dec 2023. It can help direct the surgical exploration if imaging was unnecessary or contraindicated. So yes, this is dogma.

Operations 264

Operations Outcomes 264

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

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 116

Hyperthermia / Hypothermia Outcomes Pediatrics Resuscitation 116

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

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

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 144

Outcomes Resuscitation Hospitals CPR 144

EMDocs

SEPTEMBER 27, 2023

Additionally, a 2022 study in JAMA found no association between MIPS measures and any meaningful clinical outcomes and moreover physicians who cared for the most medically and socially vulnerable were more likely to receive worse scores (8). References American Medical Association. ” from [link] Seidenwurm, D. Burleson (2014).

Emergency Department 63

Emergency Department Research Outcomes Hospitals 63

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

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 140

Poisoning Airway Management Seizures Shock 140

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 109

Dislocations Fractures Soft Tissue Injuries Outcomes 109

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

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 122

Fractures Ultrasounds Pediatrics Outcomes 122

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 140

Outcomes Research Documentation/Coding Wellness 140

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 120

EMS Outcomes Hospitals Research 120

RebelEM

MAY 29, 2023

Crit Care 2023. Limited, small studies on its use in septic shock do not make a clear argument for use. Paper: Ibarra-Estrada, M et al. Early Adjunctive Methylene Blue in Patients with Septic Shock: A Randomized Controlled Trial. NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 95% CI 15.4 95% CI 15.4 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

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 117

Emergency Department Research Outcomes 117

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 140

Administration Outcomes Resuscitation Radiology 140

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 135

Outcomes Research Hospitals Operations 135

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

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Outcomes Pediatrics 145

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

RebelEM

SEPTEMBER 14, 2023

to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% The benefits of this strategy may be outweighed by the risk of the device-related complications (i.e. bleeding, stroke, limb ischemia, and hemolysis). Zeymer HT et al.

Shock 134

Shock Outcomes Resuscitation Stroke 134

PulmCCM

JUNE 3, 2024

The ASTER Trial Ware et al conducted a phase 2b randomized trial from 2021 to 2023 among 447 patients admitted with sepsis and organ failure at 40 US academic hospitals. Patients received either 1 g of acetaminophen IV every six hours or placebo for five days.

Sepsis 52

Sepsis Outcomes Academics Hospitals 52

RebelEM

JANUARY 29, 2024

Clin Exp Emerg Med 2023. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE? Click here for Direct Download of the Podcast Paper: Aykan AC et al. Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7%

Stroke 134

Stroke Outcomes Hospitals Administration 134

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 98

Outcomes Wellness 98

RebelEM

OCTOBER 30, 2023

This could dilute any beneficial effects seen Lack of blinding may bias results (Although mortality is a solid objective primary outcome, bias may still creep in terms of management) Discussion: Authors were looking for an absolute mortality difference of 7% from baseline mortality of 26% with a 90% power. Paper: Davenport R et al.

Administration 126

Administration Blood Transfusions Outcomes Hospitals 126

The Trauma Pro

OCTOBER 6, 2023

Although many of these injuries were managed within hours, a growing number were delayed by a few days to improve outcomes. 2023 Jun 28;15(6):e41078. Ann Surg 278:e848-e854, 2023. We learned that temporizing with strict blood pressure control worked wonders at protecting the patient. doi: 10.7759/cureus.41078.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

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

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

Broome Docs

MARCH 28, 2024

doi: 10.1136/emermed-2023-213285. PMID: 38050078 Bottom line: High dose nitroglycerin seems to result in better outcomes in SCAPE, at least according to this small, single center, unblinded trial. 2023 Sep 21:ciad571. 2023 Sep 19:S0196-0644(23)00671-6. 2023 Dec;193:109991. 2023 Aug 21:S0012-3692(23)05350-3.

PPE 107

PPE Ultrasounds Resuscitation Administration 107

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 100

Outcomes 100

Pediatric EM Morsels

JULY 28, 2023

Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. Is your patient hyperglycemic, acidotic, with ketonuria? Then we’ve likely got DKA. Triple bag, triple bag, triple bag! The Pediatric Emergency Medicine Collaborative Research Commitee. 2002 Dec;141(6):793-7. PMID: 12461495.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

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 126

Ultrasounds Outcomes COPD Hospitals 126

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 Operations 114