RebelEM

SEPTEMBER 14, 2023

bleeding, stroke, limb ischemia, and hemolysis). 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% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% Zeymer HT et al. Control: 53.4% D ECLS: 18.2%

Shock 130

Shock Outcomes Resuscitation Stroke 130

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. What They Did: Retrospective review of consecutive RAO cases managed as part of a remote ophthalmology consult protocol activated on May 1, 2021, at three stroke centers across a health system.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

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 130

Stroke Outcomes Hospitals Administration 130

EMDocs

FEBRUARY 28, 2024

Code Stroke is called and he is seen by a neurologist within 10 minutes. He is admitted with a diagnosis of brainstem stroke and treated by the neurologist with ASA only. He undergoes a thrombectomy, but his outcome is poor. Plaintiff : The family’s concern is that a delay in appropriate treatment led to his poor outcome.

Documentation/Coding 92

Documentation/Coding Stroke Outcomes EMS 92

EMDocs

MAY 4, 2024

Epub 2023 Sep 17. 2: The Endovascular Therapy Train Continues Onward Spoon Feed This was an exploratory analysis of the recently published SELECT2 trial, which randomized 352 adults with acute ischemic stroke due to carotid or M1 MCA occlusion to endovascular thrombectomy (EVT) or medical management. . #2: Acad Emerg Med.

Documentation/Coding 90

Documentation/Coding Stroke Emergency Department Pediatrics 90

PulmCCM

SEPTEMBER 28, 2023

Systemic corticosteroids (such as intravenous dexamethasone) improve outcomes in severe pneumonia due to SARS-CoV-2 infection. It makes sense that inhaled steroids might improve outcomes from less severe infections. Do inhaled steroids improve Covid pneumonia? About two thirds of patients in each arm were vaccinated.

COPD 95

COPD Stroke Academics Urgent Care 95

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. What’s New in Stroke Care? 4 Repeated trials have not shown alteplase to have any signal of better outcomes, nor tenecteplase to have an association with increased adverse events.

Research 52

Research Airway Management Stroke Outcomes 52

EMDocs

SEPTEMBER 2, 2023

. #1: Dual Antiplatelets or Lytics for Minor Stroke? Spoon Feed In minor acute ischemic stroke (AIS) patients presenting within 4.5 hours of onset, dual antiplatelet therapy (DAPT) is non-inferior to intravenous alteplase for excellent neurologic outcome at 90 days. 2023 Jun 27;329(24):2135-2144. 2023 Aug 14;e232900.

Stroke 80

Stroke Pediatrics Outcomes 80

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 135

Administration Outcomes Resuscitation Radiology 135

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 70

Stroke Shock Pediatrics Resuscitation 70

EMDocs

OCTOBER 14, 2023

. #1: What’s the BEST Target SBP Post-Embolectomy for Stroke? Spoon Feed More aggressive systolic blood pressure (SBP) goals, beyond keeping it <180 mmHg, probably don’t make much of a difference in outcomes for patients who have undergone endovascular therapy for ischemic stroke. 2023 Sep 5;330(9):821-831.

Stroke 72

Stroke Administration Outcomes 72

RebelEM

SEPTEMBER 28, 2023

STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. Primary PCI: 95.7% Stents Placed: Pharmaco-Invasive Treatment: 97.4%

EKG/ECG 135

EKG/ECG Allergic Reactions Shock Stroke 135

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.

Blood Transfusions 104

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 104

Don't Forget the Bubbles

NOVEMBER 27, 2023

The amount of blood that comes from the heart with each contraction is the stroke volume (SV). The stroke volume is the difference between how full it is at the start and how full it is after a contraction. The next element of stroke volume is the emptying. Treasure Island (FL): StatPearls Publishing; January 30, 2023.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

EMDocs

AUGUST 13, 2024

HTN was the primary diagnosis in over 1 million ED visits in 2023, and rates of HTN emergencies have increased over the past 20 years. Background Hypertension (HTN) is significant issue globally and a leading risk factor for cardiovascular disease. From 2006-2013, HTN emergencies occurred in approximately 2 of every 1000 adult ED visits.

Stroke 95

Stroke Administration Outcomes Hospitals 95

The Skeptics' Guide to EM

JUNE 17, 2023

Date: June 15, 2023 Reference: Rees CA et al. Date: June 15, 2023 Reference: Rees CA et al. American Journal of Hematology Jan 2023 Guest Skeptic: Dr. Amy Drendel is a pediatric emergency medicine physician and physician scientist at Children’s Wisconsin.

Emergency Department 73

Emergency Department Pediatrics Head Injuries Administration 73

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. Heart disease and stroke statistics-2022 update: A report from the American Heart Association. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Sensible Medicine

JULY 6, 2023

In the CLEAR Outcomes trial, it was found effective in modestly reducing cholesterol and cardiovascular outcomes in statin-intolerant patients. The authors have now published a subanalysis of the main CLEAR Outcomes study. Bempedoic Acid is a cholesterol-lowering drug. JMM Sensible Medicine is a reader-supported publication.

Outcomes 94

Outcomes Stroke Wellness 94

RebelEM

MAY 18, 2023

These patients can have a vasodilated vascular bed and the initial use of fluids is hypothesized to serve two purposes: Augmenting the macrovascular system (stroke volume and cardiac output) and augmenting the microvascular perfusion (capillary blood flow). This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Liberal: 14.9%

Sepsis 95

Sepsis Shock Resuscitation Outcomes 95

The Skeptics' Guide to EM

APRIL 8, 2023

Date: April 4th, 2023 Reference: Vaughan and Browne. 2023 Apr Guest Skeptics: Dr. Louella Vaugh is an internist practising as a hospitalist physician at an academic centre in London, UK with a special interest in smaller, rural and remote healthcare. Date: April 4th, 2023 Reference: Vaughan and Browne. BMJ Qual Saf.

Stroke 56

Stroke Emergency Department COPD Academics 56

ALiEM

JANUARY 29, 2024

It requires immediate consultation with ophthalmology as well as neurology as it is considered a stroke equivalent. Case Question: What treatments can you perform in the ED for this diagnosis and do they improve outcomes? This has the potential to expedite consultations with specialty teams and treatment. PMID: 23023446.

Stroke 64

Stroke Ultrasounds Academics Outcomes 64

EMDocs

JANUARY 11, 2025

A 75-year-old woman who is bedridden after a stroke presents to the ED from a nursing facility with abdominal pain and constipation. May 18, 2023) Stercoral Colitis: A Diagnostic Challenge and Therapeutic Approach in an Elderly Patient With Chronic Constipation. 2023 Oct;48(10):3050-3062. Epub 2023 Jun 27. In StatPearls.

EMS 88

EMS Sepsis Shock Fluid Resuscitation 88

Taming the SRU

NOVEMBER 3, 2023

Broad strokes In this prospective, non-randomized study published by Kring et al in January 2022 out of Maine Medical Center, researchers compared mean pain scores at rest and during incentive spirometry before, at 15 minutes after, and then 60 minutes after treatment with a serratus anterior plane block. 11/3/2023 Ultrasound Med.

Fractures 98

Fractures Ultrasounds Outcomes Research 98

Emergency Medicine Journal

DECEMBER 30, 2024

Background Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response (‘pre-alerts’) have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke).

Emergency Department 52

Emergency Department Stroke Documentation/Coding Outcomes 52

ACEP Now

OCTOBER 3, 2023

In April 2023, the third edition of the Brain Trauma Foundation’s evidence-based guidelines for the prehospital management of traumatic brain injury (TBI) was published in Prehospital Emergency Care. 2,3 TBI outcomes are profoundly linked to the timing and quality of care provided before patients reach the hospital. Prehosp Emerg Care.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

PulmCCM

JANUARY 22, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Here is that last post: A 90-something with acute stroke. Outcome: All 4 serial hs troponin I, out to 6 hours, were undetectable. link] = My Comment by K EN G RAUER, MD ( 11/14 /2023 ): = One of the most helpful clinical clues in support that an acute cardiac event is ongoing — is the finding of " dynamic " ECG changes.

EKG/ECG 119

EKG/ECG EMS Stroke Outcomes 119

All Ohio EM

SEPTEMBER 16, 2019

By Mike Pallaci, DO Research Question: Does rapid lowering of blood pressure improve the outcome in patients with intracerebral hemorrhage? The primary outcome was determined for 2794 of these; 45 patients (1.6%) lost to follow-up. How Many Patients: The investigators enrolled 2839 patients.

Stroke 40

Stroke Outcomes Research Hospitals 40

Taming the SRU

JUNE 3, 2024

Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there.

Shock 91

Shock Seizures Airway Management Stroke 91

Taming the SRU

APRIL 22, 2023

If untreated, atrial fibrillation can increase clot formation and lead to an increased risk for heart attack and stroke as well as development of congestive heart failure. There were similar lengths of say overall and no significant difference in safety outcomes. There was no difference in safety outcomes.

Outcomes 52

Outcomes Stroke Fractures Documentation/Coding 52

PulmCCM

JANUARY 24, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 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

AED Leader

AUGUST 15, 2023

An umbrella review published in BMJ in 2023 revealed that dietary sugar consumption is associated with 10 cardiovascular outcomes, a greater risk of coronary artery disease, and an increased risk of all-cause mortality. Clogged blood vessels leading to the brain can lead to a stroke or vascular dementia.

Stroke 52

Stroke Outcomes Wellness 52

Mind The Bleep

OCTOBER 25, 2024

Adults: While strabismus is more common in children, it can also occur in adults due to trauma, stroke , or neurological conditions. For medical professionals, a multidisciplinary approach involving ophthalmologists, neurologists, and paediatricians may be necessary to ensure optimal outcomes. Updated 2023 Nov 13]. Pediatrics.

Stroke 52

Stroke Pediatrics Outcomes Wellness 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. While both conditions rely on supportive care as the mainstay of treatment, plastic surgery literature suggests better outcomes with microscopic fat embolism. As a result, our current data on AFT complications likely underestimates the actual incidence.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

ACEP Now

APRIL 5, 2024

1 However, many clinical features are common: more than 60 percent of patients present with a degree of neurological involvement, ranging from confusion to stroke and coma. Thus, early management is essential for patient outcomes. Updated April 7, 2023. 4 Early hematology consultation should be obtained when TTP is suspected.

Domestic Violence 40

Domestic Violence Emergency Department Outcomes EKG/ECG 40

Don't Forget the Bubbles

FEBRUARY 5, 2025

There is significant evidence in adults and developing in the paediatric population that TXA results in better outcomes if given early in patients with mild to moderate traumatic brain injury (TBI) and does not cause harm. Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59