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. His Glasgow Coma Scale (GCS) score is 13 with obvious head trauma as well. Prehospital Tranexamic Acid for Severe Trauma.

EMS 125

EMS Outcomes Hospitals Research 125

Pediatric EM Morsels

SEPTEMBER 22, 2023

” Children compensate for blood and volume loss very well… until they don’t. 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. 5 th Edition. 2018.14.2.47.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

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

Sensible Medicine

MAY 28, 2024

The adoption of depression screening is, of course, well-intentioned. In June 2023 , the same was recommended to adults. A 2008 Cochrane review found adult depression screening does not improve outcomes. Screening had no impact on depression, anxiety, or a host of other mental health outcomes.

Outcomes 141

Outcomes Military Psychiatric Wellness 141

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 144

Outcomes Research Documentation/Coding Wellness 144

The Trauma Pro

SEPTEMBER 20, 2023

The primary outcome was mortality, and secondary outcomes included the need for surgery, fluid and blood infusions, and the use of a massive transfusion protocol. These low numbers and the nature of this particular registry could inject significant bias as well. AAST 2023 Plenary paper #29.

Military 113

Military Blood Transfusions Outcomes Administration 113

The Trauma Pro

OCTOBER 6, 2023

At the time, there was a debate about whether the procedure should be done immediately versus waiting until the patient was well-resuscitated. 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.

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

RebelEM

AUGUST 21, 2023

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Epub 2023 Jun 15. Paper: Eastwood G, et al. N Engl J Med.

Hospitals 97

Hospitals Resuscitation Outcomes CPR 97

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Hope you’re doing well! Smith : "What was the outcome?" You taught us well!" Acute MI per se usually does not depress cardiac function and blood pressure enough to cause syncope ( Mostafa et al — J Com Hosp Intern Med Perspect 13(4):9-12, 2023 - ). A former resident texted me this case: "Hey Dr. Smith.

EMS 107

EMS CPR EKG/ECG Wellness 107

ACEP Now

AUGUST 1, 2023

A rural ED staffed by a well-trained EP is an essential resource in small communities that may be otherwise lacking in readily available healthcare resources. As your council officer, I commit to ensuring your voice contributes to the best outcome for our College, our members, EM residents, and our patients.

Emergency Department 98

Emergency Department EMS Critical Access Hospitals 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 120

Administration Blood Transfusions Outcomes Hospitals 120

The Skeptics' Guide to EM

JULY 8, 2023

Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023. Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023. She looks well enough to go home but asks if she should be prescribed oseltamivir (Tamiflu) because some of her friends have been given it recently by their doctors.

CDC 97

CDC Hospitals EMS Emergency Department 97

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 133

Shock Outcomes Resuscitation Stroke 133

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

The Skeptics' Guide to EM

DECEMBER 9, 2023

Date: November 20, 2023 Reference: Jones et al. PAIN October 2023 Guest Skeptic: Dr. Caitlin Jones is a Postdoctoral Research Associate at Sydney University’s institute for Musculoskeletal Health. Date: November 20, 2023 Reference: Jones et al. Time to reflect on open-label placebos and their value for clinical practice.

Research 78

Research Outcomes Wellness 78

RebelEM

AUGUST 24, 2023

Historical practice recommends rest to prevent adverse outcomes; however, evidence suggests strict rest is harmful. 2023 May 1;151(5):e2022059592. Symptom reporting was the most common outcome in the included studies. The “usual care intervention” was not well-defined. Pediatrics. PMID: 37073681.

Pediatrics 93

Pediatrics Outcomes Hospitals Research 93

Medagadget

OCTOBER 19, 2023

The ball, which the researchers call the Physical Artefact for Well-being Support (PAWS), is designed to be held in the hands, and sensors placed on the body monitor the user’s breathing, which the ball then reflects with its movements. See a video about the technology below.

Research 80

Research Outcomes Wellness 80

Don't Forget the Bubbles

AUGUST 7, 2023

2023 Mar;59(3):480-486 Who were the patients? The study also did not assess outcomes for each patient, and as such, the impact on deviation from the normal range was not explored. Yes Was the outcome accurately measured to minimize bias? cited 2023 Mar 19]. cited 2023 Mar 28]. cited 2023 Mar 28].

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 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% Demographics were well balanced in the two groups.

Outcomes 102

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 102

Don't Forget the Bubbles

DECEMBER 6, 2023

Recognizing that friendships play a vital role in the social lives of teenagers, this study found that friendship quality was significantly associated with mood, psychological well-being, and subjective well-being in adolescents. 2023 Nov 15. 2023 Nov 1;152(5):e2023062911. 2023 Nov 1;152(5):e2023063753. Pediatrics.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Research Hospitals 52

The Skeptics' Guide to EM

APRIL 22, 2023

Date: April 20, 2023 Reference: Franklin D, et al. JAMA 2023 Guest Skeptic: Dr. Michael Falk is a Pediatric Emergency Medicine attending at Mount Sinai Medical Center […] The post SGEM #401: Hey Ho! Date: April 20, 2023 Reference: Franklin D, et al. He is drinking well, and parents report normal urine output.

Hospitals 52

Hospitals Pediatrics Emergency Department Outcomes 52

RebelEM

AUGUST 7, 2023

This helps relieve agitation/pain while maintaining spontaneous breathing and airway reflexes allowing for adequate pre-oxygenation as well as facilitates other resuscitation interventions including IV access, vasopressors, fluids, etc. Anesth Analg 2023. that would not be possible in an agitated/combative patient.

Head Injuries 98

Head Injuries Outcomes Airway Management Burns 98

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

American Medical Compliance

JUNE 19, 2023

By providing extended Medicaid coverage, states are taking a proactive approach to safeguarding the well-being of mothers during this vulnerable period. The extended coverage empowers new mothers to seek the care they require, thereby reducing potential health risks and improving overall outcomes. Visit [link] for more information.

Wellness 52

Wellness Outcomes 52

American Medical Compliance

JULY 3, 2023

Ensuring safe working conditions for healthcare workers is paramount not only for their own health and well-being but also for the quality of patient care. An increase in provider well-being correlates to improved patient care. Reference News Medical (24 March 2023). Visit [link] for more information.

Patient Safety 52

Patient Safety Wellness Outcomes 52

EMDocs

AUGUST 22, 2024

Well-meaning providers who are not highly fluent may contribute to miscommunication and diagnostic errors. Certified interpreter use can improve communication and patient outcomes. Providers should respect and utilize this mode of communication, as well as document the patient’s request for a non-certified interpreter.

Documentation/Coding 82

Documentation/Coding Emergency Department Best Practices Federal Emergency Management Agency 82

The Skeptics' Guide to EM

APRIL 29, 2023

Date: April 26, 2023 Reference: Han et al. AEM April 2023 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. Date: April 26, 2023 Reference: Han et al. AEM April 2023 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia.

Psychiatric 40

Psychiatric Emergency Department Urgent Care Academics 40

RebelEM

APRIL 17, 2023

However, It is unclear how well POCUS performs in ruling in or ruling out the diagnosis of PTA. 2023 Jan 10. Question: How well does the US perform in diagnosing PTA compared to CT, needle aspiration, or Incision and Drainage? 2023 Feb 9;15(2):e34820. Article: Kim DJ et al. Acad Emerg Med. Epub ahead of print.

Ultrasounds 123

Ultrasounds Radiology Radiology Operations 123

Don't Forget the Bubbles

MAY 31, 2023

2023 May 17:archdischild-2022-325280. The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. What outcomes did they look at?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

ALiEM

NOVEMBER 6, 2023

WPW Syndrome consists of characteristic EKG findings as well as symptomatic arrhythmias. Outcome and use of antiarrhythmic drugs during follow-up. WPW is a pre-excitation syndrome characterized by an accessory pathway caused by a congenital failure of cells to resorb near the AV valves. Crit Care Nurse. 1994 Jun;14(3):30-9; quiz 40-1.

EKG/ECG 78

EKG/ECG Academics Outcomes Wellness 78

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Queen of hearts interpretations: Patient 1, ECG1: Patient 2, ECG1: Patient 1 Clinical Course and Outcome: The EM physician did not see that the S wave voltage has been truncated and squared off at 10 mm, thereby greatly limiting the assessment of proportionality. But he did well.

EKG/ECG 119

EKG/ECG EMS Outcomes Wellness 119

RebelEM

MAY 18, 2023

The secondary outcome of mortality was not statistically different however numerically favored the early use of norepinephrine. This could have influenced care the patients received as well as reporting of adverse events (i.e. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4

Sepsis 100

Sepsis Shock Resuscitation Outcomes 100

RebelEM

AUGUST 31, 2023

CVC placement under ultrasound guidance has decreased overall complication rates and there is increased awareness of transfusion reactions, alloimmunization, acute lung injury, circulatory overload, as well as infection. Primary Outcome – Bleeding (Grade 2 to 4) Transfusion 4.8% Paper: van Baarle FLF et al. N Engl J Med.

Ultrasounds 55

Ultrasounds Outcomes Wellness Research 55

ACEP Now

OCTOBER 9, 2023

percent) do not speak English as a primary language, and 25 million of those speak English less than well (known as “limited English proficiency” or LEP); many indicators show this number will only continue to grow. Accessed August 11, 2023. Last reviewed February 3, 2023. Accessed August 11, 2023. Census Bureau, 60.6

Emergency Department 64

Emergency Department Documentation/Coding EMS Wellness 64

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. However, it is still used in certain cases.

Outcomes 52

Outcomes Documentation/Coding Stroke Fractures 52

PulmCCM

APRIL 18, 2024

That uncertainty has been largely dispelled by large randomized trials in 2023 and 2024 confirming that video laryngoscopy is a superior method for obtaining first pass intubation success for patients with average risk airways. The real world success rates by operators experienced with intubation remained unknown.

Airway Management 98

Airway Management Operations EMS Research 98