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 135

Outcomes Research Documentation/Coding Wellness 135

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.

Military 139

Military Outcomes Psychiatric Wellness 139

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. 4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. Severe acute traumatic coagulopathy = PT >1.5

Administration 135

Administration Outcomes Resuscitation Radiology 135

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 104

Outcomes Wellness 104

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

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 Administration Outcomes 113

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 130

Shock Outcomes Resuscitation Stroke 130

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 123

Administration Blood Transfusions Outcomes Hospitals 123

Broome Docs

APRIL 6, 2023

2023 Jan 21. 2023 Feb;64:206.e1-206.e3. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. 2023 Jan 30. 2023 Jan 13;76(2):185-191. 2023 Feb;30(2):144-146. N Engl J Med. doi: 10.1056/NEJMoa2212663.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

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 129

Ultrasounds Radiology Radiology Operations 129

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 100

CDC Hospitals EMS Emergency Department 100

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

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

Ken Grauer, MD

FEBRUARY 28, 2023

As a result — IF the 1 lead you are monitoring happens to be one in which P waves are not well seen — then you might assume the irregular rhythm in front of you was AFib. A DDENDUM ( 3/1/2023 ) — Additional material relevant to today's case: How Covid-positivity in today's case may affect the heart. Additional material on MAT.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

RebelEM

JULY 27, 2023

In this group of patients, the use of alteplase poses a fine line of potential benefit (functional outcomes) vs potential harm (symptomatic intracranial hemorrhage). DAPT statistically noninferior to alteplase The finding was consistent in the per-protocol and as-treated groups as well Symptomatic ICH at 90d DAPT: 0.3% Alteplase: 91.4%

Stroke 97

Stroke Outcomes EMS Hospitals 97

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 128

EKG/ECG EMS Outcomes Wellness 128

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 88

Hospitals Resuscitation Outcomes CPR 88

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

The Trauma Pro

NOVEMBER 21, 2023

Among 30 studies that had a statistically significant binary outcome, the mean fragility index was 2. In half of these studies, having a different outcome in as few as two patients could swing the final results and conclusion of the study. Basically, a lot of well-intentioned but poorly designed research gets published.

Research 113

Research Outcomes Wellness 113

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

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.

Blood Transfusions 104

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 104

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

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 122

Ultrasounds Outcomes COPD Hospitals 122

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. The pathologic vasodilation observed in sepsis is thought to result from failure of the vascular smooth muscle to constrict appropriately, leading to hypotension as well as tissue hypoperfusion (2). Ospina-Tascón GA, Teboul J-L, Hernandez G, et al.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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. 1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Patients whose last known well (LKW) time was within 24 hours of presentation. Ophthalmology.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

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]. The Study In an Annals of Emergency Medicine paper , Preiksaitis et al.

EMS 52

EMS Burns Emergency Department Shock 52

Don't Forget the Bubbles

JUNE 30, 2023

Extracorporeal life support rewarming rate is associated with survival with good neurological outcome in accidental hypothermia. The THAPCA-OH trial found that hypothermia did not result in a statistically significant benefit for survival with good functional outcomes at one year compared to normothermia. Saczkowski, R.,

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

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 117

EMS CPR EKG/ECG Wellness 117

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

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 94

Head Injuries Airway Management Outcomes Burns 94

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

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

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

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 80

Research Outcomes Wellness 80

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 95

Sepsis Shock Resuscitation Outcomes 95

PulmCCM

JUNE 26, 2023

They announced this at the American Thoracic Society meeting in May 2023. No outcomes regarding the delirium itself were reported (i.e., Private equity-backed firms are buying and expanding physician practices and squeezing them for profit, with little regard for patient outcomes, professional standards, or ethics.

Outcomes 98

Outcomes Ultrasounds Hospitals Wellness 98

RebelEM

NOVEMBER 25, 2024

A medical librarian with expertise in systematic reviews, searched Cochrane, Embase, Medline, Scopus, and Web of Science for relevant randomized controlled trials and comparative observational studies from inception to June 2023. Studies that report the outcome of first-attempt intubation success for both bougie and non-bougie groups.

Outcomes 93

Outcomes Emergency Department Operations Hospitals 93