EMDocs

OCTOBER 21, 2023

We’ll keep it short, while you keep that EM brain sharp. The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Basilar artery occlusion remains a challenging diagnosis to make, and the delays in reaching the diagnosis can have considerable impact on health outcomes.

EMS 93

EMS Stroke Outcomes Hospitals 93

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Time to antibiotic therapy (from triage, not from onset of infection) has become a quality metric to improve the time to administration of these medications. Paper: Varney J et al. Health Sci Rep 2022. to 0.97; p = 0.02

Sepsis 130

Sepsis Hospitals Administration Outcomes 130

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. August 20, 2024 Guest Skeptic: Dr. Chris Root is an emergency medicine and emergency medicine service (EMS) physician at the University of New Mexico, Albuquerque. Chris completed his emergency medicine residency and EMS fellowship at UNM.

Hospitals 103

Hospitals CPR EMS Outcomes 103

RebelEM

OCTOBER 30, 2023

The optimal approach to fibrinogen administration in massive hemorrhage protocols is unknown. Most major hemorrhage protocols give a balanced transfusion of PRBCs, FFP, and platelets in ratios approaching concentrations found in whole blood. Fibrinogen products may also be needed to stabilize clots and stem bleeding. Paper: Davenport R et al.

Administration 125

Administration Blood Transfusions Outcomes Hospitals 125

Pediatric EM Morsels

MAY 24, 2024

Evaluation of unintentional injury and trauma is one of the hallmarks of the EM and PEM physician. Low Risk Inta-Adbominal Trauma: Just Light ‘Em Up? The post Low Risk Intra-Abdominal Trauma: Rebaked Morsel appeared first on Pediatric EM Morsels. J Am Coll Surg. 2017;224:449-460. doi:10.1016/j.jamcollsurg.2016.12.041.

Pediatrics 164

Pediatrics Blood Transfusions EMS Fractures 164

Pediatric EM Morsels

JULY 28, 2023

Risk Factors that seem to stay consistent: Administration of Bicarb for correction of acidosis has been shown to be associated with cerebral edema and DOES persist after correcting for severity of DKA! Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. Then we’ve likely got DKA.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

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 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

RebelEM

NOVEMBER 30, 2023

For those with sepsis, the administration of intravenous fluids (IVF) at the volumes recommended in the Surviving Sepsis Campaign (SSC) requires careful consideration of an individual’s chronic medical conditions and subsequent sensitivity to IVF. Studies without a clear timeframe for fluid administration. 2.89, p = 0.01.

Sepsis 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

RebelEM

SEPTEMBER 29, 2022

Outcomes: Primary: Progression to moderately severe or severe acute pancreatitis (according to the Revised Atlanta Classification). Secondary outcomes were pre-specified which helps in terms of minimizing bias (i.e. non-statistically significant difference in the primary outcome. to 9.8L) Moderate: 5.5L (Range 4.0

Administration 52

Administration Fluid Resuscitation Resuscitation Outcomes 52

RebelEM

MAY 29, 2023

Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e. 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

EMDocs

DECEMBER 6, 2024

In 1997, the Food and Drug Administration (FDA) mandated unit-dose packaging for all iron-containing products with more than 30 milligrams of elemental iron. 7 Workup other than serum iron concentration at 4 hours after ingestion not shown to accurately predict clinical outcomes or severity of toxicity. Antiemetics as needed.

Poisoning 94

Poisoning Fluid Resuscitation Seizures Resuscitation 94

RebelEM

JULY 3, 2023

Pregnant or incarcerated patients Documentation for systolic BP is incomplete Intervention: Administration of IV calcium within 60 min prior to or 30 min after IV diltiazem administration in patients with AF/AFL with RVR. Limitations: The primary and secondary outcomes were nearly all disease oriented and not patient oriented.

Administration 91

Administration Outcomes Documentation/Coding Emergency Department 91

The Skeptics' Guide to EM

OCTOBER 19, 2024

Annals of EM 2024. Ketamine’s administration is flexible, with several routes available including IV, intranasal (IN), and more recently, nebulized forms. Annals of EM 2024. mg/kg plus nebulized saline Outcome: Primary Outcome: Reduction in pain scores on. Intervention: Nebulized ketamine at 0.75

Emergency Department 94

Emergency Department EMS Research Administration 94

RebelEM

MAY 25, 2023

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

AUGUST 14, 2023

4 XBJ received approval from the China Food and Drug Administration in 2004, 2 although the FDA of the United States has not approved it. Secondary Outcome Results: ICU mortality: placebo 20.0% The primary outcome was patient oriented. Many of the secondary outcomes were changed well after most of the data was acquired.

Sepsis 97

Sepsis Outcomes Administration EMS 97

RebelEM

JUNE 8, 2023

Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose. In other words these were pre-made syringes and not mixed at the bedside.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Critical Care Now

AUGUST 18, 2024

The primary outcome showed a 28-day mortality of 6.2% Secondary outcomes included reduced mortality at 90 days, lower rates of intubation and vasopressor use, and fewer serious adverse events in the hydrocortisone group. Check out the full post on REBEL EM: [link] in the hydrocortisone group compared to 11.9%

Outcomes 93

Outcomes Sepsis Administration EMS 93

Taming the SRU

MAY 11, 2024

r1 clinical knowledge - r4 capstone - research grand rounds - the art of em - Community corner - PEM Lecture r1 Clinical knowledge: transplant complications WITH dr. gabor Time-sensitive peri-transplant emergencies: Bleeding fistula- stop the bleed. Flood syndrome- start fluids, give antibiotics, consult surgery. Is it effective?

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

RebelEM

AUGUST 22, 2024

Administration of intravenous tissue plasminogen activator (IV tPA) within 4.5 hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Administration of intravenous tissue plasminogen activator (IV tPA) within 4.5 1 week after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

RebelEM

JANUARY 29, 2024

PMID: 37188358 Clinical Question: What is the efficacy and safety of low-dose (25mg) prolonged administration (over 6hrs) of alteplase in patients with massive PE? Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. Clin Exp Emerg Med 2023. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47

Stroke 133

Stroke Outcomes Hospitals Administration 133

Pediatric EM Morsels

JUNE 9, 2023

Castillo, 2019 ] Somatostatin (or its analogues, like Octreotide) Guidelines do recommend this… There is great variability in its administration, though. Long-term Outcomes and Health Perceptions in Pediatric-onset Portal Hypertension Complicated by Varices. Call them early! Semin Liver Dis. 2023 Feb;43(1):100-116. Hepatology.

Pediatrics 154

Pediatrics Head Injuries Airway Management Administration 154

ACEP Now

NOVEMBER 8, 2024

Emergency medical services (EMS) scope of practice is governed by the state, but national scope of practice guidelines are available for the four different EMS provider levels. Conclusion EGAs offer multiple benefits in managing patient airways and have found generally wide acceptance in the protocols of numerous EMS provider levels.

Airway Management 40

Airway Management EMS Hospitals Administration 40

RebelEM

JULY 17, 2023

Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. RSI inherently carries with it risks of complications such as post-intubation hypotension and cardiac arrest in the most extreme cases.

Outcomes 93

Outcomes Emergency Department Administration Resuscitation 93

EMDocs

MARCH 19, 2024

Data on antiplatelet versus anticoagulation suggest similar outcomes. If it’s ischemic, maintain BP < 185/110 mm Hg prior to administration of thrombolytics followed by < 180/105 mm Hg. They will need to continue this for 3-6 months and follow up with neurosurgery or vascular surgery, depending on the institution.

Stroke 105

Stroke EMS Administration Ultrasounds 105

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch.

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation CPR EMS 104

Ziqitza HealthCare Ltd

FEBRUARY 7, 2024

In the ever-changing landscape of emergency medical services (EMS), innovation is the key to saving lives and improving patient outcomes. The post Ziqitza – Emergency Medical Services (EMS) Innovations appeared first on Ziqitza HealthCare Ltd | Emergency Medical/Ambulance Service Provider.

Telemedicine 52

Telemedicine EMS Ambulance Services Hospitals 52

RebelEM

SEPTEMBER 7, 2023

ClinicalTrials.gov: NCT02631759 Clinical Question : In adult patients aged 18 years or older presenting within 24 hours of a spontaneous ICH, does the administration of levetiracetam, compared to placebo, reduce the occurrence of clinical seizures? The primary outcome was patient-oriented. Lancet Neurology 2022; 21:781-91.

Seizures 123

Seizures Stroke Outcomes Research 123

The Skeptics' Guide to EM

OCTOBER 17, 2020

Salim is probably better known as the creator and founder of the wonderful knowledge translation project called REBEL EM. It is a free, critical appraisal blog and podcast […] The post SGEM#305: Somebody Get Me A Doctor – But Do I Need TXA by EMS for a TBI? first appeared on The Skeptics Guide to Emergency Medicine.

EMS 52

EMS Head Injuries Outcomes Hospitals 52

Taming the SRU

FEBRUARY 24, 2024

ENRICH Trial - the leadership journey - EMS grand rounds - r4 capstone - r1 clinical knowledge - pediatric lecture ENRICH Trial WITH visiting professor Dr. david wright ICH makes up only 10-15% of all strokes yet has a higher mortality than ischemic strokes and SAH Current 2022 AHA/ASA guidelines for spontaneous ICH (prior to ENRICH Trial) minimally-invasive (..)

Leadership 94

Leadership EMS Pediatrics Stroke 94

ACEP Now

OCTOBER 3, 2023

These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations. This document is an update of guidelines first published in 2000, and then updated in 2007.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation Pediatrics 98

RebelEM

APRIL 29, 2024

In cardiac arrest, a delay in IV access subsequently results in a delay in epinephrine administration. Intravenous vs intraosseous adrenaline administration in cardiac arrest: A protocol for systematic review and meta-analysis. Resuscitation. 2012 PMID: 21893125. 9 Zhang W et al. Medicine (Baltimore). PMID: 33350794 10 Meilandt C.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% Welcome back to the “52 in 52” series. This collection of posts features recently published must-know articles.

Sepsis 86

Sepsis Shock Resuscitation Fluid Resuscitation 86

RebelEM

OCTOBER 2, 2023

No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 tests/hr (0.8 Traditional: 1.0 tests/hr (0.8 Pre-Intervention: 1.0 tests/hr (0.9

Operations 97

Operations Academics Fluid Resuscitation Outcomes 97

RebelEM

AUGUST 7, 2023

Traditional RSI entails preoxygenation followed by near-simultaneous administration of an induction agent followed by a neuromuscular blocker. Rapid sequence intubation can be modified for patients who are agitated or combative and not tolerating standard preoxygenation. Re-oxygenation with BMV can increase airway-related adverse events (i.e.

Head Injuries 96

Head Injuries Airway Management Outcomes Burns 96

The Skeptics' Guide to EM

JANUARY 25, 2020

Case: A 60-year-old male is […] The post SGEM#281: EM Docs Got an AmbuBag – The PreVent Trial first appeared on The Skeptics Guide to Emergency Medicine. Intervention: Bag-mask ventilation (BMV) during the time between administration of sedation/paralysis and insertion of the laryngoscope into the mouth for intubation.

EMS 40

EMS Airway Management Administration Resuscitation 40

RebelEM

SEPTEMBER 28, 2023

appeared first on REBEL EM - Emergency Medicine Blog. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. 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% Primary PCI: 95.7%

EKG/ECG 137

EKG/ECG Allergic Reactions Shock Stroke 137

JournalFeed

SEPTEMBER 7, 2024

Friday Spoon Feed : In non-traumatic out of hospital cardiac arrest (OHCA), administration of an initial dose of IM epinephrine by EMS prior to an established IV or IO was associated with improved survival outcomes.

Administration 52

Administration EMS Outcomes Hospitals 52