Don't Forget the Bubbles

DECEMBER 25, 2023

Interpreting Research Outcomes with a Little Bathroom Humour You have learned a method for how to read a research paper , and now you are faced with a bunch of outcomes. There are primary, secondary, composite , and safety outcomes. What are these outcomes? We know there is a bias towards reporting positive outcomes.

Research 83

Research Outcomes Fractures Pediatrics 83

Don't Forget the Bubbles

NOVEMBER 29, 2023

Ben has a possible skull fracture and has been intubated, but his oxygen requirement is minimal. In studies including patients with trauma or Glasgow Coma Scale less than 8, intubation without sedation led to poorer neurological outcomes. A 12-year-old male is being transported by ambulance after a road traffic accident.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

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

Taming the SRU

FEBRUARY 24, 2024

non-invasive positive pressure ventilation and IV nitroglycerin infusion have been shown to reduce morbidity (intubation rates, ICU admission) & mortality. non-invasive positive pressure ventilation and IV nitroglycerin infusion have been shown to reduce morbidity (intubation rates, ICU admission) & mortality.

Leadership 94

Leadership EMS Pediatrics Stroke 94

Don't Forget the Bubbles

OCTOBER 2, 2024

He is diagnosed with a traumatic brain injury and a fracture to his right tibia and fibula. Moderate-quality evidence is available for bolus administration of hypertonic saline, while only low-quality evidence supports continuous administration. The study additionally only measures ICP one hour after bolus administration.

Administration 49

Administration Pediatrics Outcomes Research 49

Don't Forget the Bubbles

MAY 17, 2023

Early Antibiotic Use and Neonatal Outcomes Among Preterm Infants Without Infections. Video laryngoscopy-assisted less-invasive surfactant administration quality improvement initiative. Distribution and pattern of hand fractures in children and adolescents. Yu W, et al. Pediatrics. 2023 Apr 12:e2022059427. Strane D, et al.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Taming the SRU

DECEMBER 6, 2023

ems grand rounds: southwest ohio protocol updates WITH dr. weekley Ideally, medications will be administered IV or IO, therefore endotracheal tube drug administration will be de-emphasized. Occult fractures exist, therefore a high index of suspicion for these injuries is necessary, even in the setting of initially negative plain films.

Leadership 57

Leadership Stroke Airway Management Administration 57

PHEM Cast

APRIL 18, 2016

Following the lecture I found this on Minh’s PHARM website: a review of prehospital ketamine administrations. Spinal fractures occur in 2% of all major trauma. Unstable spinal fractures occur in all major trauma 0.7%. Remember this when you get on scene – 98% of patients will not have a spinal injury.

Fractures 40

Fractures Operations Administration Shock 40

Broome Docs

APRIL 6, 2023

Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Am J Emerg Med. 2023 Feb;64:206.e1-206.e3.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

PulmCCM

FEBRUARY 12, 2024

In mechanically ventilated patients with septic shock, randomized trials have not shown improved survival with steroid administration , even among those who were “cosyntropin responders” (although hemodynamics were improved with steroids ). The new evidence prompted all three societies to issue new guideline updates.

Shock 52

Shock Administration Sepsis Fractures 52

Don't Forget the Bubbles

SEPTEMBER 5, 2024

Children with complex medical conditions are at higher risk of morbidity and mortality, and this may be compounded by inaccurate weight estimation and leading to inaccurate medication dose administration. Obesity is considered a contributing factor for some musculoskeletal outcomes. PMID: 38471744 What’s it about?

Ultrasounds 52

Ultrasounds Research Emergency Department Outcomes 52

EMDocs

NOVEMBER 16, 2024

6 Periprosthetic fracture Occurs at an estimated rate of 3.5-4.1%. 5 CT if concern for occult fracture. Periprosthetic Fractures Pain prior to injury may point toward underlying pathology like infection, implant loosening, etc. Unified classification system used to describe periprosthetic hip fractures. 10% of patients.

EMS 94

EMS Dislocations Fractures Operations 94

Don't Forget the Bubbles

DECEMBER 2, 2024

The majority of them focused on the care process (86.8%), while a smaller percentage focused on care outcomes (9.3%) and structural aspects (3.9%). Most QIs focus on the care process; however, there is a lack of QIs that assess clinical outcomes. Expert panel studies and observational studies proposed 129 QIs. Why does it matter?

Documentation/Coding 98

Documentation/Coding Pediatrics Emergency Department Fractures 98

EMDocs

JUNE 3, 2023

How should pelvic fractures be identified in unstable trauma patients? Pelvic fractures can involve disruptions in any of the bony or ligamentous structures of the pelvic ring. Due to the round shape of the pelvic ring, multiple fractures typically occur concurrently. 2 Vertical shear fractures are also unstable.

Fractures 60

Fractures Resuscitation Operations EMS 60

RebelEM

MAY 22, 2023

In 2010, the United States Food and Drug Administration (FDA) granted approval for intravenous (IV) acetaminophen as a pain management option. Undoubtedly, some patients cannot tolerate oral medications and may benefit from parenteral administration. saline Comparator: Hydromorphone 0.5mg administered IV in a 100 mL bag of 0.9%

Emergency Department 82

Emergency Department Administration Dislocations Hospitals 82

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

EMDocs

NOVEMBER 4, 2024

Costochondritis, rib fractures, and pericarditis are common causes of chest pain that can be treated with multimodal regimens. 7 Rib and Sternal Fractures: Rib fractures are often caused by blunt chest trauma. Up to two-thirds of rib fractures are missed on initial chest radiographs. Most cases abate by one year.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. demonstrating that functional outcome at 3 months did not differ between the CTA and MRI groups (38.5% vs. 38.1%) with a good functional outcome.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

Taming the SRU

AUGUST 25, 2023

doxycycline Consider a splint/cast window to allow direct monitoring mainly used for fracture blisters and/or open wounds yet takes away from the strength of the splint/cast Case #3 43yo with FOOSH injury and closed wrist deformity, yet no x-ray machine is available to you Least likely injuries to need an x-ray in a resource-limiting setting?

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

Don't Forget the Bubbles

OCTOBER 4, 2023

In this issue of the Archives , we read a large retrospective study about gastric acid suppression in infancy and the increased risk of fractures. The intriguing finding of this study was the fact that non-fracture injuries increased, which could suggest that another factor (the temperament of the child rather than gastrin or VitB metabolism?)

Pediatrics 111

Pediatrics Fractures Outcomes Research 111

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64