The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. Background: We’ve discussed out-of-hospital cardiac arrest (OHCA) at least once or twice on the SGEM (see long list at end of blog). Clinical Question: Is naloxone administration in undifferentiated OHCA associated with survival to hospital discharge?

Hospitals 104

Hospitals CPR EMS Outcomes 104

PulmCCM

APRIL 14, 2025

Dr. Rivers and his center, Henry Ford Hospital, had financial relationships with Edwards Lifesciences, makers of the invasive catheter used in Rivers’s trial to measure continuous central venous oxygenation saturation. To avoid financial penalties, hospitals have had to report their compliance with the bundle elements of I.V.

Sepsis 52

Sepsis Infectious Diseases Administration Shock 52

Broome Docs

NOVEMBER 17, 2024

Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Palatinus HN, Johnson MA, Wang HE, Hoareau GL, Youngquist ST. Resuscitation.

Resuscitation 61

Resuscitation Administration Radiology Radiology 61

Emergency Medicine Journal

MARCH 25, 2025

This month’s update is by the Emergency Department Team, Wexham Park Hospital, Slough, Frimley Health NHS Foundation Trust. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. The 1-BED.

Sepsis 52

Sepsis Emergency Department Administration Outcomes 52

Pediatric EM Morsels

JULY 19, 2024

If bleeding has completely stopped, most of these children still come into the hospital for observation so access will likely be necessary and helpful should patient have rebleed event. Even those that are no longer bleeding on arrival, will often require observation in the hospital. Is there active bleeding, clot, or no bleeding ?

Airway Management 290

Airway Management Pediatrics Wellness Operations 290

American Medical Compliance

JULY 31, 2023

Nurses play an important and unique role in medicine administration. Additionally, instruction on the “five rights” or “five R’s” of drug administration—a guide to clinical medication administration and maintaining patient safety—is a requirement during nursing education.

Administration 52

Administration Patient Safety Wellness Hospitals 52

ALiEM

JUNE 24, 2024

Known Techniques of Adenosine Administration Currently, there are 2-syringe and 1-syringe methods that are widely accepted for the administration of adenosine. The unique aspect of the trick is to incorporate a high-pressure, unidirectional IV fluid administration system. With an ultrafast half-life estimated to be between 0.6

Administration 114

Administration Hospitals 114

ACEP Now

MARCH 11, 2025

2-4 A study in Annals of Emergency Medicine of almost 300,000 patients hospitalized with acute PE between 2011-2020 found that the use of UFH increased from 41.9 no increase in vasopressor use, mechanical ventilation, admission to an intensive care unit, in-hospital mortality). percent to 56.3 percent despite guideline recommendations.

Hospitals 52

Hospitals Administration Outcomes Stroke 52

ACEP Now

JANUARY 11, 2024

The wave of increasing hospital closures and service line cutbacks continues to sweep the United States. hospitals that are closing clinical departments or ending or reducing services. 2 Of these 56 additional hospitals, many are not rural; thus, this specter is expanding. 56 hospitals closing departments or ending services.

Hospitals 52

Hospitals Administration Documentation/Coding Research 52

American Medical Compliance

AUGUST 10, 2023

A California-based healthcare provider was the target of a cyberattack that led to hospital closures and redirected ambulance services in various states. Additionally, hospitals in Rhode Island faced severe negative effects due to this breach. Cyberattacks cause multiple hospitals to shut emergency rooms and divert ambulances.

Hospitals 52

Hospitals Ambulance Services Operations Administration 52

Don't Forget the Bubbles

JANUARY 31, 2024

As a Trauma Unit within the Thames Valley Trauma Network, Wexham Park Hospital hosts trainees from across the spectrum of acute specialties. Two really important patient groups were excluded – those who were admitted to hospital and families who were not fluent in English. the pre-hospital setting. Why does it matter?

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

PEMBlog

MARCH 4, 2025

Garcia T, Florin TA, Leonard J, Shah SS, Ruddy RM, Wallihan R, Desai AP, Alter S, El-Assal O, Marzec S, Keaton M, Yun KW, Leber AL, Mejias A, Cohen DM, Ramilo O, Ambroggio L; Childrens Hospitals Initiative for Research in Pneumonia (CHIRP). Clinical Features and Management Strategies in Children With Mycoplasma Pneumoniae. Pediatr Emerg Care.

Pediatrics 94

Pediatrics Military CDC Hospitals 94

ACEP Now

JANUARY 5, 2025

Fibrinogen levels should also be obtained, where available, if severe hemorrhage suggests the potential need for administration of fibrinogen concentrate. Dr. Helman is an emergency physician at North York General Hospital in Toronto. mcg/kg IV may be considered, especially if von Willebrand disease is suspected.

Airway Management 98

Airway Management Operations Resuscitation Pediatrics 98

ACEP Now

AUGUST 25, 2023

The Pediatric Pain Management Standard 1 for children was published this year to provide guidance to health organizations on how to deliver equitable and quality pain management across hospital settings. Two interesting findings were time to parenteral opioid administration and total dose of opioid morphine equivalents. Am J Hematol.

Administration 97

Administration Pediatrics Emergency Department Outcomes 97

EMDocs

NOVEMBER 19, 2024

He was extubated on hospital day 2 and was able to be discharged to psychiatry on hospital day 5. Second-generation antipsychotic medications: Pharmacology, administration, and side effects. Potassium and magnesium were replenished, and the QTc interval improved to 440 within two hours. The patient gradually improved.

Poisoning 111

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

ACEP Now

MARCH 10, 2025

At your monthly meeting with the chief medical officer (CMO) and chief nursing officer (CNO), they inform you of the hospitals plan to start a Sexual Assault Nurse Examiner (SANE) Program. 1 There are many program models including ED-based, non-ED hospital-based, hospital, and community-based programs. You accept the position.

Sexual Assault 52

Sexual Assault Forensics Leadership Pediatrics 52

RebelEM

SEPTEMBER 29, 2022

to 6.8L) WATERFALL Trial Fluid Administration Critical Findings: The trial was stopped early due to an interim analysis demonstrating a high incidence of fluid overload with no significant difference in the primary outcome. The aggressive fluid administration arm is far less aggressive than what was historically recommended for pancreatitis.

Administration 52

Administration Fluid Resuscitation Resuscitation Outcomes 52

ACEP Now

OCTOBER 13, 2023

An official reason for the closure was not immediately available from the hospital administration, but residents there said they were told the surprise move was likely because of financial reasons. “We

Patient Safety 132

Patient Safety Emergency Department Administration EMS 132

The Trauma Pro

JULY 18, 2023

Here’s the real bottom line: ” A hospital using an electronic trauma flow sheet is paying a lot of money for a product that forces them to pay even more money for people to essentially transcribe inaccurate data back onto a paper trauma flow sheet.” Talk to your administrative contacts.

Administration 100

Administration Hospitals 100

The Trauma Pro

JULY 21, 2023

In the last post, I discussed what to do if your hospital is thinking about switching to an electronic trauma flow sheet (eTFS). Use all of this information to work with your hospital administration to find ways to make it better. Once your hospital has taken the plunge and adopted the eTFS, it is very difficult to go back.

Administration 100

Administration Hospitals 100

The Skeptics' Guide to EM

OCTOBER 5, 2019

Guest Skeptic: Clay Odell is a Paramedic/RN for New London Hospital EMS in New Hampshire, USA which provides 9-1-1 coverage and Mobile Integrated Healthcare […] The post SGEM#269: Pre-Hospital Nitroglycerin for Acute Stroke Patients? The Lancet March 2019. first appeared on The Skeptics Guide to Emergency Medicine.

Stroke 52

Stroke Hospitals EMS Administration 52

EMDocs

JANUARY 11, 2025

A) Administration of IV morphine for pain control B) Admission to general surgery for IV antibiotics C) Discharge home on lactulose D) Emergent surgical consultation for exploratory laparotomy E) Manual disimpaction Correct answer: E Although uncommon, stercoral colitis is a potentially life-threatening complication of chronic constipation.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

RebelEM

JUNE 8, 2023

The retrospective design of this study omitted assessment of ventricular dysrhythmias related to push dose pressor administration, as they were reliant on information in the EMR. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

EMDocs

DECEMBER 1, 2024

Treatment significantly shortens the duration of illness, and early initiation of therapy can prevent severe complications and reduce the length of hospitalization. Food and Drug Administration. However, some experts recommend doxycycline even in pregnant patients. pregnant patients). Emerg Infect Dis. 2017;23(8):1268-1273.

EMS 105

EMS Infectious Diseases Shock Airway Management 105

RebelEM

APRIL 29, 2024

Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure. In cardiac arrest, a delay in IV access subsequently results in a delay in epinephrine administration. Impact of intraosseous versus intravenous resuscitation during in-hospital cardiac arrest: A retrospective study.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

The Skeptics' Guide to EM

FEBRUARY 25, 2023

2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Case: A 6-month-old boy presents to […] The post SGEM#394: Say Bye Bye Bicarb for Pediatric In-Hospital Cardiac Arrest first appeared on The Skeptics Guide to Emergency Medicine.

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52

RebelEM

JULY 3, 2023

What They Did: Researchers conducted a multicenter, retrospective cohort study in three community hospitals and two freestanding emergency departments. Critical information such as HR, SBP, drug administration times were occasionally missing. received CaCl 89.3% The study was dependent on EMR documentation which is prone to error.

Administration 98

Administration Outcomes Documentation/Coding Emergency Department 98

PulmCCM

JANUARY 6, 2025

With financial penalties coming for noncompliance with the new rule, hospital administrators rapidly deployed the alerts to fire on all eligible inpatients. The SCREEN Trial SCREEN was a stepped-wedge cluster randomized trial of an EMR alert for organ failure, conducted at 45 wards of 5 hospitals in Saudi Arabia from 2019 to 2021.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

Don't Forget the Bubbles

OCTOBER 12, 2024

However, hospitals vary in their use of corticosteroids, with different formulations and strengths used. When comparing corticosteroids to a placebo, children who received corticosteroids had a more significant reduction in croup scores between 2 and 12 hours of administration. Which corticosteroid should we give in croup?

Airway Management 85

Airway Management Emergency Department Administration Hospitals 85

The Trauma Pro

AUGUST 15, 2023

One of the most creative solutions I’ve seen is the use of a hospital security officer. They know the hospital layout cold, including that obscure corner where the blood bank is located. Think about it. And there are plenty around all the time! Documentation is critically important, both in the trauma bay and the blood bank.

Documentation/Coding 130

Documentation/Coding Best Practices Resuscitation Emergency Department 130

ACEP Now

OCTOBER 30, 2024

ACEP Now : Boarding What obstacles exist in Congress to address hospital boarding? We don’t incentivize experience in our systems and our laws – both the provider’s experience as well as the patient’s experience, so when it comes to hospital boarding, it falls right in line with that. ACEP MEMBER TIMOTHY C.

Telemedicine 40

Telemedicine Critical Access Emergency Department Hospitals 40

ACEP Now

OCTOBER 10, 2024

McCormick earned his Master of Business Administration from National University and medical degree from Morehouse School of Medicine in Atlanta. He completed residency in emergency medicine through Emory while training at Grady Hospital in Atlanta. Most recently, Dr. McCormick served as an emergency physician at Northside Hospital.

Telemedicine 105

Telemedicine Critical Access Hospitals Emergency Department 105

The Skeptics' Guide to EM

SEPTEMBER 2, 2023

She is an Assistant Professor and Director of Research in the Department of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. She is an Assistant Professor and Director of Research in the Department of Emergency Medicine at the NYU Grossman Long Island Hospital Campus. Date: August 30, 2023 Reference: Griffey et al.

Operations 110

Operations Diabetic Emergencies Hospitals Research 110

Sensible Medicine

MAY 15, 2024

In this week’s Sensible Medicine podcast, I asked why students have an entire lecture with prolonged discussion of whether a patient coming to the hospital from prison should be called a prisoner. I fault the administrators. What’s worse is that it is sanctioned by administrators who cannot be questioned.

Administration 119

Administration Documentation/Coding Hospitals Wellness 119

The Trauma Pro

OCTOBER 31, 2023

If you believe that harm will occur, here are your options, from least to most damaging to your professional status at the hospital: Contact another consultant in the same or overlapping specialty (if there is one). Contact the trauma medical director, service chief, or hospital administrator and see if they can intervene.

Risk Management 113

Risk Management Fractures Documentation/Coding Hospitals 113

The Trauma Pro

AUGUST 18, 2023

What happens next varies by hospital. The Broxton tool covers all the basics and includes some additional data points that cover activation criteria, TXA administration, and administration of uncrossmatched blood. Typically, one of the blood bank supervisors or a pathologist then compiles and reviews this data.

Administration 100

Administration Operations Hospitals Wellness 100

Sensible Medicine

AUGUST 21, 2023

Administrative data sets are often collected for the purpose of billing, or costing, or administrative organization, and thus are extremely vulnerable to up coding or intentional or accidental omissions. This means that the data on which the observations are based, independently of how they are analyzed, are not reliable.

Administration 98

Administration Outcomes Research COPD 98