Pediatric EM Morsels

SEPTEMBER 22, 2023

Crystalloid may help, but neurogenic shock may not respond to fluid administration. Orenstein JB, Klein BL, Gotschall CS, Ochsenschlager DW, Klatzko MD, Eichelberger MR. Age and outcome in pediatric cervical spine injury: 11-year experience. Alpha 1 agonists are necessary to maintain appropriate blood pressure. J Pediatr Surg.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

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

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 117

Sepsis Fluid Resuscitation Resuscitation Administration 117

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.

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

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

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

RebelEM

DECEMBER 23, 2024

VOE is often complicated by hypovolemia, making fluid administration a common intervention ( Lovett 2017 ). There has been ongoing study about the clinical significance of these effects, as well as whether and for whom LR might provide meaningfully better clinical outcomes ( Myburgh 2013 , Self 2018 , Semler 2018 , Self 2020 ).

Fluid Resuscitation 122

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 122

PulmCCM

NOVEMBER 7, 2024

For out-of-hospital cardiac arrest in particular, intravenous access can be difficult to establish, delaying the administration of epinephrine and other drugs and possibly worsening outcomes. During cardiac arrest, every second matters (at least potentially).

Resuscitation 98

Resuscitation Administration Hospitals Outcomes 98

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 88

Administration Outcomes Documentation/Coding Emergency Department 88

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

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 97

Administration Emergency Department Outcomes Documentation/Coding 97

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 130

Stroke Outcomes Hospitals Administration 130

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

The Trauma Pro

JANUARY 28, 2025

Preventing death: This drug doesn’t appear to reduce mortality, which is the outcome we are most interested in when treating these patients. This is a decision that you and your hospital administration will have to work out. Thrombotic complications. These do seem to be more common when AA is given.

Administration 113

Administration Outcomes Hospitals 113

EM Literature of Note

APRIL 11, 2024

The most notable feature of this trial is the simple, negative topline result – rollout of this intervention had no reliably measurable effect on patient-oriented outcomes relating to disease progression or acute clinical deterioration.

Outcomes 91

Outcomes Administration Hospitals Wellness 91

The Skeptics' Guide to EM

NOVEMBER 16, 2024

He leads an AI team intending to improve patient outcomes and healthcare system efficiency. With emergency department (ED) volumes rising, administrators are eager to explore AI-driven solutions to improve patient safety and reduce staff burnout.

Administration 87

Administration Emergency Department Outcomes Patient Safety 87

University of Maryland CC Project

JANUARY 31, 2024

The topic of their lecture today is their recently published article in CHEST: “Use and Outcomes of Peripheral Vasopressors in Early Sepsis-Induced Hypotension Across Michigan Hospitals: A Retrospective Cohort Study”. Their article can be found here: [link]

Administration 40

Administration Sepsis Research Outcomes 40

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. However, the efficacy of naloxone in improving outcomes in such cardiac arrests remains a topic of ongoing research and debate. Clinical Question: Is naloxone administration in undifferentiated OHCA associated with survival to hospital discharge?

Hospitals 96

Hospitals CPR EMS Outcomes 96

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. Researchers from the US Army performed a retrospective registry study on a sample of military casualties over four years.

Military 113

Military Blood Transfusions Administration Outcomes 113

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. A total of 800 patients were enrolled, with 401 receiving hydrocortisone and 399 receiving a placebo.

Outcomes 93

Outcomes Sepsis Administration EMS 93

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 96

Sepsis Outcomes Administration EMS 96

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. ” For example, mortality is a patient outcome—provided it can be reliably ascertained.

Administration 82

Administration Outcomes Research COPD 82

The Skeptics' Guide to EM

NOVEMBER 2, 2024

Intervention: Administration of low-dose ketamine (LDK) 0.1 Comparison: Administration of isotonic saline as placebo with morphine Outcome: Primary Outcome: Pain reduction as measured by patient-reported pain.

Emergency Department 96

Emergency Department Administration EMS Outcomes 96

St. Emlyn

OCTOBER 26, 2024

However, improvements in long-term functional outcomes were less pronounced. This review critically examines the methodology, results, and potential implications for emergency medicine practice, especially regarding the prehospital administration of TXA for TBI patients. Key insights for trauma care providers included.

Administration 76

Administration Outcomes 76

Taming the SRU

MAY 11, 2024

3% HTS appears to be safe for peripheral IV administration and does not require a central line. The available data does not support any benefit of administration of hyperosmolar therapy in the setting of a TBI. When administered IM, midazolam administration appears superior in terms of time to sedation (Nobay et al.).

Administration 91

Administration Resuscitation Fluid Resuscitation Research 91

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 120

Seizures Stroke Outcomes Research 120

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

EMDocs

AUGUST 24, 2023

Blood cultures were collected from patients before the admiration of antibiotics (gold standard), and then again 30 – 120 min following administration of antibiotics. Yields from the post-antibiotic set of blood cultures were then compared against the pre-antibiotics administration set. Difference of 12% (95% CI 5.4 Ann Intern Med.

Administration 68

Administration Sepsis Shock Outcomes 68

Pediatric EM Morsels

MAY 24, 2024

Cohort of 12,000 children with blunt IAI were prospectively enrolled to determine the number of subjects requiring acute intervention .

Pediatrics 161

Pediatrics Blood Transfusions EMS Fractures 161

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 90

Outcomes Administration Emergency Department Resuscitation 90

EMDocs

JUNE 12, 2024

HypoCa is common in trauma patients and is associated with poor outcomes. Two randomized controlled trials by Moore et al found that prehospital plasma administration in trauma patients is associated with hypoCa (53% vs 36%). Prehospital Ca administration reduces risk of hypoCa on arrival (70% vs. 28%).

Hyperthermia / Hypothermia 88

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 88

The Skeptics' Guide to EM

JUNE 17, 2023

The National Heart, Lung, and Blood Institute (NHLBI) released an expert panel report in 2014 with evidence-based guidelines for management of sickle cell disease recommending timely administration of parenteral opioids for VOE. [7] IN fentanyl has been safely used to treat pain in pediatric patients.

Emergency Department 72

Emergency Department Pediatrics Head Injuries Administration 72

EMDocs

JUNE 8, 2023

and 9 hours after onset of symptoms, with non-infarcted brain tissue, does the administration of alteplase improve functional outcome at 90 days? and 9 hours of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. to 53.54, p=0.053).

Stroke 76

Stroke Administration Documentation/Coding Outcomes 76

RebelEM

OCTOBER 5, 2023

Secondary Outcome By day 90, mortality was 9.3% Strengths: The investigators framed a research question centered on patient outcomes, ensuring the study’s relevance and practicality. Control: Normal Saline via continuous infusion according to the same regimen used in the hydrocortisone group. in the placebo group (p = 0.006).

Research 94

Research Outcomes Administration Shock 94

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.

Pediatrics 152

Pediatrics Head Injuries Airway Management Administration 152

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

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