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

EMDocs

DECEMBER 1, 2024

The disease is generally mild, but in untreated cases, it can lead to more severe outcomes, especially in patients with underlying conditions such as glucose-6-phosphate dehydrogenase deficiency. Even though the disease often resolves spontaneously, prompt antibiotic therapy is essential for optimal outcomes. pregnant patients).

EMS 101

EMS Infectious Diseases Shock Airway Management 101

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

ACEP Now

MARCH 11, 2025

1 Further, a Cochrane review found that LMWH is associated with improved outcomes compared with UFH including reduced incidence of major hemorrhage (odds ratio [OR]=0.69; 95 percent CI, 0.50-0.95) First, UFH is often perceived as stronger than alternatives, partially owing to the intravenous route of administration. Ann Emerg Med.

Hospitals 52

Hospitals Administration Outcomes Stroke 52

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 304

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 304

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 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

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 94

EMS Sepsis Shock Fluid Resuscitation 94

RebelEM

FEBRUARY 19, 2024

Historically the administration of vasopressors was restricted to central venous catheters (CVC) due to concerns for local tissue injury resulting from vasoconstriction if extravasation occurred from a peripheral IV. Peripheral Administration of Norepinephrine: A Prospective Observational Study. Paper: Yerke JR et al. CHEST 2024.

Administration 134

Administration Sepsis EMS Shock 134

PulmCCM

JANUARY 15, 2025

Draft Guidance for Industry and Food and Drug Administration Staff. Clinical Outcomes Associated With Overestimation of Oxygen Saturation by Pulse Oximetry in Patients Hospitalized With COVID-19. January 2025. Draft Guidance Document Wong et al. Fingertip oxygen sensors can fail on dark skin — now a physician is suing.

Academics 81

Academics Documentation/Coding Administration Research 81

Emergency Medicine Education

NOVEMBER 3, 2024

A recent article in NEJM highlighted that the drug administration route—IV versus IO—matters in terms of successful resuscitation, return of spontaneous circulation (ROSC), and favorable neurological outcomes. However, this is just my opinion. Link to article

Resuscitation 40

Resuscitation Administration Outcomes 40

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

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

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

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 96

Administration Outcomes 96

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

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

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 98

Administration Outcomes Research COPD 98

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 89

Administration Sepsis Shock Emergency Department 89

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 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 103

Hospitals CPR EMS Outcomes 103

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 92

Outcomes Administration Hospitals Wellness 92

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

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 95

Stroke Administration Documentation/Coding Outcomes 95

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

EMDocs

MAY 25, 2023

mg/kg or 10 mg Seizures must persist for at least 5 minutes after administration of the prespecified benzodiazepines. In light of these data, I will give levetiracetam due to its less severe side effects and ease of administration. mg/kg or 10 mg Intravenous lorazepam 0.1 mg/kg or 4 mg Intravenous midazolam 0.2

Seizures 81

Seizures Administration Anaphylaxis Outcomes 81

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

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 104

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 104

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

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. A cluster randomized trial using all-cause mortality as an outcome was always needed to determine whether EMR alerts improve outcomes for suspected severe infection.

Sepsis 45

Sepsis Documentation/Coding Hospitals Outcomes 45

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

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

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

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 92

Administration Resuscitation Fluid Resuscitation Research 92

EMDocs

AUGUST 17, 2024

24 hours after onset, without access to endovascular thrombectomy (ET), tenecteplase(TNK) administration bested standard medical treatment(SMT) in 90-day disability-free recovery. . #1: TNK Up to 24 Hours for Stroke? Spoon Feed In patients with large vessel occlusions(LVO) presenting 4.5-24 Source Tenecteplase for Ischemic Stroke at 4.5

Stroke 89

Stroke Administration Outcomes 89

The Skeptics' Guide to EM

JULY 20, 2024

This process involves the administration of supplemental oxygen before the induction of anesthesia to increase the oxygen reserves in the lungs, thereby reducing the risk of hypoxemia. Background: Preoxygenation is a critical step in the management of airway interventions, especially in critically ill patients undergoing tracheal intubation.

COPD 113

COPD Patient Safety Emergency Department Administration 113