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The Trauma Pro
APRIL 4, 2025
A recently published study examined current practices regarding antibiotic administration, timing, and adverse events. The primary outcome was any related infection, drainage, or follow-up visit requiring antibiotics. Essentially, they recommended that antibiotics not be administered to patients who do not require surgery.
113 
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.
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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).
St. Emlyn
JANUARY 13, 2025
With insights into drug protocols, administration methods, and governance, the article highlights challenges and opportunities for standardisation in prehospital care. Ideal for clinicians and researchers aiming to optimise anaesthesia practices and enhance patient outcomes in emergency settings.
The Bottom Line
JUNE 19, 2023
In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?
145 
Emergency Medicine Journal
NOVEMBER 21, 2024
This study investigated whether delayed sequence intubation (DSI), with the administration of ketamine 3 min prior.
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
132 
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).
105 
Taming the SRU
APRIL 10, 2025
The primary outcome was the resolution of EFI-related symptoms; secondary outcomes included the need for additional interventions (e.g., Symptom Relief : Two of these 17 patients (approximately 12%) experienced resolution of EFI symptoms, at 7 and 11 minutes after nitroglycerin administration. mg dissolved in 10 mL of water).
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.
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
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.
97 
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.
137 
ACEP Now
AUGUST 25, 2023
The National Heart, Lung, and Blood Institute released an expert panel report in 2014 with evidence-based guidelines for management of SCD recommending timely administration of parenteral opioids for VOE.2 Primary Outcome: Discharged home from the ED Secondary Outcomes: There were several secondary outcomes. Am J Hematol.
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.
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
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.
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.
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.
52 
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.
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.
RebelEM
FEBRUARY 1, 2024
Tenecteplase, a modified version of alteplase, is being increasingly utilized for AIS due to its favorable pharmacological profile, ease of administration, and cost effectiveness. Limitations : Open label study design Outcome assessments were done via telephone interview. mg/kg at this time for the potential treatment of AIS.
135 
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.
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?
104 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.
113 
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.
132 
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.
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.
93 
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.
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
95 
EMDocs
JUNE 29, 2024
Spoon Feed This secondary analysis of the DOSE VF trial found that DSED (dual sequence external defibrillation) was the superior strategy for obtaining ROSC and functional neurologic outcome regardless of whether the patient was in recurrent VF or shock-refractory VF after three standard defibrillation shocks.
95 
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]
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.
98 
The Skeptics' Guide to EM
OCTOBER 19, 2024
Ketamine’s administration is flexible, with several routes available including IV, intranasal (IN), and more recently, nebulized forms. mg/kg plus nebulized saline Outcome: Primary Outcome: Reduction in pain scores on. Intervention: Nebulized ketamine at 0.75
EMDocs
SEPTEMBER 30, 2024
Primary outcome: Prescription of ICS on ED discharge from the index visit Secondary outcomes: ICS prescription rates in high-risk subgroups Rates of outpatient follow-up within 30 days of an ED visit for asthma Variation in ICS prescription rates among attending ED physicians. The primary outcome was hospital admission rates.
105 
American Medical Compliance
APRIL 16, 2024
Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve healthcare outcomes. American Medical Compliance is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing education to physicians.
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.
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
104 
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% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,
92 
EMDocs
OCTOBER 14, 2023
Spoon Feed More aggressive systolic blood pressure (SBP) goals, beyond keeping it <180 mmHg, probably don’t make much of a difference in outcomes for patients who have undergone endovascular therapy for ischemic stroke. Source Peripheral administration of norepinephrine: a prospective observational study. avoided a CVC entirely.
87 
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.
154 
EMDocs
AUGUST 13, 2024
If the patient has asymptomatic elevated BP, the optimal management strategy is not clear, and there are no data that treating asymptomatic elevated BP (marked versus not) in the acute care setting improves clinical outcomes. Administration of IV antihypertensives in the absence of HTN emergency is not recommended.
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.
105
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