The Skeptics' Guide to EM

AUGUST 24, 2024

More recently, the April 2024 SGEMHOP reviewed a trial on how effective and safe an ultrasound-guided erector spinae plane block (ESPB) in adult patients with rib fractures is. The block is typically performed under ultrasound guidance, which allows for precise placement of the anesthetic and minimizes the risk of complications.

Fractures 54

Fractures Emergency Department Ultrasounds Radiology 54

The Skeptics' Guide to EM

JANUARY 25, 2020

His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. Secondary Outcome: The incidence of severe hypoxemia (oxygen saturation of less than 80%). . Reference: Casey et al.

EMS 40

EMS Airway Management Administration Resuscitation 40

Don't Forget the Bubbles

JANUARY 31, 2024

Edelman J, Taylor H, Goss A, et al Point-of-care ultrasound as a diagnostic tool in respiratory assessment in awake paediatric patients: a comparative study Archives of Disease in Childhood Published Online First: 14 December 2023 What’s it about? All of which leads to easier image acquisition. Accredited trainers are currently lacking.

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

Don't Forget the Bubbles

MAY 17, 2023

Minor head trauma in infants – how accurate is cranial ultrasound performed by trained radiologists? Finding the most suitable puncture site for intraosseous access in term and preterm neonates: an ultrasound-based anatomical pilot study. Early Antibiotic Use and Neonatal Outcomes Among Preterm Infants Without Infections.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Taming the SRU

JUNE 3, 2024

CESAR Trial Published in 2009 Found that even those who didn’t get ECMO, but were transported to a tertiary care center had better outcomes No matter where you go, critical care transport will be part of your life as a sending physician, receiving physician, or both. Benefits of transport are evidenced based.

Shock 91

Shock Seizures Airway Management Stroke 91

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

He is interested and experienced in healthcare informatics, previously worked with ED-directed EMR design, and is involved in the New York City Health and Hospitals Healthcare Administration Scholars Program (HASP). Five Rules of the SGEM Journal Club Case: A 70-year-old woman is found unresponsive and apneic at home by her partner.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Pediatric Emergency Playbook

AUGUST 1, 2017

Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. J Ultrasound. Ultrasound Evaluation for Appendicitis.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Broome Docs

APRIL 6, 2023

Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. Emerg Med J. Epub ahead of print.

Sepsis 52

Sepsis Ultrasounds Hospitals 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. Arch Dis Child. 2024 Apr 18;109(5):414-421.

Ultrasounds 52

Ultrasounds Research Emergency Department Outcomes 52

RebelEM

JANUARY 25, 2023

2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 Small bowel obstruction: Outcome and cost implications of admitting service. Am Surg 2010; 76:687-691.

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

EB Medicine

AUGUST 6, 2019

In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. Make sure to get the name, dose, and time of last administration of any DOAC. But next we should talk about ultrasound. of patients per year. Nachi: Next we have apixaban, tradename Eliquis.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

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 136

Stroke Outcomes Hospitals Administration 136

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

Northwestern EM Blog

MAY 16, 2022

What is your initial imaging test of choice, ultrasound (US) or non-contrast CT, and why? Would you be confident in a point-of-care-ultrasound evaluation or a formal ultrasound? Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? How do you proceed?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

EMDocs

DECEMBER 18, 2023

8 Based on multiple randomized controlled trials (RCTs), SSC 2021 guidelines suggest against using procalcitonin as a screening method to guide initiation of antibiotic therapy, as no difference in clinical outcomes was appreciated. Current SSC guidelines recommend the time from presentation to antibiotic administration as one hour.

Sepsis 93

Sepsis Fluid Resuscitation Resuscitation Shock 93

EMDocs

JANUARY 16, 2024

Patients can have excellent outcomes despite prolonged resuscitation. VF/asystole), a pulse cannot be identified via Doppler ultrasound for a full minute, or if lack of organized cardiac activity is confirmed on bedside echocardiogram. This is a good time to utilize an arterial line or use the ultrasound to find a central pulse.

Hyperthermia / Hypothermia 110

Hyperthermia / Hypothermia Resuscitation CPR EMS 110

Dr. Smith's ECG Blog

AUGUST 9, 2024

However the patient continued to have chest pain and bedside ultrasound showed hypokinesis of the septum with significantly reduced LVEF. Although recognition of OMI was not affected by administration of morphine in this case, use caution with analgesia in ongoing ACS without a definitive plan for angiography. Washam, J. Peacock, W.

EKG/ECG 107

EKG/ECG EMS Emergency Department Wellness 107

Broome Docs

MARCH 28, 2024

If you want to see Justin in the video format and his new Youtube series then click here: [link] If you would like to check out my current ultrasound training project then click here: WACHS Ultrasound Otherwise – enjoy the show and see you in a few weeks. Emerg Med J. 2024 Jan 22;41(2):96-102. doi: 10.1136/emermed-2023-213285.

PPE 96

PPE Ultrasounds Resuscitation Emergency Department 96

Taming the SRU

MAY 5, 2023

Despite the complexity and heterogeneity of patients with sepsis, there have been few interventions which have been demonstrated to decrease mortality: early antimicrobial and fluid administration (Levy, Evans et al. 2018, Kuttab, Lykins et al. 2019, Evans, Rhodes et al. 2021, Im, Kang et al. vs 33.2%; OR, 0.42; 95% CI 0.32-0.55;

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Taming the SRU

FEBRUARY 24, 2024

Providers should use ultrasound as early as possible to evaluate for cardiac dysfunction, pulmonary edema, and fluid status. They tend to be hypertensive, tachycardic, tachypneic, and hypoxic. Do not always appear volume overloaded on exam. Early recognition and prompt treatment is key.

Leadership 94

Leadership EMS Pediatrics Stroke 94

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. Her primary interests are in ultrasound, machine learning, and health justice.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

PulmCCM

JULY 10, 2023

In the MERCY trial, 607 critically ill patients with sepsis (most with septic shock) at 26 hospitals in Croatia, Italy, Kazakhstan, and Russia were randomized to receive meropenem by either continuous (3 g / 24 hours) or intermittent administration (1 g every 8 hours). A sequel to that trial, BLING III, is underway. access, etc.,

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

EMDocs

JULY 17, 2023

3,14 There are currently no good studies of enteric or rectal contrast administration in the evaluation of LBO and there are no society recommendations for its use. 3 Point of care ultrasound (POCUS) can be highly sensitive for free fluid and pneumoperitoneum when used by a trained physician in the appropriate patient population.

Operations 98

Operations EMS Fluid Resuscitation Resuscitation 98

Downeast Emergency Medicine

APRIL 26, 2021

2][3] If earlier treatment with TXA is better, would there be benefit in its administration in the prehospital setting? 4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] JAMA Neurol.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

ACEP Now

JULY 7, 2024

3 Of note, administration of nitroprussides before beta blockers can propagate aortic dissection due to the reflex catecholaminergic surge secondary to vasodilation, resulting in increased inotropy and downstream shearing forces on the aorta. Diltiazem, nicardipine, and nitroprusside should be considered as adjuncts.

Operations 59

Operations Hospitals Administration Outcomes 59

Dr. Smith's ECG Blog

APRIL 8, 2016

Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. The patient stabilized and had a good outcome. IV administration of potassium is indicated when arrhythmias are present or hypokalemia is severe (potassium level of less than 2.5 He was managed medically with Clopidogrel.

Resuscitation 52

Resuscitation EKG/ECG Hospitals Administration 52

EB Medicine

OCTOBER 1, 2018

In addition, they also note that our good friend, the point of care ultrasound, likely plays a role, as in one study, POCUS demonstrated a 25% improvement in sensitivity from clinical impression alone. One, lung ultrasound can be really useful to find that occult pneumonia or differentiating pneumonia from CHF. Jeff : Sounds good.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

EB Medicine

SEPTEMBER 1, 2018

Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them. Instead, since no treatment has been shown to improve outcome, you should prioritize prompt transport. Fasciotomies have not been shown to improve outcomes and are reserved only for those failing anti-venom treatment.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EB Medicine

AUGUST 1, 2018

It was peer-reviewed by Joseph Habboushe, assistant professor at NYU and Nadia Maria Shaukat, director of the emergency and critical care ultrasound at Coney Island Hospital in Brooklyn, New York. Also, be aware that there are various formulations of cannabis that allow for different routes of administration.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

NOVEMBER 4, 2024

A comprehensive, patient-centered approach to pain management ensures effective treatment across these diverse pain syndromes, ultimately improving patient outcomes. Cause and outcome of atypical chest pain in patients admitted to hospital. Evaluation by ultrasound of traumatic rib fractures missed by radiography. J R Soc Med.

Emergency Department 106

Emergency Department Fractures Burns EMS 106

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EB Medicine

FEBRUARY 1, 2019

Anyway, the last test to discuss is our good friend the ultrasound, specifically the ocular ultrasound. Nachi: In addition to monitoring ABCs, early care involves the administration of analgesics and anti-emetics. Nachi: In addition, nimodipine, 60 mg q4h, should be given to those with aneurysmal SAH to improve outcomes.

Emergency Department 40

Emergency Department Stroke Outcomes Ultrasounds 40

EMDocs

JANUARY 4, 2025

PMID: 39480221 #2: Albumin for AKI in Septic Shockor Not Spoon Feed Administration of early albumin to patients in septic shock with acute kidney injury (AKI) was associated with worse outcomes. N Engl J Med. 2024 Oct 31. doi: 10.1056/NEJMoa2407616. Epub ahead of print. 2024 Oct 18:S0012-3692(24)05315-7. doi: 10.1016/j.chest.2024.10.012.

Shock 98

Shock Ultrasounds Pediatrics Administration 98

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 106

Stroke Radiology Radiology Emergency Department 106

Dr. Smith's ECG Blog

APRIL 9, 2025

On arrival in the ED, a bedside ultrasound showed poor LV function (as predicted by the Queen of Hearts) with diffuse B-lines. But it does show a strong association of better outcome with lidocaine vs. amiodarone. We used propensity score matching (PSM) to investigate the association between antiarrhythmic and outcomes.

EKG/ECG 63

EKG/ECG Resuscitation Administration Shock 63

The Skeptics' Guide to EM

FEBRUARY 15, 2025

His expertise in critical care medicine is complemented by his research interests in critical care ultrasound and evidence-based knowledge translation. Layered on top of this are themes like collaboration/team efficiency, security and privacy, and other general administrative efficiencies (accounting + Meeting scheduling + email management).

Research 49

Research Outcomes Administration Ultrasounds 49