Journal update monthly top five
Emergency Medicine Journal
MARCH 25, 2025
The 1-BED.
Administration Outcomes Wellness 
Pre-Hospital Antibiotics in Sepsis?
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 
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Neurogenic Shock in Children
Pediatric EM Morsels
SEPTEMBER 22, 2023
” Children compensate for blood and volume loss very well… until they don’t. 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.
Shock 304
304 
EM@3AM: Stercoral Colitis
EMDocs
JANUARY 11, 2025
Well keep it short, while you keep that EM brain sharp. Admission allows for close monitoring, given the risks of perforation, ischemic bowel, and ulceration, as well as appropriate management of the condition and patient symptoms. Therefore, administration of IV morphine (A) would not be recommended. Mathis, K. Korean J Radiol.
EMS 98
98 
SGEM#453: I Can’t Go For That – No, No Narcan for Out-of-Hospital Cardiac Arrests
The Skeptics' Guide to EM
SEPTEMBER 21, 2024
Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. Your partner asks if you want to administer naloxone as well. Naloxone is a well-established medication used primarily for reversing opioid overdoses. Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in Cali.
Hospitals 104
104 
Less is More. Again: Speed of IV Fluid Administration in Pancreatitis (WATERFALL Trial)
RebelEM
SEPTEMBER 29, 2022
Outcomes: Primary: Progression to moderately severe or severe acute pancreatitis (according to the Revised Atlanta Classification). Baseline disease severity was well-balanced between groups. Secondary outcomes were pre-specified which helps in terms of minimizing bias (i.e. Median Fluid Received: Aggressive: 7.8L (Range 6.5
A Brilliant Comment Makes the Study of the Week
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.
The Concomitant Use of Calcium and Diltiazem for Rapid Atrial Fibrillation
RebelEM
JULY 3, 2023
Currently, the infusion of IV calcium before diltiazem is not well understood, and more studies have focused on administering IV calcium prior to verapamil than diltiazem. Secondary outcome All secondary outcomes were found to be similar (Not statistically significant) between groups (See table above). Article: Rossi N et al.
Anticoagulant Selection Is Cornerstone of Pulmonary Embolism Treatment
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
52 
Best Of AAST #7: How Do You Like Your Platelets – Warm Or Cold?
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. These low numbers and the nature of this particular registry could inject significant bias as well. AAST 2023 Plenary paper #29.
Military 113
113 
Remote Consult Protocols for Retinal Artery Occlusion: A Visionary Approach in Emergency Care?
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. 1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. 1 week after treatment.
Stroke 85
85 
The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults
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.
The AcT Trial: Tenecteplase vs Alteplase for Acute Ischemic Stroke
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. Earlier studies looking at tenecteplase dosing began in 2005 and have largely settled on a dose of 0.25 mg/kg at this time for the potential treatment of AIS.
Stroke 135
135 
When EHR Interventions Succeed … and Fail
EM Literature of Note
APRIL 11, 2024
Each of these disease states has well-defined pathways for “optimal” therapy and escalation. 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
92 
REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED?
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. Got FDA exemption as well as went to the community and made sure their community was ok with the trial).
Outcomes 98
98 
To Treat or Not to Treat
Sensible Medicine
NOVEMBER 28, 2023
People can rise through the academic ranks as gifted clinicians, creative and effective educators, and talented administrators. [i] Being perfectly honest, not all the articles have aged well. First, it renewed my faith that occasionally well-done studies address interesting and important questions.
Stroke 101
101 
Case Report: Coronary Vasospasm-Induced Cardiac Arrest
ACEP Now
DECEMBER 6, 2024
Repeat ECG following return of spontaneous circulation after administration of intravenous nitroglycerin. The decision was made to communicate directly with the on-call interventional cardiologist with specific and direct intent to discuss the administration of intravenous (IV) NTG. Click to enlarge.) What Would You Do Next?
Introduction to AI in Healthcare – Types of AI and replacing Healthcare Professionals (HCPs)
Mind The Bleep
APRIL 10, 2025
Examples of LLMs used in healthcare are: The main aims of using AI in healthcare would be to reduce costs, improve patient outcomes and medical education. AI can book appointments and perform other administrative tasks, for instance, retrieving medical information and billing. They performed consistently well with or without AI.
Don’t Forget About the IO in the Critically Ill Patient
RebelEM
APRIL 29, 2024
CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. In cardiac arrest, a delay in IV access subsequently results in a delay in epinephrine administration.
Resuscitation 105
105 
REBEL Cast Ep122 – Delayed vs Rapid Sequence Intubation in Agitated Trauma Patients
RebelEM
AUGUST 7, 2023
Traditional RSI entails preoxygenation followed by near-simultaneous administration of an induction agent followed by a neuromuscular blocker. Rapid sequence intubation can be modified for patients who are agitated or combative and not tolerating standard preoxygenation. that would not be possible in an agitated/combative patient.
POOs, LOOs, DOOs, and MOOs?
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
83 
A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock
Don't Forget the Bubbles
NOVEMBER 27, 2023
And lastly, it’s actually quite hard to see how well the cardiovascular system is working, and this is one of its measurable features. This works well for a while, but eventually, the heart beats too fast to fill adequately. Myth busting: Is peripheral administration safe? It’s only a piece of the puzzle, though. 2021;25(1):146.
Shock 143
143 
5 Min Sono – IVC (2024)
Core Ultrasound
MARCH 25, 2024
If one is going to access the collapsibility of the IVC one should probably look at it in the transverse plane as well 3. The IVC is unable to reliably tell you anything about fluid responsiveness but fluid responsiveness is a flawed outcome and we have to start taking a more holistic view on the administration of fluid.
Healthcare Compliance for New Providers: Getting Started
American Medical Compliance
AUGUST 7, 2024
OSHA (Occupational Safety and Health Administration) Adhering to OSHA (Occupational Safety and Health Administration) regulations is vital for ensuring safe and healthy working conditions for healthcare workers. It protects the health and well-being of staff. More importantly, it enhances the overall quality of patient care.
Meet the Emergency Physicians Running for Congress
ACEP Now
OCTOBER 10, 2024
Between deployments, Dr. McCormick earned his Master of Business Administration from National University and medical degree from Morehouse School of Medicine in Atlanta. The reason I think orthopedists have done so well because they’ve been involved, they’ve been politically engaged, they’ve used their assets to preserve their assets.
Telemedicine 105
105 
Blood Pressure Management in Neurologic Emergencies: What Does the Evidence Say?
EMDocs
JANUARY 29, 2024
hypertensive emergency, need for thrombolytic administration) [1]. However, other sources suggest that the optimal blood pressure target is not well established and may vary depending on the individual patient’s characteristics and the type of hemorrhagic transformation [7].
Stroke 101
101 
How to Ensure Dental Regulatory ComplianceÂ
American Medical Compliance
MARCH 11, 2024
While the primary focus in dentistry is patient health and well-being, carefully keeping records is equally needed. Understanding the Significance Dental recordkeeping includes the systematic documentation of a patient’s oral health history, examinations, diagnoses, treatments, and outcomes.
Hyperosmolar Therapy For Raised ICP – Salty or Sweet?
Don't Forget the Bubbles
OCTOBER 2, 2024
A previously well 6-year-old boy is brought into the emergency department at a major trauma centre via HEMS following a road traffic accident, in which he was hit by a car while crossing the road. No studies involving mannitol administration met the foundation’s inclusion criteria. A full primary survey is carried out.
Current Extraglottic Airway Devices and Prehospital Practices
ACEP Now
NOVEMBER 8, 2024
11 As with LMAs, Combitubes are at risk of balloon rupture as well, and attention is needed to avoid damaging the inflating sections of the device both while in storage and during placement. References National Association of State EMS Officials, National Highway Traffic Safety Administration. DOT HS 813 151). Published August 2021.
SGEM#243: Enough is Enough (O2 Saturation of 94-96%)
The Skeptics' Guide to EM
FEBRUARY 2, 2019
The SGEM Bottom Line was that the routine administration of supplemental oxygen in patients with suspected or confirmed acute myocardial infarction who are not hypoxic does not appear to provide a patient-oriented benefit. This study expands upon that investigation to patients with other conditions as well. Reference: Chu DK et al.
Poisoning 52
52 
Maintenance Fluids in Critical Illness
Don't Forget the Bubbles
NOVEMBER 15, 2023
One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. The REVERSE-AKI feasibility trial suggests that fluid restriction can improve outcomes without significant renal consequences. What do we need to give?
SGEM#188: Icatibant Bites the Dust – For ACE-I Induced Angioedema
The Skeptics' Guide to EM
SEPTEMBER 16, 2017
Your resident tells you that they recently read an article in the NEJM that argued for the administration of icatibant to usher along resolution of symptoms in ACE-I induced angioedema and asks whether you should consider this treatment. Background: ACE-I are prescribed to millions of patients in the US. Reference: Sinert et al.
Anaphylaxis 52
52 
SGEM#239: Febrile Seizure Recurrence – With or Without You Acetaminophen?
The Skeptics' Guide to EM
DECEMBER 15, 2018
The primary outcome was the FART (Found and Retrieved Time) score. You start to counsel the parents with likely outcomes for the future and immediate safety netting advice. During winter periods a typical emergency department may well see a child a day presenting with a febrile seizure There was a SRMA by Rosenbloom et al. (
Seizures 52
52 
A Heartfelt Plea to Become A Primary Care General Internist
Sensible Medicine
MAY 26, 2023
By way of introduction, I’ll save myself time and energy by quoting from a JGIM article (minus references), A National Survey of Internal Medicine Primary Care Residency Program Directors : Primary care has been associated with better health outcomes, higher patient satisfaction, and decreased health care cost. The medicine is amazing.
COPD 69
69 
SGEM#394: Say Bye Bye Bicarb for Pediatric In-Hospital Cardiac Arrest
The Skeptics' Guide to EM
FEBRUARY 25, 2023
Sodium bicarbonate administration will increase the pH. * 4] This association seems to hold true in the pediatric literature as well. [5-6] Sodium bicarbonate has historically been used during CPR with the goal of alkalizing blood pH and treating metabolic acidosis. But it’s not that straightforward.
Pediatrics 52
52 
Abuse, Neglect, and Exploitation in Nursing Homes Training
American Medical Compliance
APRIL 29, 2024
This course will equip caregivers and administrative staff with the necessary tools and knowledge to identify, prevent, and address these grievous issues effectively. It is crucial for caregivers to remain vigilant to ensure the well-being of nursing home residents.
Elder Abuse 52
52 
A 50 year old man with sudden altered mental status and inferior STE. Would you give lytics? Yes, but not because of the ECG!
Dr. Smith's ECG Blog
DECEMBER 26, 2020
They called their transfer center cardiologist on call, who reviewed the case on the phone with them, as well as the ECG. Long-term outcome is unknown. Thus, it seems that two mistakes may have inadvertently led accidentally to the appropriate administration of thrombolytics!! The patient was admitted for stroke management.
EKG/ECG 52
52 
Contrast Media Shortage of 2022 – Lessons Learned
EMDocs
OCTOBER 30, 2023
Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. Some institutions developed a tier-based system for outpatient imaging as well which was updated in real-time. West J Emerg Med.
Radiology 101
101 
The Latest in Critical Care, 2/5/24 (Issue #28)
PulmCCM
FEBRUARY 5, 2024
Also, many patients with infection won’t have fevers, and those that don’t may be at the highest risk for poor outcomes. As all radiologists are ostensible experts, this reads more like an endorsement of POCUS in the ICU for intensivists well-trained and experienced in the technique. °C oral measured multiple times).
Best Practices 111
111 
SGEM#223: Haven’t Got Time for the Pain – What about IV Lidocaine?
The Skeptics' Guide to EM
JUNE 24, 2018
On re-assessment at 20 minutes post-analgesia, the patient is still complaining of a moderate degree of pain and states that morphine worked well in the past, but he is wondering if you can take away his pain without an opioid. Outcomes: * Efficacy Outcomes: Reduction in pain score (through visual analog scale or any other pain asses.
Judge for yourself the management of this patient with "NSTEMI, multivessel disease"
Dr. Smith's ECG Blog
SEPTEMBER 10, 2023
It radiated to both shoulders and both upper extremities, and there was shortness of breath and diaphoresis as well. Long term outcome unknown but obviously bleak. Association of intravenous morphine use and outcomes in acute coronary syndromes: Results from the CRUSADE Quality Improvement Initiative. Am Heart J.
EKG/ECG 78
78 
SGEM#290: Neurologist Led Stroke Teams – Working 9 to 5
The Skeptics' Guide to EM
APRIL 25, 2020
She was last seen well two hours prior. The neurology led stroke team is not available and you wonder if that will affect her outcome. Clinical Question: Does the presence of a neurologist led stroke team affect the likelihood of receiving tPA and does that improve a patient-oriented outcome? Reference: Juergens et al.
Stroke 40
40 
SGEM#203: Let Me Clear My Sore Throat with a Corticosteroid
The Skeptics' Guide to EM
JANUARY 20, 2018
However, previous systematic review and meta-analyses have been confounded by co-administration of antibiotics and analgesics, as well as variability in measures of efficacy among studies. Corticosteroids exert an anti-inflammatory effect by inhibiting transcription of pro-inflammatory mediators in airway endothelial cells.
Academics 52
52 
SGEM#299: Learning to Test for COVID19
The Skeptics' Guide to EM
AUGUST 22, 2020
The US Federal Drug Administration (FDA) allowed for emergency development and use of rt-PCR assays, and dozens of companies released assay kits. This review discusses the diagnostic accuracy of rt-PCR for COVID-19, as well as signs, symptoms, imaging, and other laboratory tests.
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