Mount Sinai EM

JULY 30, 2023

Important, earlier administration may precipitate increased production of thyroid and worsening of storm. For esmolol, loading dose of 250 to 500 mcg/kg, followed by an infusion at 50 to 100 mcg/kg per minute OR a loading dose of 1 mg/kg over 30 seconds followed by approximately 150 mcg/kg/minute Thionamide – PTU preferred.

Administration 179

Administration COPD Wellness 179

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. 4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. Severe acute traumatic coagulopathy = PT >1.5

Administration 139

Administration Outcomes Resuscitation Radiology 139

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. As our fearless leader likes to say: “children are not aliens, but they are a special population with unique anatomy and physiology.”

Shock 304

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 304

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

RebelEM

SEPTEMBER 29, 2022

to 6.8L) WATERFALL Trial Fluid Administration Critical Findings: The trial was stopped early due to an interim analysis demonstrating a high incidence of fluid overload with no significant difference in the primary outcome. Baseline disease severity was well-balanced between groups. Median Fluid Received: Aggressive: 7.8L (Range 6.5

Administration 52

Administration Fluid Resuscitation Resuscitation Outcomes 52

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.

EMS 94

EMS Sepsis Shock Fluid Resuscitation 94

PEMBlog

MARCH 4, 2025

Well cover its clinical presentation, epidemiology, diagnostic approach, and management, including why standard beta-lactam antibiotics wont work. Plus, well discuss whether M. We also don’t know whether administration of antibiotics decreases the incidence or severity of associated mucocutaneous disease.

Pediatrics 94

Pediatrics Military CDC Hospitals 94

JournalFeed

APRIL 29, 2023

PROCOAG RCT Spoon Feed This well-designed RCT finds early administration of 4-factor prothrombin complex concentrate (PCC) to patients at risk of receiving massive transfusion protocol (MTP) did not reduce 24-hour blood product consumption or mortality but did increase thrombotic events.

Wellness 40

Wellness Administration 40

Ken Grauer, MD

SEPTEMBER 6, 2024

Alternatively — when a portion of the reentry circuit is made up of an AP ( A ccessory P athway ) — the retrograde P wave will typically manifest a moderately long RP' interval ( that occurs well after the QRS — usually within the latter part of the ST segment ). What is happening in today's case is different.

EKG/ECG 245

EKG/ECG Administration Operations Wellness 245

EM Literature of Note

AUGUST 25, 2024

Well, yes to all of the above, in the appropriate clinical context – But, most prominently, as featured in this brief report, for asthma – particularly childhood asthma. Move over ketamine and TXA, there’s another medication gradually approaching do-it-all darling status in Emergency Medicine: dexamethasone. Sore throats?

Emergency Department 94

Emergency Department Administration Wellness Pediatrics 94

American Medical Compliance

AUGUST 27, 2024

However, with the growing reliance on assisted living comes an even greater responsibility: ensuring the safety and well-being of residents. Healthcare providers, administrators, and staff must recognize their duty to protect residents and ensure their well-being. Among the most urgent concerns is the prevention of elder abuse.

Elder Abuse 105

Elder Abuse Domestic Violence Administration Incident Reporting 105

ACEP Now

MARCH 11, 2025

First, UFH is often perceived as stronger than alternatives, partially owing to the intravenous route of administration. First, UFH is often perceived as stronger than alternatives, partially owing to the intravenous route of administration. The pervasive maxim quick on, quick off for UFH doesnt hold up as well as touted.

Hospitals 52

Hospitals Administration Outcomes Stroke 52

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

The Trauma Pro

SEPTEMBER 15, 2023

Many centers have adopted 2-3 days to delay administration of low molecular weight heparin in patients with solid organ injury. The AAST initiated a prospective multi-institutional trial comparing early ( < 48 hours after admission) and late (>48 hours) administration of prophylactic agents.

Administration 113

Administration Fractures Wellness 113

Sensible Medicine

AUGUST 4, 2024

” This is a formula for decision making that only a university administrator could love and sounds a lot like the White House Coronavirus Task Force that produced so many failures in the US covid response. It is only two pages and well worth a read.

Academics 140

Academics Administration Hospitals Wellness 140

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

Taming the SRU

FEBRUARY 7, 2024

For blood product administration, PROPPR showed that 1:1:1 platelet, plasma, and pRBC administration led to earlier hemostasis along with less death due to blood loss and whole blood compared to separate blood product administration led to decreased death at 24 hours.

PPE 98

PPE Administration Ultrasounds Poisoning 98

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. Next week I am going to show you what a well-done medical study looks like. It is our goal. Thanks for your support.

Administration 98

Administration Outcomes Research COPD 98

RebelEM

JUNE 8, 2023

The retrospective design of this study omitted assessment of ventricular dysrhythmias related to push dose pressor administration, as they were reliant on information in the EMR. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Your partner asks if you want to administer naloxone as well. Naloxone is a well-established medication used primarily for reversing opioid overdoses. Its safety profile is well-tolerated, with the primary adverse effects related to the abrupt reversal of opioid effects, such as acute withdrawal symptoms.

Hospitals 103

Hospitals CPR EMS Outcomes 103

ACEP Now

MARCH 10, 2025

Although not typical, a medical director may be asked to participate in staff hiring and recruitment, as well as fiscal management of the program. Another consideration is any specific training or course work you may need to better prepare to take over the role.

Sexual Assault 52

Sexual Assault Forensics Leadership Pediatrics 52

The Trauma Pro

SEPTEMBER 20, 2023

These low numbers and the nature of this particular registry could inject significant bias as well. Stay with the room temp platelets for now, and wait for a well-powered prospective analysis before changing your MTP. I’m surprised that a military registry could only come up with 75 patients a year to analyze.

Military 113

Military Blood Transfusions Administration Outcomes 113

Sensible Medicine

MAY 15, 2024

There are so many things students are not learning instead — like how to read a paper or how to take care of heart failure (well). I fault the administrators. What’s worse is that it is sanctioned by administrators who cannot be questioned. In both cases, who do I fault? The students? That scares me.

Administration 120

Administration Documentation/Coding Hospitals Wellness 120

RebelEM

AUGUST 22, 2024

Administration of intravenous tissue plasminogen activator (IV tPA) within 4.5 1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Administration of intravenous tissue plasminogen activator (IV tPA) within 4.5 1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

The Trauma Pro

JUNE 30, 2023

Typically, hospital administrators pressure trauma programs to adopt an eTFS at some point after implementing the hospital-wide use of an electronic health record (EHR). Epic Systems became the first, and hospital administrators eventually became aware of it. The biggest question is, why does your hospital want you to use it?

Hospitals 100

Hospitals Administration Resuscitation Best Practices 100

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

The Trauma Pro

AUGUST 18, 2023

product ratios are way off) then it should also be discussed at your multidisciplinary trauma PI committee as well. The Broxton tool covers all the basics and includes some additional data points that cover activation criteria, TXA administration, and administration of uncrossmatched blood. Click here to check it out.

Administration 100

Administration Operations Hospitals Wellness 100

Intensive Blog

AUGUST 19, 2024

Author: Dr Ken Hoffman Peer Reviewer: A/Prof Chris Nickson In this 5 minute video we examine the use of inhaled nitric oxide in ICU, reviewing the administration, mechanism of action, indications and side effects. If you find these videos useful, please hit the like button on Youtube and subscribe to see more!

Administration 75

Administration Research Wellness 75

EMDocs

NOVEMBER 6, 2023

Naloxone administration may reverse respiratory arrest, preventing progression to cardiac arrest. Standard advanced life support with the addition of administration of sodium bicarbonate is appropriate for the treatment of life-threatening dysrhythmias caused by cocaine or other sodium channel blockers. COR 2a, LOE B-NR.

Poisoning 112

Poisoning Hyperthermia / Hypothermia Seizures Administration 112

EMDocs

NOVEMBER 19, 2024

1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. Second-generation antipsychotic medications: Pharmacology, administration, and side effects. Innov Clin Neurosci.

Poisoning 108

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 108

Sensible Medicine

JUNE 15, 2024

Being well versed in domains of history and sports may even have a greater impact in the clinic, as it allows you to bond with many patients. They would rather hire more compliance officers and mid-level administrators. A greater focus on wellness or work-life balance will solve none of these concerns.

Research 144

Research Wellness Academics Administration 144

Taming the SRU

SEPTEMBER 20, 2023

Baez Potassium Hyperkalemia Peaked T-waves (there is tall and spiked T-waves, that you “wouldn’t want to sit on”) PR interval increases Widening of the QRS Can lead to a sine wave Hypokalemia T wave widening/flattening T wave inversion and U wave (upward deflection after the T wave) Calcium Hypercalcemia Shortened QT interval Osborn wave (positive (..)

EKG/ECG 77

EKG/ECG Pediatrics Administration Wellness 77

EM Literature of Note

SEPTEMBER 1, 2023

In this study, the Epic SPM was evaluated at several difference SPS score thresholds ranging from ≥5 to ≥10 – and compared, as well, with SIRS, qSOFA, and SOFA. Alerts, alerts, alerts – what are they good for? There were two goals for the evaluation: accuracy and timeliness.

Sepsis 107

Sepsis Administration Wellness 107

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. Critical information such as HR, SBP, drug administration times were occasionally missing. Article: Rossi N et al. received CaCl 89.3%

Administration 91

Administration Outcomes Documentation/Coding Emergency Department 91

Pediatric EM Morsels

NOVEMBER 3, 2023

With concern for malaria, it is very important to identify who is non-immune and semi-immune as this can affect both the timeframe for illness after departure from the endemic country as well as severity of illness. Food and Drug Administration Approval of Artesunate for Severe Malaria: Enough to Achieve Best Practice? Clin Infect Dis.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

RebelEM

JULY 10, 2024

Take Home Points Early administration of antibiotics (within 60 min) in patients with fever and neutropenia is life saving. Fever in sickle cell is an emergency and always requires cultures and antibiotics even if the child appears well. Avoid sedation and lying supine and steroids in patients with mediastinal masses.

Seizures 58

Seizures Administration EMS Wellness 58

EM Literature of Note

APRIL 11, 2024

Each of these disease states has well-defined pathways for “optimal” therapy and escalation. These interventions were further supported by “facilitators”, persons assigned to each practice in the intervention cohort to support uptake of the EHR tools.

Outcomes 92

Outcomes Administration Hospitals Wellness 92