The Skeptics' Guide to EM

SEPTEMBER 16, 2017

Though this disorder is routinely treated with medications for anaphylaxis (i.e. Clinical Question: Does the administration of icatibant to patients with ACE-I induced angioedema improve outcomes? epinephrine, histamine blockers, corticosteroids) the underlying mechanism of action predicts that these medications will not work.

Anaphylaxis 52

Anaphylaxis Administration EMS Emergency Department 52

Northwestern EM Blog

FEBRUARY 14, 2022

The primary outcome of the study was the response in MAP three hours after the start of angiotensin II infusion. It showed improvement in blood pressure which is a clinically important parameter but not a patient-oriented outcome. However, one limitation of the study was that it was underpowered to demonstrate a mortality difference.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

EMDocs

MAY 25, 2023

Outcome: No statistically significant difference in primary outcome, which was absence of clinically apparent seizures without the need for additional anti-convulsant medications AND improving responsiveness at 60 minutes after the start of trial-drug infusion, as determined by the treating physician.

Seizures 88

Seizures Administration Anaphylaxis Outcomes 88

Northwestern EM Blog

JANUARY 24, 2022

Anaphylaxis Anaphylaxis may present as hypotension alone. Thus, it may easily be confused with a different form of shock and treated with vasopressors such as norepinephrine and vasopressin, which are not first line for anaphylaxis. Urticaria should prompt consideration of anaphylaxis. Understanding adrenal crisis.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

RebelEM

MAY 15, 2024

Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Time to antibiotics and outcomes in cancer patients with febrile neutropenia. Neutropenic enterocolitis in adults: systematic analysis of evidence quality. Eur J Haematol 2005; 75:1. 2014;14:162.

Infectious Diseases 98

Infectious Diseases Administration Sepsis Anaphylaxis 98

EM Guide Wire

NOVEMBER 2, 2020

Primary outcome was discharge to home at 24 hours. mcg/kg/min Can increase dose q30 min to max dose of 10 mcg/kg/min Can cause elevations in troponin If there hasn’t been improving, consider IM epinephrine instead Same as anaphylaxis dose 0.01 mg inhaled over the first hour of therapy Followed by 0.5 final FEV1 was 51.1%

Pediatrics 52

Pediatrics Anaphylaxis Emergency Department Administration 52

Mind The Bleep

OCTOBER 17, 2024

BASICS responders have additional skills and can provide pre-hospital emergency care to patients delivering time-critical interventions to improve outcomes. What is a BASICS responder and who can do it? Doctors can volunteer as responders with BASICS Scotland if they have undertaken a Pre-Hospital Emergency Care Course (PHECC).

Ambulance Services 52

Ambulance Services Hospitals Anaphylaxis Wellness 52

PulmCCM

MAY 8, 2023

Among 1150 patients considered high risk for aspiration at 15 French hospitals, those randomized to receive remifentanil had a higher rate of severe complications of intubation (aspiration, hypoxemia, hypotension, arrhythmia, cardiac arrest, or anaphylaxis), compared to those receiving neuromuscular blockade.

Stroke 52

Stroke Blood Transfusions Hospice Anaphylaxis 52

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. Note that antivenom will NOT reverse anaphylaxis on its own. Regardless, the treatment is the same – epinephrine.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Downeast Emergency Medicine

APRIL 26, 2021

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] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Taming the SRU

MAY 1, 2023

Subsequent exposure results in a T-cell mediated response (Type IV hypersensitivity reaction) Plants: Toxicodendron species (poison ivy, poison oak, poison sumac) Also present in foods, including pistachio, cashew, and mango.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Taming the SRU

OCTOBER 25, 2023

Ultimately, patients with variceal bleeding require endoscopic variceal ligation (EVL) but it is important to understand what therapies should be initiated promptly in the ED to improve overall outcomes. 100U (30-60 min prior), 0.25-0.375/100U

Blood Transfusions 98

Blood Transfusions Stroke Hospitals Anaphylaxis 98

Broome Docs

JANUARY 27, 2025

Correction Rates and Clinical Outcomes in Hospitalized Adults With Severe Hyponatremia: A Systematic Review and Meta-Analysis. Adrenaline Auto-Injectors for Preventing Fatal Anaphylaxis. (I would be worried if people were using this as a data point to make medical decisions.) Hyponatremia: Are we all doing this wrong? JAMA Intern Med.

Sepsis 101

Sepsis Anaphylaxis Hospitals Ultrasounds 101

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

PEMBlog

FEBRUARY 22, 2024

A potential for adverse reactions to an injection like anaphylaxis. Anaphylaxis can happen after IV infusion and it’s been rarely reported after I’m injection, like winning the Powerball odds. And I mentioned it before and I’ll say it again, but intracranial bleeding is the worst possible outcome.

Pediatrics 72

Pediatrics Anaphylaxis Administration Wellness 72