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? Primary Results Patients enrolled from 15 emergency medical services at 21 hospitals across 3 countries over 7 years.

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

Sensible Medicine

NOVEMBER 27, 2023

But, in general, blood transfusion strategies have been studied in many other clinical situations. A Cochrane review of trials of more than 21K patients have shown that restrictive strategies have led to a 50% decreased use of blood without differences in morbidity or mortality. That makes sense. I am not sure why.

Blood Transfusions 83

Blood Transfusions Outcomes Hospitals 83

The Trauma Pro

MAY 10, 2024

And its correlation with outcomes varies. It also standardizes comparisons between hospitals that use STAT. The most important one is that it relies only on the Injury Severity Score (ISS) to judge whether some type of mistriage occurred. The ISS is usually calculated after discharge, so it can only be applied after the fact.

Blood Transfusions 113

Blood Transfusions Documentation/Coding Radiology Radiology 113

EMDocs

MAY 15, 2024

Consider risk factors for multi-drug resistant microbes: Recent IV antibiotics Hospitalization within 90 days. COVID-19 and ACS COVID increases the risk of hospitalization, pneumonia, pain, and ACS in SCD patients. Causes and outcomes of the acute chest syndrome in sickle cell disease. Prior cultures with resistance microbes.

Blood Transfusions 78

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 78

Don't Forget the Bubbles

JANUARY 1, 2024

The Bubble Wrap Plus is a monthly paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). Outcomes From a Randomized Clinical Trial. Two-Year Autism Risk Screening and 3-Year Developmental Outcomes in Very Preterm Infants.

Pediatrics 98

Pediatrics Ultrasounds Blood Transfusions Sepsis 98

EMDocs

MAY 28, 2024

Consider risk factors for multi-drug resistant microbes: Recent IV antibiotics Hospitalization within 90 days. Blood transfusion Reduces the overall proportion of HbS. COVID-19 and ACS COVID increases the risk of hospitalization, pneumonia, pain, and ACS in SCD patients. 25% have an infection as the trigger for ACS.

Blood Transfusions 75

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 75

The Skeptics' Guide to EM

DECEMBER 17, 2022

Massive Blood Transfusion Following Older Adult Trauma: the Effect of Blood Ratios on Mortality. AEM December 2022 Guest Skeptic: Dr. Kirsty Challen is a Consultant in Emergency Medicine at Lancashire Teaching Hospitals. Massive Blood Transfusion Following Older Adult Trauma: the Effect of Blood Ratios on Mortality.

Blood Transfusions 52

Blood Transfusions Fractures EMS Emergency Department 52

EMDocs

JUNE 12, 2024

HypoCa is common in trauma patients and is associated with poor outcomes. A meta-analysis found that 56% of patients with severe trauma resulting in hypotension have hypoCa.There was an increase in mortality, increased need for transfusion, and increased risk of coagulopathy in patients with hypoCa. Anaesth Intensive Care. Li K, Xu Y.

Hyperthermia / Hypothermia 89

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 89

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. This feels like a bad sign.

Stroke 52

Stroke Hospice Blood Transfusions Anaphylaxis 52

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. Triage vital signs include BP 127/81, HR 119, T 102.9 C or 100.4 mg/kg, max 0.4

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

RebelEM

SEPTEMBER 26, 2022

There was no statistically significant difference in failure to control bleeding by day 5 or failure to prevent rebleeding after day 5, total hospital length of stay in the first admission, total ICU and hospital length of stay up to 42 days, or 5 and 42-day mortality rates between the two groups.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

Emergency Medicine Journal

MAY 23, 2023

Methods A single-centre retrospective study was performed including patients with suspected UGIB visiting the ED of Saint-Antoine hospital (Paris, France) from January 2016 to December 2018. Demographic and medical data needed to calculate GBS and CANUKA were collected, as well as outcomes data.

Emergency Department 40

Emergency Department Blood Transfusions Hospitals Wellness 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

EMDocs

DECEMBER 6, 2024

7 Workup other than serum iron concentration at 4 hours after ingestion not shown to accurately predict clinical outcomes or severity of toxicity. Blood transfusion for clinically significant blood loss. Iron Ingestion: an Evidence-Based Consensus Guideline for Out-of-Hospital Management. Antiemetics as needed.

Poisoning 76

Poisoning Fluid Resuscitation Seizures Resuscitation 76

Broome Docs

DECEMBER 22, 2024

This month we cover a few out-of-hospital arrest trials. Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial. A Randomized Trial of Drug Route in Out-of-Hospital Cardiac Arrest. Intraosseous or Intravenous Vascular Access for Out-of-Hospital Cardiac Arrest.

Blood Transfusions 52

Blood Transfusions Hospitals Outcomes Emergency Department 52

Don't Forget the Bubbles

NOVEMBER 18, 2024

Epidemiology in Australia In Australia, the reported prevalence of neonatal hypotension in preterm infants is like that in the UK, with around 20-30% of very low birth weight infants experiencing significant hypotension during their initial hospital stay. Check the haemoglobin and haematocrit levels early in these cases. and Roberts, N.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

EB Medicine

OCTOBER 1, 2018

For those listening, my hospital probably looks a little bit like yours. Roughly half of in-hospital mortality is associated with septic in some fashion. clearly this is an important topic if it warrants it’s own chair at a major hospital in NYC. At our hospital in southern Manhattan, patients tend to breathe around 16.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

EMDocs

JUNE 3, 2023

Her Glasgow Coma Scale (GCS) is 14 (3E-5V-6M), and she arrives in a cervical collar placed pre-hospital. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality. Management and outcomes of open pelvic fractures: An update. J Clin Orthop Trauma.

Fractures 54

Fractures Resuscitation Operations EMS 54

RebelEM

FEBRUARY 1, 2024

Limitations : Open label study design Outcome assessments were done via telephone interview. mg/kg, max 25mg) vs. intravenous alteplase (0.09 mg/kg followed by 0.81 vs Alteplase 34.8% Unadjusted risk difference 2.1% [ 95% CI -2.6 mg/kg, max 25mg) vs. intravenous alteplase (0.09 mg/kg followed by 0.81 vs Alteplase 34.8% mg/kg followed by 0.81

Stroke 133

Stroke Blood Transfusions Outcomes EMS 133

PulmCCM

JANUARY 8, 2024

Smaller blood-collection tubes to reduce red blood cell transfusion (STRATUS trial) Cumulatively, daily labs on hospitalized patients deplete substantial volumes of blood, almost all of which is wasted. They have a less-powerful vacuum that removes about half as much blood per tube.

Blood Transfusions 96

Blood Transfusions Hospitals Outcomes Operations 96

EMDocs

MARCH 6, 2024

Post-hoc analysis of patients with LGIB compared a liberal transfusion threshold of 9 g/dL (8 g/dL in those with acute coronary syndrome) with restrictive strategy and found no difference in in-hospital mortality. 2023 ACG guidelines recommend against transfusing platelets to reverse an antiplatelet agent. 2017;2(5):354–60.

Blood Transfusions 85

Blood Transfusions Outcomes Resuscitation Radiology 85

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.

Blood Transfusions 97

Blood Transfusions Hospitals Stroke Anaphylaxis 97

EMDocs

JULY 3, 2023

Introduction SAH has the potential for rapid progression and devastating outcomes. Hematoma expansion Reducing blood pressure to a level that limits bleeding but maintains perfusion is critical to limit hematoma expansion, especially in spontaneous SAH. Short- and long-term outcome of patients with aneurysmal subarachnoid hemorrhage.

Seizures 85

Seizures Stroke Outcomes EMS 85

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 63

Documentation/Coding Seizures Psychiatric Wellness 63

RebelEM

FEBRUARY 22, 2024

Background : Concurrent anemia worsens outcomes in patients that present with acute myocardial infarctions. Transfusions increase the oxygen carrying capacity of blood which can improve the perfusion of at-risk cardiac tissue. An optimal transfusion hemoglobin cutoff has not yet been established in these patients.

Blood Transfusions 59

Blood Transfusions Outcomes Wellness Research 59