The Skeptics' Guide to EM

JULY 20, 2024

Case: A 70-year-old man presents to the emergency department (ED) with an exacerbation of COPD. These results are promising and may influence future guidelines and clinical practices, emphasizing the importance of optimizing preoxygenation strategies to improve outcomes in critically ill patients.

COPD 122

COPD Patient Safety Emergency Department Administration 122

Ken Grauer, MD

FEBRUARY 28, 2023

Applying the Above to Today's Case: In addition to being Covid-positive — the patient in today's case had longstanding COPD. He was wheezing, and required supplemental oxygen.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

Sensible Medicine

AUGUST 21, 2023

This is a common probably insurmountable problem with morbidities, such as hypertension, diabetes , COPD , etc. In these cases, not only is the diagnosis completely arbitrary on the part of the clinician, but the severity of the condition has an extremely strong influence on its contribution to the usually measured outcome.

Administration 97

Administration Outcomes Research COPD 97

RebelEM

AUGUST 21, 2023

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Paper: Eastwood G, et al.

Hospitals 96

Hospitals Resuscitation Outcomes CPR 96

Sensible Medicine

MARCH 11, 2024

In the assessment of a clinical trial, we want to know if differences in baseline characteristics may have played a role in the observed outcome. The question to consider is…are the actual differences seen between the groups with regards to baseline characteristics large enough to have influenced the outcome?

Outcomes 118

Outcomes Research Stroke COPD 118

ACEP Now

DECEMBER 6, 2024

A 45-year-old male with a history of chronic obstructive pulmonary disease (COPD), asthma, amphetamine and tetrahydrocannabinol (THC) use, and coronary vasospasm presented to triage with chest pain. During initial assessment, an ECG was obtained and revealed ST-segment elevation (STE) in the inferior leads with ST depression anteriorly.

Resuscitation 98

Resuscitation EKG/ECG Documentation/Coding COPD 98

Dr. Smith's ECG Blog

DECEMBER 13, 2023

Outcome: 100% LAD Occlusion Here the Queen explains why: The dark blue tells us that she is looking especially at the QRS in V3 and the T-wave in V2 and V3. The differential diagnosis for "low voltage" that is frequently put forth by many providers is often limited to COPD and/or pericardial effusion.

EKG/ECG 123

EKG/ECG COPD Wellness Outcomes 123

The Skeptics' Guide to EM

JUNE 29, 2019

Comparison:None * Outcome: * Primary Outcome(s): Death within three months and CriSTAL’s predictive ability. Secondary Outcome: Predictive ability for in-hospital death This is an SGEMHOP episode and usually we have the lead author on the show. Intervention:The CriSTAL score, and its various components.

Emergency Department 52

Emergency Department COPD Hospitals Outcomes 52

PulmCCM

MARCH 25, 2024

In a well-randomized trial, equal numbers of clinically important differences in outcomes in opposite directions could average out to a null result, hiding the variability between patients. Neither PILOT nor ICU-ROX found a difference in outcomes with higher vs lower oxygenation targets in mechanical ventilated patients.

COPD 52

COPD Outcomes Research Wellness 52

Taming the SRU

OCTOBER 1, 2023

It can be further divided into two types: primary--those that occur in generally healthy individuals without underlying lung disease, and secondary--those that occur in individuals with underlying lung disease such as COPD [1]. Persistent air-leak in spontaneous pneumothorax--clinical course and outcome. 2023;78(Suppl 3):s1-s42.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

COPD, Idiopathic PAH, acute or chronic PE, pulmonary valve stenosis, etc) 3) Conditions affecting RV myocardial contractility, such as ARVD or RV infarction The ECGs does not really show any signs of chronic RV dilation or hypertrophy. Any cause of pulmonary hypertension. Our THANKS to Dr. Magnus Nossen for sharing this case with us.

EKG/ECG 116

EKG/ECG COPD Shock Wellness 116

The Skeptics' Guide to EM

APRIL 8, 2023

The main outcome was the adjusted odds ratio for in-hospital mortality and hazard ratio for 30-day mortality with some pre-specified subgroups. The reconfiguration included the centralisation of hospitals and the establishment of emergency departments with specialists present around the clock.

Stroke 57

Stroke Emergency Department COPD Academics 57

Dr. Smith's ECG Blog

NOVEMBER 25, 2017

Written by Pendell Meyers, edits by Smith: Case A 72 year old female with hypertension and COPD presented with sudden shortness of breath and chest pain. Peak troponin, echocardiographic findings, and long term outcome are unknown. There is sinus rhythm with PACs and PVCs. Learning Points: 1.

COPD 52

COPD EKG/ECG Wellness Outcomes 52

Dr. Smith's ECG Blog

APRIL 12, 2023

A 49 year old woman with h/o COPD only presented with sudden dyspnea. Outcome : She was diagnosed with stress cardiomyopathy, though it is not entirely classic. She had acute pulmonary edema on exam. There is STE and hyperacute T-waves in V2 and V3, with significant STE in I and aVL, and inferior reciprocal STD.

EKG/ECG 52

EKG/ECG COPD Ultrasounds Outcomes 52

PulmCCM

JUNE 10, 2024

Background I’m not sure if you’ve noticed this, but patients and families frequently disagree with their physicians about the likely outcomes from critical illness. 3 days for anoxic encephalopathy to regain pupillary responses after cardiac arrest, 4-7 days for a DNR/DNI patient to receive NIPPV for COPD exacerbation, etc.)

COPD 45

COPD Outcomes Hospitals EMS 45

Sensible Medicine

JUNE 30, 2023

1] Would the outcomes be different? He had COPD and depended on home oxygen. From a professional standpoint, there is no question that my answer to the final question would be, “the past.” ” There are a dozen or so patients that I want a second chance at. Would some of the people still be here?

Hospitals 98

Hospitals Hospice Resuscitation COPD 98

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.

COPD 61

COPD Wellness Outcomes Operations 61

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

He has a history of chronic obstructive pulmonary disease (COPD), hypertension (HTN), congestive heart failure (CHF), and benign prostatic hypertrophy (BPH). All three showed no statistical difference between the two treatments for their primary outcome ( SGEM#69 , SGEM#92 and SGEM#113 ). He’s afebrile.

Sepsis 40

Sepsis Emergency Department COPD Hospitals 40

Mind The Bleep

NOVEMBER 21, 2023

Ensure you management plan includes how you plan to rule out any immediate concerns and what the outcome is likely to be if normal. Your trust will have guidelines on the treatment regimen using chlordiazepoxide/lorazepam and pabrinex.

Documentation/Coding 52

Documentation/Coding COPD EKG/ECG Wellness 52

Taming the SRU

MARCH 17, 2023

mepivacaine (1-3 h) 1% lidocaine +/- epi (2-3h) 0.25% bupivacaine (2-3 h) 0.25-0.5% mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2

Seizures 40

Seizures Fractures Burns Pediatrics 40

EB Medicine

OCTOBER 1, 2018

Sepsis is coming in at a higher readmission rate and cost per admission than acute MI, CHF, COPD, and PNA. Be careful just sending a patient who is on the fence to the floor because several studies have demonstrated that patients who are later upgraded have worse outcomes. Jeff : Next we have epinephrine.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Sensible Medicine

SEPTEMBER 22, 2024

In studies, and in practice, these people tend to be patients with COPD who have resting O 2 sats of < 88%. The primary outcome was a composite of hospitalization or death from any cause within one year. About 80% had either COPD or pulmonary fibrosis and the mean PaO 2 and O 2 sats were about 50mm Hg and 80%, respectively.

COPD 115

COPD Outcomes Shock Hospitals 115

ACEP Now

JUNE 14, 2024

Chronic obstructive pulmonary disease (COPD) is a chronic disease of the lungs caused by inflammatory and structural changes of the small airways and parenchyma of the lungs that result in chronic airflow obstruction and gas trapping. In 2019, the global prevalence of COPD was estimated to be 10.3 Click to enlarge.

COPD 52

COPD Hospitals Emergency Department Outcomes 52

EMDocs

FEBRUARY 12, 2024

Louis); Marina Boushra, MD (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case Emergency Medical Services brings in a 62-year-old male with COPD in acute on chronic hypoxemic respiratory failure (usually on 3 L nasal cannula, now on non-rebreather at 15 L/min). Notably, in the initial analysis of blunt chest trauma (i.e.

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

The Skeptics' Guide to EM

MARCH 25, 2018

Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review. Christina loves serving as […] The post SGEM#212: Holding Back the Years – Risk Factors for Adverse Outcomes in Older Adults with Blunt Chest Trauma first appeared on The Skeptics Guide to Emergency Medicine. Reference: Sawa et al.

Outcomes 40

Outcomes Geriatric Emergencies Emergency Department COPD 40

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

PulmCCM

OCTOBER 23, 2023

Read in JAMA Does Paxlovid Improve Covid-19 Outcomes in the Omicron Era? Even people with COPD or asthma under age 50 did not benefit from Paxlovid, in that analysis. absolute risk reduction in the composite outcome among the immunocompromised or those with significant medical conditions. Paxlovid was associated with about a 1.5-2.5%

Hospitals 98

Hospitals COPD Emergency Department CDC 98

PulmCCM

SEPTEMBER 28, 2023

Systemic corticosteroids (such as intravenous dexamethasone) improve outcomes in severe pneumonia due to SARS-CoV-2 infection. It makes sense that inhaled steroids might improve outcomes from less severe infections. Do inhaled steroids improve Covid pneumonia? About two thirds of patients in each arm were vaccinated.

COPD 95

COPD Stroke Academics Urgent Care 95

The Skeptics' Guide to EM

JANUARY 22, 2022

There is strong evidence that systemic steroids improve outcomes in patients with severe COVID-19 ( First10EM: Steroids for COVID ). Their primary outcome was a ‘COVID-19 related’ urgent care visit, emergency department assessment, or hospitalization, and was significantly reduced in the budesonide arm (15% vs 3%, p=0.009).

Urgent Care 40

Urgent Care COPD Outcomes Emergency Department 40

Dr. Smith's ECG Blog

FEBRUARY 18, 2025

Written by Willy Frick A man in his 50s with COPD presented with dizziness and hypotension. The patient's long term outcome is unknown. He had worked overnight the night before and presented to the hospital after his shift. His first recorded blood pressure was 88/53 mm Hg. Here is his presenting ECG: What do you think?

EKG/ECG 63

EKG/ECG COPD CPR Administration 63

Taming the SRU

NOVEMBER 18, 2024

Additionally, cardiac instrumentation, recent procedures such as bronchoscopy/endoscopy, central venous catheter placement/displacement, aortic aneurysm, pneumonia, asthma, COPD, pleural effusion, and pericarditis can manifest as intractable hiccups through similar mechanisms. BMC Cancer. 2022;22:659. J Pain Symptom Manage. 2021;62(3).

Stroke 86

Stroke Administration COPD Dehydration 86

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Written by Magnus Nossen, edits by Smith The patient in today's case is an 85-year-old male with a history of COPD and dementia. The above said given the patient's age, co-morbidities, and the decision that he was not a surgical candidate, there was little to do clinically that would alter this patient's guarded outcome.

EKG/ECG 89

EKG/ECG Shock COPD Wellness 89

Sensible Medicine

JANUARY 3, 2024

I served the neighborhood of Austin, disproportionately debilitated by opioid overdoses, gun violence, and incarceration, not to mention COPD, diabetes and asthma. The predictable outcome has been mass hysteria. Direct evidence on hard clinical outcomes is needed. It was peak Delta wave on the West Side of Chicago.

CDC 143

CDC Allergic Reactions Hospitals COPD 143