Sensible Medicine

MAY 22, 2023

See screenshot: The endpoint was the proportion of patients whose chart had a documented goals of care care discussion. In a university hospital system known for its strength in palliative care, only a third of seriously ill patients in the intervention arm have a documented goals of care discussion. The absolute risk difference of 4.1%

Documentation/Coding 57

Documentation/Coding Hospitals Shock Outcomes 57

Ken Grauer, MD

FEBRUARY 28, 2023

These 2 settings are: i ) In patients with severe , often longstanding pulmonary disease ; and / or , ii ) In acutely ill patients with multi-system disease ( ie, sepsis, shock, electrolyte and/or acid-base disorders ). MAT almost always occurs in one of 2 common predisposing settings.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). Trauma: In the trauma setting, metabolic acidosis often occurs secondary to hypoperfusion from hemorrhagic shock.

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Long term outcome is unavailable. Smith : LAD OMI with RBBB/LAFB is not only subtle on the ECG, but most of these patients are extremely ill: most I have seen are post-ROSC, in cardiogenic shock, or arrested shortly after. Post cath EF was estimated at 15% with severe global hypokinesis, and akinesis of the apex.

EKG/ECG 86

EKG/ECG EMS Documentation/Coding Shock 86

RebelEM

MARCH 2, 2023

Essentially there was no difference, meaning we wouldn’t expect to find a difference in outcomes Although not patient oriented, why is there no breakdown of how many patients had cardiogenic shock, congestive heart failure, echocardiographic findings, or even troponin levels. Low O2 protocol: 3.1% aOR 0.96, 95% CI 0.86

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52

Dr. Smith's ECG Blog

AUGUST 9, 2024

He had no previously documented medical problems except polysubstance use. Opioids associate with worse outcomes in myocardial infarction , probably because they eliminate the pain signal that informs the clinician of the urgency of revascularization. These diagnoses were not found in his medical records nor even a baseline ECG.

EKG/ECG 88

EKG/ECG EMS Emergency Department Outcomes 88

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

JANUARY 11, 2024

Individualize the choice of using inotropes, vasopressors, or fluids to treat post-CA hypotension and to target the likely cause(s) contributing to the shock and hemodynamic state (100%, 23/23). In patients with enteral intolerance or shock, start with trophic EN (rates of 10–20 mL/h) and adjust according to tolerance (91%, 19/21).

Seizures 75

Seizures Shock Infectious Diseases CPR 75

Mind The Bleep

FEBRUARY 27, 2024

The children who received no bolus had significantly better outcomes and reduced mortality compared to the two bolus group. [2] saline vs balanced crystalloid solutions for initial fluid management in the treatment of septic shock which may give us more insight into this topic. [5] Boluses were given in 20-40ml/kg aliquots.

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

RebelEM

NOVEMBER 30, 2023

Current SSC guidelines recommend fluid resuscitation with at least 30mL/kg IV crystalloid in patients with sepsis induced hypoperfusion or septic shock within the first three hours of resuscitation, regardless of comorbidities. Outcomes: Primary Outcome: In-hospital mortality. 2.89, p = 0.01. times more intubations and 2.15

Sepsis 113

Sepsis Fluid Resuscitation Resuscitation Administration 113

RebelEM

OCTOBER 5, 2023

Secondary Outcome By day 90, mortality was 9.3% Strengths: The investigators framed a research question centered on patient outcomes, ensuring the study’s relevance and practicality. Control: Normal Saline via continuous infusion according to the same regimen used in the hydrocortisone group. in the placebo group (p = 0.006).

Research 93

Research Outcomes Administration Shock 93

Don't Forget the Bubbles

JULY 26, 2023

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

RebelEM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

Outcomes 74

Outcomes Hospitals Operations Shock 74

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.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

EB Medicine

MARCH 1, 2019

Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. Post opiate hypotension in prehospital trauma patients is a rare but documented complication. The latter also recommend ED thoracotomy in those with refractory shock.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47

Stroke 133

Stroke Outcomes Hospitals Administration 133

Pediatric Emergency Playbook

APRIL 1, 2016

There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We could use it to track treatment , and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults. Clinical Chemistry.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. And sepsis-3 redefined septic shock as “hypotension not responsive to fluid resuscitation” with the added requirement of vasopressors to maintain a MAP greater than or equal to 65 and with a lactate > 2. That’s where we’re at.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

EB Medicine

AUGUST 6, 2019

In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Jeff: That is simply shocking! of patients per year. Let’s also talk lab studies.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EB Medicine

JUNE 6, 2019

Nachi: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic. Nachi: Moving on to blood pressure: frank hypotension should make you immediately think of a ruptured AAA or septic shock 2/2 an intra abd infection. In one study, a SI > 0.7 Jeff: As for the lactate.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. 4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. This is a critical error that leads to poorer outcomes for patients in need of critical care.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

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 Wellness Psychiatric 63

EB Medicine

JULY 8, 2019

Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. with generally good clinical outcomes including improved quality of life and reducing or staving off comorbidities.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

RebelEM

SEPTEMBER 26, 2022

Randomized study design Blind adjudication of transfusion reaction outcomes Follow-up was complete. The primary outcome was disease-oriented The enrolled cohort appears to be a convenience sample Sealed envelopes are a weak type of allocation and prone to error and manipulation. Significant coagulopathy: INR > 1.8

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

EB Medicine

AUGUST 1, 2018

Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 In fact, cannabis use has been documented for medical use dating as far back as 600 BC in West and Central Asia. Marijuana actually maintains the highest lifetime use of an illicit drug used within the US.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EB Medicine

JANUARY 2, 2019

With opportunities to improve outcomes for both the fetus and the mother, I’m confident that this episode will be worth your time. Nachi: For patient who have a threatened miscarriage in the first trimester, there is a 2-fold increased risk of subsequent maternal and fetal adverse outcomes.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

EB Medicine

MAY 3, 2019

Jeff: And finally, how many of you wish there was a clearly outlined evidence-based approach to managing such patients to improve care and outcomes? Jeff: And while it seems crass to even mention the financial impact, the number is shocking - suicide has an estimated economic burden of $5.4 Nachi: That would certainly be helpful.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

Don't Forget the Bubbles

NOVEMBER 5, 2023

Reviews and opinion articles An update on the role of fluid overload in the prediction of outcome in acute kidney injury. Parental physical disease severity and severe documented physical child abuse: a prospective cohort study. Newborn and Early Infant Outcomes Following Maternal COVID-19 Vaccination During Pregnancy.

Pediatrics 105

Pediatrics Hospitals Infectious Diseases Outcomes 105

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. coli and Staphylococcus aureus.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Sensible Medicine

SEPTEMBER 4, 2024

Furthermore, this administration just paid for more COVID19 tests without data that these tests improve outcomes. It’s shocking how many of you read and support our effort. There is no evidence to support aggressive boosting, and it may be harmful. Yet, this recommendation lacks high-quality evidence, per the UK Cass report.

Administration 128

Administration Operations CDC Documentation/Coding 128