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Chuck Pilcher, MD, FACEP Editor, Medical Malpractice Insights Editor, Med Mal Insights Excellent documentation supports standard of care, avoids lawsuit Vertebral artery CVA leaves patient disabled. Code Stroke is called and he is seen by a neurologist within 10 minutes. He undergoes a thrombectomy, but his outcome is poor.
Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. Below you will find some of the points we discussed.
PMID: 31082090 Post Peer Reviewed By: Anand Swaminathan MD, MPH (Insta @EMSwami) The post Elbow Dislocations appeared first on REBEL EM - Emergency Medicine Blog. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.
Now let’s look at the actual sequence, with the addition of clinical context, and see how the patient was managed: The patient received aspirin from EMS and arrived at triage painfree (ECG #1). What was the outcome and final diagnosis? But that’s not always the case.
Written by Pendell Meyers A man in his 40s called EMS for acute chest pain that awoke him from sleep, along with nausea and shortness of breath. Long term outcome is unavailable. For clarity in Figure-1 — I've labeled the 2 EMS ECGs and the baseline ECG recorded ~1 month earlier.
A critical MORSEL is that every child you treat for DKA needs to have an initial thorough neuro exam including cranial nerves and then frequent neuro reassessments … and document it ( so your colleagues who take over care for the kid can know if there has been a change )! Is your patient hyperglycemic, acidotic, with ketonuria?
Exam documents that he is alert and oriented but “tired appearing” and “not appearing post-ictal.” Defense : The EP did address the seizure when he documented “not post-ictal.” There is no negligence, as the documentation supports reasonable judgment. EM is a “team sport.” VS are normal with a temp of 97.3.
Her first set of vitals were documented: BP 116/57 Pulse 94bpm Respiratory rate 24/min O2 sat 90% on room air Temp 97F She had been cleaning a Jeep in the sun, and was sunburned. The physician documented “normal sinus rhythm”. The physician documented that she was “improved” and the patient was discharged. CK MB was 1.9
Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table. A code stroke is activated, and a CT head shows a left basal ganglia hemorrhage with no vascular lesions on CT angiography. Reversal of Warfarin: Freeman et al.
This document is an update of guidelines first published in 2000, and then updated in 2007. These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations.
13 Interventions may include: Ascertaining a patient’s preferred language early in the clinical encounter (during registration, for instance), and clearly documenting this preference in a place that is visible to all providers. Utilizing certified interpreters and documenting their use. Educating patients on their rights.
This story, while unlikely to reflect the standards of most readers, has a somewhat surprising outcome. An unknown EP reviews the report, determines that there is no reason to notify the patient, and documents nothing. An attorney is consulted and a lawsuit filed against the hospital, the first ED physician, the EM group, and the PCP.
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 to 4.0mg/hr typically given in EKOS therapy (See Below).
Outcomes: Primary Outcome: In-hospital mortality. Secondary Outcomes: Delayed hypotension, increased ICU stay, and other relevant outcomes. There was no specified time-frame for the primary outcome, potentially affecting the precision of the findings. Mayo Clin Proc Innov Qual Outcomes. 2.89, p = 0.01.
hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Outcomes: Primary Outcome: Visual Acuity (VA) Improvement Measured using logarithm of the minimum angle of resolution (logMAR). Within 24 hours after treatment. 1 week after treatment.
Pregnant or incarcerated patients Documentation for systolic BP is incomplete Intervention: Administration of IV calcium within 60 min prior to or 30 min after IV diltiazem administration in patients with AF/AFL with RVR. Limitations: The primary and secondary outcomes were nearly all disease oriented and not patient oriented.
r1 clinical knowledge - r4 capstone - research grand rounds - the art of em - Community corner - PEM Lecture r1 Clinical knowledge: transplant complications WITH dr. gabor Time-sensitive peri-transplant emergencies: Bleeding fistula- stop the bleed. Flood syndrome- start fluids, give antibiotics, consult surgery.
A proportion of the patients who were initially missed using the CDR were found to actually have risk factors documented in EMS reports or the medical record. Were the predictor variables and the outcome evaluated in a blinded fashion? Were the predictor variables and the outcome evaluated in the initial sample?
EMS had reported she had coded en route. ED providers should be familiar with several extraction techniques for foreign bodies in the external auditory canal including the use of manual extractors, irrigation, and other methods such as adhesives and acetone. She regained pulses with warming on arrival.
Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.
He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR […] The post SGEM#329: Will Corticosteroids Help if…I Will Survive a Cardiac Arrest? He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR Safety Team. first appeared on The Skeptics Guide to Emergency Medicine.
He had no previously documented medical problems except polysubstance use. About 2 hours later the patient arrived at a PCI-capable center and repeat ECG was obtained: The transferring EMS crew noted “runs of VT” during transport. FINAL Point: During transport to the PCI center — the EMS crew noted, "runs of VT". Washam, J.
One case report highlighted an unfortunate outcome from aspiration pneumonia, later found to be due to crayons rather than the expected culprits such as food, secretions, or beverages. This makes documentation and communication of the utmost importance for these patients for their health and safety. EM Resident. J Emerg Med.
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 (..)
A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. A Contemporary Analysis Using National EMS Information System (NEMSIS) Data. The EMS crew arrives and performs a 3 lead EKG that does not show an ST elevated myocardial infarction. Date: April 24th, 2020 Reference: Watanabe et al.
This was not a Code 3 respiratory distress, fentanyl overdose with minimal response to Narcan or even an unconscious stroke patient with the blood pressure of a giraffe. How does “resulting” or the tendency to equate a decision’s quality with its outcome affect learning in and after residency? How would the hemodynamics respond to RSI?
Somewhat surprisingly, we’ve never covered SBO on the SGEM, although Ped EM Superhero, Dr Anthony Crocco shared his views on the (lack of) utility of abdominal X-rays in paediatric constipation back in 2016 ( SGEM Xtra: RANThony#4 ). Charles Brower is a second-year resident training in Emergency Medicine at the University of Cincinnati.
Emergency Department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. Joint Position Statement of Nat Assoc EMS Physicians and ACS Committee on Trauma. Emergency thoracotomy in thoracic trauma: a review. Injury; 2006 (37): 1-19. Clay et al. World Journal of Emergency Surgery; 2006: 1:4. Rhee et al.
It can be challenging and time consuming to access the information required to reflect upon their clinical practice by reviewing the outcomes of their individual patients, referred to as patient follow-up. Patient outcomes are commonly documented in electronic health records (EHR). It was implemented in December 2020.
Written by Jesse McLaren A previously healthy 60 year old developed exertional chest pain with diaphoresis, and called EMS. Here’s the EMS ECG, digitized with PM cardio. What do you think? There’s sinus arrhythmia with normal conduction, normal axis and normal voltages. There’s loss of R waves in V2-3 with hyperacute waves V1-5.
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).
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. appeared first on REBEL EM - Emergency Medicine Blog.
NEJM Oct 2019 Guest Skeptic: Dr. Laura Melville (@lmelville535) is an emergency physician in Brooklyn, New York, is a part of the New York ACEP Research Committee, ALL NYC EM, and is the NYP-Brooklyn Methodist Resident Research Director. Case: A 59-year-old woman comes is brought into your emergency department (ED) by EMS in cardiac arrest.
The study by Alam et al took adult patients with a diagnosis of suspected infection and randomized them to ceftriaxone 2g IV started pre-hospital or usual care with a primary outcome of all-cause mortality at 28 days. The Surviving Sepsis Campaign makes a number of recommendations in their 2016 guideline.
I have been a part of many traumatic codes and resuscitations during my training, but I knew this one would probably be my most difficult one. Early contact with Medcom ensured that they would be able to activate one of the most effective and competent air EMS teams in the state – AirCare. Should be here in 5 minutes.” She was calm.
Despite adherence to strict ACLS protocols, neurologic outcomes remain poor. The VA-ECMO set-up is specifically used for eCPR Meta-analyses for eCPR have shown aggregate survival rates with good neurologic outcomes up to 21.3% Debrief codes and odd encounters for yourself, your team, and your hospital system. R2 CPC: WITH drs.
The MR CLEAN trial showed improved functional outcome if endovascular therapy was initiated within 6 hrs. Finally, we are reminded of a Rebel EM post that gives an awesome break down of the literature surrounding endovascular therapy. Shout out to University of Cincinnati EM, who took home 1 st place in the sim competition.
Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. This is a critical error that leads to poorer outcomes for patients in need of critical care. Unfortunately, its not clear whether the documentation came from RTs or ED providers.
Case: You are working a regular shift in the emergency department when you hear a code blue called. SGEM#64 : Classic EM Papers (OPALS Study) * SGEM#136 : CPR – Man or Machine? From a patient oriented outcome perspective, more than 80% of adults with IHCA who do survive end up having a favorable neurologic outcome at discharge.
On investigating you find a collection of nursing, EMS and hospital security personnel surrounding an obviously agitated patient with blood on his head who is attempting to punch them. Exclusions: Prisoners or those in police custody, pregnant or breast-feeding, or with documented allergy to any study medications.
Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. Would you be satisfied with only US and no follow-up CT?
He also hosts a great #FOAMed blog and podcast called TOTAL EM. Exclusions: There were 26 exclusions in their supplemental documentation. Guest Skeptic: Chip Lange is an Emergency Medicine Physician Assistant (PA) working primarily in rural Missouri in community hospitals.
Guidance documents College of Paramedics Statement on Intubation, available here. The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury. Difficult prehospital endotracheal intubation – predisposing factors in a physician based EMS. Tracheal intubation. 20(12);681-686.
It is well documented with continuous 12-lead monitoring that acute re-occlusion is frequently asymptomatic. It shows that on a 7 day angiogram, only 58% of re-occlusions were symptomatic: Ohman EM, Califf RM, Topol EJ et al. Silent ischemia as a marker for early unfavorable outcomes in patients with unstable angina.
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