AENJ: Current Issue

MAY 8, 2024

The article titled “Using Artificial Intelligence to Predict Adverse Outcomes in Emergency Department Patients With Hyperglycemic Crises in Real Time,” authored by C.

Emergency Department 40

Emergency Department Outcomes Sepsis Research 40

ACEP Now

JANUARY 5, 2025

The PREOXI trial compared oxygen mask pre-oxygenation versus noninvasive positive-pressure ventilation (NIPPV) in patients requiring intubation in emergency departments (EDs) and intensive care units. 1 The primary outcome was the frequency of observed hypoxemia, defined as any pulse oximetry reading below 85 percent.

Sepsis 40

Sepsis Research Airway Management Outcomes 40

Don't Forget the Bubbles

AUGUST 7, 2023

Heart rate (HR) and respiratory rate (RR) are THE major vital signs used in Advanced Paediatric Life Support ( APLS) guidance , sepsis guidelines , and Paediatric Early Warning Scores (e.g., Identify the percentage of children whose heart or respiratory rate would exceed the “severe” cut-off from the UK Sepsis Trust and NICE guidelines.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

Don't Forget the Bubbles

MAY 31, 2023

Children presenting with diabetes and diabetic ketoacidosis to Emergency Departments during the COVID-19 pandemic in the UK and Ireland: an international retrospective observational study. During the COVID-19 pandemic , we noticed a change in the type of patients presenting to the Emergency Department. Arch Dis Child.

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

ACEP Now

JULY 7, 2023

Emergency departments (EDs) focus on rapid initiation of medical treatment. Patients with sepsis get antibiotics. However, rapid initiation of treatment is actually patient-centered care that can both lead to better outcomes and limit ED boarding. Ann Emerg Med. West J Emerg Med. Am J Emerg Med.

Emergency Department 52

Emergency Department Psychiatric Administration Best Practices 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. When seven South Florida gluteal AFT patients died tragically in one year alone, the Florida Board of Medicine issued an emergency regulation restricting fat injection to the subcutaneous space rather than injecting into muscle. units per patient. Plast Reconstr Surg.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. 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

The Skeptics' Guide to EM

OCTOBER 14, 2023

Case: A 5-year-old boy presents to the emergency department (ED) with his parents for fever and fatigue. We have been reading online about something called sepsis that can be deadly. Does he have sepsis?” Specifically, heart rate and respiratory rates are used in early attempts to detect sepsis.

Pediatrics 87

Pediatrics Sepsis Urgent Care Emergency Department 87

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. The primary outcome was the successful intubation on the second attempt. Secondary outcomes included tracheal intubation adverse events (TIAEs) or severe desaturation.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

The Skeptics' Guide to EM

SEPTEMBER 25, 2021

Most emergency department patients meeting sepsis criteria are not diagnosed with sepsis at discharge. Guest Skeptic: Dr. Jess Monas is a Consultant in the Department of Emergency Medicine at the Mayo Clinic Hospital, Phoenix, Arizona. Background: We have covered sepsis many times on the SGEM since 2012.

Sepsis 40

Sepsis Emergency Department COPD Hospitals 40

Sensible Medicine

JULY 29, 2024

Yet the failure of the hospital readmission penalty policy and sepsis protocols expose the risks of implementing a policy because it sounds good. The background for cash giveaways stem from the association of low income and worse health outcomes. Their primary endpoint was emergency department visits.

Outcomes 106

Outcomes Research Sepsis Emergency Department 106

EMDocs

DECEMBER 18, 2024

A 36-year-old male presents to the emergency department after being found down at home by his spouse. Alcohol withdrawal syndrome: improving outcomes through early identification and aggressive treatment strategies. Emerg Med Pract. Acad Emerg Med. 2015; 17(6): 1-19. Borgundvaag B, Bellolio F, Miles I, et al.

Seizures 88

Seizures Emergency Department Hyperthermia / Hypothermia EMS 88

RebelEM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). Amiodarone versus digoxin for acute rate control of atrial fibrillation in the emergency department. Am J Emerg Med. Am J Emerg Med. 2022 Sep 7.

Emergency Department 52

Emergency Department Administration EMS Dehydration 52

Critical Care Now

JULY 14, 2024

For example, let’s say I want to examine the efficacy of using lemonade to treat sepsis (an absurd, clinically improbable example made to illustrate the principles discussed here – although the LOVIT trial did happen… ). Three studies were included – ARREST, Prague OHCA and INCEPTION.

Resuscitation 98

Resuscitation CPR Outcomes Sepsis 98

RebelEM

JULY 17, 2023

Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. RSI inherently carries with it risks of complications such as post-intubation hypotension and cardiac arrest in the most extreme cases. Range 5 to 9) Diff -0.2;

Outcomes 95

Outcomes Administration Emergency Department Resuscitation 95

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

The Skeptics' Guide to EM

FEBRUARY 17, 2018

Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Case: EMS is dispatched to a retirement […] The post SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis. first appeared on The Skeptics Guide to Emergency Medicine. The Lancet Nov 2017. The Lancet Nov 2017.

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane). 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 94

Sepsis Fractures Documentation/Coding Administration 94

EMDocs

AUGUST 24, 2023

Study design Multicenter prospective observational cohort study across seven urban emergency departments. Blood Culture Results Before and After Antimicrobial Administration in Patients With Severe Manifestations of Sepsis: A Diagnostic Study. Exclusion criteria: Severe coagulopathy A platelet count below 20, 000 INR > 6.0

Administration 69

Administration Sepsis Shock Outcomes 69

EM Updates

JUNE 15, 2021

Maimonides Medical Center (MMC) is Brooklyn’s largest hospital, an academic quaternary care center with, in normal times, 711 total beds, 66 intensive care beds, and an Emergency Department that treats approximately 120,000 patients per year. On March 9, the first patient with a novel coronavirus infection was admitted to MMC.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

The Skeptics' Guide to EM

JUNE 6, 2020

Max Hockstein trained as an Emergency Medicine physician at University of Texas Southwestern and is finishing his Intensive Care fellowship at Emory. Case: It’s another day in your emergency department (ED). Background: I think we have covered sepsis more often than any other topic on the SGEM. increase in MAP).

Sepsis 52

Sepsis Shock Resuscitation Administration 52

EMDocs

JANUARY 11, 2025

Clinical exam: 2, 3, 9 Abdominal distension and tenderness Nausea and vomiting Stool present in the rectal vault Peritonitis may be accompanied by hemodynamic instability in the case of sepsis. 2-4, 6 If there is a concern for perforation or sepsis, surgical consultation, blood cultures, empiric antibiotics, and fluids are recommended.

EMS 72

EMS Sepsis Shock Fluid Resuscitation 72

Don't Forget the Bubbles

JULY 17, 2023

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. Clinical Outcomes of COVID-19 in Newborns and Infants: A Multicenter Experience of 576 Cases. 2023 Jun Oral food challenge outcomes in children and adolescents in a tertiary centre: A 5-year experience. Paediatr Child Health. Van Rossem EJD, et al.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Guest Skeptics: Dr. Erin Willard is a PGY-3 Emergency Medicine Resident, Department of Emergency Medicine, University of Arkansas for Medical Sciences. Critical Care Medicine.

Sepsis 52

Sepsis Shock Outcomes Stroke 52

Taming the SRU

MAY 5, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. N Engl J Med. 2023;388(6):499-510.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. Sepsis PCT may have some utility in guiding posttest probability for sepsis when the diagnosis is unclear.

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

Don't Forget the Bubbles

JULY 22, 2024

Randomised controlled trials addressing the benefit of steroids in preschool wheeze have compared different cohorts, used different trial designs and measured different outcomes. This is a way to overcome different trial outcomes. This paper’s primary outcome was a change in wheeze severity score (WSS). What does this mean?

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

Taming the SRU

JUNE 11, 2023

End-tidal carbon dioxide measured at emergency department triage outperforms standard triage vital signs in predicting in-hospital mortality and intensive care unit admission. Acad Emerg Med 2023; 10.1111/acem.14703 The primary outcome was in-hospital mortality. The secondary outcome focused on ICU admissions.

Hospitals 86

Hospitals Emergency Department EMS Outcomes 86

EM Curious

JULY 8, 2015

LACTATE KNOWLEDGE BOMB UNDERSTANDING LACTATE IN SEPSIS [BLOG]: Raise your hand if you think elevated lactic acid in sepsis is from anaerobic metabolism? BENIGN EARLY REPOLARIZATION [BLOG]: Have a quick skill brush-up on this common ECG finding that could be looking quite concerning if you are not familiar with it.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Don't Forget the Bubbles

MAY 8, 2024

An interesting study (JAMA Pediatrics) shows the benefits of newborn screening for spinal muscular atrophy (SMA), as initiating disease-modifying therapy earlier improves clinical outcomes. These findings advocate for expanding newborn screening programs to enhance outcomes for children with SMA. Dell KM, et al. Akkaya B et al.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

EB Medicine

SEPTEMBER 1, 2018

Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Don't Forget the Bubbles

NOVEMBER 18, 2024

Research and guidelines from Australian centres, like those published by the Australian and New Zealand Neonatal Network (ANZNN), emphasize early detection and management to improve outcomes. Sepsis: This can induce widespread vasodilation and capillary leak, exacerbating hypotension.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

The Skeptics' Guide to EM

JANUARY 15, 2022

Intensive Care Med 2021 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a professor of Emergency Medical Services at Tacoma Community College’s paramedic program. Trial: Prospective, randomized, parallel-assignment, open-label, single-center trial ( NCT02643381 )

Sepsis 42

Sepsis Shock Emergency Department Outcomes 42

Don't Forget the Bubbles

MAY 17, 2023

This month’s list features answers to intriguing questions such as: ‘ Is the neonatal sepsis calculator useful if women were not screened for GBS? ’, ‘ Who can best score postoperative pain: parents or the children? ’, ‘ Is functional constipation associated with hypohydration? Diagnosis and Management of Pituitary Adenomas: A Review.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

The Skeptics' Guide to EM

JULY 16, 2022

Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. Rezaie completed his medical school training at Texas A&M Health Science Center and continued his medical education with a combined Emergency Medicine/Internal Medicine residency at East Carolina University. Date: July 16th, 2022 Reference: Lamontagne F et al.

Sepsis 40

Sepsis Shock Outcomes EMS 40

RebelEM

OCTOBER 5, 2023

Background: Community-acquired pneumonia (CAP) can lead to pulmonary and systemic inflammation, resulting in impaired gas exchange, sepsis, organ failure, and an increased risk of death. Secondary Outcome By day 90, mortality was 9.3% 5148 excluded 800 enrolled and randomized in the trial. in the hydrocortisone group vs. 11.9%

Research 94

Research Outcomes Administration Shock 94