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.

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Emergency Department Outcomes Sepsis Research 40

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.

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Emergency Department Operations Ultrasounds Shock 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.

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Emergency Department Operations Academics Documentation/Coding 52

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity.

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Resuscitation Shock Stroke Hospitals 98

EMDocs

AUGUST 24, 2023

Study design Multicenter prospective observational cohort study across seven urban emergency departments. 18.6%) Takeaways: Drawing blood cultures 30-120 min and 30-240 min after antibiotics has significant decrements in the rate of culture positivity in patients with septic shock. Difference of 12% (95% CI 5.4

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Administration Sepsis Shock Emergency Department 96

EMDocs

DECEMBER 23, 2024

Do we still shock? Gorgels et al (5) looked at procainamide vs lidocaine and again and primary outcome was VTach termination. Its narrow indication for stable VT means many emergency departments may not routinely stock the medication. If the patient has a BP of 60/palp, its easy, right? Are there any meds you can give?

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EKG/ECG Shock Wellness EMS 75

ALiEM

OCTOBER 30, 2024

Bupe Allergy Buprenorphine induction has been the mainstay of emergency department treatment of opioid use disorder for more than a decade [11, 12]. Emergency department-initiated buprenorphine for opioid dependence with continuation in primary care: outcomes during and after intervention. 2017 Jun;32:660-6.

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Emergency Department Operations Psychiatric Hospitals 64

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.

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Administration Emergency Department Outcomes Documentation/Coding 98

RebelEM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

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Ultrasounds Outcomes COPD Hospitals 129

ACEP Now

OCTOBER 10, 2023

A 76-year-old female presents to the emergency department obtunded with left hemiplegia. Both INTERACT-2 and ATACH-2 showed no statistical difference in their primary outcome between intensively lowering the BP and a less-intensive strategy. Symptoms began just prior to presentation. Her blood pressure (BP) is 195/104 mmHg.

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Outcomes Stroke Emergency Department Hospitals 52

Taming the SRU

SEPTEMBER 21, 2023

Exclusion criteria were pre-intubation hypotension, use of topical anesthesia, or missing data including primary outcome, patient weight, etomidate / ketamine dose. Primary outcome was post-intubation hypotension, defined as SBP < 100mg Hg within the first 15 minutes post-intubation.

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Outcomes Emergency Department Shock 93

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The children’s Emergency department sees approximately 50,000 presentations per year. International Consensus Criteria for Pediatric Sepsis and Septic Shock.

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Hospitals Sepsis Fractures Emergency Department 78

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. He writes an […] The post SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock first appeared on The Skeptics Guide to Emergency Medicine. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018.

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Shock Sepsis Emergency Department Resuscitation 40

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Assessment was severe sudden cardiogenic shock. He remained hypotensive and in shock. The physicians found him to be in s hock, with very poor O2 saturations. What is it? There is STE in V2-V6.

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Shock EKG/ECG Outcomes Hospitals 52

Taming the SRU

JANUARY 10, 2024

89% agree that violence in the emergency department has harmed patient care. Phenobarbital has been proven to be equivalent to benzodiazepines with regard to clinical, pharmacologic and utilization outcomes. None of the physicians in the study believe that the rate of violence has decreased at all.

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EKG/ECG Shock Fractures Dislocations 93

Don't Forget the Bubbles

OCTOBER 10, 2024

The others, such as respiratory rate, heart rate, and decompensated shock, were excluded due to the presumed difficulty for non-healthcare professionals to assess them accurately. Reviewed by: Isabella Davenport Article 2: Does it improve outcomes if you replace the nail in nail bed repair? The assessors scored both groups 5.

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Emergency Department Outcomes Research Operations 75

ACEP Now

JUNE 6, 2023

When considering an optimized environment for compassionate patient communication, the chaotic emergency department (ED) probably gives some clinicians pause. Example: “ I can imagine this comes as a shock” or “ I can hear how upset you are.” Example: “Would it be okay for me to share some of my concerns?”

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Emergency Department Hospitals Best Practices Shock 98

The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Guest Skeptic: Dr. 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).

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Sepsis Shock Resuscitation Administration 52

RebelEM

APRIL 29, 2024

Given AHA guidelines recommend early epinephrine administration in cardiac arrest, obtaining access is imperative for resuscitative efforts ( 9) When evaluating over 300,000 out-of-hospital cardiac arrests, a meta-analysis found no significant change in primary outcomes when IV and IO access were compared ( 10 ). Crit Care Med. Resuscitation.

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Resuscitation Administration Emergency Department Ultrasounds 105

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).

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Research Outcomes Administration Shock 94

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.

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Sepsis Pediatrics Outcomes Documentation/Coding 75

EMDocs

JANUARY 4, 2024

Cardiogenic shock and hypotension can occur (systolic heart failure with reduced ejection fraction.) 10,12 Refractory shock or malignant arrhythmias occur in < 5% of patients. Whole bowel irrigation: 3 Not routinely performed and limited evidence to support improved outcome in general. World J Emerg Med.

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Seizures EKG/ECG Poisoning Shock 94

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

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Ann Emerg Med. link] Published April 13, 2023.

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Hyperthermia / Hypothermia Resuscitation CPR EMS 110

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.

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Sepsis Shock Outcomes Stroke 52

The Skeptics' Guide to EM

AUGUST 14, 2021

Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Circulation 2020 Guest Skeptic: Missy Carter is a PA practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program.

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Shock CPR Hyperthermia / Hypothermia EMS 52

EB Medicine

MARCH 1, 2019

This month, after a few months of primarily medical topics, we’re talking trauma, specifically Blunt Cardiac Injury: Emergency Department Diagnosis and Management. Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema.

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Emergency Department EKG/ECG Operations Fractures 40

EM Literature of Note

MARCH 2, 2023

First, and not least, the Annals of Emergency Medicine Podcast , the Ryan and Rory Show, recapping the articles from each month’s issue, available for free on your choice of streaming platforms: Apple Podcasts Google Podcasts Soundcloud Then, there’s always something to learn from ACEP Now!

Emergency Department 52

Emergency Department Resuscitation Shock EMS 52

RebelEM

NOVEMBER 20, 2023

Military practice guidelines recommend REBOA for profound shock (SBP <90mmHg) 1 and ACEP along with the American College of surgeons recommend REBOA for traumatic life-threatening hemorrhage below the diaphragm in patients with hemorrhagic shock who are unresponsive or transiently responsive to resuscitation.

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Resuscitation Operations Outcomes Hospitals 91

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. below) Other examples of AIVR: Young man with Gunshot wound to right chest with hemorrhagic shock, but bullet path not near heart.

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EKG/ECG EMS Emergency Department Wellness 107

Taming the SRU

MAY 5, 2023

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. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

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Sepsis Shock Administration Resuscitation 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. 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.

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Resuscitation Operations Sepsis Pediatrics 139

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. Both agents are considered hemodynamically stable, but any induction agent may precipitate shock in the critically ill.

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Sepsis Shock Emergency Department Outcomes 43

PHEM Cast

APRIL 10, 2016

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. Am J Emerg Med. Severe Sepsis in Pre-Hospital Emergency Care. Academic Emergency Medicine. Emergency Medicine Journal. Prehosp Emerg Care.

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Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

EB Medicine

MAY 3, 2019

This month, we’re moving into uncharted territories for the podcast… we’re talking psychiatry Nachi: Specifically, we’ll be discussing Depressed and Suicidal Patients in the emergency department. The strongest predictor for suicide-related outcomes is history of prior suicidal ideation or suicide attempt.

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Emergency Department Psychiatric Documentation/Coding Outcomes 40

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

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Anaphylaxis Shock Sepsis Resuscitation 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. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause.

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Emergency Department Sepsis Operations Dehydration 40