St. Emlyn

JUNE 23, 2024

St.Emlyn's - Emergency Medicine #FOAMed Background Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality globally, with a survival rate of less than 10% despite emergency medical services (EMS) interventions.

Shock 86

Shock Outcomes Hospitals EMS 86

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. August 20, 2024 Guest Skeptic: Dr. Chris Root is an emergency medicine and emergency medicine service (EMS) physician at the University of New Mexico, Albuquerque. Chris completed his emergency medicine residency and EMS fellowship at UNM.

Hospitals 103

Hospitals CPR EMS Outcomes 103

EMDocs

OCTOBER 19, 2024

We’ll keep it short, while you keep that EM brain sharp. 2][3][9] Glucocorticoid were not shown to alter clinical course or patient outcomes. [2][3] Care Variations and Outcomes for Children Hospitalized With Bacterial Tracheostomy-Associated Respiratory Infections. Hospital Pediatrics. Rev Infect Dis.

EMS 106

EMS Pediatrics Sepsis Airway Management 106

Pediatric EM Morsels

APRIL 19, 2024

No formal follow up was scheduled Outcomes were: effectiveness, parental satisfaction, and economic benefits The majority of children wore their braces as directed (94%)There was no re-fractureAll parents were happy with the treatment (100%) and felt comfortable removing the brace (100%). West, 2005. Plint, 2006. J Pediatr Orthop.

Fractures 290

Fractures Pediatrics Best Practices Outcomes 290

ACEP Now

JUNE 21, 2023

emergency medicine (EM) residency training length has been a decades-long dilemma: four vs. three years. First, is three years enough time to become an EM physician? But critical questions remain unanswered when it comes to specialization, career trajectory, and actual competence as an EM physician. 11 What should we take away?

EMS 114

EMS Academics Telemedicine Operations 114

EMDocs

JULY 13, 2024

We’ll keep it short, while you keep that EM brain sharp. This patient appears septic and recently underwent a cesarean section delivery, which makes hospital admission and parenteral antibiotics the better choice for management. Incidence, treatment and outcome of peripartum sepsis. Am J Clin Pathol. 1999 Aug;112(2):211-5.

OB/GYN 81

OB/GYN EMS Sepsis Fluid Resuscitation 81

EMDocs

OCTOBER 21, 2023

We’ll keep it short, while you keep that EM brain sharp. The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Basilar artery occlusion remains a challenging diagnosis to make, and the delays in reaching the diagnosis can have considerable impact on health outcomes.

EMS 93

EMS Stroke Outcomes Hospitals 93

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. N Engl J Med. Epub 2023 Jun 15.

Hospitals 92

Hospitals Resuscitation Outcomes CPR 92

The Skeptics' Guide to EM

JULY 2, 2023

He is the Creator and founder of REBEL EM, a free, critical appraisal blog that tries to cut down knowledge translation gaps of […] The post SGEM#408: Hey, I, Oh I’m Still Alive – Is it due to TXA? Most of the times the RCTs we critically appraised did not demonstrate superiority for their primary outcome.

EMS 140

EMS Outcomes Hospitals Research 140

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. Methods This was a prospective observational study enrolling all patients who presented to the ED through the lobby and via EMS.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

Pediatric EM Morsels

JULY 21, 2023

We had just received a young child from EMS who was post-ictal with decreased mentation. Orso 2020] One pediatric study in this systematic review, and the intubated patients had worse outcome than non-intubated Early airway protection = lower rates of complications (in TRAUMA), but this is not always true with medical patients.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

RebelEM

JUNE 1, 2023

Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC. Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. In theory, rapid identification of the underlying cause should improve outcomes by allowing clinicians to tailor management.

Outcomes 144

Outcomes Resuscitation Hospitals CPR 144

EMDocs

NOVEMBER 18, 2023

We’ll keep it short, while you keep that EM brain sharp. Early hepatic artery thrombosis after liver transplantation: a systematic review of the incidence, outcome and risk factors. Sonographic diagnosis and outcome of hepatic artery thrombosis after orthotopic liver transplantation in adults. Am J Transplant. 2009;9(4):746-757.

EMS 89

EMS Ultrasounds Emergency Department Outcomes 89

RebelEM

FEBRUARY 15, 2024

PMID: 38019968 Clinical Question: In patients with suspected acute poisoning and GCS <9, is a conservative airway strategy of withholding intubation associated with a reduction in death, ICU LOS, and hospital LOS compared with routine practice of intubation?

Poisoning 139

Poisoning Airway Management Seizures Shock 139

The Skeptics' Guide to EM

JANUARY 6, 2024

July 2023 Date: Dec 11, 2023 Guest Skeptic: Dr. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC. Rachel Hatcliffe is a pediatric emergency medicine attending at Children’s National Hospital in Washington, DC. Veterans Affairs and prison hospitals.

Emergency Department 127

Emergency Department Pediatrics Anaphylaxis Leadership 127

The Skeptics' Guide to EM

APRIL 27, 2024

Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care.

Resuscitation 90

Resuscitation Airway Management EMS Outcomes 90

ACEP Now

NOVEMBER 8, 2024

Historically, the endotracheal tube (ETT) has been considered the definitive airway of choice in both the prehospital and in-hospital setting. Emergency medical services (EMS) scope of practice is governed by the state, but national scope of practice guidelines are available for the four different EMS provider levels.

Airway Management 40

Airway Management EMS Hospitals Administration 40

Pediatric EM Morsels

MAY 24, 2024

Evaluation of unintentional injury and trauma is one of the hallmarks of the EM and PEM physician. Low Risk Inta-Adbominal Trauma: Just Light ‘Em Up? IAI Rule – The Validation A multicenter prospective validation was planned at hospitals distinct from those where the initial derivation was performed. J Am Coll Surg.

Pediatrics 164

Pediatrics Blood Transfusions EMS Fractures 164

The Skeptics' Guide to EM

OCTOBER 5, 2019

Guest Skeptic: Clay Odell is a Paramedic/RN for New London Hospital EMS in New Hampshire, USA which provides 9-1-1 coverage and Mobile Integrated Healthcare […] The post SGEM#269: Pre-Hospital Nitroglycerin for Acute Stroke Patients? Hypertension is common in acute stroke and is a predictor of poor outcome [ 1 ].

Stroke 52

Stroke Hospitals EMS Administration 52

RebelEM

OCTOBER 30, 2023

This could dilute any beneficial effects seen Lack of blinding may bias results (Although mortality is a solid objective primary outcome, bias may still creep in terms of management) Discussion: Authors were looking for an absolute mortality difference of 7% from baseline mortality of 26% with a 90% power. Cryoprecipitate Group: 25.3%

Administration 125

Administration Blood Transfusions Outcomes Hospitals 125

RebelEM

MAY 25, 2023

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

MAY 29, 2023

It also reduced length of stay in ICU and hospital without adverse effects. What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9%

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

The Skeptics' Guide to EM

JULY 8, 2023

Evaluation of oseltamivir used to prevent hospitalization in outpatients with influenza: a systematic review and meta-analysis. Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at Staten Island University Hospital. Managing editor of EM:RAP and Associate Editor at REBEL EM. JAMA Int Med 2023.

CDC 107

CDC Hospitals EMS Emergency Department 107

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 to 4.0mg/hr typically given in EKOS therapy (See Below). to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 133

Stroke Outcomes Hospitals Administration 133

RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? Primary Results Patients enrolled from 15 emergency medical services at 21 hospitals across 3 countries over 7 years.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

RebelEM

MAY 27, 2024

The primary outcomes are patient-centered and objectively measured, potentially ensuring relevance and reliability. The unblinded nature of the study could influence outcomes due to observer bias. Employing P-values to compare demographics between groups could mislead interpretations of the data’s relevance to the primary outcomes.

Outcomes 134

Outcomes Research Operations Hospitals 134

The Skeptics' Guide to EM

JUNE 1, 2024

Caleb Ward is a pediatric emergency medicine attending and Associate Professor of Pediatrics and Emergency Medicine at Children’s National Hospital and The George Washington School of Medicine and Health Sciences in Washington, DC. His research focuses on the pre-hospital care of children by EMS.

Pediatrics 87

Pediatrics EMS Emergency Department Research 87

RebelEM

JULY 1, 2024

PMID: 34277241 For More Thoughts on This Topic Checkout: EMCrit 341: AVAPS (Average Volume Assured Pressure Support) NIPPV with Alex Bracey Post Peer Reviewed By: Anand Swaminathan, MD (Twitter/X: @EMSwami ) The post BPAP vs AVAPS for Hypercapnic Respiratory Failure in the ED appeared first on REBEL EM - Emergency Medicine Blog. AVAPS: 0.07

COPD 129

COPD Emergency Department Outcomes EMS 129

RebelEM

NOVEMBER 30, 2023

PMID: 37597449 Clinical Question : In sepsis patients with CHF, does a restricted volume resuscitation strategy of less than 30mL/kg IV crystalloid initiated within the first three hours of sepsis identification, compared to volume resuscitation with 30 mL/kg IV crystalloid, decrease in-hospital mortality? 2.89, p = 0.01.

Sepsis 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

RebelEM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Outcomes: Primary Outcome: Reduction of dyspnea measured on a verbal dyspnea scale (VDS) from 0 to 10 recorded at enrollment, then at 2, 4, and 5 hours after arrival.

Ultrasounds 125

Ultrasounds Outcomes COPD Hospitals 125

RebelEM

MARCH 30, 2023

Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. Article: How-Berlemont C, Lamhaut L, Diehl J, et al. JAMA Cardiol.

Hospitals 59

Hospitals Outcomes EKG/ECG Resuscitation 59

RebelEM

SEPTEMBER 19, 2022

Background: There are only two interventions that have been proven in the medical literature to improved outcomes in cardiac arrest: high-quality CPR and early defibrillation. Over the years, we as a scientific community have worked extensively to find other interventions that improve outcomes. However, human data is sorely lacking.

CPR 52

CPR Outcomes Resuscitation EMS 52

EMDocs

DECEMBER 6, 2024

7 Workup other than serum iron concentration at 4 hours after ingestion not shown to accurately predict clinical outcomes or severity of toxicity. Iron Ingestion: an Evidence-Based Consensus Guideline for Out-of-Hospital Management. 6 Absence of visualized tablets on x-ray does not exclude iron ingestion. Antiemetics as needed.

Poisoning 94

Poisoning Fluid Resuscitation Seizures Resuscitation 94

RebelEM

SEPTEMBER 7, 2023

OUTCOMES Primary: Occurrence of at least one clinical or electrographic seizure recorded on continuous EEG within 72 hours after inclusion. 0.38, p=0.0021) No statistically significant results were reported in the other clinical outcomes studied. The primary outcome was patient-oriented. OR 0.07, 95% CI 0.01-0.38,

Seizures 123

Seizures Stroke Outcomes Research 123

The Skeptics' Guide to EM

OCTOBER 19, 2024

Annals of EM 2024. Guest Skeptic: Dr. Brendan Freeman is an emergency medicine physician, assistant professor of emergency medicine, and medical education fellow at Staten Island University Hospital. Annals of EM 2024. mg/kg plus nebulized saline Outcome: Primary Outcome: Reduction in pain scores on.

Emergency Department 94

Emergency Department EMS Research Administration 94

Ziqitza HealthCare Ltd

FEBRUARY 7, 2024

In the ever-changing landscape of emergency medical services (EMS), innovation is the key to saving lives and improving patient outcomes. Use of Telemedicine in Pre-hospital Care: The advent of telemedicine has revolutionized healthcare, and Sweta Mangal Ziqitza has seamlessly integrated this technology into pre-hospital care.

Telemedicine 52

Telemedicine EMS Ambulance Services Hospitals 52

RebelEM

AUGUST 14, 2023

days 2 most common sites of infection were lung (44.8%) and inta-abdominal (32.1%) Majority of infections were community-acquired (≈84%) Over half the patients were on mechanical ventilation (≈53%) Primary Outcome Results: 28-day mortality rate: Placebo 26.1% (230/882) vs. XBJ 18.8% (165/878); P<0.001 The risk difference was 7.3% (95% CI, 3.4-11.2)

Sepsis 97

Sepsis Outcomes Administration EMS 97