Emergency Medicine Journal

NOVEMBER 28, 2023

Background The regional emergency medical service (EMS) in Lombardy (Italy) developed clinical algorithms based on operator-based interviews to detect patients with COVID-19 and refer them to the most appropriate hospitals. Results The training set includes 264 976 patients, median age 74 (IQR 55–84). to 0.98), respectively.

Operations 52

Operations EMS Hospitals Outcomes 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. 5 Orogastric lavage may also be considered for GI decontamination but likely to be limited by location, size of tablets, and operator familiarity. Antiemetics as needed. 2 L/hr in adults.

Poisoning 94

Poisoning Fluid Resuscitation Seizures Resuscitation 94

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? 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7% Prehospital Tranexamic Acid for Severe Trauma.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

RebelEM

OCTOBER 2, 2023

The SQuID Protocol (Subcutaneous Insulin in /diabetic Ketoacidosis): Impacts on ED Operational Metrics. No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 A more optimal, and promising, solution may be the use of SQ insulin in mild to moderate DKA.

Operations 97

Operations Academics Fluid Resuscitation Outcomes 97

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

Taming the SRU

SEPTEMBER 25, 2023

This places a significant responsibility on the EM physician to diagnose and treat fractures. Specifically, EM physicians should be able to recognize fractures that will likely require operative management and facilitate close follow up, such as a Maisonneuve fracture. screws for medial malleolus. Orthop Surg. doi: 10.1111/os.12733.

Fractures 101

Fractures Operations Emergency Department EMS 101

Ziqitza HealthCare Ltd

JANUARY 23, 2024

In the rapidly changing landscape of healthcare, Emergency Medical Services (EMS) play a critical role in saving lives and providing timely medical assistance. As we step into 2024, one company stands out as a pioneer in transforming EMS – Ziqitza Healthcare ltd.

EMS 52

EMS Telemedicine Ambulance Services Operations 52

The Skeptics' Guide to EM

MARCH 2, 2024

He will need to be transferred to the tertiary care center which is 35 minutes away by ground EMS if it is a dissection. Type A AoDs generally require an emergent trip to the operating room as soon as they are identified to reduce the likelihood of a terrible outcome. You suspect an acute aortic dissection (AoD).

Emergency Department 131

Emergency Department Stroke Operations Hospitals 131

Dr. Smith's ECG Blog

JUNE 13, 2024

EMS arrived to a pulseless patient in V fib. They sued the the county-operated EMS service for allegedly not dispatching the call fast enough. You can read the defense EM expert report on Dr. Funk's site: [link] Case Outcome The EMTs were found to have personal immunity as part of their employment with the local government.

EKG/ECG 93

EKG/ECG Documentation/Coding EMS Burns 93

RebelEM

NOVEMBER 20, 2023

Comparator: The control group received standard care provided at a major trauma center, including intubation, blood product transfusion, interventions like tourniquet application, and early operative or endovascular hemorrhage control. Outcome: Primary Outcome: All-cause mortality at 90 days.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

EMDocs

SEPTEMBER 4, 2024

Disparities are measured differences in outcomes for people of different backgrounds. Literature shows disparity across the different outcomes, including wait times, triage levels and delivery of pain medications. Dr. Migita noted differences in admission rates for asthma and bronchiolitis based on race. Discuss as often as possible.

Pediatrics 97

Pediatrics Outcomes Operations Hospitals 97

Taming the SRU

MAY 11, 2024

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.

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

RebelEM

APRIL 17, 2023

While operator dependent, the dynamic ability of POCUS augments bedside diagnosis and can assist with drainage. appeared first on REBEL EM - Emergency Medicine Blog. Additionally, potential increases in resource utilization, healthcare expense, and ED length of stay are also essential considerations.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

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. These procedures require an experienced operator.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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

Don't Forget the Bubbles

JUNE 19, 2024

Children in the validation cohort were admitted to the intensive care unit or operating room less frequently than those in the derivation cohort. 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.

CPR 124

CPR Research Documentation/Coding Outcomes 124

RebelEM

AUGUST 7, 2023

PMID: 37058727 Post Peer Reviewed By: Anand Swaminathan, MD (Twitter: @EMSwami ) The post REBEL Cast Ep122 – Delayed vs Rapid Sequence Intubation in Agitated Trauma Patients appeared first on REBEL EM - Emergency Medicine Blog. Re-oxygenation with BMV can increase airway-related adverse events (i.e.

Head Injuries 96

Head Injuries Airway Management Outcomes Burns 96

ACEP Now

JULY 7, 2023

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. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. Circulation. 2018;137(12). Kimblad H, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

RebelEM

AUGUST 22, 2024

hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. Moreover, there are multiple operational and patient-specific barriers rendering timely thrombolytic administration difficult. Documented at the following time points: Before treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

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 81

Outcomes Hospitals Operations Shock 81

Taming the SRU

NOVEMBER 3, 2023

The thought with introducing the serratus anterior plane block was that regional anesthesia is well within the purview of EM physicians and can offer a safe alternative to systemic pain medications. The primary outcome in this study was a change in pain score at rest 60 minutes after block. SD 3.28) and 6.5, respectively.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

Taming the SRU

JUNE 11, 2023

Utilized in the pre-hospital setting, ICU and the Operating Room, it is a non-invasive measurement that reflects a patient’s current state of metabolism, circulation and ventilation. 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

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

ACEP Now

NOVEMBER 16, 2023

emergency medicine (EM) residency training length has been a decades-long dilemma: four versus 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. percent versus 90.8

Academics 52

Academics EMS Telemedicine Research 52

The Skeptics' Guide to EM

JULY 30, 2022

Background: Somewhere between two and four percent of patients presenting to US EDs with abdominal pain have a small bowel obstruction (SBO) – those who are managed operatively (who are only 20-30%) account for 60,000 hospitalizations and 565,000 inpatient care days per year. Also joining us is Dr. Andrew Goldsmith.

Ultrasounds 52

Ultrasounds Operations Documentation/Coding Outcomes 52

RebelEM

APRIL 29, 2024

One may speculate that the US-guided CVC placement would have a higher first-pass success rate with fewer complications, however, this may potentially add time to the procedure depending on the operator and institution’s use of ultrasound during emergencies and maintaining sterile technique with the US probe.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

EMDocs

OCTOBER 30, 2023

Pillai, MBBS (@sspillai01, EM Resident Physician, University of Kentucky) and Christopher N. 2 In response to the constrained availability of contrast media, emergency medicine (EM) and radiology departments were compelled to enact modifications in their imaging techniques. Authors: Saran S. 11 Table 1.

Radiology 92

Radiology Radiology Emergency Department Hospitals 92

EMDocs

SEPTEMBER 25, 2023

Still, there are those that believe that FPS is more of a physician-centered endpoint that does not fully reflect important patient-centric outcomes (16). Improved Visualization: Video laryngoscopes allow for the use of standard or hyperangulated geometry, essentially allowing the operator to “look around the corner” on an anterior airway.

Emergency Department 84

Emergency Department Soft Tissue Injuries Airway Management Operations 84

Ziqitza HealthCare Ltd

MARCH 29, 2024

However, the reality is that ambulance response times vary significantly based on geographic location, a critical factor that can greatly impact outcomes for patients in need. Understanding Ambulance Response Times The urgency of medical emergencies necessitates a rapid response from emergency medical services (EMS).

Ambulance Services 52

Ambulance Services Outcomes EMS Operations 52

PHEM Cast

DECEMBER 12, 2016

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.

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Training in chest drain insertion is essential in Emergency Medicine (EM) as approximately 25,000 patients undergo in England and Wales undergo this procedure annually. There is little research in the Irish setting, specifically regarding the outcomes of patients who receive chest drains in Irish EDs.

Emergency Department 40

Emergency Department EMS Research Operations 40

Critical Care Now

JULY 7, 2024

The primary outcome showed higher mortality in the REBOA+SC group (54%) compared to the SCA group (42%), with an odds ratio (OR) of 1.58 (95% CI 0.72 – 3.52) and a posterior probability of OR > 1 at 86.9%. Check out the full post on REBEL EM

Resuscitation 52

Resuscitation Military Outcomes Hospitals 52

Don't Forget the Bubbles

MAY 17, 2023

Post-operative pain in children: Comparison of pain scores between parents and children. Hegeman EM, et al. Schwindt EM, et al. Early Antibiotic Use and Neonatal Outcomes Among Preterm Infants Without Infections. J Pediatr Gastroenterol Nutr. 2023 Apr 24. Cetinkaya PG, et al. Eur J Pediatr. 2023 Apr 12. Niu T, et al.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Northwestern EM Blog

MAY 16, 2022

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?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

EM Updates

MARCH 24, 2021

Video laryngoscopy uses a blade with a camera at the end; once the blade is positioned, the operator intubates looking at the screen. HAVL , which uses a blade that goes around the tongue, requires that the operator look at the screen. VL can employ either SG or HA blades.

Operations 52

Operations Airway Management EMS Wellness 52

RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

RebelEM

NOVEMBER 6, 2023

Methylene Blue for Vasoplegic Syndrome After Cardiac Operation: Early Administration Improves Survival. PMID: 36039127 Post Peer Reviewed By : Salim Rezaie, MD (Twitter: @Srrezaie ) The post Hydroxycobalamin vs Methylene Blue for Vasoplegic Shock from Cardiopulmonary Bypass appeared first on REBEL EM - Emergency Medicine Blog.

Shock 71

Shock Administration Academics Hospitals 71