EMDocs

FEBRUARY 28, 2024

Code Stroke is called and he is seen by a neurologist within 10 minutes. He is admitted with a diagnosis of brainstem stroke and treated by the neurologist with ASA only. He undergoes a thrombectomy, but his outcome is poor. The family consults an attorney who has the records reviewed by an EM expert before filing a lawsuit.

Documentation/Coding 105

Documentation/Coding Stroke Outcomes EMS 105

The Skeptics' Guide to EM

OCTOBER 5, 2019

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomized, sham-controlled, blinded, phase 3 trial. He’s been involved in EMS for over 30 years in a variety of roles and is a strong advocate for evidence-based EMS protocols. The Lancet March 2019.

Stroke 52

Stroke Hospitals EMS Administration 52

Emergency Medicine Cases

JULY 4, 2017

In this part 2 of EM Cases Journal Jam podcast on Thrombolysis and Endovascular Therapy for Stroke Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world's literature on endovascular therapy for stroke.

Stroke 52

Stroke EMS Outcomes 52

The Skeptics' Guide to EM

MAY 15, 2021

Daniel Schwerin is employed with Prisma Health-Upstate as a clinical assistant professor, emergency medicine GME director for emergency medical services and medical director for several local EMS agencies and has lectured on prehospital stroke management. Their local EMS service arrives quickly with a conventional ambulance.

Stroke 52

Stroke EMS Outcomes 52

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. What They Did: Retrospective review of consecutive RAO cases managed as part of a remote ophthalmology consult protocol activated on May 1, 2021, at three stroke centers across a health system.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

The Skeptics' Guide to EM

FEBRUARY 26, 2019

This has been through various peer reviewed publications, doing Emergency Medicine Abstracts (EMA) audio program […] The post SGEM Xtra: No Retreat, No Surrender – Thrombolysis for Acute Ischemic Stroke first appeared on The Skeptics Guide to Emergency Medicine. It appears his concerns may have come true. Six trials showed no benefit.

Stroke 52

Stroke EMS Research Outcomes 52

Taming the SRU

AUGUST 7, 2023

The patient needs a transvaginal ultrasound w/ doppler with gynecology consult and possible laparotomy TVUS is not just for torsion, it can also be used for ectopic pregnancies or pregnancy of unknown location Acute Ischemic Stroke Updates WITH Drs. hours increased the NNT for a good outcome to 20. The expanded window of 3-4.5

Stroke 93

Stroke Outcomes EKG/ECG Research 93

RebelEM

FEBRUARY 8, 2024

patients with more discrepant readings had NIBP checked more frequently) Some patients were on multiple vasopressors, but for an unclear reason the authors decided to only evaluate the dose of norepinephrine MAP discrepancy is not a patient oriented outcome (i.e. appeared first on REBEL EM - Emergency Medicine Blog. to 1.12; p = 0.03

Resuscitation 125

Resuscitation Outcomes EMS Sepsis 125

The Skeptics' Guide to EM

APRIL 25, 2020

Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. He has been practicing in Emergency Medicine for over 40 years and involved in EMS services for over 30 years.

Stroke 40

Stroke Emergency Department Outcomes Administration 40

The Skeptics' Guide to EM

JANUARY 1, 2022

He became double board certified in Emergency Medicine (EM) and Emergency Medical Services (EMS). Prospective, multicenter, controlled trial of mobile stroke units. He became double board certified in Emergency Medicine (EM) and Emergency Medical Services (EMS). Howie also has a Master of Public Health.

Stroke 52

Stroke EMS Outcomes Administration 52

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. Heart disease and stroke statistics-2022 update: A report from the American Heart Association. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Emergency Medicine Cases

JANUARY 18, 2022

The post EM Quick Hits 35 – 10 Best Papers of 2021, Peripartum Cardiomyopathy, Crashing Asthmatic, Febrile Neutropenia, Anaphylaxis update appeared first on Emergency Medicine Cases.

Anaphylaxis 52

Anaphylaxis EMS Outcomes Hyperthermia / Hypothermia 52

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 101

Radiology Radiology Emergency Department Hospitals 101

Taming the SRU

NOVEMBER 3, 2023

Broad strokes In this prospective, non-randomized study published by Kring et al in January 2022 out of Maine Medical Center, researchers compared mean pain scores at rest and during incentive spirometry before, at 15 minutes after, and then 60 minutes after treatment with a serratus anterior plane block. Ultrasound Med. 41, 2695–2701 (2022).

Fractures 98

Fractures Ultrasounds Research Outcomes 98

Dr. Smith's ECG Blog

APRIL 2, 2024

No wall motion abnormality Decreased left ventricular systolic performance, severe Left ventricular enlargement, marked Dilated cardiomyopathy severe Est. stroke volume 52 cc at HR 70 = 3.64 Patient received 11 shocks by ICD and was in V-fib when EMS arrived. The patient awoke and had a good outcome! l/min cardiac output.

EKG/ECG 131

EKG/ECG Shock CPR Stroke 131

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Here is that last post: A 90-something with acute stroke. Outcome: All 4 serial hs troponin I, out to 6 hours, were undetectable. EMS arrived — and recorded 2 ECGs. 14 minutes later — ECG #2 was recorded by EMS. She has no chest symptoms. What is the diagnosis? He stated he had never had this before.

EKG/ECG 115

EKG/ECG EMS Stroke Outcomes 115

ACEP Now

AUGUST 25, 2023

Primary Outcome: Discharged home from the ED Secondary Outcomes: There were several secondary outcomes. Another interesting secondary outcome that could confound the results is that children who received IN fentanyl received higher overall total parenteral opioid morphine equivalents. Am J Hematol.

Administration 97

Administration Pediatrics Emergency Department Outcomes 97

The Skeptics' Guide to EM

JULY 9, 2022

Risk of selection bias assessment in the NINDS rt-PA stroke study. Risk of selection bias assessment in the NINDS rt-PA stroke study. While this is true, we are part of the team that diagnose and treat acute stroke patients. They published their findings in Annals of EM 2009. Reference: Garg R, Mickenautsch S.

Stroke 52

Stroke Emergency Department EMS Outcomes 52

RebelEM

JUNE 8, 2023

They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine. 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

RebelEM

MARCH 13, 2024

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?

Documentation/Coding 58

Documentation/Coding Outcomes EMS Stroke 58

RebelEM

MARCH 8, 2023

Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. CRAO is a stroke of the eye; patients should be considered for a complete stroke work up. Rezaie, MD (Twitter: @srrezaie ) The post REBEL Core Cast 97.0 – Acute Vision Loss II appeared first on REBEL EM - Emergency Medicine Blog.

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

Dr. Smith's ECG Blog

DECEMBER 26, 2020

The EM provider asked if the cardiologist thought it was a "STEMI." The case was reviewed by the receiving team who had concerns for acute stroke or other cause of acute altered mental status. The patient was admitted for stroke management. Long-term outcome is unknown. There was again no intracranial hemorrhage.

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

The Skeptics' Guide to EM

DECEMBER 5, 2020

She is the New York ACEP liaison for the Research and Education Committee and is a past ALL NYC EM Resident Education Fellow. You’re about to call in your MRI tech from home, but then you remember reading that the HINTS exam is more sensitive than early MRI for diagnosis of posterior stroke. How hard can it be?”

Stroke 40

Stroke Documentation/Coding Emergency Department Hospitals 40

ACEP Now

JULY 7, 2024

35-year-old man presents by EMS with seizures. He has been seizing for 30 minutes, despite treatment of intravenous lorazepam by EMS. Early and established status epilepticus: the impact of timing of intervention, treatment escalation and dosing on outcome. J Am Coll Emerg Physicians Open. 2023;4(4):e13004. 2023;111:98-102.

Seizures 52

Seizures Emergency Department Outcomes EMS 52

The Skeptics' Guide to EM

DECEMBER 16, 2017

Case: Johnny is a 22-year-old male patient who presents to the emergency department via EMS with a seizure. There was no statistical difference in the primary outcome between 33C vs. 36C ( SGEM#82 ). Clinical Question: Does induced therapeutic hypothermia improve neurologic outcomes in patients with convulsive status epilepticus?

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

ACEP Now

NOVEMBER 7, 2023

EMS physicians report he was found in ventricular fibrillation. The primary outcome was survival to hospital discharge. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Simon EM, Tanaka K. A 67-year-old man presents to the emergency department (ED) in cardiac arrest.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

RebelEM

MARCH 22, 2023

Amal Mattu’s ECG Blog has an excellent review of AVNRT vs. VT and REBEL EM reviews the sensitivity and specificity of various algorithms. Serum troponin testing in patients with paroxysmal supraventricular tachycardia: outcome after ED care. Troponin elevation in supraventricular tachycardia: primary dependence on heart rate.

EKG/ECG 52

EKG/ECG EMS Pediatrics Stroke 52

Emergency Medicine Ireland

FEBRUARY 6, 2023

Whereas in SAH you have a whole bunch of interesting and well proven interventions that can improve outcome for the lucky patients who haven’t already prognosticated themselves by presenting with a GCS of 3. Though i’ll admit that that question is delving much more into the realm of EM than hard core crit care.

Stroke 52

Stroke EMS Radiology Radiology 52

The Skeptics' Guide to EM

MARCH 13, 2021

You page neurosurgery at the bigger ED in town, and while you wait for the page back, you wonder if giving tranexamic acid (TXA) could help improve the patient’s chances for a good outcome given its effects in other bleeding processes. Dr. Perry did publish a prospective implementation of the Ottawa SAH Rule ( Stroke 2019 ).

Stroke 40

Stroke Emergency Department EMS Outcomes 40

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

The Skeptics' Guide to EM

OCTOBER 5, 2024

Headpulse measurement can reliably identify large-vessel occlusion stroke in prehospital suspected stroke patients: Results from the EPISODE-PS-COVID study. Case: The family of a 69-year-old woman activated emergency medical services (EMS) for slurred speech that they noticed when she woke up a couple of hours before.

Stroke 116

Stroke EMS Outcomes Research 116

RebelEM

JULY 27, 2023

Background: Current stroke guidelines recommend IV alteplase for patients with acute ischemic stroke presenting within 4.5hrs of symptom onset based on the NINDS and ECASS III publications. Both NINDS and ECASS III excluded patients with mild stroke symptoms but failed to clearly define a threshold for mild stroke.

Stroke 98

Stroke Outcomes EMS Hospitals 98

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

EMDocs

DECEMBER 16, 2023

We’ll keep it short, while you keep that EM brain sharp. A 34-year-old male is brought via EMS after collapsing during an outdoor adventure race. EMS reports the patient was conscious but altered, with slurred speech and confusion. Both can result in heat exhaustion and heat stroke and have many overlapping symptoms.

Hyperthermia / Hypothermia 95

Hyperthermia / Hypothermia EMS Stroke Seizures 95

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 3, 6 Among patients with stroke or traumatic brain injury (TBI), the risk may be as high as 28%-76% and 23%-60%, respectively. 4, 8 Paper: Dahyot-Fizelier, C., 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 122

CDC Radiology Radiology Head Injuries 122

The Skeptics' Guide to EM

AUGUST 10, 2024

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.

Stroke 90

Stroke Airway Management Documentation/Coding Outcomes 90

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145