RebelEM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. Below you will find some of the points we discussed.

CPR 144

CPR EMS Documentation/Coding Outcomes 144

Pediatric EM Morsels

SEPTEMBER 22, 2023

), we here at the Ped EM Morsels Bakery have cooked up a morsel to remind you that pediatric trauma can be even more difficult than you think. ” Children compensate for blood and volume loss very well… until they don’t. Available from: [link] The post Neurogenic Shock in Children appeared first on Pediatric EM Morsels.

Shock 304

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 304

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Hope you’re doing well! Here is the case: Report from EMS was witnessed syncope, his son did CPR, but the patient had pulses when EMS arrived. When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. Smith : "What was the outcome?" You taught us well!"

EMS 115

EMS CPR EKG/ECG Wellness 115

EMDocs

JULY 13, 2024

We’ll keep it short, while you keep that EM brain sharp. Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. 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

APRIL 27, 2024

We’ll keep it short, while you keep that EM brain sharp. However, the bioavailability of antipseudomonal antibiotics has improved outcomes, limiting surgery as a confirmatory diagnostic procedure and as needed for granulation tissue removal. He says the pain is worse at night and when he is chewing. and Staphylococcus spp.

EMS 102

EMS Infectious Diseases Radiology Radiology 102

Dr. Smith's ECG Blog

JANUARY 3, 2024

Written by Pendell Meyers A woman in her 70s had acute chest pain and called EMS. On arrival, EMS recorded relatively normal vital signs and this EMS ECG: What do you think? However, saddlebacks are only true saddlebacks when there is a well-formed normal voltage S-wave. So the cath lab was not activated. Ongoing OMI.

EMS 103

EMS EKG/ECG Wellness Outcomes 103

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

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

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? His Glasgow Coma Scale (GCS) score is 13 with obvious head trauma as well. Prehospital Tranexamic Acid for Severe Trauma.

EMS 140

EMS Outcomes Hospitals Research 140

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" But he did well. Both were awake and alert with normal vital signs. What do you think?

EKG/ECG 127

EKG/ECG EMS Outcomes Wellness 127

RebelEM

JANUARY 21, 2025

Wells’ , Revised Geneva ) or clinical gestalt. PMID: 39487597 Clinical Question: Can a negative D-dimer safely exclude PE in patients with high pre-test probability for PE (as determined by Wells or Revised Geneva Scores)? REBEL EM: Age Adjusted D-dimer Testing The Bottom Line: PEG-eD St. Emlyns: Level Pegging?

EMS 45

EMS Research Wellness Outcomes 45

RebelEM

JUNE 1, 2023

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. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study.

Outcomes 144

Outcomes Resuscitation Hospitals CPR 144

RebelEM

FEBRUARY 15, 2024

Additionally, intubation can risk hemodynamic instability as well as hypoxemia from the procedure itself. not a patient oriented outcome) Single country study which may limit generalizability Excluded pregnancy where risk of emesis is increased due to gravid uterus Alcohol was the implicated in the overwhelming majority of patients.

Poisoning 139

Poisoning Airway Management Seizures Shock 139

EMDocs

DECEMBER 23, 2024

The most recent and well-known trial is the PROCAMIO trial (1). Well, the trial was a multicenter prospective open label trial. Well, lets look at some other trials. Gorgels et al (5) looked at procainamide vs lidocaine and again and primary outcome was VTach termination. Ok, so what did the PROCAMIO trial find?

EKG/ECG 75

EKG/ECG Shock Wellness EMS 75

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Three outcomes were evaluated, with none being deemed the primary outcome. appeared first on REBEL EM - Emergency Medicine Blog. to 0.97; p = 0.02 to 2.07; p = 0.91 to 12.33; p = 0.26 to 0.97; p = 0.02

Sepsis 130

Sepsis Hospitals Administration Outcomes 130

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. 4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. Severe acute traumatic coagulopathy = PT >1.5

Administration 139

Administration Outcomes Resuscitation Radiology 139

RebelEM

JULY 1, 2024

AVAPS may be useful, but we still need a well conducted RCT to find out if it is (i.e AVAPS: 0.07 P = 0.015 PaCO2 Excretion in 1 st Hour BPAP S/T: 4.75 AVAPS: 10.20 AVAPS: 0.07 P = 0.015 PaCO2 Excretion in 1 st Hour BPAP S/T: 4.75 AVAPS: 10.20 AVAPS: 0.07 P = 0.015 PaCO2 Excretion in 1 st Hour BPAP S/T: 4.75 AVAPS: 10.20

COPD 129

COPD Emergency Department Outcomes EMS 129

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Written by Pendell Meyers A man in his 40s called EMS for acute chest pain that awoke him from sleep, along with nausea and shortness of breath. Long term outcome is unavailable. For clarity in Figure-1 — I've labeled the 2 EMS ECGs and the baseline ECG recorded ~1 month earlier.

EKG/ECG 122

EKG/ECG EMS Documentation/Coding Shock 122

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. If large number of tablets are visualized on abdominal x-ray, it can help guide GI decontamination decisions. 6 Absence of visualized tablets on x-ray does not exclude iron ingestion.

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% Demographics were well balanced in the two groups.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

Pediatric EM Morsels

AUGUST 11, 2023

This is the 601st Ped EM Morsel ! Having authored 575 ( well, now 576 ) of them, I am often quite convinced that there are no new topics to discuss. Infections there become complicated very quickly and the outcomes can be very poor. The post Perichondritis of the Ear in Children appeared first on Pediatric EM Morsels.

Burns 130

Burns Pediatrics EMS Outcomes 130

The Skeptics' Guide to EM

JUNE 1, 2024

His research focuses on the pre-hospital care of children by EMS. He is the principal investigator for EMSC State Partnership in Washington, DC and is also involved in various multi-center EMS studies with the Pediatric Emergency Care Applied Research Network (PECARN). EMS placed him in a C-collar and brought him to you.

Pediatrics 87

Pediatrics EMS Emergency Department Research 87

The Skeptics' Guide to EM

JULY 8, 2023

Managing editor of EM:RAP and Associate Editor at REBEL EM. Managing editor of EM:RAP and Associate Editor at REBEL EM. She looks well enough to go home but asks if she should be prescribed oseltamivir (Tamiflu) because some of her friends have been given it recently by their doctors.

CDC 107

CDC Hospitals EMS Emergency Department 107

Taming the SRU

FEBRUARY 24, 2024

ENRICH Trial - the leadership journey - EMS grand rounds - r4 capstone - r1 clinical knowledge - pediatric lecture ENRICH Trial WITH visiting professor Dr. david wright ICH makes up only 10-15% of all strokes yet has a higher mortality than ischemic strokes and SAH Current 2022 AHA/ASA guidelines for spontaneous ICH (prior to ENRICH Trial) minimally-invasive (..)

Leadership 94

Leadership EMS Pediatrics Stroke 94

RebelEM

SEPTEMBER 14, 2023

to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% Control: 53.4% D ECLS: 18.2% Control 8.7% Control 38.0% Control: 49.0% RR 0.98; 95% CI 0.80 to 1.19; p = 0.81 vs 13.9% (RR 0.58; 95% CI 0.33 Control: 9.6% Control 3.8%

Shock 133

Shock Outcomes Resuscitation Stroke 133

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

ACEP Now

NOVEMBER 8, 2024

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. Conclusion EGAs offer multiple benefits in managing patient airways and have found generally wide acceptance in the protocols of numerous EMS provider levels.

Airway Management 40

Airway Management EMS Hospitals Administration 40

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

The Skeptics' Guide to EM

OCTOBER 17, 2020

Salim is probably better known as the creator and founder of the wonderful knowledge translation project called REBEL EM. It is a free, critical appraisal blog and podcast […] The post SGEM#305: Somebody Get Me A Doctor – But Do I Need TXA by EMS for a TBI? first appeared on The Skeptics Guide to Emergency Medicine.

EMS 52

EMS Head Injuries Outcomes Hospitals 52

The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC? first appeared on The Skeptics Guide to Emergency Medicine.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

ACEP Now

OCTOBER 3, 2023

These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations. This document is an update of guidelines first published in 2000, and then updated in 2007.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation Pediatrics 98

RebelEM

SEPTEMBER 21, 2023

Troponins are highly specific to cardiac myocytes but do exist in other muscle types as well. The available literature shows that SVT is not associated with ACO, Type I MI or serious outcomes either in the short term or after prolonged follow up ( Gabrielli 2022 ). appeared first on REBEL EM - Emergency Medicine Blog.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

RebelEM

JULY 27, 2023

In this group of patients, the use of alteplase poses a fine line of potential benefit (functional outcomes) vs potential harm (symptomatic intracranial hemorrhage). DAPT statistically noninferior to alteplase The finding was consistent in the per-protocol and as-treated groups as well Symptomatic ICH at 90d DAPT: 0.3% Alteplase: 91.4%

Stroke 98

Stroke Outcomes EMS Hospitals 98

Don't Forget the Bubbles

JUNE 19, 2024

Well-designed multicentre large studies in children were warranted; cue Leonard et al. 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. Were the predictor variables and the outcome evaluated in a blinded fashion?

CPR 124

CPR Research Documentation/Coding Outcomes 124

Dr. Smith's ECG Blog

AUGUST 9, 2024

About 2 hours later the patient arrived at a PCI-capable center and repeat ECG was obtained: The transferring EMS crew noted “runs of VT” during transport. The LCx and OM vessels are not as well visualized. Prophylactic lidocaine use in acute myocardial infarction: incidence and outcomes from two international trials.

EKG/ECG 108

EKG/ECG EMS Emergency Department Wellness 108

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