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.,

CDC 125

CDC Outcomes Radiology Radiology 125

The Trauma Pro

MAY 9, 2023

The Pennsylvania Trauma Outcomes Study database contains a huge amount of data. This represents when after arrival, patients start dying due to their injuries. Penetrating injury plus hypotension kills the fastest at 19 minutes and head injuries the slowest at 1:20.

Head Injuries 130

Head Injuries Operations Documentation/Coding Outcomes 130

The Trauma Pro

OCTOBER 25, 2024

Here are the factoids: The original data were derived from a 17-center study conducted from 2018-2020; this study only included 1,387 patients who had pelvic fractures (as well as other injuries). The primary outcome was the development of VTE during the hospitalization.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

EMDocs

MARCH 9, 2024

Spoon Feed In adults presenting to EMS after OHCA, those receiving epinephrine prior to advanced airway management (AAM = supraglottic airway, SGA, or endotracheal tube) experienced better outcomes and prehospital ROSC than those receiving AAM before epinephrine. This was true for both shockable and non-shockable initial rhythms.

Head Injuries 83

Head Injuries Airway Management Outcomes EMS 83

The Trauma Pro

SEPTEMBER 12, 2023

Bottom line: This is an intriguing abstract, pointing me to the original paper published in NEJM. This multi-center study was performed in conjunction with the research coordinating center at Johns Hopkins, which designs some top-notch research.

Fractures 113

Fractures Head Injuries Research Outcomes 113

Pediatric EM Morsels

JUNE 9, 2023

Maybe injuries to the spleen or kidney come to mind. Perhaps thoughts of pelvic injuries or severe head injury dominate our considerations. Long-term Outcomes and Health Perceptions in Pediatric-onset Portal Hypertension Complicated by Varices. Semin Liver Dis. 2023 Feb;43(1):100-116. doi: 10.1055/s-0042-1759613.

Pediatrics 152

Pediatrics Head Injuries Airway Management Administration 152

Don't Forget the Bubbles

OCTOBER 19, 2023

Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. This is what they found: Length of hospital stay (time from randomisation to the time of hospital discharge or death), the primary outcome, was significantly longer in the high-flow group at 1.77

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

The Skeptics' Guide to EM

JULY 17, 2018

He is also the CME editor for Academic Emergency Medicine Case: You’re working in a small rural emergency department when a seven-year-old girl comes in by EMS with a head injury. She hit a rock, and went over the bars, striking her head on a small tree as she fell. Corey Heitz is an emergency physician in Roanoke, Virginia.

Pediatrics 52

Pediatrics Head Injuries Academics Emergency Department 52

Emergency Medicine Cases

AUGUST 24, 2021

In this Part 1 of our 2-part EM Cases podcast series on Geriatric Trauma, Dr. Barbara Haas, Dr. Camilla Wong and Dr. Bourke Tillman answer questions such as: why are older patients under-triaged to trauma centers and how does that affect outcomes? Which older patients do not require head or c-spine imaging after a ground level fall?

Resuscitation 52

Resuscitation Head Injuries Airway Management Shock 52

The Bottom Line

JUNE 24, 2024

NEJM June 13 2024; doi:10.1056/NEJMoa240360 Clinical Question In adult patients with moderate or severe traumatic brain injury, does a liberal transfusion strategy (transfusion if haemoglobin <10g/dl) compared to a restrictive strategy (transfusion if haemoglobin <7g/dl) reduce the rate of an unfavourable Glasgow Outcome Scale – Extended, (..)

Outcomes 109

Outcomes Head Injuries 109

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

The Bottom Line

OCTOBER 26, 2024

PMID: 39382241 Clinical Question In patients with acute brain injury, does a liberal, compared to a restrictive strategy of blood transfusion, improve neurological outcomes at 180 days? Background The TRICC study, published over 20 years go, led to the widespread adoption of restrictive thresholds for blood […]

Blood Transfusions 101

Blood Transfusions Outcomes Head Injuries 101

Taming the SRU

DECEMBER 8, 2023

r4 case follow-up WITH DR. milligan CC: Found down The case: A young F was found down in a snow bank after a GSW to the head. She presented with a core temp of 30C and her CT scan did not show a devastating head injury as was expected. EMS had reported she had coded en route. She regained pulses with warming on arrival.

Hyperthermia / Hypothermia 88

Hyperthermia / Hypothermia Head Injuries Resuscitation Documentation/Coding 88

The Skeptics' Guide to EM

JUNE 17, 2023

American Journal of Hematology Jan 2023 * Population: Children aged 3-21 years old, with sickle cell disease (Hemoglobin SS disease or Hemoglobin Sβ Thalassemia) who presented with vaso-occlusive pain episodes to * Excluded: Children with upper respiratory infection, concern for stroke or altered mental status, or head injury, acute chest * Intervention: (..)

Emergency Department 73

Emergency Department Pediatrics Administration Head Injuries 73

The Skeptics' Guide to EM

FEBRUARY 3, 2024

Excluded: Oropharyngeal trauma combined with other severe head injury or multisystem trauma, not primary research, non-English publication * Intervention: CTA * Comparison: No CTA * Outcome: radiologic and clinical outcomes including infection, injury to vasculature, cerebrovascular injury, and neurologic abnormalities.

Pediatrics 66

Pediatrics Radiology Radiology Head Injuries 66

The Skeptics' Guide to EM

OCTOBER 17, 2020

Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury. Case: A 42-year-old helmeted bicycle rider is involved in an accident where he hits his head on the ground. Reference: Rowell et al. Reference: Rowell et al.

EMS 52

EMS Head Injuries Outcomes Hospitals 52

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

In an attempt to improve resource utilization, emergency department length of stay, limit cost and improve outcomes, there have been multiple Clinical Decision Rules (CDRs) created to help guide clinicians in their decision-making process. Traditionally CT imaging was obtained for fear of missing intracranial pathology.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

RebelEM

AUGUST 24, 2023

Background: Sports-related concussions are among the most common injuries in children and adolescents, affecting millions of youth athletes annually. Historical practice recommends rest to prevent adverse outcomes; however, evidence suggests strict rest is harmful. Symptom reporting was the most common outcome in the included studies.

Pediatrics 98

Pediatrics Outcomes Research Hospitals 98

RebelEM

NOVEMBER 20, 2023

Outcome: Primary Outcome: All-cause mortality at 90 days. The primary outcome focused on patient-centered outcomes. The outcomes were predominantly binary and objective, reducing the potential for subjective interpretation and bias. 97% of patients sustained blunt trauma.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

Dr. Smith's ECG Blog

JULY 22, 2012

A 6 yo girl had significant trauma from an MVC, with head injury (initial GCS 10, but no intracranial bleeding) and mild orthopedic injuries. Inpatient stay : She quickly awoke and was observed for a couple days, treated for minor orthopedic injuries, and recovered well from the head injury.

Head Injuries 52

Head Injuries EKG/ECG Outcomes Ultrasounds 52

The Skeptics' Guide to EM

MAY 30, 2020

The evidence for TXA providing a patient-oriented outcome (POO) has been mixed. It seems to work for epistaxis ( SGEM#53 and SGEM#210 ), failed to demonstrate a decrease in all-cause mortality in post-partum hemorrhage ( SGEM#214 ), and did not result in an improved neurologic outcome in hemorrhagic strokes ( SGEM#236 ). TXA vs. 19.8%

Head Injuries 52

Head Injuries Academics Outcomes EMS 52

Emergency Medicine Ireland

MAY 3, 2021

This is part of Oh’s Manual Chapter 77 on head injury and we covered ICP monitoring before in number 20. This is part of Oh’s Manual Chapter 77 on head injury and we covered ICP monitoring before in number 20. Welcome back to the tasty morsels of critical care podcast. The following summarises some of the headlines.

Head Injuries 40

Head Injuries Hyperthermia / Hypothermia Documentation/Coding Outcomes 40

Don't Forget the Bubbles

JUNE 30, 2023

Whilst you were busy managing head injuries and drownings, Ranulf had been out with a group of boys from school this evening. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. Back in ED with Ranulf, and pack two has gone through. J Pediatr Surg.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Emergency Medicine Journal

NOVEMBER 28, 2023

We hypothesized that there is a specific coagulopathy of ITBI, detectable using functional coagulation tests and that coagulopathy is associated with worse outcomes including raised intracranial pressure (ICP), progression of intracranial haemorrhage (PICH), and mortality.

Head Injuries 40

Head Injuries Radiology Radiology Outcomes 40

Pediatric Emergency Playbook

JANUARY 1, 2016

Abusive head injury is the most common cause of death from child abuse. Up to 30% of infants with abusive head injury may be misdiagnosed on initial presentation. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. Louwers et al. J Emerg Med. 2012; 43(1): e49–e51.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

The Injectable Orange

JUNE 20, 2017

The world is a strange place when we can’t do something so simple when it’s critical, but we do it so well when the outcomes are meaningless. The ED team had just finished an in situ simulation where the focus was on rapid sequence intubation (RSI) in head injury, and using the new intubation checklist.

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

Rural Doctors Net

AUGUST 30, 2013

Flooding him with crystalloid is going to dilute his clotting factors, make him hypothermic and potentially worsen outcomes. Check his pupils – any signs of head injury or subdural from flying debris? Even EMST-ATLS has (at last) moved away from the old mantra of “two litres of crystalloid, stat”.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

EMDocs

JULY 20, 2023

A second primary outcome was added at the 30-month time frame by request of the FDA, the trial was still blinded at that time. A second primary outcome was added at the 30-month time frame by request of the FDA, the trial was still blinded at that time. POWER: 86% to detect a 1-point difference in the group’s first primary outcome.

Stroke 73

Stroke Outcomes Head Injuries Psychiatric 73

Taming the SRU

MAY 10, 2024

r4 Capstone WITH Dr. Stark Learn from your poor patient outcomes. isolated head injury, asphyxia or any other cause of a likely hypoxic respiratory arrest blunt cardiac injury underlying medical cause for the arrest Role of US in TCA? meanwhile, pseudo-PEA may be associated with a favorable outcome.

Leadership 83

Leadership CPR Head Injuries Outcomes 83

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

PHEM Cast

MARCH 3, 2019

Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial. Trench entrapment: is ketamine safe to use for sedation in head injury? Emergency Medicine Journal. 2014 Dec;31(12):1029. 2014 Oct;31(10):840–3.

Emergency Department 52

Emergency Department Head Injuries Hospitals Pediatrics 52

The Skeptics' Guide to EM

APRIL 9, 2022

Included in this differential is transient epileptic amnesia, transient ischemic attack, stroke, metabolic disorders, psychogenic disorders, and post traumatic amnesia. We did the March episode at the end of last month and the April episode is the first week of this month.

Head Injuries 52

Head Injuries Emergency Department Seizures Stroke 52

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Emergency Medicine Journal

FEBRUARY 20, 2024

We aimed to identify variables that are associated with adverse outcomes in older patients admitted to a trauma centre for an isolated orthopaedic injury. Conclusion We identified eight predictors of adverse outcomes in patients >64 years of age admitted to a trauma centre for orthopaedic injury.

Outcomes 40

Outcomes Head Injuries 40