The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. Background: We’ve discussed out-of-hospital cardiac arrest (OHCA) at least once or twice on the SGEM (see long list at end of blog). Clinical Question: Is naloxone administration in undifferentiated OHCA associated with survival to hospital discharge?

Hospitals 98

Hospitals CPR EMS Outcomes 98

St. Emlyn

NOVEMBER 22, 2024

St.Emlyn's - Emergency Medicine #FOAMed This retrospective study explores the link between intra-arrest arterial blood pressure (IBP) and return of spontaneous circulation (ROSC) in out-of-hospital cardiac arrest (OHCA). While promising, further research is needed to validate its integration into standard prehospital care practices.

Hospitals 113

Hospitals CPR Resuscitation Research 113

The Trauma Pro

SEPTEMBER 6, 2024

I’ve included a printable pdf file, as well as the original Microsoft Publisher file in case you want to make a few modifications to suit your own hospital. Here’s a reference sheet formatted at a 3×5 index card that you can keep in your pocket. When to call Urology reference card (pdf)

Operations 264

Operations Hospitals Wellness 264

The Trauma Pro

SEPTEMBER 20, 2024

Getting there includes an obvious problem: what happens when the physician leaves the hospital? Other surgeons may be available in the hospital during the daytime, although they may have other responsibilities keeping them busy. For emergency physicians, there are generally several on duty, so one will not be missed too much.

Hospitals 187

Hospitals EMS Wellness 187

The Trauma Pro

FEBRUARY 23, 2024

Unfortunately, they were very conservative, recommending days of bedrest, extended NPO status, very frequent blood draws, and a lengthy hospital stay. Many hospitals, including mine, developed less conservative management routines, noting that children nearly always tolerate liver and spleen injury better than adults.

Pediatrics 199

Pediatrics Hospitals Resuscitation 199

Mount Sinai EM

AUGUST 7, 2024

Rapidly intervened-upon cardiac tamponade in PEA during cardiac arrest has significantly higher hospital discharge rates. survival to hospital discharge rate. Evidence of right heart strain is important but the evidence of fibrinolysis during arrest is mixed with many studies showing no 30-day mortality benefit to lysing during a code.

Ultrasounds 235

Ultrasounds CPR Documentation/Coding COPD 235

The Trauma Pro

SEPTEMBER 24, 2024

I would discourage the use of propofol because it is difficult to titrate outside the hospital and may contribute to hypotension. Finally, don’t assume that you will accompany the patient (and possibly their limb) back to the hospital. Paralytics, sedatives and analgesics are essential.

Hospitals 203

Hospitals 203

The Trauma Pro

JULY 9, 2024

This problem was associated with a significantly longer ICU stay and a somewhat longer overall hospital stay. They studied a series of 79 of their patients who were treated with a halo. A full 66% had problems with their swallowing evaluation. Bottom line: Suspect dysphagia in all patients with cervical fractures, especially the elderly.

Head Injuries 264

Head Injuries Fractures Hospitals Wellness 264

Ken Grauer, MD

DECEMBER 29, 2023

The "good news" — is that after an extended hospitalization, the patient was finally discharged home, and doing well. = . = The H ISTORY in T oday's C ASE: The patient in today's case is a teenager who presented to the ED ( E mergency D epartment ) in cardiac arrest after electrocution.

EKG/ECG 430

EKG/ECG Resuscitation Hospitals Wellness 430

The Trauma Pro

MAY 28, 2024

A recent Massachusetts General Hospital study involved a larger group (97 patients with 110 fixators). Consult your radiologists and physicists to develop a policy that is specific to the scanners used at your hospital. Most MRIs were performed to evaluate the cervical spine. There were no adverse events. Most were performed on a 1.5T

Fractures 261

Fractures Hospitals 261

The Trauma Pro

SEPTEMBER 17, 2024

Getting them to the scene will always take extra time since they are typically hospital-based. Look at your local resources and the logistics imposed by the environment, traffic, hospital, and other factors. In contrast, the prehospital providers are already present and are used to working in an austere environment.

Airway Management 199

Airway Management Operations Hospitals Wellness 199

The Trauma Pro

JUNE 21, 2024

References: “ The VIP Syndrome”: A Clinical Study in Hospital Psychiatry. Order the same tests you usually would, use the same consultants, and take control of all of their recommendations, trying to do things your usual way. This will provide the VIP with the best care possible, which is actually the same as what everybody else gets.

Documentation/Coding 290

Documentation/Coding Outcomes Hospitals Wellness 290

The Trauma Pro

NOVEMBER 8, 2024

Another disadvantage is that if the patient moves away or presents to another hospital for flap replacement, the logistics of transferring a frozen piece of bone are very challenging. There are reports of some mineral loss from the flap after replacement, and occasional infection. And occasionally the entire piece is misplaced.

Hospitals 260

Hospitals 260

The Trauma Pro

MARCH 1, 2024

The US military has adopted its routine use at forward combat hospitals. This drug is cheap and has antifibrinolytic properties that may be beneficial if given for life-threatening bleeding within 3 hours of initial injury. It’s typically given as a rapid IV infusion, followed by a slower followup infusion.

Military 279

Military Resuscitation Administration Hospitals 279

Ken Grauer, MD

FEBRUARY 21, 2025

The patient left before a final ECG could be done so we do not know what the rhythm was at the time the patient left the hospital. Putting the "story" together in today's case: In Figure-7 are 2 additional 12-lead ECGs that were obtained during the course of this patient's hospitalization. What Then is the Rhythm in Figure-4?

226

226

Pediatric EM Morsels

NOVEMBER 3, 2023

This allowed US hospitals to stock the drug to ensure quick treatment of suspected severe cases, rather than having to ship it from the CDC under the prior expanded-access protocol (Thomas 2023). Higher Rates of Misdiagnosis in Pediatric Patients versus Adults Hospitalized with Imported Malaria. June 28, 2023. J Travel Med.

Seizures 278

Seizures Pediatrics CDC Infectious Diseases 278

The Trauma Pro

NOVEMBER 17, 2023

My previous statements were based on the way that we organize our trauma team and trauma activations at this hospital. At our hospital, we have 8 people clustered immediately around the patient, with half of them being surgery or emergency medicine residents. In principle, I agree.

Resuscitation 214

Resuscitation Ultrasounds Hospitals Wellness 214

The Trauma Pro

JUNE 27, 2023

Since I last published the series, I’ve visited numerous hospitals that use the eTFS and a diminishing number that have stuck with the paper trauma flow sheet. I’ll kick off the series with my next post, which describes why your hospital wants you to switch to some newfangled eTFS. But alas, that is not the case.

Hospitals 185

Hospitals 185

St. Emlyn

NOVEMBER 14, 2023

St.Emlyn's - Emergency Medicine #FOAMed Simplifying urgent care data translation is essential for hospital flow improvement. This post provides a perspective on how to achieve this. The post Speaking urgent care flow fluently appeared first on St.Emlyn's.

Urgent Care 140

Urgent Care Hospitals Teamwork Leadership 140

The Trauma Pro

FEBRUARY 7, 2025

The work was done at a large teaching hospital and Level I trauma center in Australia. If you read the article closely, the trauma service at this hospital was staffed with a higher number of trainees after hours and on weekends than during office hours. What about the time of day? What gives?

Hospitals 127

Hospitals 127

The Trauma Pro

SEPTEMBER 1, 2023

more likely In-hospital cardiac arrest – 5x The authors concluded that even if your patient does not have injuries that might limit their daily activities, it is still important to discuss goals of care with our elderly trauma patients. The point is that injuries limiting daily activities are a predictable factor for withdrawal of care.

Hospitals 198

Hospitals Wellness 198

Pediatric EM Morsels

JULY 19, 2024

If bleeding has completely stopped, most of these children still come into the hospital for observation so access will likely be necessary and helpful should patient have rebleed event. Even those that are no longer bleeding on arrival, will often require observation in the hospital. Is there active bleeding, clot, or no bleeding ?

Airway Management 286

Airway Management Pediatrics Wellness Operations 286

The Trauma Pro

MAY 17, 2024

This is a major reason for the relative lack of availability, especially at smaller hospitals. However, it can be frozen and used only when needed. Platelets are another short-lifespan product, typically lasting only five days. Unfortunately, freezing them or attempting cold storage renders them less active.

Resuscitation 263

Resuscitation Research Hospitals 263

Sensible Medicine

DECEMBER 28, 2024

The purpose of universal prophylaxis is to reduce RSV-associated hospitalizations. For RSV-associated lower respiratory tract infection (LRTI) hospitalizations, three studies found a significant effect and two found a null effect. The secondary endpoint of hospitalization for RSV-associated LRTI occurred in 0.6%

Hospitals 129

Hospitals CDC Documentation/Coding Outcomes 129

Ken Grauer, MD

SEPTEMBER 15, 2024

For full discussion of the case — CLICK HERE — ECG Rhythm Overview: A 12-year-old boy was admitted to our hospital with severe myocardial dysfunction and chaotic rhythm with tachy- and bradycardic arrhythmias. ECG #2: Figure-2: ECG #2 is from the 4th hospital day.

EKG/ECG 195

EKG/ECG Hospitals Wellness 195

Ken Grauer, MD

JUNE 22, 2024

During my decades of working with residents when hospital Attending — by far, the most commonly overlooked vital sign was respiratory rate. . = PEARL # 3: An Often Forgotten Clinical NOTE. Initial assessment of the patient for possible acute PE begins by counting the respiratory rate.

EKG/ECG 429

EKG/ECG Stroke Documentation/Coding Wellness 429

Sensible Medicine

OCTOBER 15, 2024

It is my pleasure to introduce this article by Joseph Marine, MD in response to mandatory masking policies in a number of California hospitals. The State of Maryland reinstated a health care mask mandate last winter based on the state reaching a threshold of 10 RSV/flu/covid hospitalizations per 100,000 population.

Hospitals 136

Hospitals Wellness 136

The Trauma Pro

AUGUST 9, 2024

He spent his career at the Charity Hospital there, weathering multiple political storms over the years, as well as the big one, Hurricane Katrina. He was instrumental in achieving Level I Trauma Center status for its replacement, Interim LSU Hospital.

EMS 147

EMS Hospitals Wellness 147

RebelEM

DECEMBER 23, 2024

saline affect hospital-free days by day 30? PMID: 39250114 Clinical Question: In adult patients admitted for a vaso-occlusive episode, does early fluid resuscitation with Lactated Ringer solution compared to 0.9%

Fluid Resuscitation 121

Fluid Resuscitation Resuscitation Documentation/Coding Outcomes 121

EM Ottawa

MAY 30, 2024

In this month’s PTM Journal Club, we explored the most recent literature on trauma care in the pre-hospital setting. If you missed last months PTM Journal Club, make sure to check-it out by clicking HERE.

Hospitals 110

Hospitals Ultrasounds 110

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 137

Poisoning Airway Management Seizures Shock 137

The Trauma Pro

JUNE 14, 2024

Patients with no other injuries could potentially be discharged from the hospital before they become overtly symptomatic, leading to delayed treatment. The authors suggested that if such patients had no other injuries requiring hospitalization, they could potentially be discharged home.

Operations 147

Operations Radiology Radiology Hospitals 147

NIOSH Science Blog

NOVEMBER 8, 2023

Despite legislation and improved technology, data from Massachusetts hospitals show that sharps injuries have increased in the operating room (OR) [1]. The Massachusetts data highlight a gap and the need to establish a national surveillance program that would help hospitals develop further measures to prevent sharps injuries.

Operations 125

Operations Hospitals 125

Pediatric EM Morsels

APRIL 19, 2024

Hospital versus home management of children with buckle fractures of the distal radius. Buckle fractures of the distal radius are safely treated in a soft bandage: a randomized prospective trial of bandage versus plaster cast. J Pediatr Orthop. 2005;25:322–325. Symons S, Rowsell M, Bhowal B, et al. A prospective, randomised trial.

Fractures 286

Fractures Pediatrics Best Practices Outcomes 286

The Trauma Pro

DECEMBER 12, 2023

This necessitates an inter-hospital transfer that is subject to scrutiny by the trauma performance improvement program of both trauma centers. The work-up from the referring hospital can be re-evaluated. In some hospitals, orthopedics may choose to place a traction pin to provide initial fracture management.

Emergency Department 124

Emergency Department Operations Hospitals Radiology 124

The Trauma Pro

JUNE 25, 2024

Readmission of any patient to the hospital is considered a quality indicator. Was the patient discharged too soon for some reason? Were there any missed or undertreated injuries?

Fractures 194

Fractures Academics Hospitals 194

Pediatric EM Morsels

JUNE 30, 2023

Congential Cystic Adenomatoid Malformation: A Teritriay Care Hospital Experience. Neonatology. Apr 110 (2): 101-15. PMID: 27070354 Mehta AA, Viswanathan N, Vasudevan AK, Paulose, R, Abraham, M. J Clin Diagn Res. Nov: 10 (11): SC01-SC04. PMID: 28050458 Salerno M, Sessa F, Cocimano G, Roccuzzo S, Esposito M, Pomara C.

Ultrasounds 281

Ultrasounds Pediatrics Operations EMS 281