PulmCCM

OCTOBER 28, 2024

It was hypothesized that much earlier treatment with steroids, i.e., by paramedics en route to the hospital, might improve outcomes. Four hundred and one patients (76%) were assessed for the primary outcome (median size of the completed infarct). 6.9%) There were no differences in other secondary outcomes.

Outcomes 98

Outcomes Hospitals Wellness 98

St. Emlyn

JUNE 23, 2024

Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality globally, with a survival rate of less than 10% despite […] The post JC: The impact of double sequential external defibrillation timing on outcomes during refractory out-of-hospital cardiac arrest appeared first on St.Emlyn's.

Outcomes 76

Outcomes Hospitals Resuscitation 76

PulmCCM

SEPTEMBER 17, 2023

The Centers for Disease Control and Prevention formally called on hospitals to develop robust sepsis care programs to systematically identify and treat sepsis, track outcomes, and improve care delivery. ” What is that, a sepsis Stasi? Unlike strokes and STEMIs, sepsis has no gold standard for diagnosis.

CDC 98

CDC Sepsis Hospitals Documentation/Coding 98

St. Emlyn

JUNE 23, 2024

St.Emlyn's - Emergency Medicine #FOAMed Background Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality globally, with a survival rate of less than 10% despite emergency medical services (EMS) interventions.

Shock 67

Shock Outcomes Hospitals EMS 67

The Trauma Pro

JUNE 21, 2024

This situation was first documented in a paper published in the 1960s, which noted that VIP patients have worse outcomes. References: “ The VIP Syndrome”: A Clinical Study in Hospital Psychiatry. Who is a VIP? It may be a celebrity. A family member. Or even a colleague. Or the President of the United States. Cleve Clin J Med.

Documentation/Coding 290

Documentation/Coding Outcomes Hospitals Wellness 290

RebelEM

AUGUST 21, 2023

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Paper: Eastwood G, et al. N Engl J Med. Epub 2023 Jun 15.

Hospitals 98

Hospitals Resuscitation Outcomes CPR 98

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). Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in Cali. JAMA Network Open.

Hospitals 95

Hospitals CPR EMS Outcomes 95

Mount Sinai EM

AUGUST 7, 2024

Initially, data suggested that the use of ultrasound during arrest increased pauses between compressions which worsens outcomes. Rapidly intervened-upon cardiac tamponade in PEA during cardiac arrest has significantly higher hospital discharge rates. survival to hospital discharge rate.

Ultrasounds 235

Ultrasounds CPR Documentation/Coding COPD 235

The Trauma Pro

JANUARY 2, 2024

EAST sponsored a prospective, multicenter study to identify factors influencing neurologic outcomes after spinal cord injury. It would be interesting to see if patients who had very consistent MAP therapy, say greater than 90% or 95% of the time, had any difference in outcomes. Could a single low MAP cause damage?

Outcomes 264

Outcomes Hospitals 264

Pediatric EM Morsels

APRIL 19, 2024

No formal follow up was scheduled Outcomes were: effectiveness, parental satisfaction, and economic benefits The majority of children wore their braces as directed (94%)There was no re-fractureAll parents were happy with the treatment (100%) and felt comfortable removing the brace (100%). West, 2005. Plint, 2006. J Pediatr Orthop.

Fractures 286

Fractures Pediatrics Best Practices Outcomes 286

Emergency Medicine Journal

NOVEMBER 21, 2024

Background Because of their young age and lack of known comorbidities, paediatric patients with out-of-hospital cardiac arrest (OHCA) often undergo prolonged cardiopulmonary resuscitation (CPR). We aimed to determine the association between prehospital and in-hospital CPR duration and neurological outcomes.

Hospitals 52

Hospitals Outcomes Resuscitation CPR 52

Intensive Blog

MARCH 13, 2024

This showed a similar rate of survival to discharge (27%), of whom approximately 50% had a favourable neurological outcome on discharge (CPC 1 or 2). Multiple meta-analyses 9,10 found that ECPR, when compared to conventional CPR (CCPR), was associated with improved 30-day mortality and neurological outcomes. More recently ….

CPR 130

CPR Resuscitation Outcomes Hospitals 130

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 141

Poisoning Airway Management Seizures Shock 141

RebelEM

JUNE 1, 2023

Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC. 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.

Outcomes 145

Outcomes Resuscitation Hospitals CPR 145

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

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 129

Ultrasounds Outcomes COPD Hospitals 129

The Skeptics' Guide to EM

NOVEMBER 30, 2024

The Paramedic 3 Trial: A randomized clinical trial of drug route in out-of-hospital cardiac arrest. Case: You’re doing a ride along with your local emergency medical service (EMS) crews and responding to an out-of-hospital cardiac arrest (OHCA). Date: November 10, 2024 Reference: Couper et al.

Administration 86

Administration CPR Airway Management Outcomes 86

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 136

Stroke Outcomes Hospitals Administration 136

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. SECONDARY OUTCOMES At day 28 , ceftriaxone group had (vs placebo): Lower VAP risk (20% vs 36%); hazard ratio 0.62 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 125

CDC Outcomes Radiology Radiology 125

Sensible Medicine

SEPTEMBER 16, 2024

In the study by Makhnevich and colleagues, the team included adults with dementia who were admitted to 11 diverse hospitals in New York. The primary outcome was death in the hospital. Other outcomes included respiratory complications (pneumonia), intubation and hospital length of stay (LOS).

Outcomes 121

Outcomes Hospitals Research 121

RebelEM

MAY 25, 2023

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

The Trauma Pro

MAY 3, 2024

Various hospital outcomes were tabulated, including hospital charges, mortality, and discharge location. AE and PPP have equivalent outcomes. You can feel comfortable that outcomes will be the same as AE. This eliminated patients who might have received other additional management that could cloud the data.

Fractures 113

Fractures Documentation/Coding Radiology Radiology 113

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 128

Administration Blood Transfusions Outcomes Hospitals 128

The Trauma Pro

JANUARY 5, 2024

The group at the Medical College of Wisconsin performed a trial of thoracic cavity irrigation and compared the outcomes with patients who did not undergo irrigation. The study excluded patients with chest tubes placed in other hospitals, tubes placed late (after 24 hours), or patients who had a chest procedure within 6 hours.

Hospitals 133

Hospitals Wellness Outcomes 133

Dr. Smith's ECG Blog

JULY 11, 2024

On day three of his hospital admission, he had a cardiac MRI taken: The MRI showed: Increased LV volume Severe segmental LV dysfunction with a calculated EF of 26% Thinning and akinesis of the entire anterior wall, apical segments, entire anterior septum, and the mid inferior wall. Here is the post-cath EKG: There is no change.

EKG/ECG 98

EKG/ECG Outcomes Hospitals Wellness 98

RebelEM

NOVEMBER 30, 2023

PMID: 37597449 Clinical Question : In sepsis patients with CHF, does a restricted volume resuscitation strategy of less than 30mL/kg IV crystalloid initiated within the first three hours of sepsis identification, compared to volume resuscitation with 30 mL/kg IV crystalloid, decrease in-hospital mortality? 2.89, p = 0.01.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

RebelEM

MAY 29, 2023

It also reduced length of stay in ICU and hospital without adverse effects. What They Did: Single-center, parallel, double blind, randomized controlled trial performed in a medical-surgical ICU (Mexico) Both groups received: Adjunctive vasopressin initiated at a dose of 0.03 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9%

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

Emergency Medicine Journal

AUGUST 21, 2024

Methods This was a multicentre, parallel-group, open-label, feasibility RCT in seven hospitals in England and Scotland. Feasibility outcomes were recruitment, retention and adherence. Feasibility outcomes were recruitment, retention and adherence. Pain and some frailty-specific outcomes were not feasible to collect.

Fractures 97

Fractures Research Outcomes Hospitals 97

RebelEM

SEPTEMBER 7, 2023

OUTCOMES Primary: Occurrence of at least one clinical or electrographic seizure recorded on continuous EEG within 72 hours after inclusion. 0.38, p=0.0021) No statistically significant results were reported in the other clinical outcomes studied. The primary outcome was patient-oriented. OR 0.07, 95% CI 0.01-0.38,

Seizures 133

Seizures Stroke Outcomes Research 133

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 137

Outcomes Research Hospitals Operations 137

RebelEM

FEBRUARY 5, 2024

Sites: Investigators recruited patients at 31 French emergency departments at university and nonuniversity hospitals Duration : June 1, 2009 to March 31, 2015. Funding: The Cardinal Health Laboratory provided Turkel thoracentesis kits to two hospitals Trial Registry: Clinicaltrials.gov: NCT01008228.

Outcomes 105

Outcomes Hospitals Research Emergency Department 105

PulmCCM

NOVEMBER 14, 2024

Although early mobilization and physical therapy for vented patients would intuitively seem to have indisputable benefits, early mobility programs have failed to consistently show improvements in meaningful patient-centered outcomes (e.g, increased functional independence or exercise ability after ICU discharge). Of course not.

Hospitals 105

Hospitals Outcomes 105

PulmCCM

NOVEMBER 7, 2024

For out-of-hospital cardiac arrest in particular, intravenous access can be difficult to establish, delaying the administration of epinephrine and other drugs and possibly worsening outcomes. During cardiac arrest, every second matters (at least potentially). Read more

Resuscitation 98

Resuscitation Administration Hospitals Outcomes 98

The Trauma Pro

OCTOBER 6, 2023

Although many of these injuries were managed within hours, a growing number were delayed by a few days to improve outcomes. We learned that temporizing with strict blood pressure control worked wonders at protecting the patient. Nowadays, thoracic endovascular aortic repair (TEVAR) is routine and much less morbid than the open procedure.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

RebelEM

OCTOBER 2, 2023

Mild to moderate DKA represents a subgroup of patients that often require admission to the ICU due to hospital policies not allowing insulin infusions outside of this clinical setting. No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 tests/hr (0.8 Traditional: 1.0

Operations 105

Operations Academics Outcomes Fluid Resuscitation 105

The Bottom Line

JUNE 19, 2023

In patients resuscitated from out-of-hospital cardiac arrest (OOHCA) does targeted mild hypercapnia compared to targeted normocapnia improve 6-month neurological outcomes?

Resuscitation 98

Resuscitation Outcomes Hospitals 98

Sensible Medicine

JULY 29, 2024

Yet the failure of the hospital readmission penalty policy and sepsis protocols expose the risks of implementing a policy because it sounds good. The background for cash giveaways stem from the association of low income and worse health outcomes. The primary outcome was positive but there were caveats.

Outcomes 119

Outcomes Research Sepsis Emergency Department 119