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

ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. Christopher’s Hospital for Children by private equity (PE) firm Paladin Healthcare Capital for 170 million dollars. Christopher’s was able to find a buyer prior to bankruptcy but Hahnemann could not.

Hospitals 113

Hospitals Radiology Radiology Administration 113

RebelEM

APRIL 17, 2023

33 studies selected for full review Of those 33 studies, 17 of those met criteria for inclusion Of the 18 studies, 1 was an RCT, 14 were prospective cohort studies, and 3 were retrospective cohort studies Total of 812 patients of whom 541 had PTA from 17 studies.

Ultrasounds 129

Ultrasounds Radiology Radiology Operations 129

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. Survival was better, both at 24 hours and six months, in the TXA group, although the primary outcome, a quality of life score at six months, called the Glasgow Outcome Scale Extended (GOS-E), was the same in both groups ( 53.7%

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

Sensible Medicine

NOVEMBER 30, 2023

Typically, we place the burden on manufacturers to show that their products improve health outcomes prior to sale. At 50% of GDP on health care, we will give everyone a weekly pass to get unlimited, unnecessary radiologic imaging, and if two doctors on Twitter think you should get a solid organ transplant, insurers have to pay.

Research 145

Research Radiology Radiology Administration 145

The Skeptics' Guide to EM

FEBRUARY 3, 2024

March 2023 Date: January 30, 2024 Guest Skeptic: Dr. Alexandra (Ali) Espinel is an Associate professor of pediatrics and otolaryngology at Children’s National Hospital and George Washington University. She is also the director of the Pediatric Otolaryngology Fellowship at Children’s National Hospital. Laryngoscope. I’m the Problem.

Pediatrics 68

Pediatrics Radiology Radiology Head Injuries 68

ACEP Now

DECEMBER 7, 2024

3,4 In addition, for patients with contraindications or those who have failed thrombolysis, catheter-directed thrombolysis and surgical thrombectomy are useful treatment modalities that are associated with low major complication rates and improved patient outcomes.

Ultrasounds 52

Ultrasounds Radiology Radiology EKG/ECG 52

Sensible Medicine

APRIL 12, 2024

There have been observational studies and a handful of actual RCTs looking at how duty hours have affected medical education, patient outcomes, the prevalence of medical errors, housestaff satisfaction, sleep duration… I am definitely not one to question whether restricting housestaff duty hours was necessary.

Radiology 81

Radiology Radiology Hospitals Documentation/Coding 81

EMDocs

OCTOBER 10, 2024

Hospital Inpatient : R thigh is indurated and blistered but abdomen is all but ignored. On the 2nd hospital day, she becomes obtunded and is intubated. She only gets worse, and by the 4th hospital day she is unresponsive. High level amputation is considered, but she dies of sepsis and multiorgan failure on hospital day 7.

Documentation/Coding 95

Documentation/Coding Hospitals Sepsis Infectious Diseases 95

RebelEM

NOVEMBER 20, 2023

Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. Outcome: Primary Outcome: All-cause mortality at 90 days. Patients in the standard care alone group had more intensive care unit-free and hospital-free days.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

The Trauma Pro

MAY 10, 2024

And its correlation with outcomes varies. It also standardizes comparisons between hospitals that use STAT. The most important one is that it relies only on the Injury Severity Score (ISS) to judge whether some type of mistriage occurred. The ISS is usually calculated after discharge, so it can only be applied after the fact.

Blood Transfusions 113

Blood Transfusions Radiology Radiology Documentation/Coding 113

EMDocs

NOVEMBER 20, 2023

Key Concept: For patients with LGIB on cardiac aspirin for secondary prevention, aspirin should be continued during hospitalization if possible. Resumption of antiplatelet medications and risk of recurrence Recommendation: We recommend discontinuing nonaspirin NSAIDs after hospitalization for diverticular hemorrhage.

Resuscitation 101

Resuscitation Fluid Resuscitation Hospitals Research 101

Don't Forget the Bubbles

FEBRUARY 5, 2025

All hospitals will have different makeups of trauma teams and possibly different levels of activation) Do I need any additional expertise outside of who would typically be in the trauma team? E.g. burns, neurosurgery, interventional radiology. Clinical Radiology: Major paediatric trauma radiology guidance.

Fluid Resuscitation 59

Fluid Resuscitation Domestic Violence Head Injuries Sexual Assault 59

RebelEM

OCTOBER 5, 2023

Pneumonia diagnosis supported by clinical and radiologic criteria. Secondary Outcome By day 90, mortality was 9.3% Strengths: The investigators framed a research question centered on patient outcomes, ensuring the study’s relevance and practicality. Population Inclusion Criteria: Adult patients (≥18 years old). to −0.8).

Research 94

Research Outcomes Administration Shock 94

The Skeptics' Guide to EM

JUNE 4, 2017

However, when we assess major trauma that includes chest, abdominal and pelvic trauma, the initial radiologic evaluation is left to the treating physician’s judgement. Many studies (most retrospective) have assessed the use of pan scanning as an initial radiologic evaluation. Reference: Sierink et al.

Radiology 52

Radiology Radiology CPR Hospitals 52

Sensible Medicine

APRIL 16, 2024

The idea was that the software would examine patients’ medical records – the entire medical record: clinical notes; labs; radiology; and their admission histories – and learn to stratify people in terms of their risk for readmission. The idea was that interventions could then be tested in the high-risk groups.

Radiology 91

Radiology Radiology Stroke Hospitals 91

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. were hospitalizations during f/u period; 26.4%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

SheMD

JUNE 8, 2023

July 1st is almost here and hospitals around the country will welcome in their new interns. The transition from internal medicine or surgery intern to Radiology resident (or any other residency) feels daunting to most. Advocate · As a woman in radiology (and most fields in medicine), you are a minority. You CAN do this!

Radiology 52

Radiology Radiology Outcomes Hospitals 52

Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. May be considered first line in the future however results may be dependent upon provider training and hospital resources [17].

Fractures 96

Fractures COPD Hospitals Emergency Department 96

The Skeptics' Guide to EM

AUGUST 24, 2024

Case: A 67-year-old male presents to your hospital emergency department (ED) after a fall from his bicycle. JAMA Surg 2024 Population: Patients aged 16 years or older with clinically suspected or radiologically confirmed rib fractures. Interests include information systems and digital health, research and education.

Fractures 53

Fractures Emergency Department Ultrasounds Radiology 53

EMDocs

FEBRUARY 26, 2024

Laboratory evaluations that return after admission to the hospital are remarkable for microcytic hypochromic anemia (hemoglobin 9.2 4 Early diagnosis is key to allow for early treatment to improve outcomes. Outcome and prognostic factors of Pneumocystis jirovecii pneumonia in immunocompromised adults: a prospective observational study.

Radiology 108

Radiology Radiology Outcomes Ultrasounds 108

EMDocs

JUNE 22, 2023

As usual, I was the only physician staffing this rural critical access hospital with limited resources which sits 61 miles away from our state’s only Level 1 trauma center. The radiology tech has his hand on a weak femoral pulse. Did I mention that we only had one unit of blood in the hospital for emergent release?

Resuscitation 98

Resuscitation Ultrasounds Critical Access Radiology 98

Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED? ETT onto a fiberoptic scope.

CPR 90

CPR Burns Airway Management Wellness 90

Taming the SRU

OCTOBER 23, 2023

A radiology performed ultrasound is ordered and has similar findings– Impression: no definitive IUP with a small amount of free fluid within physiologic limits. After a short period of recovery in the hospital, she is discharged home in stable condition with follow-up with OBGYN. Am J Emerg Med. 2019 Jun;37(6):1165-1168. 2019.03.025.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

The Skeptics' Guide to EM

JULY 18, 2020

* SGEM#263 : Please Stop, Prescribing – Antibiotics for Viral Acute Respiratory Infections * SGEM#216: Pump It Up – Corticosteroids for Patients with Pneumonia Admitted to Hospital * SGEM#120 : One Thing or Two for Community Acquired Pneumonia?

Radiology 52

Radiology Radiology Emergency Department Outcomes 52

ACEP Now

NOVEMBER 14, 2023

So next time you are faced with a patient with massive hemoptysis heading for respiratory failure in your ED, take an organized approach such as this seven-step one to maximize your patient’s chance of survival with good neurologic outcome. Dr. Helman is an emergency physician at North York General Hospital in Toronto.

Radiology 52

Radiology Radiology Emergency Department Airway Management 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. As a starter for 10: in which meningeal space in the brain do you find an SAH?

Stroke 52

Stroke EMS Radiology Radiology 52

EB Medicine

JUNE 6, 2019

Taylor and Shaukat of Emory and Coney Island Hospital respectively for their efforts in peer reviewing this huge topic. CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: All valid points, but let’s dive in too some actual detail.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

PEMBlog

SEPTEMBER 13, 2023

The causes are many – it could be a force of habit, a medical liability concern for “missing something,” a desire to please the caregivers, a previous seizure patient of theirs who had a bad outcome, or numerous other causes.

Seizures 52

Seizures Pediatrics Point-of-Care Testing Wellness 52

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The hospital is the Paediatric Major Trauma Centre for the South-West. It’s a great idea and maybe something for other centres to copy!) in lower-resource settings.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

EMDocs

NOVEMBER 16, 2024

16 US or CT guided biopsy/joint aspiration (typically performed by Orthopedic surgery or Interventional Radiology). 13 Management: Dislocation As with all dislocation, early reduction improves outcomes. Hospitals, 2018. Epidemiology of total hip arthroplasty: demographics, comorbidities and outcomes. 2021 Aug 31.

EMS 96

EMS Dislocations Fractures Operations 96

Taming the SRU

SEPTEMBER 18, 2024

Methods and Results This study was carried out at 3 university-affiliated, urban teaching hospitals in Canada over the course of approximately 3 years. The form included information that, based on literature review and expert opinion, was thought to be either positively or negatively associated with one of the serious outcomes.

Stroke 87

Stroke Outcomes Emergency Department Radiology 87

Don't Forget the Bubbles

FEBRUARY 7, 2024

My first real encounter with the healthcare system took place when I was about seven years old and had to go into hospital for an orchidopexy, so I can empathize with all the young people who come through our emergency department with acute testicular pain. Pediatric radiology , 48 , pp.735-744. This dropped to 79.3% Bandarkar, A.N.

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

EMDocs

MARCH 6, 2024

In other patients who are stable and the bleeding has resolved, CTA is of low yield If they are critically ill and have severe bleeding, resuscitate first and consult IR, radiology, and surgery. There is no clear improvement with idarizucimab or andexanet alfa on patient-oriented outcomes. If severe bleeding, administer PCC.

Blood Transfusions 104

Blood Transfusions Outcomes Resuscitation Radiology 104

Don't Forget the Bubbles

DECEMBER 2, 2024

An international team joining DFTB Bubble Wrap from Aghia Sophia Childrens Hospital ED , Athens, Greece, tell us what is new in thepaediatric literature Led by Spyridon Karageorgos, a Paediatrician enthusiastic about Paediatric Emergency Medicine, reducing antibiotic use in paediatric patients, and Medical Education. Why does it matter?

Documentation/Coding 98

Documentation/Coding Pediatrics Emergency Department Fractures 98

RebelEM

SEPTEMBER 11, 2023

Outcomes: Primary: Percent change in management decisions after introducing the Radiology Department RUQ US. A change in clinical course resulting from a discrepancy between POCUS and radiology department imaging only occurred in 2% of patients (not 10%). appeared first on REBEL EM - Emergency Medicine Blog.

Ultrasounds 68

Ultrasounds Radiology Radiology Emergency Department 68

EMDocs

OCTOBER 17, 2023

In patients with suspected ALCD, we suggest a complete assessment of the patients using clinical history, signs, laboratorial inflammation markers, and radiological findings (weak recommendation based on very low-quality evidence, 2D).” “In American College of Radiology ACR Appropriateness Criteria (2023) Left lower quadrant pain.

Radiology 89

Radiology Radiology Operations Best Practices 89