Don't Forget the Bubbles

DECEMBER 31, 2024

The skills needed to deliver the best possible outcomes for children and young people are multifaceted and constantly evolving. Reading Body language in tense meetings, phraseology when making referrals, and quick corridor conversations when hospital capacity is at a premium may all result in improved outcomes but are rarely intentional.

Leadership 140

Leadership Emergency Department Outcomes Operations 140

Emergency Medicine Journal

MARCH 25, 2025

This month’s update is by the Emergency Department Team, Wexham Park Hospital, Slough, Frimley Health NHS Foundation Trust. We used a multimodal search strategy, drawing on free open-access medical education resources and literature searches. The 1-BED.

Sepsis 52

Sepsis Emergency Department Administration Outcomes 52

ACEP Now

MARCH 10, 2025

A sense of purpose is an integral part of well-being. Dr. Koo is faculty and an emergency physician at MedStar Washington Hospital Center in Washington, D.C., Marys Hospital in Leonardtown, Maryland. Ikigai and subsequent health and wellbeing among Japanese older adults: longitudinal outcome-wide analysis. 2022;21:100391.

Academics 85

Academics Wellness CPR Hospitals 85

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 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.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Taming the SRU

JUNE 11, 2023

End-tidal carbon dioxide measured at emergency department triage outperforms standard triage vital signs in predicting in-hospital mortality and intensive care unit admission. It’s reflection of underlying metabolism, circulation and ventilation may serve well to identify patients with early dysfunction of physiologic functions.

Hospitals 88

Hospitals Emergency Department EMS Outcomes 88

ACEP Now

MARCH 11, 2025

1 Further, a Cochrane review found that LMWH is associated with improved outcomes compared with UFH including reduced incidence of major hemorrhage (odds ratio [OR]=0.69; 95 percent CI, 0.50-0.95) no increase in vasopressor use, mechanical ventilation, admission to an intensive care unit, in-hospital mortality). percent to 56.3

Hospitals 52

Hospitals Administration Outcomes Stroke 52

Mind The Bleep

FEBRUARY 2, 2025

” Yes, I have seen clerking look like this and I can confirm, it does not go down well. Examples of examination findings you might find helpful to keep in mind (list not exhaustive): GCS 15/15- alert, orientated, looks comfortable, warm and well perfused, in obvious pain, looks pale and clammy etc.

Documentation/Coding 95

Documentation/Coding COPD EKG/ECG Wellness 95

American Medical Compliance

MARCH 21, 2025

Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve patient care outcomes. They explore core ethics in this course as well as corollary principles. This helps ensure care remains respectful, patient-centered, and ethically sound.

Outcomes 52

Outcomes Patient Safety Hospitals Wellness 52

The Skeptics' Guide to EM

JULY 2, 2023

His Glasgow Coma Scale (GCS) score is 13 with obvious head trauma as well. Emergency Medical Services (EMS) calls in ahead of time to warn the facility that they are 20 minutes out, to give report about the patient, and ask whether they should give tranexamic acid (TXA) pre-hospital. Prehospital Tranexamic Acid for Severe Trauma.

EMS 145

EMS Outcomes Hospitals Research 145

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

Don't Forget the Bubbles

MARCH 31, 2025

This was a secondary analysis of the Management and Outcome of Fever in Children in Europe (MOFICHE) study. The primary outcome measure was SBI, and 1854 children included were diagnosed with an SBI. However, excessive fluid administration can lead to fluid overload, which has been linked to worse clinical outcomes.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

Sensible Medicine

AUGUST 12, 2024

Surely you do as well. You can improve your chances by eating well, exercising, avoiding smoking and too much alcohol. What patients, doctors, hospitals and payers want to know is that does the $43 billion spent on screening lead to better outcomes in the average patient. My thinking aligns well with his.

Outcomes 133

Outcomes Research Wellness Hospitals 133

ACEP Now

OCTOBER 29, 2024

4 However, emergency physicians rely on gestalt to predict outcomes well. The externally validated Canadian Syncope Risk Score (CSRS) demonstrated no better prediction of 30-day adverse outcomes for “very low” and “low” risk patients than clinical judgment alone of emergency physicians. Mary’s Hospital in Leonardtown, Maryland.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

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 113

EKG/ECG Outcomes Hospitals Wellness 113

The Trauma Pro

OCTOBER 6, 2023

At the time, there was a debate about whether the procedure should be done immediately versus waiting until the patient was well-resuscitated. Although many of these injuries were managed within hours, a growing number were delayed by a few days to improve outcomes.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

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

RebelEM

OCTOBER 30, 2023

Cryoprecipitate Group: 25.3% OR 0.96; 95% CI 0.75 to 1.23; p = 0.74 vs 10%; OR 1.74; 95% CI 1.20 Cryoprecipitate Group: 25.3% OR 0.96; 95% CI 0.75 to 1.23; p = 0.74 vs 10%; OR 1.74; 95% CI 1.20 Cryoprecipitate Group: 25.3% OR 0.96; 95% CI 0.75 to 1.23; p = 0.74 vs 10%; OR 1.74; 95% CI 1.20 Cryoprecipitate Group: 25.3% OR 0.96; 95% CI 0.75

Administration 128

Administration Blood Transfusions Outcomes Hospitals 128

Don't Forget the Bubbles

JANUARY 31, 2024

As a Trauma Unit within the Thames Valley Trauma Network, Wexham Park Hospital hosts trainees from across the spectrum of acute specialties. Two really important patient groups were excluded – those who were admitted to hospital and families who were not fluent in English. the pre-hospital setting. Why does it matter?

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

The Trauma Pro

JULY 5, 2024

But under-prescribing can create problems as well. Uncontrolled pain is a huge patient dissatisfier, and can lead to unwelcome complications as well (think pneumonia after rib fractures). Make sure all is documented well on the consent or in the EHR.

Documentation/Coding 113

Documentation/Coding Fractures Emergency Department Wellness 113

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Admission allows for close monitoring, given the risks of perforation, ischemic bowel, and ulceration, as well as appropriate management of the condition and patient symptoms. Fecal Impaction and Nonperforated Stercoral Colitis: Red Flags for Poor Outcomes. Mathis, K.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

The Trauma Pro

OCTOBER 4, 2024

Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. Adherence to guidelines was assessed by a follow-up phone call two months after injury.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

The Trauma Pro

OCTOBER 25, 2024

To sum up, both are equally effective in controlling hemorrhage, but the hospital costs for patients undergoing angioembolization are significantly less. Authors from several well-known trauma centers collaborated to re-analyze data from the CLOTT study. The primary outcome was the development of VTE during the hospitalization.

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

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 118

Outcomes Research Sepsis Emergency Department 118

Stop and Think

AUGUST 28, 2024

Doctors and hospitals make money. Trial after trial after trial finds that fixing stable coronary artery disease does not improve outcomes over basic medications and lifestyle changes. The trial found no difference in outcomes. of patients had a primary outcome (death or heart attack). Patients feel fixed.

Outcomes 120

Outcomes Shock Hospitals Wellness 120

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 AVAPS: 0.07

COPD 132

COPD Emergency Department Outcomes EMS 132

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 119

CDC Radiology Radiology Head Injuries 119

The Skeptics' Guide to EM

JULY 8, 2023

Evaluation of oseltamivir used to prevent hospitalization in outpatients with influenza: a systematic review and meta-analysis. Guest Skeptic: Dr. Anand Swaminathan is an Assistant Professor of Emergency Medicine at Staten Island University Hospital. Date: July 6, 2023 Reference: Hanula R et al. JAMA Int Med 2023. JAMA Int Med 2023.

CDC 108

CDC Hospitals EMS Emergency Department 108

Sensible Medicine

JUNE 28, 2024

A 76-year-old woman presents to a community hospital after waking with garbled speech and right-sided weakness. There were no personal crises or untoward patient outcomes. Case 1: Excess An elderly woman is admitted to a community hospital with a minor stroke. The hospital does an excellent job. I love my job.

Stroke 105

Stroke Academics EKG/ECG Hospitals 105

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. Iron Ingestion: an Evidence-Based Consensus Guideline for Out-of-Hospital Management. 6 Absence of visualized tablets on x-ray does not exclude iron ingestion. Antiemetics as needed.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

EM Literature of Note

APRIL 11, 2024

Each of these disease states has well-defined pathways for “optimal” therapy and escalation. The most notable feature of this trial is the simple, negative topline result – rollout of this intervention had no reliably measurable effect on patient-oriented outcomes relating to disease progression or acute clinical deterioration.

Outcomes 92

Outcomes Administration Hospitals Wellness 92

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? Primary Results Patients enrolled from 15 emergency medical services at 21 hospitals across 3 countries over 7 years.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

Taming the SRU

MARCH 27, 2024

Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial. The primary outcome was cumulative norepinephrine use during the first 48 hours of admission. Crit Care 2024;28(1):28. There were 114 patients included in the final analysis.

Resuscitation 99

Resuscitation CPR Outcomes Hospitals 99

Don't Forget the Bubbles

JUNE 30, 2023

A rapid rewarming rate greater than 5°C/hr is associated with higher in-hospital mortality. Extracorporeal life support rewarming rate is associated with survival with good neurological outcome in accidental hypothermia. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. The “sweet spot” is between 0.5-2⁰C

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

See these 2 articles Association between pre-hospital chest pain severity and myocardial injury in ST elevation myocardial infarction: A post-hoc analysis of the AVOID study Author links open overlay panel [link] 1 Background We sought to determine if an association exists between prehospital chest pain severity and markers of myocardial injury.

EKG/ECG 119

EKG/ECG Hospitals Outcomes Wellness 119