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Pre-Hospital Antibiotics in Sepsis?

RebelEM

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . PMID: 35387313 Clinical Question: Do prehospital antibiotics impact 28 day mortality, length of stay in the hospital and ICU length of stay for patients triggering sepsis compared to usual care (No prehospital antibiotics)?

Sepsis 132
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The VIP Syndrome In Healthcare (Very Important Person)

The Trauma Pro

The VIP syndrome occurs in healthcare when a celebrity or other well-connected “important” person receives a level of care that the average person does not. This situation was first documented in a paper published in the 1960s, which noted that VIP patients have worse outcomes. Who is a VIP? It may be a celebrity. A family member.

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Can early steroids improve STEMI outcomes?

PulmCCM

However, in those trials, glucocorticoids were given well after the onset of STEMI. 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).

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SGEM#453: I Can’t Go For That – No, No Narcan for Out-of-Hospital Cardiac Arrests

The Skeptics' Guide to EM

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. Your partner asks if you want to administer naloxone as well. 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). JAMA Network Open. Reference: Dillon et al.

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TAME Trial: Mild Hypercapnia vs Normocapnia in Out-of-Hospital Cardiac Arrest

RebelEM

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.

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The NICO Trial: NIV in Comatose Patients with Acute Poisoning

RebelEM

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
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The CT FIRST Trial: Should We Pan-CT After ROSC?

RebelEM

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