This site uses cookies to improve your experience. To help us insure we adhere to various privacy regulations, please select your country/region of residence. If you do not select a country, we will assume you are from the United States. Select your Cookie Settings or view our Privacy Policy and Terms of Use.
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Used for the proper function of the website
Used for monitoring website traffic and interactions
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Strictly Necessary: Used for the proper function of the website
Performance/Analytics: Used for monitoring website traffic and interactions
We have mentioned the Glasgow Coma Scale in multiple delicious morsels: Minor closed head injuries in <3 month olds and in the rebaked morsel , Blunt cerebrovascular injury , Cerebral edema in DKA , Pediatric Trauma Pitfalls , and Carbon monoxide poisoning. When is it useful and what does it tell us?
. #2: The Endovascular Therapy Train Continues Onward Spoon Feed This was an exploratory analysis of the recently published SELECT2 trial, which randomized 352 adults with acute ischemic stroke due to carotid or M1 MCA occlusion to endovascular thrombectomy (EVT) or medical management. 3: Could Teleconsultation Reduce Pediatric Transfers?
Did the new treatment reduce the bad outcome so much so that the difference meets a statistical threshold? Two examples explain the challenge of using statistics to judge science In large studies, a tiny difference in outcomes—one that is not “clinically” significant can easily reach statististical significance.
. #1: Dual Antiplatelets or Lytics for Minor Stroke? Spoon Feed In minor acute ischemic stroke (AIS) patients presenting within 4.5 hours of onset, dual antiplatelet therapy (DAPT) is non-inferior to intravenous alteplase for excellent neurologic outcome at 90 days. JAMA Pediatr. 2023 Aug 14;e232900.
Spoon Feed High-dose nitroglycerin improves outcomes in patients with sympathetic crashing acute pulmonary edema (SCAPE) without significant side effects when compared to low-dose nitroglycerin. sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock. Crit Care Med.
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%
1 The primary outcome was the frequency of observed hypoxemia, defined as any pulse oximetry reading below 85 percent. Serious patient-oriented outcomes such as cardiac arrest were rare, but almost all occurred in the oxygen mask cohort. The obvious winner was NIPPV, whose 9.1
A 75-year-old woman who is bedridden after a stroke presents to the ED from a nursing facility with abdominal pain and constipation. Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Fecal Impaction and Nonperforated Stercoral Colitis: Red Flags for Poor Outcomes.
Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. She is a Professor of Pediatrics and Interim Chief of the Section of Pediatric Emergency Medicine at the Medical College of Wisconsin.
Get up-to-date in the understanding and management of pediatric status epilepticus. Pediatric status epilepticus is analogous to the multi-organ dysfunction syndrome in severe sepsis. Case 3: Headache and Arteriovenous Malformation Unlike in adults, stroke in children is divided evenly between hemorrhagic and ischemic etiologies.
The amount of blood that comes from the heart with each contraction is the stroke volume (SV). The stroke volume is the difference between how full it is at the start and how full it is after a contraction. The next element of stroke volume is the emptying. Pediatr Crit Care Med. Pediatr Crit Care Med.
non-invasive positive pressure ventilation and IV nitroglycerin infusion have been shown to reduce morbidity (intubation rates, ICU admission) & mortality.
These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations. This document is an update of guidelines first published in 2000, and then updated in 2007.
pediatric airways - Landmark studies in em - ebm in the prehospital setting - cpc - r1 diagnostics: pneumothorax - r4 capstone pediatric airways WITH dr. dean Intubation attempts should follow distinct, slow, and deliberate steps. This study did stop early using these rules.
The PATCH-Trauma trial took a critical look at TXA in major trauma in the advanced trauma systems of Australia and found a mixed result: a slightly greater number of patients were still alive six months following TXA administration, but there was no difference in survival with a good functional outcome. What’s New in Stroke Care?
Also used for severe MS, stroke, TBI, chronic pain. J Neurosurg Pediatrics. Complications of Intrathecal Baclofen Pump Therapy in Pediatric Patients. J Pediatr Orthop. Pediatr Neurosurg. for the Pediatric Heart Transplant Study Investigators. Prospective Trial of a Pediatric Ventricular Assist Device.
Read in JAMA Endovascular thrombectomy for large ischemic stroke came to prominence based on limited data showing its efficacy in patients with smaller strokes; large strokes were excluded. This was a noninferiority trial; remifentanil fell below the prespecified threshold for inferiority, though with a wide confidence interval.
The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Critical Care Medicine. Critical Care Medicine.
The Annals of Emergency Medicine Podcast continues apace, with free monthly updates from the original research published in the journal: iTunes Link SoundCloud Link Likewise, the Annals of Emergency Medicine Journal Club has published several monthly installments: Predicting Outcomes in Pediatric Pneumonia: Are We Omnipotent or Incompetent?
Read on to go from bread-and-butter pediatric blood work to answer the question – what’s up with troponin, lactate, d-dimer, and BNP in kids? This is especially true in children – the majority of pediatric ambulatory visits do not require blood work to make a decision about acute care. The punchline is, use a pediatric reference.
There are a variety of triggers, including infection (most common in pediatric patients), fat embolism, vaso-occlusive pain crisis, pulmonary embolism, and others. Causes and outcomes of the acute chest syndrome in sickle cell disease. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Am J Emerg Med. 2022 Aug;58:235-244.
There is significant evidence in adults and developing in the paediatric population that TXA results in better outcomes if given early in patients with mild to moderate traumatic brain injury (TBI) and does not cause harm. Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms.
High-dose IN Fentanyl Spoon Feed: Higher doses of intranasal (IN) fentanyl for pain ranging from 2-5 μg/kg (with a maximum of 200 μg) were given in a pediatric emergency department, with no documented episodes of apnea, hypotension, or respiratory failure.
In adults, cryptogenic stroke is a current indication for treatment of an identified PFO. Adults with a cryotogenic stroke are more likely to have a PFO (up to 40-50%), and a 2017 New England Journal of Medicine study found that interventional closure of adult PFO decreased recurrent ischemic strokes. with timing 37-5137 days).
Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. 3 A study of CT use trends in the ED has shown increasing use of CTs by almost 60% from 2005 to 2013.
There are a variety of triggers, including infection (most common in pediatric patients), fat embolism, vaso-occlusive pain crisis, pulmonary embolism, and others. Causes and outcomes of the acute chest syndrome in sickle cell disease. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Underestimates alveolar hypoxemia.
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. He endorses nausea without vomiting and denies fever.
High-quality studies in the SCT population are needed to clarify the health-outcomes as many studies are necessarily smaller or not able to be performed as rigorously. There is no positive association for deep venous thrombosis, cardiomyopathy, heart failure, stroke and no abnormalities of growth parameters in the pediatric population.
Adults: While strabismus is more common in children, it can also occur in adults due to trauma, stroke , or neurological conditions. For medical professionals, a multidisciplinary approach involving ophthalmologists, neurologists, and paediatricians may be necessary to ensure optimal outcomes. Pediatrics. 2016;137(5) S.E.
Pediatric patients should be considered for admission and further cardiology evaluation. Serum troponin testing in patients with paroxysmal supraventricular tachycardia: outcome after ED care. mg/kg (most studies gave 5 mg over 2-5 minutes). Patients with frequent recurrences should be sent to a electrophysiologist for follow up.
Although they may not appear as physically injurious as convulsive seizures, nonconvulsive seizures can significantly impact the neurological outcomes and overall prognosis of patients in critical care settings. Utility of electroencephalogram in the pediatric emergency department. Ann Emerg Med. 2014;63(4):437-447. Am J Emerg Med.
Long term, infants have higher risks of hypertension, stroke and increased body mass index. Preeclampsia and neonatal outcomes in adolescent and adult patients. D’Alessandro, MD Professor of Pediatrics, University of Iowa Pregnancy Hypertens. 2018;12:11-15. doi:10.1016/j.preghy.2018.02.003 J Med Life. Pre-eclampsia.
stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e. Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C
The post EM Quick Hits 35 – 10 Best Papers of 2021, Peripartum Cardiomyopathy, Crashing Asthmatic, Febrile Neutropenia, Anaphylaxis update appeared first on Emergency Medicine Cases.
Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.
First reported in 1879 in the case of diphtheria in a pediatric patient, TIF is fatal without surgical treatment due to hemorrhage and failure of airway security. Fatal outcomes postoperatively may be due to re-bleeding after attempts to preserve flow in the innominate artery or using sutures or prosthetic material in an infected area.22,23
Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. The diagnostic accuracy of fecal calprotectin during the investigation of suspected pediatric inflammatory bowel disease.
Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them. Instead, since no treatment has been shown to improve outcome, you should prioritize prompt transport. Fasciotomies have not been shown to improve outcomes and are reserved only for those failing anti-venom treatment.
This week, NCEPOD (National Confidential Enquiry into Patient Outcomes and Death) produced a much-anticipated report on how we manage acute testicular torsion in young people. “Time is brain” urges us to think about thrombolysis or clot retrieval in acute strokes. Pediatric radiology , 48 , pp.735-744. Coelho, A.Q.,
Stimulation of baroreceptors results in a catecholamine-mediated increase in heart rate , stroke volume, contractility, and systemic vascular resistance (SVR). What are the long-term outcomes for children with dilated cardiomyopathy? Outcomes at 1 year seem to be influenced by the severity of illness at presentation.
The Pediatric Pain Management Standard 1 for children was published this year to provide guidance to health organizations on how to deliver equitable and quality pain management across hospital settings. IN fentanyl has been safely used to treat pain in pediatric patients. It offers a way to deliver analgesia without IV access.3,
Jeff: For more on synthetic intoxications in the ED, be sure to take a look at the recent May 2018 issue of Pediatric Emergency Medicine Practice on Synthetic Drug Intoxication in Children if you haven’t already read it. First up is the link between cannabis use and stroke or TIA. times higher risk of stroke or TIA.
for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9% 2015) reported a sensitivity of 98.9%
We organize all of the trending information in your field so you don't have to. Join 5,000+ users and stay up to date on the latest articles your peers are reading.
You know about us, now we want to get to know you!
Let's personalize your content
Let's get even more personalized
We recognize your account from another site in our network, please click 'Send Email' below to continue with verifying your account and setting a password.
Let's personalize your content