The Skeptics' Guide to EM

OCTOBER 21, 2023

SGEM#366 concluded that we could not recommend the routine use of skeletal muscle relaxants, SGEM#304 agreed that adding acetaminophen to ibuprofen did not improve one-week outcomes, while SGEM#173 concluded the same about diazepam (there’s a theme here!). AEM October 2023.

Emergency Department 128

Emergency Department Radiology Radiology Hospitals 128

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 111

CDC Radiology Radiology Head Injuries 111

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

The Skeptics' Guide to EM

NOVEMBER 11, 2023

However, the x-rays read as “normal” by radiology. Intervention: Various physical examination maneuvers * Comparison: N/A * Outcome: Diagnostic accuracy expressed as sensitivities, specificity, and likelihood ratios Authors’ Conclusions: “No single feature satisfactorily excludes an occult scaphoid fracture.

Fractures 120

Fractures Military Radiology Radiology 120

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

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

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

The Skeptics' Guide to EM

FEBRUARY 3, 2024

. * Excluded: Oropharyngeal trauma combined with other severe head injury or multisystem trauma, not primary research, non-English publication * Intervention: CTA * Comparison: No CTA * Outcome: radiologic and clinical outcomes including infection, injury to vasculature, cerebrovascular injury, and neurologic abnormalities.

Pediatrics 68

Pediatrics Radiology Radiology Head Injuries 68

RebelEM

FEBRUARY 12, 2024

The panel included physicians from Emergency Medicine, Urology and Radiology and was published in major journals of all three specialities. Research from our very own SIUH department of radiology recommended that contrast-enhanced CT scans can safely exclude obstructive urolithiasis just as well as noncontrast CTs. 2011; 18(7):699-707.

Radiology 67

Radiology Radiology Emergency Department Ultrasounds 67

EMDocs

SEPTEMBER 7, 2024

Transfer to the interventional radiology suite for embolization (D) is indicated in patients with ongoing hemorrhage after a blunt injury to zone III, rather than a penetrating injury. Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. J Emerg Med. 2012 Aug;43(2):e157-61. doi: 10.1016/j.jemermed.2011.06.006.

EMS 93

EMS Fluid Resuscitation Resuscitation Radiology 93

The Trauma Pro

MAY 10, 2024

And its correlation with outcomes varies. 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. What is NFTI, Exactly?

Blood Transfusions 113

Blood Transfusions Radiology Radiology Documentation/Coding 113

Don't Forget the Bubbles

FEBRUARY 5, 2025

E.g. burns, neurosurgery, interventional radiology. 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. Available at: [link] Advanced Life Support Group.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

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 84

Radiology Radiology Hospitals Documentation/Coding 84

SheMD

JUNE 8, 2023

The transition from internal medicine or surgery intern to Radiology resident (or any other residency) feels daunting to most. 10 pages a day One of the things that helped me immensely during radiology residency was setting “micro-goals” for myself. Advocate · As a woman in radiology (and most fields in medicine), you are a minority.

Radiology 52

Radiology Radiology Outcomes Hospitals 52

EMDocs

APRIL 27, 2024

However, the bioavailability of antipseudomonal antibiotics has improved outcomes, limiting surgery as a confirmatory diagnostic procedure and as needed for granulation tissue removal. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. The Lancet. link] Grandis, J.,

EMS 102

EMS Infectious Diseases Radiology Radiology 102

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. The primary outcome focused on patient-centered outcomes. 97% of patients sustained blunt trauma.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

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 98

Radiology Radiology Stroke Hospitals 98

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. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

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

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. Radiology Business. Heartland-Charleston of Hanahan SC LLC et al. Stempniak M.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

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

AUGUST 24, 2024

JAMA Surg 2024 Population: Patients aged 16 years or older with clinically suspected or radiologically confirmed rib fractures. Outcome: Primary Outcome: Composite pain score reduction 4 hours after enrollment, defined as a reduction in the pain score by 2 or more p.

Fractures 53

Fractures Emergency Department Ultrasounds Radiology 53

EMDocs

FEBRUARY 26, 2024

4 Early diagnosis is key to allow for early treatment to improve outcomes. 15 Diagnostic considerations Timely diagnosis of PJP is absolutely essential for effective management and improved disease outcomes. Pneumocystis pneumonia in patients with HIV infection: clinical manifestations, laboratory findings, and radiological features.

Radiology 106

Radiology Radiology Outcomes Ultrasounds 106

Emergency Medicine Journal

JULY 22, 2024

The main outcome variable was the diagnosis of acute appendicitis. Background and objectives The ability to rule appendicitis in or out using ultrasound is limited by studies where the appendix is not visualised.

Ultrasounds 52

Ultrasounds Radiology Radiology Emergency Department 52

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. Discrimination between an IUP and an interstitial pregnancy is critical as interstitial pregnancies can have devastating outcomes. Am J Emerg Med. 2019 Jun;37(6):1165-1168.

Ultrasounds 98

Ultrasounds Operations Radiology Radiology 98

EMDocs

MAY 11, 2024

Brainstem stroke: anatomy, clinical and radiological findings. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion. Locked-in syndrome. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. doi: 10.1053/j.sult.2013.01.004.

Stroke 107

Stroke EMS EKG/ECG Radiology 107

EMDocs

OCTOBER 10, 2024

A delay in antibiotics administration was unfortunate but no one can say on a “more probable than not” basis that earlier treatment would have changed the outcome. Takeaways : There are more questions than answers in this case, but: This is a common outcome. Is it possible that the two were un-related? No case was filed.

Documentation/Coding 93

Documentation/Coding Hospitals Sepsis Infectious Diseases 93

Pediatric Education

JUNE 9, 2024

The radiologic evaluation of ultrasound showed an enlarged right ovary with a large follicular cyst and decreased blood flow in the pedicle. Overall outcomes are good. Interestingly there is worse outcome for a “normal” ovary that undergoes torsion than with one that has an identified mass as the cause of torsion.

Pediatrics 52

Pediatrics Ultrasounds Radiology Radiology 52

The Skeptics' Guide to EM

DECEMBER 28, 2019

This is an SGEM Xtra and is a result of a paper that was published in three journals ( Annals of EM , Journal of Urology and Journal of the American College of Radiology ). There was a trial published in 2014 comparing radiology department ultrasound, POCUS and CT for suspected nephrolithiasis (Smith-Bindman et al. NEJM 2014 ).

Radiology 40

Radiology Radiology Ultrasounds Emergency Department 40

EMDocs

NOVEMBER 20, 2023

Management of Positive CTA Recommendation: We recommend that patients who have a CTA demonstrating extravasation be promptly referred to interventional radiology for transcatheter arteriography and possible embolization. (Conditional recommendation, low-quality evidence). Strong recommendation, moderate-quality evidence).

Resuscitation 99

Resuscitation Fluid Resuscitation Hospitals Research 99

American Medical Compliance

APRIL 25, 2024

For radiologic technicians or healthcare professionals, our Level 2 Training will greatly enhance your expertise in MRI practices. Our Continuing Medical Education (CME) program is committed to enhancing the knowledge, skills, and professional performance of healthcare providers to improve healthcare outcomes.

Radiology 52

Radiology Radiology Operations Research 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]. doi:10.1148/radiology.144.4.7111716 Persistent air-leak in spontaneous pneumothorax--clinical course and outcome. AJR Am J Roentgenol. doi:10.2214/ajr.165.5.7572489

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Pediatric Education

FEBRUARY 4, 2024

The radiologic evaluation of an ultrasound examination showed a small hypoechoic mass in the area of right adrenal gland that was smaller than previously recorded prenatally. This close monitoring does not appear to have poorer outcomes if the patient has neuroblastoma. The diagnosis of a healthy male was made. Pediatr Surg Int.

Ultrasounds 52

Ultrasounds Radiology Radiology Pediatrics 52

Pediatric Education

OCTOBER 22, 2023

The radiologic evaluation confirmed that these were subcutaneous fat necrosis. Discussion The main outcome of any delivery is to have a healthy mother and healthy child. Subcutaneous fat necrosis of the newborn: a systematic evaluation of risk factors, clinical manifestations, complications and outcome of 16 children.

Radiology 52

Radiology Radiology Fractures Pediatrics 52

The Skeptics' Guide to EM

JULY 18, 2020

AEM July 2020 * Population: Adolescents and adults presenting with symptoms of respiratory infection or clinically suspected pneumonia in the outpatient setting * Intervention: Any clinical sign or symptom (including vital signs) for pneumonia * Comparison: * Outcome: Radiologically confirmed pneumonia (using CXR as the gold standard) This is an

Radiology 52

Radiology Radiology Emergency Department Outcomes 52

EMDocs

JUNE 22, 2023

The radiology tech has his hand on a weak femoral pulse. After this experience, I realized some crucial factors that contributed to this patient’s outcome: (1) Know your resources. Nurses are throwing on monitor leads, and we completely expose him and do a fast roll to look at his back. No other injuries. It’s still present.

Resuscitation 98

Resuscitation Ultrasounds Critical Access Radiology 98