The Skeptics' Guide to EM

FEBRUARY 11, 2023

Research interests include simulation-based assessment, transport medicine, and critical care analgesia. Intervention: * Vector Change Defibrillation: Pads are placed in an anterior-posterior pad placement after standard anterior-anterior configuration following the third shock with standard defibrillation.

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Shock CPR Hyperthermia / Hypothermia Hospitals 56

Sensible Medicine

AUGUST 26, 2024

In population studies, AF associates with worse outcomes. In CABANA, ablation reduced AF episodes on monitors, but hard outcomes did not differ significantly. The problem here is that it’s hard to compare a subjective outcome (like feeling better) when one group of patients get a procedure and the other group gets tablets.

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Stroke Outcomes Shock Research 99

RebelEM

OCTOBER 5, 2023

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. Control: Normal Saline via continuous infusion according to the same regimen used in the hydrocortisone group. to −0.8).

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Research Outcomes Administration Shock 94

Sensible Medicine

DECEMBER 16, 2024

With that in mind, the reported outcomes, such as the reduction in heart failure hospitalizations at three years, and even the questionable reduction in total mortality in the first years of follow-up, are likely to be the result of statistical noise. This drastic reduction in power was not properly acknowledged in the manuscript.

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Shock Hospitals Outcomes Research 97

AENJ: Current Issue

MAY 8, 2024

This column on translating research into practice is crafted to offer advanced practice registered nurses an analysis of current research topics that hold practical relevance for emergency care settings.

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Emergency Department Outcomes Sepsis Research 40

RebelEM

AUGUST 14, 2023

in both groups Mean APACHE II score was 12 in both groups Almost half of the patients had septic shock at enrollment Mean time from sepsis identification to randomization was 1.4 Secondary Outcome Results: ICU mortality: placebo 20.0% Investigators asked a patient-centered research question. vs. XBJ 14.2% vs. XBJ 17.0%

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Sepsis Outcomes Administration EMS 97

Emergency Medicine Journal

OCTOBER 26, 2023

Despite decades of investment and research, survival remains disappointingly low. Inclusion criteria were non-traumatic cardiac arrests treated with at least one external electric shock with an automated external defibrillator from the basic life support team and resuscitated by a physician-staffed ALS team.

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Resuscitation Basic Life Support Hospitals CPR 75

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.

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Ultrasounds Outcomes COPD Hospitals 125

RebelEM

NOVEMBER 20, 2023

Military practice guidelines recommend REBOA for profound shock (SBP <90mmHg) 1 and ACEP along with the American College of surgeons recommend REBOA for traumatic life-threatening hemorrhage below the diaphragm in patients with hemorrhagic shock who are unresponsive or transiently responsive to resuscitation.

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Resuscitation Operations Outcomes Hospitals 91

Taming the SRU

APRIL 17, 2024

The primary outcome was defined as agreement of less than 10 % of the mean arterial pressure (MAP) between simultaneously recorded IABP and NIBP measurements. Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. References Evans L, Rhodes A, Alhazzani W, et al. Crit Care Med.

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Sepsis Research Stroke Academics 94

PulmCCM

JUNE 5, 2023

Corticosteroids for community-acquired pneumonia have been studied with inconclusive results, and expert guidelines currently advise against their use except in patients with refractory septic shock. Patients with septic shock or influenza were excluded. standards of care. In the U.S.,

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Advances Cardiac Life Support (ACLS) Documentation/Coding CPR Shock 96

Stop and Think

JUNE 13, 2023

It’s shocking how many have subscribed and supported this newsletter. He says it is cynical and if I say a study was done for marketing it might insult the researchers. If the much larger trial could not show a statistically significant benefit in outcomes, how could a trial 1/10th the size tell us much?

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Outcomes Academics Shock Hospitals 98

Don't Forget the Bubbles

OCTOBER 10, 2024

The others, such as respiratory rate, heart rate, and decompensated shock, were excluded due to the presumed difficulty for non-healthcare professionals to assess them accurately. Reviewed by: Isabella Davenport Article 2: Does it improve outcomes if you replace the nail in nail bed repair? The assessors scored both groups 5.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

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.

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Sepsis Shock Outcomes Stroke 52

Don't Forget the Bubbles

JANUARY 10, 2024

The factorial design chosen by Dr Maitland and her research group means that several comparisons in transfusion practice could be carried out at the same time. What were the research questions? Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. N Engl J Med. 2019;381(5):407-419.

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Blood Transfusions Research Outcomes Hospitals 78

Don't Forget the Bubbles

JUNE 26, 2023

But, they may present postnatally with cyanosis/hypoxaemia due to insufficient pulmonary blood flow, cardiogenic shock due to insufficient systemic blood flow, or both. These cases illustrate some of the common issues associated with each shunt type, but what does the evidence say about outcomes? What is the best option for repair?

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Operations Research Hyperthermia / Hypothermia Hospitals 128

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. Optimal management of septic patients has been a source of intense research, stemming from the landmark study by Rivers in 2001. Jeff : Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice.

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Sepsis Shock Fluid Resuscitation Hospitals 40

AED Leader

DECEMBER 6, 2024

This article explores Stryker’s impactful role in revolutionizing cardiac emergency preparedness worldwide, from pioneering technologies and addressing healthcare disparities to aligning with major organizations like the American Heart Association in pursuit of improved outcomes.

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Basic Life Support Resuscitation Outcomes Hospitals 52

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

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Shock Resuscitation Fluid Resuscitation Sepsis 52

AED Leader

SEPTEMBER 21, 2024

Why is defibrillation important Defibrillation is the process of delivering an electrical shock to a person experiencing life-threatening heart rhythms, like ventricular fibrillation (VF) or pulseless ventricular tachycardia. The defibrillator administers a shock measured in joules to the heart at precisely the right moment.

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CPR Shock Resuscitation Hospitals 52

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

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Anaphylaxis Shock Sepsis Resuscitation 52

AED Leader

JULY 5, 2024

The HeartStart OnSite AED boasts a quick start-up time and delivers a shock within eight seconds if it detects a shockable rhythm. The HeartStart OnSite AED has a long-life lithium battery that can deliver up to 200 shocks or provide approximately four hours of continuous monitoring.

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CPR Resuscitation Shock Pediatrics 52

ACEP Now

JUNE 6, 2023

Example: “ I can imagine this comes as a shock” or “ I can hear how upset you are.” Often, the outcome of an ED visit is not what the patient wants, but this skill prepares the patient for the reality. For some chest pain I had last night.” References Phillips KA, Ospina NS. Physicians interrupting patients. 2017;318(1):93–94.

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Emergency Department Hospitals Best Practices Shock 98

Dr. Smith's ECG Blog

AUGUST 9, 2024

Opioids associate with worse outcomes in myocardial infarction , probably because they eliminate the pain signal that informs the clinician of the urgency of revascularization. below) Other examples of AIVR: Young man with Gunshot wound to right chest with hemorrhagic shock, but bullet path not near heart. Do not treat AIVR.

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EKG/ECG EMS Emergency Department Wellness 108

Critical Care Now

JULY 7, 2024

Military practice guidelines, along with ACEP and the American College of Surgeons, recommend REBOA for traumatic life-threatening hemorrhage below the diaphragm in patients with hemorrhagic shock who are unresponsive or transiently responsive to resuscitation. Check out the full post on REBEL EM

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Resuscitation Military Outcomes Hospitals 52

The Skeptics' Guide to EM

DECEMBER 11, 2021

Date: December 10th, 2021 Guest Skeptic: Dr. Carly Eastin is an Associate Professor, Division of Research and Evidence Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences. Fujii et al ( VITAMINS RCT) JAMA 2020: n=216 patients with septic shock.

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Sepsis Shock Outcomes Research 40

Don't Forget the Bubbles

JULY 26, 2023

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

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EKG/ECG Hospitals Shock Documentation/Coding 98

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

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Sepsis Shock Hospitals Infectious Diseases 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. Center for Economic and Policy Research (CEPR). Finance research letters, forthcoming.

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Hospitals Radiology Radiology Emergency Department 113

PHEM Cast

APRIL 10, 2016

And from our buddies at HEFT EM CAST: [link] A bit more detail covering some of the research in an easy to understand way. This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. 2009;13(5):R167. 2014 Oct 28;:1–9.

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Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Thinking Critical Care

MAY 18, 2023

In 1983 I was an Englishman abroad, the London anaesthetist who was appointed to be the English anaesthetist on the Shock Team only because the outstanding candidate from Oxford had preferred to take up a job doing muscle relaxant research with Kitz and Katz in the USA. 4] The research agenda at the time was broad.

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Shock Research Sepsis Resuscitation 40

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. Damping Damping is essentially the shock absorbers in the pressurized system.

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Shock Resuscitation Ultrasounds Research 59

Pediatric Emergency Playbook

APRIL 1, 2016

There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We could use it to track treatment , and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults. Clinical Chemistry.

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Pediatrics Sepsis Shock Outcomes 52

The Skeptics' Guide to EM

JULY 16, 2022

Salim is also the creator and founder of REBEL EM and REBEL Cast, a free, critical appraisal blog and podcast that try to cut down knowledge translation gaps of research to bedside clinical practice. She is admitted to the intensive care unit (ICU) for septic shock. She is found to have a urinary tract infection.

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Sepsis Shock Outcomes EMS 40

Don't Forget the Bubbles

NOVEMBER 15, 2023

One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. She had septic shock on presentation and was resuscitated with 60ml/kg of balanced crystalloid solution and escalating vasoactive medications. Ann Intensive Care.

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Resuscitation Dehydration Administration Shock 80

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.

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Head Injuries Administration Outcomes Seizures 52

The Skeptics' Guide to EM

JANUARY 7, 2023

We just said there is so much research being published every day. As Professor Altman said in the BMJ back in 1994; “we need less research, better research and research done for the right reasons.” As Professor Feynman said…It’s ok to say: “I don’t know”.

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Emergency Department Research Shock EKG/ECG 40