Sensible Medicine

JUNE 28, 2024

She is admitted with suspected stroke. 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. And then, I guess because cancer-related hypercoagulability could conceivably cause a stroke, they went further. I love my job.

Stroke 94

Stroke Academics Hospitals EKG/ECG 94

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? 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7% Prehospital Tranexamic Acid for Severe Trauma.

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

Taming the SRU

NOVEMBER 3, 2023

Ultrasound‐Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. Ultrasound Med. The primary outcome in this study was a change in pain score at rest 60 minutes after block. 41, 2695–2701 (2022).

Fractures 98

Fractures Ultrasounds Outcomes Research 98

ALiEM

JANUARY 29, 2024

It requires immediate consultation with ophthalmology as well as neurology as it is considered a stroke equivalent. Case Question: What treatments can you perform in the ED for this diagnosis and do they improve outcomes? Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine vol.

Stroke 64

Stroke Ultrasounds Academics Outcomes 64

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Dr. Smith's ECG Blog

APRIL 2, 2024

Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines. No wall motion abnormality Decreased left ventricular systolic performance, severe Left ventricular enlargement, marked Dilated cardiomyopathy severe Est. stroke volume 52 cc at HR 70 = 3.64 The patient awoke and had a good outcome!

EKG/ECG 135

EKG/ECG Shock CPR Stroke 135

Taming the SRU

FEBRUARY 24, 2024

Providers should use ultrasound as early as possible to evaluate for cardiac dysfunction, pulmonary edema, and fluid status. They tend to be hypertensive, tachycardic, tachypneic, and hypoxic. Do not always appear volume overloaded on exam. Early recognition and prompt treatment is key.

Leadership 93

Leadership EMS Pediatrics Stroke 93

RebelEM

MARCH 8, 2023

Rapid diagnosis and emergency referral improves outcomes of ophthalmologic interventions. CRAO is a stroke of the eye; patients should be considered for a complete stroke work up. 790-819 Core Ultrasound: Vitreous vs Retinal Detachmen t Post Created By: Anand Swaminathan MD, MPH Post Peer Reviewed By: Salim R.

Stroke 52

Stroke Emergency Department Ultrasounds Outcomes 52

PulmCCM

JULY 10, 2023

At 28 days, there were no observed differences in the primary outcome (an odd composite of mortality and emergence of antibiotic resistance), and no difference in survival at 90 days. There’s a period of time after ischemic stroke when damaged cerebral blood vessels are susceptible to bleeding. access, etc., detailed here.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

Resus Review

OCTOBER 9, 2015

However, advancements in percutaneous coronary intervention (such as drug-eluting stents and techniques, risk stratification, and intravascular ultrasound) have increased the viability of this treatment option. Long-term clinical outcomes after unprotected left main trunk percutaneous revascularization in 279 patients.

Stroke 52

Stroke Ultrasounds Outcomes 52

Northwestern EM Blog

MAY 16, 2022

What is your initial imaging test of choice, ultrasound (US) or non-contrast CT, and why? Would you be confident in a point-of-care-ultrasound evaluation or a formal ultrasound? Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? How do you proceed?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

EMDocs

MAY 15, 2024

Ultrasound Sensitivity 88-100%, specificity 68-94% Positive likelihood ratio of 14.6 (95% While chest radiograph is often the first-line imaging modality, lung ultrasound has higher sensitivity and can detect pulmonary abnormalities earlier; CT imaging should be considered if initial imaging is negative or if concern for PE is present.

Blood Transfusions 78

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 78

Taming the SRU

JUNE 3, 2024

Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there. Benefits of transport are evidenced based.

Shock 91

Shock Seizures Airway Management Stroke 91

EMDocs

MAY 28, 2024

Ultrasound Sensitivity 88-100%, specificity 68-94% LR+ of 14.6 (95% While chest radiograph is often the first-line imaging modality, lung ultrasound has higher sensitivity and can detect pulmonary abnormalities earlier; CT imaging should be considered if initial imaging is negative or if concern for PE is present. pneumoniae, C.

Blood Transfusions 75

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 75

Resus Review

OCTOBER 28, 2015

With hemodynamically significant regurgitation, a postdilation can often significantly reduce paravalvular regurgitation without increased risk of stroke or permanent pacemaker placement. 5-year outcome after transcatheter aortic valve implantation. The cross-sectional area of the regurgitation typically decreases about 45% (0.36

Stroke 52

Stroke Ultrasounds Outcomes 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. 6 Theoretically, ultrasound guidance should decrease this risk, which formed the basis for the 2022 Florida Medical Board regulation. 7 The impact of this latest set of regulations on the complication rate has yet to be reported. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Pediatric Emergency Playbook

OCTOBER 1, 2017

Also used for severe MS, stroke, TBI, chronic pain. Ultrasound-guided refilling of an intrathecal baclofen pump—a case report. Outcomes of Children Bridged to Heart Transplantation With Ventricular Assist Devices: A Multi-Institutional Study. Are VNS safe in everyday life? Pediatr Neurosurg. 2013; 49:138–144. Childs Nerv Syst.

Pediatrics 52

Pediatrics Seizures Stroke Ultrasounds 52

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. MI or stroke).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

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. Urology took him for orchiopexy.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

All Ohio EM

FEBRUARY 11, 2019

Dr. Mike Pallaci covered endovascular therapy for stroke with a quick review of some very relevant studies that put endovascular therapy on the map. The MR CLEAN trial showed improved functional outcome if endovascular therapy was initiated within 6 hrs. Third, POCUS (point-of-care ultrasound) is your friend. NNT 7, NNH 19.

EMS 52

EMS Stroke Leadership Documentation/Coding 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Stroke-volume:50 ml. The problem is difficult to study because angiographic visualization of arteries is not perfect, and not all angiograms employ intravascular ultrasound (IVUS) to assess for unseen plaque or for plaque whose rupture and ulceration cannot be seen on angiogram. Left ventricular end-diastolic volume: 99 ml.

EKG/ECG 108

EKG/ECG Ultrasounds Wellness Stroke 108

Taming the SRU

AUGUST 25, 2023

wrist in extension clavicle tibial pediatric forearm Most likely injuries to need an x-ray? bicarb <18mEq/L) ketosis (preferably serum beta-hydroxybutyrate >3mmol/L) Risk factors SGLT2 inhibitor use fasting state ketogenic diet intra-abdominal pathology (AGE, pancreatitis, etc.) to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

EB Medicine

AUGUST 6, 2019

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.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Dr. Smith's ECG Blog

MAY 30, 2023

Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. 1 mg of Atropine was given and the heart rate increased transiently to 60. RVMI explains part of the shock. STE and STD were measured at the J-point, relative to the PQ junction.

Shock 86

Shock EKG/ECG Academics Stroke 86

Mind The Bleep

NOVEMBER 21, 2023

Ensure you management plan includes how you plan to rule out any immediate concerns and what the outcome is likely to be if normal. Document main findings from any imaging including if normal Differential Diagnoses You can use the surgical sieve approach to identify appropriate differential diagnoses.

Documentation/Coding 52

Documentation/Coding COPD EKG/ECG Wellness 52

Taming the SRU

MAY 1, 2023

Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Emergency Department Seizures 52

Taming the SRU

AUGUST 30, 2023

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]. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45].

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

EB Medicine

SEPTEMBER 1, 2018

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.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Don't Forget the Bubbles

FEBRUARY 7, 2024

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. What is the role of ultrasound?

Pediatrics 111

Pediatrics Ultrasounds Operations Hospitals 111

EB Medicine

FEBRUARY 1, 2019

Nachi: And patients with neurologic deficits or severe sudden-onset headaches, should be transported immediately to the nearest available stroke center. Anyway, the last test to discuss is our good friend the ultrasound, specifically the ocular ultrasound. For a visual reference, see Table 3 in the print issue.

Emergency Department 40

Emergency Department Stroke Outcomes Ultrasounds 40

EB Medicine

AUGUST 1, 2018

It was peer-reviewed by Joseph Habboushe, assistant professor at NYU and Nadia Maria Shaukat, director of the emergency and critical care ultrasound at Coney Island Hospital in Brooklyn, New York. First up is the link between cannabis use and stroke or TIA. times higher risk of stroke or TIA. times higher risk of stroke or TIA.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. demonstrating that functional outcome at 3 months did not differ between the CTA and MRI groups (38.5% 8 The data in Mayer et al.

Stroke 87

Stroke Radiology Radiology Emergency Department 87

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

NOVEMBER 4, 2024

80 It can be caused by traumatic nerve, spinal cord, or brain injury (including stroke) or can be a sequela of conditions like diabetes, HIV/AIDS, postherpetic neuropathies, multiple sclerosis, cancer, or chemotherapies. Cause and outcome of atypical chest pain in patients admitted to hospital. Am J Emerg Med. May 2014;32(5):421-31.

Emergency Department 99

Emergency Department Fractures Burns EMS 99

Sensible Medicine

NOVEMBER 11, 2024

Medical scientists would design and conduct experiments to answer important questions, say, whether a drug or surgery, improves an outcome. The outcome would not matter because knowledge is gained from either a negative or positive result. Bottom left is stroke—also not significantly different.

Stroke 94

Stroke Outcomes Hospitals Ultrasounds 94