EM Literature of Note

DECEMBER 4, 2024

In modern parlance, “diagnostic errors” become “missed opportunities for diagnosis” (MODs), and well-meaning researchers are devising further methods to shine bright lights upon our inadequacies. For this “stroke” example, 47 of the 100 patients reviewed were identified to have had MODs.

Emergency Department 92

Emergency Department Stroke Patient Safety Research 92

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Sensible Medicine

OCTOBER 2, 2023

The general concept is how trials measure, report and interpret outcomes. Before any experiment, choices have to be made about which outcome(s) to measure. People will argue about the choices, but a steadfast rule should be that reporting outcomes should be consistent over time. More on the specifics in a moment. The HR was 1.3

Stroke 106

Stroke Outcomes Wellness 106

RebelEM

AUGUST 22, 2024

hours of symptom onset appears to be the most promising approach for improving visual outcomes, supported by multiple studies and meta-analyses. 1,2 Intra-arterial (IA) tPA has also shown benefit but is less well studied. Patients whose last known well (LKW) time was within 24 hours of presentation. 1 week after treatment.

Stroke 85

Stroke Administration Outcomes Documentation/Coding 85

RebelEM

SEPTEMBER 14, 2023

bleeding, stroke, limb ischemia, and hemolysis). to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% Zeymer HT et al. Control: 53.4% D ECLS: 18.2%

Shock 136

Shock Outcomes Resuscitation Stroke 136

Sensible Medicine

MAY 20, 2024

The authors chose a composite primary endpoint of three things: hemostatic efficacy as defined by expansion of the hematoma by 35% or less, an increase in the stroke scale called NIHSS by less than 7 points (0-42 scale), and no receipt of rescue therapy (like surgical drainage). Ischemic stroke occurred in 6.5% It was 10.3%

Stroke 109

Stroke Outcomes Hospitals Wellness 109

PulmCCM

SEPTEMBER 28, 2023

Systemic corticosteroids (such as intravenous dexamethasone) improve outcomes in severe pneumonia due to SARS-CoV-2 infection. It makes sense that inhaled steroids might improve outcomes from less severe infections. Do inhaled steroids improve Covid pneumonia? About two thirds of patients in each arm were vaccinated.

COPD 95

COPD Stroke Academics Urgent Care 95

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. 4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

Sensible Medicine

FEBRUARY 13, 2024

In brief, the trial compared apixaban vs aspirin in patients who had had a stroke of unknown source and evidence of atrial cardiopathy. Recurrent stroke (the primary endpoint) occurred in 40 patients in each group. Apixaban did not reduce the rate of recurrent stroke over aspirin in these patients. The hazard ratio was 1.00.

Stroke 79

Stroke Outcomes Wellness EKG/ECG 79

Sensible Medicine

AUGUST 28, 2023

I describe it here for two reasons: it is an example of well-conducted unbiased study, and it deals with an increasingly common problem of short-duration episodes of atrial fibrillation. Some background: In patients with certain risk factors, AF increases the risk of having a stroke. The incidence of stroke was 0.9%

Stroke 90

Stroke Wellness EKG/ECG Outcomes 90

EMDocs

JANUARY 29, 2024

This article will discuss blood pressure goals and preferred pharmacotherapy for non-traumatic ischemic and hemorrhagic strokes. Ischemic Strokes: Ischemic stroke is characterized by a blockage of a blood vessel in the brain. The BP targets for patients with ischemic strokes depend on the available therapeutic options.

Stroke 73

Stroke Outcomes EMS Seizures 73

Sensible Medicine

NOVEMBER 13, 2023

We call the primary endpoint of SELECT—CV death, MI or stroke—a hard cardiovascular endpoint. of patients experienced a first primary outcome event in the semaglutide arm vs 8.0% The Kaplan-Meier curves for outcomes began separating early and continued over 3-4 years. There were other positive results as well.

Outcomes 111

Outcomes Stroke Wellness Research 111

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 3, 6 Among patients with stroke or traumatic brain injury (TBI), the risk may be as high as 28%-76% and 23%-60%, respectively. 4, 8 Paper: Dahyot-Fizelier, C., 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 125

CDC Outcomes Radiology Radiology 125

Sensible Medicine

AUGUST 26, 2024

In population studies, AF associates with worse outcomes. Strokes and heart failure are the main complications of AF. And even when drugs suppress AF, trials failed to show that doing so reduces stroke or heart failure. In CABANA, ablation reduced AF episodes on monitors, but hard outcomes did not differ significantly.

Stroke 85

Stroke Outcomes Shock Research 85

The Skeptics' Guide to EM

MAY 1, 2021

Review article: Why is there still a debate regarding the safety and efficacy of intravenous thrombolysis in the […] The post SGEM Xtra: The NNT is Mellow Yellow for tPA in Acute Ischemic Stroke first appeared on The Skeptics Guide to Emergency Medicine. improvement in good neurologic outcome, a 5.4% Emerg Med Australas 2016.

Stroke 52

Stroke Outcomes Wellness 52

Taming the SRU

AUGUST 7, 2023

The patient needs a transvaginal ultrasound w/ doppler with gynecology consult and possible laparotomy TVUS is not just for torsion, it can also be used for ectopic pregnancies or pregnancy of unknown location Acute Ischemic Stroke Updates WITH Drs. hours increased the NNT for a good outcome to 20. The expanded window of 3-4.5

Stroke 93

Stroke Outcomes EKG/ECG Research 93

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

EM Literature of Note

MARCH 9, 2021

As we are well aware, a brain globally deprived of oxygen, for even the briefest moments, suffers irreversible damage. ” This “current literature” of which they speak is primarily a citation from last year’s Stroke , a single-center cohort study and updated patient-level meta-analysis.

Stroke 40

Stroke Outcomes Wellness 40

The Skeptics' Guide to EM

APRIL 25, 2020

Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. Effectiveness of emergency physician determinations of the need for thrombolytic therapy in acute stroke. She was last seen well two hours prior. There is no previous history of stroke. Reference: Juergens et al.

Stroke 40

Stroke Emergency Department Outcomes Administration 40

Sensible Medicine

NOVEMBER 28, 2023

Being perfectly honest, not all the articles have aged well. First, it renewed my faith that occasionally well-done studies address interesting and important questions. The primary outcome was stroke or systemic embolism and the primary safety outcome was major bleeding. This study made me happy for two reasons.

Stroke 82

Stroke Academics Outcomes Administration 82

Sensible Medicine

DECEMBER 28, 2023

The idea is to prevent stroke and reduce bleeding by plugging the appendage. But, get this: PREVAIL did not find noninferiority in its first co-primary endpoint of stroke, systemic embolism or cardiovascular death. Longer term data (3 years) found higher rates of poor outcomes. P-value now 0.049.

Stroke 124

Stroke Ultrasounds Outcomes Hospitals 124

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% Demographics were well balanced in the two groups.

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

RebelEM

SEPTEMBER 28, 2023

neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. Primary PCI: 95.7% Stents Placed: Pharmaco-Invasive Treatment: 97.4% Primary PCI: 95.7% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3%

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Heart disease and stroke statistics-2022 update: A report from the American Heart Association.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

RebelEM

MAY 18, 2023

These patients can have a vasodilated vascular bed and the initial use of fluids is hypothesized to serve two purposes: Augmenting the macrovascular system (stroke volume and cardiac output) and augmenting the microvascular perfusion (capillary blood flow). This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Liberal: 14.9%

Sepsis 105

Sepsis Shock Resuscitation Outcomes 105

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

NOVEMBER 27, 2023

And lastly, it’s actually quite hard to see how well the cardiovascular system is working, and this is one of its measurable features. This works well for a while, but eventually, the heart beats too fast to fill adequately. The amount of blood that comes from the heart with each contraction is the stroke volume (SV).

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Taming the SRU

FEBRUARY 24, 2024

non-invasive positive pressure ventilation and IV nitroglycerin infusion have been shown to reduce morbidity (intubation rates, ICU admission) & mortality. non-invasive positive pressure ventilation and IV nitroglycerin infusion have been shown to reduce morbidity (intubation rates, ICU admission) & mortality.

Leadership 93

Leadership EMS Pediatrics Stroke 93

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 Outcomes Pediatrics 145

Sensible Medicine

MARCH 11, 2024

In the assessment of a clinical trial, we want to know if differences in baseline characteristics may have played a role in the observed outcome. The question to consider is…are the actual differences seen between the groups with regards to baseline characteristics large enough to have influenced the outcome?

Outcomes 108

Outcomes Research Stroke COPD 108

ACEP Now

SEPTEMBER 6, 2024

This comes out of INTERACT-4, a trial testing the efficacy of blood pressure reduction in undifferentiated acute stroke syndromes. Without delving into too much detail, approximately half of the over 2,300 patients in the trial suffered ischemic stroke, and the remainder hemorrhagic stroke.

Research 49

Research Stroke Outcomes Sepsis 49

ACEP Now

MARCH 6, 2024

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?

Research 52

Research Airway Management Stroke Outcomes 52

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? This has the potential to expedite consultations with specialty teams and treatment. PMID: 23023446.

Stroke 64

Stroke Ultrasounds Academics Outcomes 64

Sensible Medicine

SEPTEMBER 23, 2024

They also found that the largest difference between truncated and nontruncated trials occurred when the truncated trials had fewer than 500 outcome events. The rate of the composite primary outcome of CV death, MI, unstable angina, stroke or transient attack was 4.29% with asa vs 4.48% with placebo.

Stroke 95

Stroke Academics Outcomes Shock 95

Sensible Medicine

OCTOBER 2, 2023

The general concept is how trials measure, report and interpret outcomes. Before any experiment, choices have to be made about which outcome(s) to measure. People will argue about the choices, but a steadfast rule should be that reporting outcomes should be consistent over time. More on the specifics in a moment. The HR was 1.3

Stroke 52

Stroke Outcomes Wellness 52

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. 3) Methods This study was a retrospective observational study at a single academic tertiary care facility in their medical intensive care unit (MICU).

Sepsis 93

Sepsis Research Stroke Academics 93

RebelEM

JUNE 8, 2023

They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98