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

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

The Trauma Pro

OCTOBER 25, 2024

Authors from several well-known trauma centers collaborated to re-analyze data from the CLOTT study. Here are the factoids: The original data were derived from a 17-center study conducted from 2018-2020; this study only included 1,387 patients who had pelvic fractures (as well as other injuries).

Fractures 113

Fractures Head Injuries Operations Ultrasounds 113

Sensible Medicine

NOVEMBER 6, 2023

Today I will tell you about one-year results of the SWISS-APERO trial—which compared outcomes with the two most common types of closure devices. This study report included only 45-day outcomes. They main outcome measure was patency of the left atrial appendage. This is a decidedly bad outcome. Pause there.

Stroke 133

Stroke Outcomes Ultrasounds Wellness 133

The Trauma Pro

OCTOBER 4, 2024

Clinical outcomes assessed at 60 days included an unplanned return to the emergency department (ED), re-admission, complications, and development of new bleeding confirmed by surgery, ultrasound, or computed tomography (CT) at 60 days post-injury. Adherence to guidelines was assessed by a follow-up phone call two months after injury.

Pediatrics 113

Pediatrics Outcomes Operations Emergency Department 113

PulmCCM

FEBRUARY 5, 2024

Also, many patients with infection won’t have fevers, and those that don’t may be at the highest risk for poor outcomes. As all radiologists are ostensible experts, this reads more like an endorsement of POCUS in the ICU for intensivists well-trained and experienced in the technique. °C oral measured multiple times).

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

Sensible Medicine

AUGUST 19, 2024

One of the core ideas in cardiology is that improving blood flow to a heart with severe reduction of flow due to coronary stenoses will improve outcomes. The addition of patients with a weak heart muscle makes it even more likely that improvement of blood flow should improve outcomes— over medical therapy. The median EF was 28%.

Outcomes 106

Outcomes Ultrasounds Wellness 106

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.

Blood Transfusions 105

Blood Transfusions Outcomes 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 thought with introducing the serratus anterior plane block was that regional anesthesia is well within the purview of EM physicians and can offer a safe alternative to systemic pain medications.

Fractures 98

Fractures Ultrasounds Research Outcomes 98

Sensible Medicine

JUNE 28, 2024

There were no personal crises or untoward patient outcomes. Even though the patient was already up to date on age-appropriate cancer screening (cervical, colon, and breast) and was perfectly well, with no symptoms, the medical center doctors completed an upper endoscopy with ultrasound (EUS), MRCP, and genetic testing.

Stroke 103

Stroke Academics EKG/ECG Hospitals 103

Sensible Medicine

DECEMBER 28, 2023

One makes an ultrasound device, the other a radiofrequency device. Here is Kaul again: My translation is that the Recor device (ultrasound) approval was very weak. Longer term data (3 years) found higher rates of poor outcomes. It turns out the device performed less well during the pandemic. There are two companies.

Stroke 138

Stroke Ultrasounds Outcomes Hospitals 138

PulmCCM

JUNE 26, 2023

No outcomes regarding the delirium itself were reported (i.e., Private equity-backed firms are buying and expanding physician practices and squeezing them for profit, with little regard for patient outcomes, professional standards, or ethics. whether haloperidol actually reduced delirium).

Outcomes 98

Outcomes Ultrasounds Hospitals Wellness 98

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

Don't Forget the Bubbles

DECEMBER 25, 2023

Interpreting Research Outcomes with a Little Bathroom Humour You have learned a method for how to read a research paper , and now you are faced with a bunch of outcomes. There are primary, secondary, composite , and safety outcomes. What are these outcomes? We know there is a bias towards reporting positive outcomes.

Research 83

Research Outcomes Fractures Pediatrics 83

Mount Sinai EM

OCTOBER 11, 2024

There was significant heterogeneity among studies and outcomes were not measured consistently. Hennepin Ultrasound has a blog post on how to perform this both statically and dynamically–visualizing the needle as it aspirates the PTA. And well before the depth at which it would reach the carotid). And there you have it!

Ultrasounds 100

Ultrasounds Wellness Outcomes Hospitals 100

EB Medicine

APRIL 30, 2017

In it, co-authors Emily Singer Fisher, MD, and Boyd Burns, DO, FACEP, FAAEM, both of the University of Oklahoma School of Community Medicine, cover evidence published in 190 articles, and 10 reviews from the Cochrane database, as well as current guidelines issued by the American Heart Association and the American College of Cardiology Foundation.

Outcomes 40

Outcomes Burns Best Practices Ultrasounds 40

PulmCCM

JULY 3, 2023

(If those grizzled veterans give you a hard time, remember, they’re also the ones who dispensed attaboys in the pre-ultrasound era like “if you’re not cannulating the carotid artery or dropping lungs, you’re not doing enough central lines!”)

Airway Management 105

Airway Management Outcomes Hospitals Emergency Department 105

RebelEM

APRIL 29, 2024

CVC vs PIV The critically ill patient is often associated with pathology that makes IV access difficult such as shock state, hypovolemia, obesity, IV drug abuse, end-stage renal disease, cardiac arrest, as well as other conditions. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

RebelEM

AUGUST 31, 2023

CVC placement under ultrasound guidance has decreased overall complication rates and there is increased awareness of transfusion reactions, alloimmunization, acute lung injury, circulatory overload, as well as infection. Primary Outcome – Bleeding (Grade 2 to 4) Transfusion 4.8% Non-inferiority margin was set at 2.5%

Ultrasounds 58

Ultrasounds Outcomes Wellness Research 58

Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED?

CPR 90

CPR Burns Airway Management Wellness 90

Dr. Smith's ECG Blog

AUGUST 9, 2024

However the patient continued to have chest pain and bedside ultrasound showed hypokinesis of the septum with significantly reduced LVEF. The LCx and OM vessels are not as well visualized. Association of intravenous morphine use and outcomes in acute coronary syndromes: Results from the Crusade Quality Improvement Initiative.

EKG/ECG 107

EKG/ECG EMS Emergency Department Wellness 107

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

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 94

Leadership EMS Pediatrics Stroke 94

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

Core Ultrasound

MARCH 25, 2024

If one is going to access the collapsibility of the IVC one should probably look at it in the transverse plane as well 3. The IVC is unable to reliably tell you anything about fluid responsiveness but fluid responsiveness is a flawed outcome and we have to start taking a more holistic view on the administration of fluid.

Administration 75

Administration Sepsis Ultrasounds Outcomes 75

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

I sent it to 5 of my OMI friends without any clinical information or outcome and all 5 independently responded with exactly the same diagnosis: "reperfused inferior OMI". 3-vessel disease can make resuscitation very difficult, since CPR does not perfuse diseased vessels as well as one would like.

EKG/ECG 135

EKG/ECG Resuscitation CPR Emergency Department 135

Don't Forget the Bubbles

JANUARY 31, 2024

Edelman J, Taylor H, Goss A, et al Point-of-care ultrasound as a diagnostic tool in respiratory assessment in awake paediatric patients: a comparative study Archives of Disease in Childhood Published Online First: 14 December 2023 What’s it about? All of which leads to easier image acquisition. Accredited trainers are currently lacking.

Hospitals 72

Hospitals Ultrasounds Emergency Department Pediatrics 72

Dr. Smith's ECG Blog

MAY 13, 2024

There are findings concerning for anterolateral OMI including ST elevation and hyperacute T waves in the anterolateral leads most prominent in V2-V5, as well as hyperacute T waves in the inferior leads. On our ultrasound machine, the TEX, normal strain is considered -18 % and higher (more negative).

EKG/ECG 120

EKG/ECG Emergency Department Ultrasounds Documentation/Coding 120

Don't Forget the Bubbles

JANUARY 17, 2024

Abdominal ultrasound, used in 34 cases, was able to visualize a rounded intraluminal image corresponding to a bead in 28 patients. Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. Kim, Y.B.,

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Cook County EM Blog

MAY 1, 2023

A point-of-care ultrasound was performed, which identified thickening of the skin overlying the elbow with a cobblestone appearance, and an underlying fluid collection consistent with an olecranon bursitis. Ultrasound is often a more useful imaging modality and is readily available at the bedside. and ESR 26. 2017 Dec;45(6):781-786.

Ultrasounds 52

Ultrasounds Emergency Department Hospitals Outcomes 52

Pediatric Education

JUNE 9, 2024

She said she hadn’t felt well for a couple hours before that and had had some nausea and emesis before the pain. She had eaten the same food as her college roommates who were all well. The radiologic evaluation of ultrasound showed an enlarged right ovary with a large follicular cyst and decreased blood flow in the pedicle.

Pediatrics 52

Pediatrics Ultrasounds Radiology Radiology 52

EM Curious

JULY 8, 2015

ULTRASOUND GOODIE BAG ULTRASOUND FOR LATE PREGNANCY [PODCAST]: While not a routine exam we perform other than confirming fetal heart tones, definitely some great pearls on more advanced US topic. Consider an ultrasound guided ulnar nerve block. Well, this may not be completely true. Part 1 here.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Accuracy of Ultrasound in Diagnosis of Pneumothorax: A Comparison between Neonates and Adults-A Systematic Review and Meta-Analysis. Published 2020 Jul 23.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

RebelEM

FEBRUARY 12, 2024

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. CT in Detecting Urinary Tract Calculi: Influence on Patient Imaging and Clinical Outcomes Radiology. ” The Journal of Urology 199.4S (2018): e683-e684.

Radiology 77

Radiology Radiology Emergency Department Ultrasounds 77

Sensible Medicine

MAY 31, 2024

This is not to say that I always agree with the process or outcomes of medical decision-making. Second guessing, also called post-call quarterbacking, is alive and well in medicine and, when done thoughtfully, can be a great way to teach and learn. As part of his evaluation, a doppler ultrasound of his carotid arteries is ordered.

Operations 75

Operations Wellness Academics Ultrasounds 75

EMDocs

JULY 13, 2024

Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. Incidence, treatment and outcome of peripartum sepsis. Plasma cell endometritis is associated with Chlamydia trachomatis infection. Am J Clin Pathol. PMID: 10439801.

OB/GYN 89

OB/GYN EMS Sepsis Fluid Resuscitation 89

The Skeptics' Guide to EM

DECEMBER 10, 2022

One-year outcome of surgery compared with immobilization in a cast for adults with an undisplaced or minimally displaced scaphoid fracture: A meta-analysis of randomized controlled trials. We mentioned x-rays were unreliable as well to rule-out a scaphoid injury. 0.23) * Ultrasound 0.27 (0.13–0.56) Initial X-ray 0.24 (0.07–0.79)

Operations 52

Operations Fractures Military Emergency Department 52