Taming the SRU

DECEMBER 8, 2023

r4 case follow-up WITH DR. milligan CC: Found down The case: A young F was found down in a snow bank after a GSW to the head. She presented with a core temp of 30C and her CT scan did not show a devastating head injury as was expected. EMS had reported she had coded en route. She regained pulses with warming on arrival.

Hyperthermia / Hypothermia 89

Hyperthermia / Hypothermia Head Injuries Resuscitation Documentation/Coding 89

The Skeptics' Guide to EM

JUNE 17, 2023

American Journal of Hematology Jan 2023 * Population: Children aged 3-21 years old, with sickle cell disease (Hemoglobin SS disease or Hemoglobin Sβ Thalassemia) who presented with vaso-occlusive pain episodes to * Excluded: Children with upper respiratory infection, concern for stroke or altered mental status, or head injury, acute chest * Intervention: (..)

Emergency Department 74

Emergency Department Pediatrics Head Injuries Administration 74

The Bottom Line

OCTOBER 26, 2024

PMID: 39382241 Clinical Question In patients with acute brain injury, does a liberal, compared to a restrictive strategy of blood transfusion, improve neurological outcomes at 180 days? Background The TRICC study, published over 20 years go, led to the widespread adoption of restrictive thresholds for blood […]

Blood Transfusions 101

Blood Transfusions Outcomes Head Injuries 101

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

The Skeptics' Guide to EM

SEPTEMBER 14, 2019

In an attempt to improve resource utilization, emergency department length of stay, limit cost and improve outcomes, there have been multiple Clinical Decision Rules (CDRs) created to help guide clinicians in their decision-making process. Traditionally CT imaging was obtained for fear of missing intracranial pathology.

Head Injuries 52

Head Injuries Emergency Department Seizures EMS 52

Dr. Smith's ECG Blog

JULY 22, 2012

A 6 yo girl had significant trauma from an MVC, with head injury (initial GCS 10, but no intracranial bleeding) and mild orthopedic injuries. Inpatient stay : She quickly awoke and was observed for a couple days, treated for minor orthopedic injuries, and recovered well from the head injury.

Head Injuries 52

Head Injuries EKG/ECG Ultrasounds Outcomes 52

RebelEM

AUGUST 24, 2023

Background: Sports-related concussions are among the most common injuries in children and adolescents, affecting millions of youth athletes annually. Historical practice recommends rest to prevent adverse outcomes; however, evidence suggests strict rest is harmful. Symptom reporting was the most common outcome in the included studies.

Pediatrics 92

Pediatrics Outcomes Research Hospitals 92

Emergency Medicine Ireland

MAY 3, 2021

This is part of Oh’s Manual Chapter 77 on head injury and we covered ICP monitoring before in number 20. This is part of Oh’s Manual Chapter 77 on head injury and we covered ICP monitoring before in number 20. Welcome back to the tasty morsels of critical care podcast. The following summarises some of the headlines.

Head Injuries 40

Head Injuries Hyperthermia / Hypothermia Documentation/Coding Outcomes 40

Emergency Medicine Journal

NOVEMBER 28, 2023

We hypothesized that there is a specific coagulopathy of ITBI, detectable using functional coagulation tests and that coagulopathy is associated with worse outcomes including raised intracranial pressure (ICP), progression of intracranial haemorrhage (PICH), and mortality.

Head Injuries 40

Head Injuries Radiology Radiology Outcomes 40

The Injectable Orange

JUNE 20, 2017

The world is a strange place when we can’t do something so simple when it’s critical, but we do it so well when the outcomes are meaningless. The ED team had just finished an in situ simulation where the focus was on rapid sequence intubation (RSI) in head injury, and using the new intubation checklist.

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

Don't Forget the Bubbles

JUNE 30, 2023

No, I don’t give TXA to kids with isolated head injuries We want to stop any clot breakdown to try and slow any potential bleeding. The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. What about head injury , though? This is not good.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

Pediatric EM Morsels

JULY 21, 2023

We have mentioned the Glasgow Coma Scale in multiple delicious morsels: Minor closed head injuries in <3 month olds and in the rebaked morsel , Blunt cerebrovascular injury , Cerebral edema in DKA , Pediatric Trauma Pitfalls , and Carbon monoxide poisoning.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Don't Forget the Bubbles

NOVEMBER 11, 2024

One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. A 12-year-old boy presents with a significant head injury following a road traffic accident. Four RCTs showed no significant difference in mortality or outcomes.

Hyperthermia / Hypothermia 117

Hyperthermia / Hypothermia Pediatrics Outcomes Resuscitation 117

RebelEM

MAY 25, 2023

Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8% vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Don't Forget the Bubbles

FEBRUARY 5, 2025

In the context of a child with a head injury- what was the best GCS/ GCS on arrival of the crew? E: Exposure and Environmental Control: Fully expose to check for other life-threatening injuries while maintaining normothermia. In addition, consider if there are any signs of injury with ENT, neurological or respiratory symptoms.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

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.,

CDC 119

CDC Radiology Radiology Head Injuries 119

The Skeptics' Guide to EM

AUGUST 5, 2023

Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. He is a […] The post SGEM#412: I Can’t Choose…from all the Head Injury Prediction Rules first appeared on The Skeptics Guide to Emergency Medicine. So, should we CT scan children with minor head injury?

Head Injuries 40

Head Injuries Pediatrics Outcomes Fractures 40

EMDocs

JULY 20, 2023

A second primary outcome was added at the 30-month time frame by request of the FDA, the trial was still blinded at that time. A second primary outcome was added at the 30-month time frame by request of the FDA, the trial was still blinded at that time. POWER: 86% to detect a 1-point difference in the group’s first primary outcome.

Stroke 98

Stroke Outcomes Head Injuries Psychiatric 98

Don't Forget the Bubbles

OCTOBER 19, 2023

Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. This is what they found: Length of hospital stay (time from randomisation to the time of hospital discharge or death), the primary outcome, was significantly longer in the high-flow group at 1.77

Head Injuries 81

Head Injuries Fractures Outcomes Hospitals 81

The Trauma Pro

OCTOBER 6, 2023

Although many of these injuries were managed within hours, a growing number were delayed by a few days to improve outcomes. The mortality trends do not appear to be related to injury grade, overall injury severity, or the presence of head injury.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

The Trauma Pro

SEPTEMBER 12, 2023

Bottom line: This is an intriguing abstract, pointing me to the original paper published in NEJM. This multi-center study was performed in conjunction with the research coordinating center at Johns Hopkins, which designs some top-notch research.

Fractures 113

Fractures Head Injuries Research Outcomes 113

The Skeptics' Guide to EM

JULY 17, 2018

He is also the CME editor for Academic Emergency Medicine Case: You’re working in a small rural emergency department when a seven-year-old girl comes in by EMS with a head injury. She hit a rock, and went over the bars, striking her head on a small tree as she fell. Corey Heitz is an emergency physician in Roanoke, Virginia.

Pediatrics 52

Pediatrics Head Injuries Academics Emergency Department 52

The Skeptics' Guide to EM

OCTOBER 17, 2020

Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury. Case: A 42-year-old helmeted bicycle rider is involved in an accident where he hits his head on the ground. Reference: Rowell et al. Reference: Rowell et al.

EMS 52

EMS Head Injuries Outcomes Hospitals 52

Emergency Medicine Journal

FEBRUARY 20, 2024

We aimed to identify variables that are associated with adverse outcomes in older patients admitted to a trauma centre for an isolated orthopaedic injury. Conclusion We identified eight predictors of adverse outcomes in patients >64 years of age admitted to a trauma centre for orthopaedic injury.

Outcomes 40

Outcomes Head Injuries 40

Taming the SRU

MAY 10, 2024

r4 Capstone WITH Dr. Stark Learn from your poor patient outcomes. isolated head injury, asphyxia or any other cause of a likely hypoxic respiratory arrest blunt cardiac injury underlying medical cause for the arrest Role of US in TCA? meanwhile, pseudo-PEA may be associated with a favorable outcome.

Leadership 85

Leadership CPR Head Injuries Outcomes 85

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.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

The Trauma Pro

MAY 9, 2023

The Pennsylvania Trauma Outcomes Study database contains a huge amount of data. This represents when after arrival, patients start dying due to their injuries. Penetrating injury plus hypotension kills the fastest at 19 minutes and head injuries the slowest at 1:20.

Head Injuries 130

Head Injuries Operations Documentation/Coding Outcomes 130

RebelEM

NOVEMBER 20, 2023

Outcome: Primary Outcome: All-cause mortality at 90 days. The primary outcome focused on patient-centered outcomes. The outcomes were predominantly binary and objective, reducing the potential for subjective interpretation and bias. 97% of patients sustained blunt trauma.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

The Skeptics' Guide to EM

MAY 30, 2020

The evidence for TXA providing a patient-oriented outcome (POO) has been mixed. It seems to work for epistaxis ( SGEM#53 and SGEM#210 ), failed to demonstrate a decrease in all-cause mortality in post-partum hemorrhage ( SGEM#214 ), and did not result in an improved neurologic outcome in hemorrhagic strokes ( SGEM#236 ). TXA vs. 19.8%

Head Injuries 52

Head Injuries Academics EMS Outcomes 52

Don't Forget the Bubbles

JUNE 30, 2023

Whilst you were busy managing head injuries and drownings, Ranulf had been out with a group of boys from school this evening. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. Back in ED with Ranulf, and pack two has gone through. J Pediatr Surg.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Pediatric Emergency Playbook

JANUARY 1, 2016

Abusive head injury is the most common cause of death from child abuse. Up to 30% of infants with abusive head injury may be misdiagnosed on initial presentation. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. Louwers et al. J Emerg Med. 2012; 43(1): e49–e51.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

PHEM Cast

MARCH 3, 2019

Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial. Trench entrapment: is ketamine safe to use for sedation in head injury? Emergency Medicine Journal. 2014 Dec;31(12):1029. 2014 Oct;31(10):840–3.

Emergency Department 52

Emergency Department Head Injuries Pediatrics Hospitals 52

The Skeptics' Guide to EM

APRIL 9, 2022

Included in this differential is transient epileptic amnesia, transient ischemic attack, stroke, metabolic disorders, psychogenic disorders, and post traumatic amnesia. We did the March episode at the end of last month and the April episode is the first week of this month.

Head Injuries 52

Head Injuries Emergency Department Seizures Stroke 52

Rural Doctors Net

AUGUST 30, 2013

Flooding him with crystalloid is going to dilute his clotting factors, make him hypothermic and potentially worsen outcomes. Check his pupils – any signs of head injury or subdural from flying debris? Even EMST-ATLS has (at last) moved away from the old mantra of “two litres of crystalloid, stat”.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

EMDocs

APRIL 25, 2025

Follow the MARCH Algorithm for Trauma Management: Prioritize Massive hemorrhage, Airway, Respirations, Circulation, and Hypothermia/Head Injury , ensuring a systematic approach to treating the most life-threatening issues first. Controlled ventilation and maintaining adequate oxygenation and perfusion are key to improving outcomes.

Pediatrics 70

Pediatrics EMS Head Injuries Hyperthermia / Hypothermia 70

Emergency Medicine Journal

FEBRUARY 21, 2025

Details about the author, date of publication, country of publication, patient group studied, study type, relevant outcomes (skull fracture), results and study limitations were tabulated.

Fractures 52

Fractures Head Injuries Ultrasounds Outcomes 52

ACEP Now

APRIL 14, 2025

No scenario demands more rapid, high-stakes decision-making than pediatric traumathe leading cause of death for childrenwhere timely interventions significantly influence outcomes. Incorporating these evidence-based guidelines and resources into practice will decrease unnecessary imaging and improve pediatric outcomes and trauma care.

Pediatrics 75

Pediatrics Emergency Department Best Practices Outcomes 75