EMDocs

OCTOBER 14, 2023

. #3: Peripheral Pressors Prevent Patient Pokes Spoon Feed This prospective observational cohort study found implementing a protocol for peripheral norepinephrine (NE) decreased median number of central venous catheter (CVC) days per patient by one, and 51.6% avoided a CVC entirely. Chest , S0012-3692(23)05350-3.

Stroke 62

Stroke Administration Outcomes 62

The Skeptics' Guide to EM

OCTOBER 14, 2023

Time to change the reference ranges of children’s physiological observations in emergency care? Time to change the reference ranges of children’s physiological observations in emergency care? They are often incorporated into many early warning systems, risk-stratification systems, and treatment protocols. A prospective study.

Pediatrics 98

Pediatrics Sepsis Urgent Care Emergency Department 98

RebelEM

SEPTEMBER 28, 2023

If timely PCI is unavailable, this pharmaco-invasive strategy is a reasonable alternative, provided that contraindications to fibrinolysis are observed and excess anticoagulation is avoided.” neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. Primary PCI: 95.7% Primary PCI: 95.7% Primary PCI: 78.4%

EKG/ECG 127

EKG/ECG Allergic Reactions Shock Stroke 127

Sensible Medicine

MARCH 1, 2024

He dives into the debate on whether screening studies should prioritize intention to treat (ITT) or per protocol analyses. [ii] Attia argues that when we are trying to find out if screening works, we should look at people who actually got screened, rather than those to whom screening was recommended – a so called per protocol analysis.

Outcomes 93

Outcomes 93

RebelEM

APRIL 29, 2024

An observational prospective study comparing tibial and humeral intraosseous access using the EZ-IO. Intravenous vs intraosseous adrenaline administration in cardiac arrest: A protocol for systematic review and meta-analysis. Ngo AS, Oh JJ, Chen Y, Yong D, Ong MEH. Int J Emerg Med 2009 PMID: 20157465 4. Ong MEH, Chan YH, Oh JJ, et al.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

EMDocs

AUGUST 24, 2023

Study design Multicenter prospective observational cohort study across seven urban emergency departments. Protocol was amended to include patients in whom the second (post-antibiotic) set of blood cultures were collected between 120-240 min.

Administration 67

Administration Sepsis Shock Outcomes 67

EMDocs

NOVEMBER 29, 2023

Question: In adult patients with ROSC post OHCA, does protocolized head-to-pelvis sudden death CT (SDCT) improve the diagnostic yield in comparison to standard practice? Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. Resuscitation. 2023 Jul;188:109785.

Outcomes 80

Outcomes Resuscitation EKG/ECG 80

PulmCCM

JUNE 5, 2023

Hydrocortisone was administered by continuous infusion for four days, then continued or tapered for up to 14 days according to pre-specified protocols — atypical regimens by U.S. Patients receiving hydrocortisone required more insulin, but did not have higher observed rates of hospital-acquired infections or gastrointestinal bleeding.

Advances Cardiac Life Support (ACLS) 96

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

PulmCCM

NOVEMBER 6, 2023

The therapy was approved for emergency use in 2020 by FDA after an observational study of 10 patients showed likely benefit (yes, 10, which should remind us of our collective desperation). the higher the SOFA score), the greater the observed benefit of convalescent plasma, if they received it early. The sicker the patients (i.e.

Operations 98

Operations Blood Transfusions Resuscitation Infectious Diseases 98

RebelEM

MARCH 23, 2023

REBEL Cast Ep115 – Phenobarbital vs Lorazepam in Alcohol Withdrawal Click here for Direct Download of the Podcast Clinical question : Is a phenobarbital-based or lorazepam-based alcohol detoxification protocol associated with a lower hospital length of stay compared to Ativan for alcohol withdrawal? Paper : Hawa F et al.

Emergency Department 52

Emergency Department Outcomes Hospitals Burns 52

Taming the SRU

JULY 14, 2023

Manual Vacuum or Manual Uterine Aspirations are becoming standard of care in emergency departments across the country as a time/cost-effective and efficient alternative to expectant, medical, or surgical management Protocol requires significant clinical bleeding and inevitable and incomplete abortion or concern for retained products of conception, (..)

Documentation/Coding 58

Documentation/Coding Emergency Department 58

Pediatric EM Morsels

APRIL 7, 2023

Observation, interaction with patient, as well as parent information is key to bring the whole picture together! While MRI is preferred, CT with perfusion may be the best option at your facility… it is wise to develop a protocol before you need it! Get the picture! Increase the Adult Percent!

Stroke 130

Stroke Pediatrics Seizures Sepsis 130

PulmCCM

MARCH 11, 2024

Observational data suggests palliative care consultation might reduce length of stay and costs , but the question had never been put to a serious randomized trial. Each hospital’s Medical Executive Committee approved the protocol, and data was collected 2016-2018. by some accounts (after HCA and the VA).

Hospice 52

Hospice Documentation/Coding Administration Hospitals 52

ACEP Now

OCTOBER 15, 2023

In fact, the original trial protocol required patients to have had pain for at least two weeks prior to recruitment, further limiting generalizability to the scope of patients presenting to the emergency department. Rather, the research protocol describes a prolonged six-week program of follow-up and repeated prescribing.

Emergency Department 52

Emergency Department Outcomes CDC Research 52

Taming the SRU

SEPTEMBER 15, 2023

Limited availability of radiology-performed US services in certain hospitals, especially overnight Can avoid unnecessary anticoagulation in patients Reduce time in ED to disposition In terms of workflow, when there is suspicion for a DVT, you need to first calculate a Wells’ Score for a DVT If low/moderate risk, can start with a D-dimer prior to committing (..)

CPR 79

CPR Burns Airway Management Wellness 79

The Skeptics' Guide to EM

MAY 8, 2021

Crit Care Med Feb 2021 Case: A 58-year-old male has a witnessed cardiac arrest while admitted to the observation unit for a chest pain evaluation. The resuscitation team arrives and ACLS protocols are continued. CPR is initiated and a hospital rapid response team is called.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

RebelEM

AUGUST 21, 2023

It’s unlikely that one intervention or protocol will have a large benefit in outcomes across a heterogeneous population With the above said, while we have to be careful with algorithmic approaches to post-cardiac arrest care, this method is often needed to show a tested intervention works or doesn’t work. Epub 2023 Jun 15. Resuscitation.

Hospitals 77

Hospitals Resuscitation Outcomes CPR 77

Mind The Bleep

FEBRUARY 27, 2024

Once cardiovascular status has improved start maintenance fluids at 42ml/hr [B] No need for fluid bolus, start IV maintenance fluids at 42ml/hr [C] No need for IV fluids, give the child some calpol or neurofen and observe to ensure his HR comes down as his fever resolves. Offer a fluid challenge of dioralyte or yoghurts and ice lollies. [D]

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

ALiEM

AUGUST 9, 2023

Scanning Protocols There are different protocols to scan the lung depending on the purpose of the evaluation. Figure 2: The 6-zone lung scanning protocol includes anterior, lateral, and posterior lung fields bilaterally. Use a linear high frequency probe. Consolidated lung and pleural effusion are also commonly seen.

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

Taming the SRU

SEPTEMBER 27, 2023

Practice skills of observation. You can pick up a lot while obtaining your interview and talking with a patient by observing the patient in their environment. Open access publications are essential to continuing to spread EBM within this space and beyond. Secondary spontaneous PTX have a poorer prognosis.

Stroke 52

Stroke EMS Pediatrics Outcomes 52

Don't Forget the Bubbles

AUGUST 28, 2023

Depending on the location of the mediastinal mass, lying a child flat or using a rapid sequence induction protocol may cause cardiorespiratory arrest. The evidence related to mediastinal masses in children is largely based on case reports, expert consensus opinions, and observational imaging studies. What causes a mediastinal mass?

Pediatrics 97

Pediatrics Research Emergency Department Wellness 97

ALiEM

APRIL 12, 2024

One often used thrombolytic regimen is the MIST-II protocol, which involves the combination of alteplase (tPA) 10 mg BID plus dornase alfa (DNase) 5 mg BID [13, 14]. Assessment of Pleural Effusion and Small Pleural Drain Insertion by Resident Doctors in an Intensive Care Unit: An Observational Study. The Journal of Emergency Medicine.

Patient Safety 73

Patient Safety Emergency Department 73

PulmCCM

JULY 10, 2023

A 2018 meta-analysis reviewed here suggested that prolonged infusion of antipseudomonal beta-lactams reduced mortality by 30% compared with shorter infusions, and more observational data has accumulated since that time. Many institutions have created protocols for extended infusions of beta lactam antibiotics, available online.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

Don't Forget the Bubbles

MAY 6, 2024

oxygen was titrated based on saturations), and those in the more conservative group had higher rates of deviation from the protocol—although it was felt that there were similar amounts of deviations seen in similar adult trials. Pediatric Critical Care Medicine , 25 (3), pp.e117-e128. What’s it about?

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

ACEP Now

DECEMBER 10, 2023

In 2023, that number falls to $2,500 based on ED protocols to increase outpatient management and safely avoid hospital admission. The effect of physician risk tolerance and the presence of an observation unit on decision making for ED patients with chest pain. Ann Emerg Med. 2023 Sep;82(3):316-325. Am J Emerg Med. 2010;28:771-9.

Emergency Department 52

Emergency Department Hospitals Documentation/Coding 52

The Skeptics' Guide to EM

OCTOBER 8, 2022

Most studies are observational studies rather than randomized control trials (RCTs) [1-3]. Background: The use of High-Flow Nasal Cannula (HFNC) has increased in both PICU and in the Pediatric ED, especially for infants presenting acutely ill with respiratory distress requiring non-invasive ventilation (NIV). In 2018, Ramnarayan et al.

Pediatrics 52

Pediatrics Emergency Department Hospitals 52

PulmCCM

NOVEMBER 18, 2021

For example, in a very large observational investigation – the OpenSAFELY platform – patients with both chronic obstructive pulmonary disease and asthma who received ICS had increased risk of COVD-19-related death compared with similar patients who did not receive ICS. days, probability of superiority > 0.999].

Urgent Care 40

Urgent Care Hospitals Stroke Wellness 40

The Skeptics' Guide to EM

JANUARY 1, 2022

A systematic review and meta-analysis which included seven randomized controlled trials and four observational studies including 21,297 patients was critically appraised. The issue of having a MSU has also been discussed on SGEM#330.

Stroke 52

Stroke EMS Outcomes Administration 52

PulmCCM

OCTOBER 31, 2021

Accordingly, a unique, randomized, double-blinded controlled trial in outpatients with COVID-19 was published, followed by an observational study of a COVID-19 outbreak in congregate living. and Seftel and Boulware , the TOGETHER trial added fluvoxamine to its protocol. In an effort to replicate the findings of Lenze et al.

Outcomes 40

Outcomes Hospitals Psychiatric Wellness 40

PulmCCM

JULY 17, 2023

Protocol violations were seen in more than a third of patients (use of open label TXA, or not receiving the full dose). ” But no harms were observed in the 163 enrolled patients with Covid and severe kidney disease, leading to the drug’s approval. At six months, some of this benefit persisted (19% vs 23% mortality).

Infectious Diseases 52

Infectious Diseases Outcomes Operations Research 52

Sensible Medicine

AUGUST 15, 2023

Whether that observation was made by Nietzsche , Time Magazine , or John Lennon , the reason has never been agreed upon. Suggestions for getting a protocol through our IRBs are welcome.) Here we suggest that, thanks to pharma, maybe the sins are not that deadly anymore. Sensible Medicine is a reader-supported publication.

Documentation/Coding 74

Documentation/Coding 74

PulmCCM

JANUARY 8, 2024

Rollout was delayed by several months at many centers during the Covid-19 pandemic, creating protocol deviations to be dealt with later.) Stepped-wedge designs require adjustment for confounding by time, because temporal trends could be responsible for any observed effect; there was no such confounding detected. g/dL per patient.

Blood Transfusions 96

Blood Transfusions Hospitals Outcomes Operations 96

ACEP Now

MARCH 6, 2024

In a similar vein, “CRYOSTAT-2” tested whether routinely adding cryoprecipitate to massive transfusion protocols improved all-cause mortality. TRACE-2 continues to demonstrate these observations. Empiric PCC infusion was associated only with increased pro-thrombotic events without corresponding witnessed benefits.

Research 52

Research Airway Management Stroke Outcomes 52

Sensible Medicine

JUNE 12, 2023

Statistical tests would then measure the surprise value of the observed data given this assumption of no difference. The authors defend their approach in their rationale/protocol paper. In this case, the H0 would be that there was no difference in the two strategies in the rate of the primary outcome.

Stroke 85

Stroke Outcomes 85

PulmCCM

DECEMBER 3, 2023

Some ventilators have a “sigh” function built in, but more than ad hoc implementation would at most hospitals require changes to respiratory care protocols, training of respiratory therapists, agreement among attending physicians, etc. In the NICO randomized trial, the question was put to the test in intoxicated patients.

Poisoning 64

Poisoning Outcomes Hospitals Academics 64

Sensible Medicine

APRIL 12, 2024

There have been observational studies and a handful of actual RCTs looking at how duty hours have affected medical education, patient outcomes, the prevalence of medical errors, housestaff satisfaction, sleep duration… I am definitely not one to question whether restricting housestaff duty hours was necessary.

Radiology 74

Radiology Radiology Hospitals Documentation/Coding 74

Intensive Blog

AUGUST 17, 2023

Impact of major bleeding and thrombosis on 180-day survival in patients with severe COVID-19 supported with veno-venous extracorporeal membrane oxygenation in the United Kingdom: a multicentre observational study. What is an appropriate “trigger threshold” for blood transfusion in ECMO patients? Br J Haematol, 196: 566-576.

Blood Transfusions 52

Blood Transfusions Operations Wellness 52