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

Pediatric Education

FEBRUARY 4, 2024

The radiologic evaluation of an ultrasound examination showed a small hypoechoic mass in the area of right adrenal gland that was smaller than previously recorded prenatally. This close monitoring does not appear to have poorer outcomes if the patient has neuroblastoma. The diagnosis of a healthy male was made. Pediatr Surg Int.

Ultrasounds 52

Ultrasounds Pediatrics Radiology Radiology 52

RebelEM

APRIL 17, 2023

33 studies selected for full review Of those 33 studies, 17 of those met criteria for inclusion Of the 18 studies, 1 was an RCT, 14 were prospective cohort studies, and 3 were retrospective cohort studies Total of 812 patients of whom 541 had PTA from 17 studies.

Ultrasounds 127

Ultrasounds Radiology Radiology Operations 127

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

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

Pediatric Education

OCTOBER 22, 2023

The radiologic evaluation confirmed that these were subcutaneous fat necrosis. Discussion The main outcome of any delivery is to have a healthy mother and healthy child. Subcutaneous fat necrosis of the newborn: a systematic evaluation of risk factors, clinical manifestations, complications and outcome of 16 children.

Radiology 52

Radiology Radiology Fractures Pediatrics 52

The Skeptics' Guide to EM

DECEMBER 28, 2019

This is an SGEM Xtra and is a result of a paper that was published in three journals ( Annals of EM , Journal of Urology and Journal of the American College of Radiology ). There was a trial published in 2014 comparing radiology department ultrasound, POCUS and CT for suspected nephrolithiasis (Smith-Bindman et al. NEJM 2014 ).

Radiology 40

Radiology Radiology Ultrasounds Emergency Department 40

Emergency Medicine Journal

APRIL 22, 2024

Emergency departments (EDs) are required to have safe systems in place to manage radiology reports. Radiology reports typically only become available after the patient has been discharged. Reviewing and acting on diagnostic reports is a professional obligation.

Radiology 52

Radiology Radiology Emergency Department Outcomes 52

EMDocs

MAY 11, 2024

Brainstem stroke: anatomy, clinical and radiological findings. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion. Locked-in syndrome. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. doi: 10.1053/j.sult.2013.01.004.

Stroke 79

Stroke EMS EKG/ECG Radiology 79

The Skeptics' Guide to EM

JUNE 4, 2017

However, when we assess major trauma that includes chest, abdominal and pelvic trauma, the initial radiologic evaluation is left to the treating physician’s judgement. Many studies (most retrospective) have assessed the use of pan scanning as an initial radiologic evaluation. Reference: Sierink et al.

Radiology 52

Radiology Radiology CPR Hospitals 52

Taming the SRU

OCTOBER 23, 2023

A radiology performed ultrasound is ordered and has similar findings– Impression: no definitive IUP with a small amount of free fluid within physiologic limits. Discrimination between an IUP and an interstitial pregnancy is critical as interstitial pregnancies can have devastating outcomes. Am J Emerg Med. 2019 Jun;37(6):1165-1168.

Ultrasounds 87

Ultrasounds Operations Radiology Radiology 87

PHARM

MAY 12, 2023

Take for example a patient having an xray in the radiology department. You are used to odd hours , fatigue and dealing with bad outcomes often beyond your control. Put simply its location and resources available that define prehospital care. The location can even be within an hospital.

Dislocations 52

Dislocations Hospitals Radiology Radiology 52

Taming the SRU

SEPTEMBER 8, 2023

Prognosis of acute severe autoimmune hepatitis (as-AIH): The role of corticosteroids in modifying outcome.” The British Journal of Radiology, vol. Hepatology, vol. 2, 2013, pp. 612–621, [link] Yeoman, Andrew D., Journal of Hepatology, vol. 4, 2014, pp. 876–882, [link] Potts, Jonathan R. Digestive Diseases and Sciences, vol.

Radiology 59

Radiology Radiology Ultrasounds EMS 59

The Skeptics' Guide to EM

JULY 18, 2020

AEM July 2020 * Population: Adolescents and adults presenting with symptoms of respiratory infection or clinically suspected pneumonia in the outpatient setting * Intervention: Any clinical sign or symptom (including vital signs) for pneumonia * Comparison: * Outcome: Radiologically confirmed pneumonia (using CXR as the gold standard) This is an

Radiology 52

Radiology Radiology Emergency Department Outcomes 52

EMDocs

JULY 3, 2023

Introduction SAH has the potential for rapid progression and devastating outcomes. 10 Additionally, discussion with radiology and neurology is advisable prior to obtaining an MRI, as data is not available to guide the specific timing of the test following symptom onset. What are the next steps in the management of this patient?

Seizures 83

Seizures Stroke Outcomes EMS 83

Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. doi:10.1148/radiology.144.4.7111716 Persistent air-leak in spontaneous pneumothorax--clinical course and outcome. AJR Am J Roentgenol. doi:10.2214/ajr.165.5.7572489

Fractures 85

Fractures COPD Hospitals Emergency Department 85

EMDocs

NOVEMBER 20, 2023

Management of Positive CTA Recommendation: We recommend that patients who have a CTA demonstrating extravasation be promptly referred to interventional radiology for transcatheter arteriography and possible embolization. (Conditional recommendation, low-quality evidence). Strong recommendation, moderate-quality evidence).

Resuscitation 78

Resuscitation Fluid Resuscitation Hospitals Research 78

Mind The Bleep

AUGUST 5, 2023

One-year outcomes following surgery for necrotising enterocolitis: a UK-wide cohort study. Management It is useful to be aware of Bell’s modified staging for NEC for deciding on treatment. Below is a simplified version. 1, 3-4, 7-8, 12) Medical Management : Nil by mouth (NBM) to rest the bowel. In: StatPearls [Internet]. Lakhoo, K. &

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

EMDocs

JUNE 22, 2023

The radiology tech has his hand on a weak femoral pulse. After this experience, I realized some crucial factors that contributed to this patient’s outcome: (1) Know your resources. Nurses are throwing on monitor leads, and we completely expose him and do a fast roll to look at his back. No other injuries. It’s still present.

Resuscitation 95

Resuscitation Ultrasounds Critical Access Documentation/Coding 95

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 79

CPR Burns Airway Management Wellness 79

EM Literature of Note

OCTOBER 18, 2021

Obviously, in a low-risk population with rare adverse outcomes, there can be no reasonable expectation of value in testing. So, a small decrease in invasive testing counterbalanced by the large baseline investment in non-invasive testing – without any clear patient-oriented benefit on health outcomes.

Outcomes 40

Outcomes EKG/ECG Wellness Radiology 40

Dr. Smith's ECG Blog

JUNE 27, 2021

A chest X-ray was obtained: This was read by radiology as "Bilateral lower lobe interstitial opacities. We should not have been fooled by the radiology reading of "pneumonia". The patient was given morphine, which is associated with worse outcomes in NonSTEMI (probably because it fools you into thinking you have treated the ischemia).

EKG/ECG 52

EKG/ECG Radiology Radiology Ultrasounds 52

Taming the SRU

MAY 22, 2023

Certain injuries carry risks of further injury, injury-related complications, and poor outcomes which are exacerbated if they are inappropriately managed in the ED. As an EM physician, it is important to have an understanding of the spectrum of ankle injuries and how these are appropriately evaluated. Injuries discussed are shown in Image 1.

Fractures 69

Fractures Dislocations Operations Radiology 69

ACEP Now

MARCH 14, 2024

15,19 Endovascular intervention depends upon the patient’s hemodynamic stability and availability of interventional radiology. Fatal outcomes postoperatively may be due to re-bleeding after attempts to preserve flow in the innominate artery or using sutures or prosthetic material in an infected area.22,23

Operations 52

Operations Pediatrics Airway Management Radiology 52

EMDocs

OCTOBER 30, 2023

2 In response to the constrained availability of contrast media, emergency medicine (EM) and radiology departments were compelled to enact modifications in their imaging techniques. In most cases, the radiology team functioned as the main decision-maker playing a key role in drafting institutional protocols. 11 Table 1.

Radiology 72

Radiology Radiology Emergency Department Hospitals 72

ACEP Now

JULY 7, 2023

Will this be enough for the general surgeon, or will they want an US performed by the radiology department to make their surgical decision? Clinical Question What is the value of radiology-performed US (RUS) compared to BUSED in terms of the surgical decision-making in acute biliary disease? Click to enlarge. Reference: Hilsden, et al.

Ultrasounds 52

Ultrasounds Radiology Radiology Emergency Department 52

Northwestern EM Blog

MAY 16, 2022

Do outcomes for patients with suspected nephrolithiasis differ based on the initial imaging? However, with ultrasonography becoming more prevalent in EDs, it may be possible that initial imaging may avoid this radiation risk and still have similar outcomes for patients. Would you be satisfied with only US and no follow-up CT?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

RebelEM

MAY 25, 2023

vs 3U) but no difference in mortality (Study not powered for this outcome) Clinical Take Home Point: The use of vasopressors is controversial and requires a nuanced approach SUMMARY OF MINIMIZING IATROGENIC INJURY RESTORE PERFUSION VOLUME REPLACEMENT Blood Products >>> Crystalloids Holcomb JB et al. NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

NOVEMBER 20, 2023

Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. Outcome: Primary Outcome: All-cause mortality at 90 days. The primary outcome focused on patient-centered outcomes. 97% of patients sustained blunt trauma.

Resuscitation 91

Resuscitation Outcomes Operations Hospitals 91

Pediatric Emergency Playbook

NOVEMBER 1, 2016

What am I seeing -- or not seeing -- here? First a refresher on radiographic anatomy of the elbow -- Images courtesy of Radioglypics (Open Access Radiology Education). Acute compartment syndrome of the upper extremity in children: diagnosis, management, and outcomes. Position of comfort, analgesia, xrays, and now what?

Pediatrics 52

Pediatrics Fractures Dislocations Radiology 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

Treatment: stabilization, embolization by interventional radiology, elective extirpation when more stable. Incidence, cause, and short-term outcome of convulsive status epilepticus in childhood: prospective population-based study. Other options for stable patients include an endovascular flow-directed microcatheter using cyanoacrylate.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

RebelEM

FEBRUARY 29, 2024

1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. SECONDARY OUTCOMES At day 28 , ceftriaxone group had (vs placebo): Lower VAP risk (20% vs 36%); hazard ratio 0.62 4, 8 Paper: Dahyot-Fizelier, C.,

CDC 94

CDC Outcomes Radiology Radiology 94

PEMBlog

SEPTEMBER 13, 2023

The causes are many – it could be a force of habit, a medical liability concern for “missing something,” a desire to please the caregivers, a previous seizure patient of theirs who had a bad outcome, or numerous other causes.

Seizures 52

Seizures Pediatrics Point-of-Care Testing Wellness 52

RebelEM

OCTOBER 5, 2023

Pneumonia diagnosis supported by clinical and radiologic criteria. Secondary Outcome By day 90, mortality was 9.3% Strengths: The investigators framed a research question centered on patient outcomes, ensuring the study’s relevance and practicality. Population Inclusion Criteria: Adult patients (≥18 years old). to −0.8).

Research 94

Research Outcomes Administration Shock 94

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 124

Administration Outcomes Resuscitation Radiology 124

EMDocs

APRIL 27, 2024

However, the bioavailability of antipseudomonal antibiotics has improved outcomes, limiting surgery as a confirmatory diagnostic procedure and as needed for granulation tissue removal. The changing face of malignant (necrotising) external otitis: clinical, radiological, and anatomic correlations. The Lancet. link] Grandis, J.,

EMS 81

EMS Infectious Diseases Radiology Radiology 81