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

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 104

Stroke Outcomes Shock Research 104

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. Admission allows for close monitoring, given the risks of perforation, ischemic bowel, and ulceration, as well as appropriate management of the condition and patient symptoms. Fecal Impaction and Nonperforated Stercoral Colitis: Red Flags for Poor Outcomes. Mathis, K.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

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 109

Stroke Academics EKG/ECG Hospitals 109

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. Ann Emerg Med. 2024;84(3):246-258.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

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 98

Stroke Academics Outcomes Administration 98

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

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 81

Stroke Outcomes Wellness EKG/ECG 81

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 94

Stroke Outcomes EKG/ECG Research 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

ACEP Now

MARCH 11, 2025

1 Further, a Cochrane review found that LMWH is associated with improved outcomes compared with UFH including reduced incidence of major hemorrhage (odds ratio [OR]=0.69; 95 percent CI, 0.50-0.95) The pervasive maxim quick on, quick off for UFH doesnt hold up as well as touted. Stubblefield WB, Helderman R, Strokes N, et al.

Hospitals 52

Hospitals Administration Outcomes Stroke 52

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

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

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

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 124

Outcomes Research Stroke COPD 124

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

Taming the SRU

NOVEMBER 3, 2023

Broad strokes In this prospective, non-randomized study published by Kring et al in January 2022 out of Maine Medical Center, researchers compared mean pain scores at rest and during incentive spirometry before, at 15 minutes after, and then 60 minutes after treatment with a serratus anterior plane block. Ultrasound Med. 41, 2695–2701 (2022).

Fractures 99

Fractures Ultrasounds Research Outcomes 99

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

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

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 95

Sepsis Research Stroke Academics 95

Taming the SRU

APRIL 22, 2023

If untreated, atrial fibrillation can increase clot formation and lead to an increased risk for heart attack and stroke as well as development of congestive heart failure. There were similar lengths of say overall and no significant difference in safety outcomes. However, it is still used in certain cases.

Outcomes 52

Outcomes Stroke Fractures Documentation/Coding 52

Dr. Smith's ECG Blog

DECEMBER 26, 2020

They called their transfer center cardiologist on call, who reviewed the case on the phone with them, as well as the ECG. The case was reviewed by the receiving team who had concerns for acute stroke or other cause of acute altered mental status. The patient was admitted for stroke management. Long-term outcome is unknown.

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

PulmCCM

JANUARY 22, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

EMDocs

OCTOBER 30, 2023

Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. Some institutions developed a tier-based system for outpatient imaging as well which was updated in real-time.

Radiology 103

Radiology Radiology Emergency Department Hospitals 103

Sensible Medicine

OCTOBER 4, 2023

The device becomes a screening test or provides information to “promote wellness.” Perhaps the most well-known example happened when the nature of primary hyperparathyroidism changed with the advent of automated multi-channel chemistry tests. Devices used to monitor disease in patients often get marketed to healthy people.

Research 91

Research Outcomes Stroke Academics 91

RebelEM

MARCH 13, 2024

This was not a Code 3 respiratory distress, fentanyl overdose with minimal response to Narcan or even an unconscious stroke patient with the blood pressure of a giraffe. Would they ever be well enough to be extubated? The patient came in working hard to breath, had minimal improvement after meds and treatments and was clearly tiring.

Documentation/Coding 58

Documentation/Coding Outcomes EMS Stroke 58

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

This definition includes clinically apparent seizures as well as those seen only on EEG.) Or… is it something else as well? Case 3: Headache and Arteriovenous Malformation Unlike in adults, stroke in children is divided evenly between hemorrhagic and ischemic etiologies. In other words – time is brain. ACEP Scientific Assembly.

Pediatrics 40

Pediatrics Seizures Stroke Radiology 40

PulmCCM

JANUARY 24, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

Emergency Medicine Ireland

FEBRUARY 6, 2023

Whereas in SAH you have a whole bunch of interesting and well proven interventions that can improve outcome for the lucky patients who haven’t already prognosticated themselves by presenting with a GCS of 3. This is now well defined and supported by randomised controlled level evidence. What pray tell is this new calamity?

Stroke 52

Stroke Radiology Radiology EMS 52

PulmCCM

JANUARY 4, 2022

” -Fran Lebowitz Background Quite recently, the BaSICS investigators evaluated the infusion rate of a fluid bolus on patient outcome. The primary outcome was identification of the optimal volume for assessing fluid responsiveness. If I get to the dry cleaners without having a huge fight, that’s challenging enough.”

Wellness 40

Wellness Outcomes Sepsis Stroke 40

Mind The Bleep

OCTOBER 25, 2024

Adults: While strabismus is more common in children, it can also occur in adults due to trauma, stroke , or neurological conditions. The choice of treatment depends on factors such as the type, severity, and underlying cause of the strabismus, as well as the age and overall health of the patient. What are the Complications? Pediatrics.

Stroke 52

Stroke Pediatrics Outcomes Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Over some time and the pain moved into her other arm as well as her jaw. Stroke-volume:50 ml. Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. Over the course of the next hour, this pain turned into a pressure in her chest.

EKG/ECG 109

EKG/ECG Ultrasounds Wellness Stroke 109

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Nachi: Well, I’m sure more of those studies are still coming. Show More v Jeff: Fair enough, we’ll take what we can get. Jeff: Agree.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Pediatric Education

SEPTEMBER 3, 2023

He had no concerns and he was doing well in school and with his friends. He had a sprained ankle the previous year that he says was well-healed. High-quality studies in the SCT population are needed to clarify the health-outcomes as many studies are necessarily smaller or not able to be performed as rigorously. Ann Intern Med.

Dehydration 40

Dehydration Hyperthermia / Hypothermia Pediatrics Military 40

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. Myopericarditis in Children: Elevated Troponin I Level Does Not Predict Outcome.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Dr. Smith's ECG Blog

MAY 30, 2023

IV fluids for more preload are indicated, but not too much, as the RV can be overloaded with fluid, cause the septum to bow into the LV, and then harm LV stroke volume and cardiac output, leading to worsening hypotension, worse RV perfusion, worse RV function, and more RV failure. The RV is supplied during systole as well as diastole.

Shock 97

Shock EKG/ECG Academics Stroke 97

Dr. Smith's ECG Blog

NOVEMBER 18, 2019

Case outcome The Na was 109. For clarity — I’ve reproduced and have labeled both the initial ECG ( = E CG # 1 ) , as well as the follow-up tracing done 2 days later ( = E CG # 2 ) after correction of the electrolyte disorders ( Figure-1 ). This was the etiology of seizures. He was treated with hypertonic saline.

EKG/ECG 52

EKG/ECG Seizures Stroke Wellness 52