1-20 of 324 results by Robert Flint
This secondary review of a prospective observational group of 1200 syncope/presyncope patients over age 40 found 5.6% experienced a significant adverse outcome within 30 days. These patients had no diagnosis after their ED evaluation. Their conclusion was admission to the hospital “increased the diagnostic yield for SAOs and accelerated time to diagnosis.”
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This study conclusion states: “Prehospital epinephrine administration in patients with traumatic cardiac arrest was associated with increased survival to hospital discharge and prehospital ROSC.” When you investigate the methods, only 809 of the 22,105 patients in traumatic cardiac arrest actually received epinephrine. In the study country, EMS gets orders from base station physicians for epinephrine. Why did these 809 get the epinephrine and the other 97% did not? It is hard to know what to do with this data. It certainly doesn’t say epinephrine saves patients in traumatic cardiac arrest. More research is needed.
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In a randomized pragmatic study of critically ill trauma patients, video laryngoscopy was successful in 88% of first pass attempts versus 68% in direct laryngoscopy.
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This Japanese hospital has a CT scanner hybrid resuscitation room. They did a retrospective study comparing their blunt trauma patients to a Japanese trauma database. Their patients had a shorter time to operative or interventional procedure, slightly less PRBC use over 24 hours and similar 24 hour mortality.
Interesting concept. Not ready for adoption.
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There is sound literature that older patients who board in the ED have higher rates of delirium, longer hospital stays, more complications and possibly higher mortality. Some institutions are starting to prioritize moving older patients upstairs ahead of others who may have been boarding longer in the ED. Hopefully some data will be out soon to see if this intuitive approach actually improves these outcomes.
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This South African study looked at 219 trauma patients who required damage control surgery and, not surprisingly, low GCS, low pH and elevated lactate all were independently associated with mortality.
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Question
The construction worker presents to the ED with this rash. What is it and what is the treatment?
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These authors used a database of 323 hospitals to find over 20,000 firearm injured patients. They looked at positive cultures to assess for post injury infection. Infection rate was 5%. Most infections were in the immediate post injury period. Those with surgical procedures on head, neck, lower abdomen, and spine were most likely to develop infection. Infection did not appear to be associated with increased mortality. Current guidelines recommend antibiotics for the first 24 hours post injury only.
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Looking at a national EMS database, these authors found advanced airway management (intubation, cricothyrotomy, rescue devices) occurred in 4/1000 trauma patients. Firearm related injury and motorcycle crashes had the highest use rate. Firearm related injury had the highest use rate of cricothyrotomy. This data should help drive prehospital education.
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This single center study at an academic center compared pre and post provider in triage implementation radiology ordering rate. They found higher CT utilization and lower positive CT findings in the post implementation period. Further work is needed, however is provider in triage good medicine or good for metric numbers?
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In 2023 there was a similar Canadian wildfire smoke pollution issue in the United States as there was in July 2026. The CDC found:
“Emergency department visits for asthma were 17% higher than expected during 19 days of wildfire smoke that occurred during April–August 2023.”
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The US FDA has approved the first freeze dried plasma. It is stored at room temperature in plastic bags which makes it ideal for austere environments. It is easily reconstituted and is given to patients who require plasma, bypassing the need to thaw FFP.
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This single center study asked patients about barriers to health carrier after ED discharge (example transportation, lack of PCP, inability afford medications, trouble with ADLs) and then surveyed EM residents about those same patients' barriers. Resident physicians way under perceived barriers to care in their patients. ("20.4% of patients reported they had no primary care physician (PCP) and 9.8% of residents reported their patient had no PCP . Limited health literacy was identified in 59.0% of patients and reported by 37.6% of residents . Abnormal cognition was present in 53.6% of adults age ??65 and reported by 16.7% of residents .")
Another example of if you do not ask, you will not know. Be careful of assumptions.
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This Canadian study looking at older patients presenting to EDs with suicidal ideation or attempt found most were female, arrived by ambulance from home, had poor social determinates of health, had a mental health history and attempts were by poisoning. Similar risk factors to other age groups. Mental health conditions donot tend to improve with age.
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A good reminder to consider careful prescribing to older patients at the time of ED discharge.
From this study: “Nearly 1 in 10 older adults filled a high-risk GEMS-Rx medication within 3?days of ED discharge between 2017 and 2022. Despite a decline in GEMS-Rx medication fills over time, younger cohorts of older adults and females were more likely to fill a high-risk medication upon ED discharge.”
Click for Gems-RX list
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Intuitively, both younger and older patients would have better outcomes at level 1 vs level 3 centers. This was true in younger patients in this large trauma database study. It was only true for older patients with traumatic brain injury and a high injury severity score. Is this a function of care delivery being better at level 3 or less geriatric focus at level 1 trauma centers?
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This study looking at older patient contact with the health system within 30 days of ED discharge found an overall lower rate of follow up for those patients with dementia. Perhaps extra care at time of discharge in arranging follow up is warranted for older dementia patients.
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This Canadian study found women, even when controlling for injury severity, socioeconomic conditions etc, were less likely to be admitted to a trauma center than their male counterparts. Further investigation into this bias is warranted.
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These authors looked at outcomes related to patients who underwent prehospital cold water immersion for acute heat stroke in Phoenix. They found immersion dropped temperature and improved neurologic function. This is a great reminder to cool these patients as soon as possible and a prehospital cooling protocol is feasible and helpful.
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This review article in the Journal of Trauma and Acute Care Surgery states:
“In obtunded patients, an adequate and normal high-quality CT supports collar removal without the need for adjunctive imaging.”