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National Performance on the Medicare SEP-1 Sepsis Quality Measure
We examined the hospital factors associated with reporting SEP-1 data, the hospital factors associated with performance on the SEP-1 measure, and the relationship between SEP-1 performance and performance on other quality measures related to time-sensitive medical conditions. A total of 3,283 hospitals were eligible for the analysis, of which 2,851 (86.8%) reported SEP-1 performance data. SEP-1 reporting was more common in larger, nonprofit hospitals. The most common reason for nonreporting was an inadequate case volume. Among hospitals reporting SEP-1 performance data, overall bundle compliance was generally low, but it v...
Source: Critical Care Medicine - July 13, 2019 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Neighborhood-level stroke hot spots within major United States cities
Identifying communities at high risk of stroke is an important step in improving systems of stroke care. Stroke is known to show spatial clustering at the state and county levels, but it is not known if clusters are present within city boundaries.
Source: The American Journal of Emergency Medicine - June 24, 2019 Category: Emergency Medicine Authors: Daniel A. Dworkis, James Marvel, Nerses Sanossian, Sanjay Arora Source Type: research

NAEMT and Sepsis Alliance Announce Results of National Sepsis Survey
In a recent national survey of more than 1,300 EMS providers, the National Association of Emergency Medical Technicians (NAEMT) in association with the Sepsis Alliance found that although nearly all respondents (98%) consider sepsis a medical emergency, only about half (51%) feel very confident in their ability to recognize symptoms of sepsis—the body’s life-threatening response to an infection. Each year, about 1.7 million people in the United States are diagnosed with sepsis, with 270,000 dying, making sepsis a priority public health issue. This is reflected in the 83% of respondents who say that they’ve seen sepsi...
Source: JEMS: Journal of Emergency Medical Services News - March 15, 2019 Category: Emergency Medicine Authors: JEMS Staff Tags: Patient Care News Source Type: news

How should we treat patients who wake up with a stroke? A review of recent advances in management of acute ischemic stroke
Acute ischemic strokes account for 85% of all strokes and are the fifth leading cause of mortality in the United States. About one in five of all ischemic strokes occur during sleep and are not noticed until the patient wakes up with neurological deficits. There is growing evidence to support that a significantly higher number of stroke patients could benefit from more aggressive care, especially those patients who wake up with strokes. There is increasing research to support a physiologically-based approach based on advanced imaging rather than simply a time-based determination of whether or not a patient would benefit from reperfusion.
Source: The American Journal of Emergency Medicine - February 21, 2019 Category: Emergency Medicine Authors: Danielle Biggs, Michael E. Silverman, Frank Chen, Brian Walsh, Peter Wynne Source Type: research

Do High Sensitivity Troponin and Natriuretic Peptide Predict Death or Serious Cardiac Outcomes After Syncope?
CONCLUSION: HscTnT and NT-proBNP are independent predictors of 30-day death and serious outcomes in older ED patients presenting with syncope. This article is protected by copyright. All rights reserved. PMID: 30721554 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - February 5, 2019 Category: Emergency Medicine Authors: Clark CL, Gibson TA, Weiss RE, Yagapen AN, Malveau SE, Adler DH, Bastani A, Baugh CW, Caterino JM, Diercks DB, Hollander JE, Nicks BA, Nishijima DK, Shah MN, Stiffler KA, Storrow AB, Wilber ST, Sun BC Tags: Acad Emerg Med Source Type: research

Nearly Half of U.S. Adults have Heart or Blood Vessel Disease
A new report estimates that nearly half of all U.S. adults have some form of heart or blood vessel disease, a medical milestone that's mostly due to recent guidelines that expanded how many people have high blood pressure. The American Heart Association said Thursday that more than 121 million adults had cardiovascular disease in 2016. Taking out those with only high blood pressure leaves 24 million, or 9 percent of adults, who have other forms of disease such as heart failure or clogged arteries. Measuring the burden of diseases shows areas that need to improve, the heart association's chief science and medical officer, D...
Source: JEMS: Journal of Emergency Medical Services News - February 1, 2019 Category: Emergency Medicine Tags: News Patient Care Cardiac & Resuscitation Source Type: news

Not Just Acid Reflux: The Need to Think Worst First
Discussion Heart disease is the leading cause of death in the United States.1 This year, 720,000 Americans will have a new coronary event—defined as first hospitalized myocardial infarction (MI) or coronary heart disease death—and around 335,000 will have a recurrent event. Approximately 35% of people who experience a coronary event in a given year and around 14% of patients who have an acute coronary syndrome will die from it.1 Roughly 60% of patients with an acute coronary syndrome are transported to the emergency department via ambulance.2–4. Up to one-third of patients experiencing an MI may not complain of chest...
Source: JEMS Special Topics - January 13, 2019 Category: Emergency Medicine Authors: Stephen Sanko, MD, FACEP Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

Fool Me Once: An Uncommon Presentation of PE
​BY FREDDIE IRIZARRY-DELGADO; VAROON KAKAIYA; & AHMED RAZIUDDIN, MDAn 86-year-old African-American woman was brought to the ED by her daughter after two days of nutritional neglect, abdominal pain, and altered mental status. Her daughter said her mother felt lightheaded, appeared dehydrated, and vomited nonbilious watery fluid once. The patient had a history of diabetes mellitus type 2, DVT/PE, dementia, and early signs of parkinsonism.Her vital signs were remarkable only for tachypnea (24 bpm). Her troponin I was markedly elevated at 1.7 ng/mL. A D-dimer was ordered because of her history of unprovoked DVT/PE, and i...
Source: The Case Files - November 27, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Debilitating Headache after an Excited Reaction
​BY GREGORY TAYLOR, DO, & MATTHEW WARPINSKI, DOA 35-year-old man with a history of uncontrolled hypertension and medical noncompliance was brought to the emergency department by EMS complaining of a headache. The family said the patient was watching football and developed an acute headache after he stood up screaming in excitement.His family said he had not taken his blood pressure medication for years. He was afebrile, his blood pressure was 245/129 mm Hg, his respiratory rate was 18 bpm, his heart rate was 68 bpm, and he weighed 340 pounds. The patient was obtunded with a Glasgow Coma Scale score of 4 and was subse...
Source: The Case Files - November 20, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Tenecteplase utility in acute ischemic stroke patients: A clinical review of current evidence
Acute ischemic stroke is leading cause of disability in the United States. Treatment is aimed at reducing impact of cerebral clot burden and life-long disability. Traditional fibrinolytic treatment with recombinant tissue plasminogen activator (tPA) has shown to be effective but at high risk of major bleeding. Multiple studies have evaluated tenecteplase as an alternative to tPA.
Source: The American Journal of Emergency Medicine - November 14, 2018 Category: Emergency Medicine Authors: Amelia Nelson, Gregory Kelly, Richard Byyny, Catherine Dionne, Candice Preslaski, Kevin Kaucher Source Type: research

Firefighting and On-Duty Cardiac Deaths
Conclusion Using autopsy data from on-duty fatalities that occurred over a 15-year period, the underlying cardiac pathological conditions associated with sudden cardiac death were investigated among firefighters. Our data suggest a need for updated and improved medical screening for firefighters. Particularly, screening for CHD and cardiac enlargement should be incorporated into a firefighter’s routine screening. Given the important role of EMS in ensuring both civilian and firefighter safety, EMS personnel should be alert to the potential to encounter either sudden cardiac arrest or a myocardial infarction in firefighte...
Source: JEMS Special Topics - November 12, 2018 Category: Emergency Medicine Authors: Denise L. Smith, PhD, FACSM Tags: Training Exclusive Articles Source Type: news

An Update on Pediatric Stroke Protocol
Pediatric stroke is relatively rare, with approximately 1000 childhood strokes in the United States per year. However, the occurrence of stroke in children leads to significant morbidity and mortality, warranting the development proven screening tools, protocols, and treatment options. Because significant delays in seeking medical attention can occur, time to recognition of pediatric stroke in the emergency department is uniquely challenging and critical. Once recognized, a trained multidisciplinary team with a multifaceted approach is needed to provide the best possible outcome for the patient. Key elements of the pediatr...
Source: Pediatric Emergency Care - November 1, 2018 Category: Emergency Medicine Tags: CME Review Article Source Type: research

A Pregnancy Complication to Look out for even after Pregnancy
​BY GREGORY TAYLOR, DO, & SHERIF G. EL-ALAYLI, DOA 30-year-old G5P3 presented to the ED with bilateral lower-extremity edema and headache for three days. She presented one week after an uncomplicated full-term vaginal delivery with an unremarkable pregnancy course and no prior requirement for antihypertensive therapy. The headache was described as achy to sharp, with associated photophobia. She also noted occasional vaginal spotting, which was common a few weeks after delivery. She denied any chest pain, shortness of breath, nausea or vomiting, abdominal pain, or any other symptoms. She admitted to occasional mild cr...
Source: The Case Files - August 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

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