Handtevy - Pediatric Emergency Standards, Inc.

🚑 How reliable is the Glasgow Coma Scale (GCS) in predicting traumatic brain injury (TBI) during prehospital care?

A recent analysis sheds light on the effectiveness of early GCS scores in predicting TBI. Here's what they found:

🌟 Key Findings:

Analysis included 1,490 patients from three randomized prehospital trials:
‣ PAMPer
‣ STAAMP
‣ PPOWER.

✦ GCS Distribution:
‣ GCS 3: 59.5% had TBI.
‣ GCS 4-12: 42.4% had TBI.
‣ GCS 13-15: 11.8% had TBI.
✦ Predictive Value:
‣ GCS 3 had a positive predictive value (PPV) of 60% for TBI.
‣ Lower GCS strongly associated with higher mortality.

📋 Detailed Insights:

➊ Patients with low GCS often required prehospital intubation and were more likely to suffer from severe injury and shock.

➋ Hypotension and prehospital intubation were strong predictors of low GCS scores.

➌ GCS alone had limited utility in predicting TBI, highlighting the need for additional diagnostic tools.

📝 Conclusions:

➡ While GCS is widely used, it has a low PPV for TBI in the prehospital setting, especially in patients with hemorrhagic shock.
➡ Improved scoring systems and diagnostic technologies are essential to enhance early TBI diagnosis and guide prehospital interventions effectively.

📚 Read the Full Study for More Insights: https://ow.ly/FO1050SLR75

� Could injecting Suboxone lead to a heart attack?

A recent case report details an acute non-ST segment elevation myocardial infarction (NSTEMI) following the intravenous injection of sublingual Suboxone (buprenorphine/naloxone).

Here’s a summary of the findings:

� Case Summary:

A 41-year-old male with a history of intravenous fentanyl use.

He presents with total body pain, nausea, vomiting, diaphoresis, chest pain, and shortness of breath after injecting crushed Suboxone.

Vital Signs: BP 102/57, HR 85, 97.1°F, RR 15, SpO2 98% RA.

Initial EKG: Normal sinus rhythm without acute ST segment changes.

High-Sensitivity Troponin: Elevated from 110 ng/L to 602 ng/L over two hours.

Interventions: Aspirin, nitroglycerin, heparin drip, IV fluids, clonidine, ondansetron, and albuterol.

Cardiology Findings: Coronary angiography showed minor luminal irregularities but no acute plaque rupture or culprit stenosis.

� Discussion:

Mechanism: The intravenous injection of Suboxone, which includes naloxone, can precipitate withdrawal and potentially cause myocardial stress, leading to NSTEMI.

Clinical Implications: Similar symptoms between NSTEMI and acute withdrawal highlight the need for careful differential diagnosis.

High serum adrenaline levels from naloxone can increase cardiac stress.

� Conclusions:

Clinicians should consider NSTEMI in patients presenting with chest pain following misuse of buprenorphine/naloxone.

� Read the Full Study for More Insights: https://ow.ly/OcSU50SWqlH

� Do you know what speciality has the worst clinical feedback?

You guessed it, it's EMS.

� Can you guess which specialty has the best clinical feedback?

This one makes sense, it's anesthesiology � Gas on, patient asleep....gas off, patient awake! �

A group from the Mayo Clinic evaluated whether reviewing patient outcomes after EMS calls could make for better EMS clinicians?

Here's what they found.

� Study Highlights:
➊ EMS crews who requested performance feedback and patient outcome follow-ups had significantly better peer-review scores on subsequent calls.
➋ Leaders with 5+ prior feedback requests had peer-review scores 0.39 points higher compared to those with fewer requests.
➌ The entire crew's performance also improved, with a 0.32-point increase in peer-review scores after engaging in feedback processes.

� Takeaway:
� Consistently seeking feedback and patient outcomes is linked to better clinical care. It’s time to make feedback a regular part of your practice!

� Read the Full Study for More Insights: https://ow.ly/1MPY50STtL5



� Read the Full Study for More Insights: https://ow.ly/1MPY50STtL5

🚑 Mark your calendars!

🚨 Are ambulances being held hostage?

Have hospital bed delays taken EMS units out of service for hours in 911 systems preventing them from responding to other emergencies?

Check out the enroute podcast Saturday, August 31st at 12pm.

https://ow.ly/lXSW50SOO6L

Your patient is in shock and you need to secure vascular access quickly. What do you do?

This new technique is a show stopper, and it comes from a large author group including our good friend Scotty Bolleter from San Antonio.

Their team published a paper on this technique named "Graduated Vascular Access for Hypotensive Patient," or GAHP for short.

What is GAHP? It's the placement of an IO with infusion of fluid using the LifeFlow in order to "plump up" the veins of that extremity. It makes the placement of an IV much easier.

� Study Insights:
Method: In a study involving 23 cadavers, IO needles were inserted into four sites: distal radius, proximal humerus, distal femur, and distal tibia.

Results:
➊ Vessel Circumference Increase: A significant mean increase of 1.03 cm (102%) was observed during IO fluid bolus.

➋ Time to Optimization: No significant difference across sites; median time to maximum circumference was 14.92 seconds.

➌ Volume Required: Volume needed to achieve maximum circumference varied significantly across sites.

� Conclusions:
� GAHP effectively increases the circumference of proximal veins, facilitating easier and faster venous access.
� This method could significantly improve the efficiency of resuscitation efforts, particularly in emergency and critical care settings.
� Further research is needed to validate these findings in live, hypotensive patients.

� Read the Full Study for More Insights: https://www.handtevy.com/wp-content/uploads/2024/07/Mind-the-GAHP.pdf

🚑 Are Push-Dose Vasopressors Effective During Peri-Intubation in Critical Care Transport? 🚑

When managing critically ill patients, ensuring hemodynamic stability during intubation is crucial. But how effective are push-dose vasopressors in this scenario?

We review a Dartmouth study recently published in the Air Medical Journal that evaluated this question.

🔍 Key Insights from the Study:
➡ Objective: Evaluate the use and effectiveness of push-dose vasopressors during peri-intubation in critical care transport.

➡ Study Design: Retrospective chart review of 334 adult patients intubated between January 2017 and May 2023.

📊 Results:
Incidence of Use:
⦿ 14.7% (49 patients) received push-dose vasopressors.
⦿ 69.4% of these patients received multiple doses (mean: 2.5 doses).

Persistent Hypotension:
⦿ 79.6% of patients had persistent hypotension within 20 minutes of administration.
⦿ 30.6% were subsequently started on continuous vasopressor infusion.
⦿ 11.1% had an increase in their existing infusion rate.

Vital Signs (Mean Values):
⦿ Pre-intubation SBP: 103.9 mm Hg
⦿ Pre-intubation heart rate: 101.2 bpm
⦿ Pre-intubation shock index: 1.1
⦿ Post-intubation SBP < 65 mm Hg: 14.3%
⦿ Post-intubation cardiac arrest: 10.2%

What was the predominant push-pressor in this study?
➡ Push-pressor BEFORE induction (n,%)
1. Phenylephrine 43 (87.8%)
2. Epinephrine 9 (18.4%)
➡ Push-pressor AFTER-intubation(n,%)
1. Phenylephrine 30 (61.2%)
2. Epinephrine 8 (16.3%)

📈 Conclusions:
➊ The authors conclude that push-dose vasopressors, while convenient, often fail to address underlying shock and may necessitate continuous vasopressor infusion.

➋ High Incidence of Multiple Doses: Many patients required multiple administrations, highlighting the need for better strategies or earlier initiation of continuous infusion.

➌ Clinical Implications: For critically ill patients, reliance on push-dose vasopressors should be reevaluated, favoring a more robust resuscitation approach.

📚 Read the Full Study for More Insights: https://ow.ly/oq8350SrW4T

What are your thoughts on this study?

� How Accurate are EMS Impressions for Pediatric Patients?

When EMS responds to a child in an emergency, how often do their initial assessments match the hospital’s diagnosis?

A recent study examined this critical question and revealed some key insights:

� Study Highlights:

Sample Size: 35,833 pediatric transports with linked prehospital and in-hospital data.

Common Diagnoses: Trauma (24.6%), Neurologic diseases (16.4%), Psychiatric/Behavioral diseases (11.6%), and Respiratory diseases (9.5%).

Agreement Rate: 64.8% overall concordance between EMS impressions and hospital diagnoses.

Highest Concordance:
• Trauma: 77.3%
• Neurologic diseases: 70.3%
• Psychiatric/Behavioral diseases: 73.9%
• Respiratory diseases: 64.5%

Statistical Measure: Cohen’s Kappa statistic showed a moderate agreement (κ = 0.59).

� Implications:

Training and Protocols: Improving EMS training and protocols could enhance the accuracy of initial impressions, potentially leading to better patient outcomes.

Future Research: More studies are needed to understand discrepancies and how to address them.

�� Conclusion:
Enhanced training and protocols could bridge this gap, ensuring that children receive the best possible care from the moment EMS arrives.

� Read the Full Study for More Insights:https://ow.ly/QMUt50SOmlw

Your patient needs rapid medication, but IV access is challenging or not feasible. What do you do?

Is intranasal (IN) route for medication delivery your next and best option?

Here's what the research found:

🌍 Study Insights:
Intranasal Medications Analyzed:
⦿ Midazolam
⦿ Ketamine
⦿ Fentanyl
⦿ Glucagon
⦿ Diamorphine
⦿ Naloxone.

Total Patients Treated: 24,097

📊 Key Findings:

✦ Fentanyl:
→ Effective analgesic, particularly in pediatric patients.
→ Consistently reported good side effect profiles.
→ Mean pain reduction Fentanyl IN was 4.22 (95% CI: 3.74–4.71),
- Compared to Morphine IV at 3.57 (95% CI: 3.10–4.03)​​.
→ IN fentanyl had slightly lower efficacy compared to IV morphine in some studies​​.

✦ Ketamine:
→ Demonstrated utility as a safe analgesic.
→ Further studies needed for larger sample sizes and comparisons with other agents​​.

✦ Midazolam:
→ Mixed results, with some studies showing it as inferior to IV and IM routes​​.
→ Superior to PR diazepam in prehospital settings but not to IV diazepam​​.

✦ Naloxone:
→ Mixed findings on efficacy compared to IM route.
→ Some studies found longer times to achieve spontaneous respiration with IN administration compared to IM​​.

✦ Glucagon:
→ Limited studies but showed potential for treating hypoglycemia when IV access is not available​​.

📈 Conclusions:
IN medication delivery is a feasible alternative in prehospital settings, particularly for analgesia and when IV access is challenging.

More high-quality research is needed to establish definitive efficacy and safety guidelines.

📚 Read the Full Study for More Insights: https://ow.ly/6YO050SGkes

Have you ever heard of Alfentanil?

It's a derivative of fentanyl, with one fourth of the potency, yet its onset is immediate and the peak effect occurs within 1 minute.

With almost 18K patients treated by a Swedish EMS service, they've published their findings in Prehospital Emergency Care. 🚑

This eleven-year follow-up study provides some compelling insights discussing Alfentanil as a reliable choice for managing pain in the prehospital setting.

🔍 Key Findings from the Study:
➡ Study Duration: September 2011 to September 2022
➡ Population: 17,796 patients treated with alfentanil for various painful conditions
➡ Assessment Metrics: Visual Analogue Scale (VAS) for pain, adverse events (AE), and serious adverse events (SAE)

📊 Results:
✦ Pain Reduction:
1. Median VAS score before treatment: 8 (IQR 3)
2. Median VAS score after treatment: 4 (IQR 3)
3. Mean pain reduction: −4.1 ± 2.6

✦ Safety:
1. Adverse events occurred in 2.5% of patients
2. Serious adverse events were extremely rare (0.01%), with 25 cases reported

✦ Common Conditions Treated:
1. Abdominal pain: 37.9%
2. Leg injury: 25.1%
3. Back pain: 8.8%
4. Arm/shoulder injury: 8.0%

📈 Conclusions:
Efficacy:
✅Alfentanil provides significant pain relief with a mean reduction in VAS score of 4.1 points.

Safety:
✅ The incidence of serious adverse events is very low, indicating that alfentanil is a safe option for prehospital pain management when administered carefully.

Clinical Integration:
✅ Alfentanil has become a common first-line analgesic in the studied EMS, with consistent use and dosing over the eleven years.

📚 Read the Full Study for More Insights: https://ow.ly/Qjwo50SrVjA

🚑 Is Oral Risperidone Safe for Treating Prehospital Agitation?

When faced with an agitated patient in the field, would an oral antipsychotic be a viable option? This recent study explores the use of oral risperidone in prehospital settings.

Background:
➡ Agitation is a common prehospital problem and frequently presents without a clear etiology.
➡ Given the dynamic environment of the prehospital setting, there has historically been a varied approach to treating agitation with a heavy reliance on parenteral medications.
➡ Newer best practice guidelines recommend the incorporation of oral medications to treat patients experiencing agitation.
➡Therefore, the group from Hennepin EMS evaluated the use of oral risperidone in their system after a change in protocol occurred.

🔍 Key Insights from the Study:

Study Design: Retrospective chart review over 8 months in an urban/suburban EMS system.
Primary Outcome: Need for additional medications to manage agitation.

📊 Results:
Acceptance Rate: 96.6% of patients accepted risperidone.
- Population: 552 records screened
- 530 patients offered risperidone
- 512 patients accepted.
Effectiveness: Only 1.8% (9 patients) required additional medications for agitation.

Complications:
⦿ Low incidence of potential complications (0.8%)
⦿ 4 cases noted:
- Nausea (1)
- Hypoglycemia (1)
- Seizure with hypoxia (1)
- Apnea responding to naloxone (1).

Safety: No injuries reported to paramedics or patients.

📈 Conclusions:
➊ Oral risperidone is a feasible option for managing mild agitation prehospital, reducing the need for additional medication and minimizing complications.
➋ Offering an oral option enhances patient cooperation and therapeutic rapport.

📚 Read the Full Study for More Insights: https://ow.ly/f97750SrUXm

Are you prepared to manage a severely agitated patient with hyperactive delirium in the field?

🌟 Key Insights from a Recent Study just published in AJEM:

🔍 Study Overview:
Researchers evaluated the safety and effectiveness of a FIXED 250 mg dose of ketamine for prehospital management of hyperactive delirium with severe agitation (HDSA). The study was a retrospective review of EMS records from four agencies.

📊 Study Findings:
Patient Demographics:
⦿ 60 patients met the inclusion criteria
⦿ Median age 34.5 years,
⦿ Median weight 80 kg.
⦿ 75% were male.

Ketamine Administration:
⦿ 80% of patients required only a single 250 mg dose.
⦿ 20% received a second 250 mg dose, none experienced adverse events.

Adverse Events:
⦿ 4 patients had prehospital adverse events likely related to ketamine:
- 1 required suctioning
- 3 needed BVM support.
⦿ No patients were intubated by EMS.
⦿ In the ED, 6 patients (10%) were intubated, including the 3 who needed BVM.

Safety and Effectiveness:
➡ All patients were discharged alive with a CPC 1 ➡ The 250 mg dose equated to ≤5 mg/kg in all cases.

💡 Key Takeaways:
➊ A fixed 250 mg dose of ketamine is effective for managing HDSA in prehospital settings.
➋ The protocol minimizes dosing errors and is generally safe, with few adverse events.

Further research is needed to refine dosing protocols and confirm these findings.

📚 Read the Full Study for More Insights: https://ow.ly/QuzO50SjjSv

🚑 How Do You Manage a Severely Contaminated Airway in Trauma Patients? 🚑

The SALAD technique is your lifesaver!

🔍 Key Insights from the Case Report:

Patient Background: A 17-year-old male with a gunshot wound to the mouth. Continuous bloody secretions obstructing the airway, complicating intubation.
Suction-Assisted Laryngoscopy and Airway Decontamination (SALAD) technique was used.

📊 SALAD Technique Highlights:

➊ Suction First: Use a large bore suction catheter (Use Ducanto not a Yankauer) to clear the oropharynx and hypopharynx.
➋ Maintain Visibility: Continuous suction keeps the video laryngoscope (VL) camera view unobstructed.

➡ Step-by-Step Approach:
➊ Insert the suction catheter first, creating space for the laryngoscope.
➋ Position the catheter in the esophagus to maintain continuous suction.
➌ Intubate with a clear view, ensuring a high first-pass success rate.

📈 Case Conclusion:
⦿ The patient was intubated on the first attempt without desaturation.
⦿ No hypoxia, hypotension, or bradycardia during the procedure.
⦿ Patient was transported to a pediatric trauma center, underwent surgery, and was discharged home after 40 days.

This case emphasizes the need for effective techniques like SALAD in managing contaminated airways in prehospital settings.

What should you do at your organization?
⦿ Incorporate the SALAD technique at least once a year using a soiled airway mannequin, or better yet a cadaver lab.
⦿ Reach out to us if you'd like more resources on this topic.

📖 Read the Full Case Report for More Insights: https://ow.ly/7OjO50SrUIX

🚑 What Do You Do When You Run Out of Blood During an Entrapment Rescue? 🚑

Here’s how one team managed this high-stakes scenario!

🔍 Key Insights from the Case Report:

Patient Background:
⦿ A 26-year-old male entrapped in a vehicle for 144 minutes after a rollover accident.
⦿ The patient suffered severe lower extremity injuries, leading to hemorrhagic shock.

Solution:
⦿ Activation of Helicopter EMS (HEMS) and Surgical Emergency Response Team (SERT) for massive transfusion at the scene.

📊 Rescue and Treatment Highlights:
Initial Response:
⦿ Fire rescue and ALS provided initial care.
⦿ HEMS initiated patient monitoring and transfused 2 units of packed red blood cells (PRBCs).
⦿ Activation of SERT:
⦿ SERT brought additional blood products:
- 4 units of O- PRBC
- 2 units of thawed plasma (TP)
- Platelets.
⦿ Continued transfusion during extrication.
⦿ Total Blood Products Given:
- Prehospital: 7 units PRBC, 3 units TP, and 1 pack of platelets.
- In-hospital: 2 more units PRBC, 2 units TP.
⦿ Total: 12 units of blood components.

📈 Outcomes:
⦿ The patient’s vitals stabilized after massive transfusion.
⦿ The patient was transported to the hospital, underwent multiple surgeries, and was discharged to rehabilitation after 11 days.

📚 Conclusion:
➡ Prehospital massive transfusion can be crucial for patients with prolonged entrapment and severe hemorrhage.
➡ Integration of blood bank services and physician-guided resuscitation can significantly improve outcomes.

📖 Read the Full Case Report for More Insights: https://ow.ly/cA9F50SrUMx

� How Important is the Speed of Chest Recoil in CPR? �

Ever wondered which factor is most crucial in ensuring effective chest compressions during CPR?

This new research has some answers!

� Key Findings from the Study:

Optimal CPR Factors:
Compression rate, depth, and recoil velocity were modeled, with ETCO2 used as a marker for effectiveness.

Recoil Velocity is Crucial: Strongly linked to higher ETCO2, suggesting it’s a primary driver of effective CPR.

� Study Highlights:

Linear Relationships: Higher compression depth and recoil velocity lead to better ETCO2 readings.

Parabolic Relationships: Both extremely fast and slow compression rates resulted in less effective CPR, showing the importance of maintaining optimal rates.

Model Findings:
Recoil velocity outperformed compression depth in influencing ETCO2.

Structural equation modeling confirmed recoil velocity’s significant impact on cardiac output during CPR.

� Conclusion:
Maximize Chest Recoil: The study emphasizes the need to focus on chest recoil for effective CPR, potentially suggesting updates to CPR guidelines.

� Read the Full Study:https://www.handtevy.com/wp-content/uploads/2024/06/Chest-Decompressions-the-Driver-of-CPR-Efficacy-Exploring-the-relationship-between-compression-rate-depth-recoil-velocity-and-end-tidal-CO2.pdf

To all our incredible EMS professionals, your dedication and bravery embody the true spirit of freedom. As we celebrate the 4th of July, we remember that your tireless work keeps us safe and healthy. Thank you for giving us the peace of mind to enjoy this Independence Day. Happy 4th of July 🇺🇸

If you live and die by high-performance CPR, you know that longer pauses in chest compressions during pediatric in-hospital cardiac arrest can significantly reduce survival chances.

A new study validates the point and we'd recommend you use this to continue to beat the drum on working kids on scene, and applying HP-CPR principles to them, just like you do for adults.

📊 Key Insights from the Recent Study:

Researchers investigated the link between chest compression (CC) pause duration and survival outcomes in pediatric in-hospital cardiac arrests (IHCA).

Analyzed data from the pediRES-Q collaborative, covering 562 IHCA cases from July 2015 to December 2021.

👶 Participant Demographics:
⦿ Median age: 2.9 years
⦿ 43% female, 13% had a shockable rhythm

⏱️ Chest Compression Pause Durations:
⦿ Median longest CC pause: 29.8 seconds

📈 Survival Outcomes:
⦿ Each 5-second increase in the longest CC pause was linked to:
a) 3% lower chance of neuro intact survival (aRR, 0.97; P=0.01).
b) 2% lower chance of survival to hospital d/c (aRR, 0.98; P=0.01).
c) 7% lower chance of ROSC (aRR, 0.93; P10 seconds and >20 seconds were associated with lower probability of ROSC but not significantly linked to survival or neurological outcomes.

⦿ The number of pauses >10 seconds and >20 seconds per 2 minutes was significantly associated with lower adjusted probability of ROSC.

💡 Key Takeaways:
➡ Longer CC pauses during pediatric IHCA significantly decrease the chances of survival and favorable neurological outcomes.
➡This study supports the AHA's recommendation of keeping CC pauses under 10 seconds to improve outcomes.

📚 Read the Full Study for More Insights: https://ow.ly/fFl550SjjIA

Did you know that using two sets of pads for cardioversion in obese patients with ATRIAL FIBRILLATION can be more effective than one for refractory patients?

But wait.....if we are considering Double Direct Current Cardioversion (DCCV) doesn't that mean the charge fires as the SAME EXACT TIME?

Doesn't that mean the monitor will become damaged?

Well....maybe not!

🌟 Key Insights from a Recent Study:

🔍 Study Overview:
A randomized clinical trial conducted across three sites in Louisiana from August 2020 to 2023.
Focused on patients with obesity (BMI ≥ 35) and atrial fibrillation undergoing nonemergent electrical cardioversion.

📊 Study Findings:
Participants:
➡ 210 patients were randomized; 200 completed the study (67.6 years median age, 63.5% male).
➡ Mean BMI was 41.2.

How did they do it:
⦿ Biphasic cardioversion shocks were delivered via ZOLL-R Series external cardioverter-defibrillator units (ZOLL Medical), with 1 set of electrodes attached to each defibrillator unit.
⦿ The single-DCCV group received a single QRS-synchronous 200-J shock from the primary electrode pair.
⦿ The dual-DCCV group received simultaneous QRS-synchronized shocks using both the primary and secondary electrode pairs, totaling 400 J.
⦿ In dual DCCV, the defibrillator units’ shock buttons were pressed simultaneously, resulting in delivery of shocks from both units synchronized to the same QRS complex.

Primary Outcome ➡ Success Rate:
➡ DCCV had a significantly higher success rate compared to standard cardioversion:
⦿ 98% vs. 86% (P = .002).
➡ Odds ratio for success with dual DCCV:
⦿ 6.7 (95% CI, 3.3-13.6; P = .01).

Secondary Outcomes:
➡ No significant difference in post-procedure chest discomfort between the two groups.
➡ No adverse cardiovascular events were reported in either group.
➡ No report of monitors being affected.

💡 Key Takeaways:

⦿ Dual DCCV is more effective for cardioversion in obese patients with atrial fibrillation without increasing patient discomfort or complications.
⦿ The study supports dual DCCV as a potential standard practice for this patient population to improve cardioversion success rates.

📚 Read the Full Study for More Insights: https://ow.ly/vxJe50SjjHz

🎥 Watch the video here: https://edhub.ama-assn.org/jn-learning/video-player/18881247

🚑🎙️ Dive into the EMS P.O.D with Chief Doug Randell and Dr. Peter Antevy and learn about South Florida's pioneering whole blood program! 🩸 Discover best practices, protocols, and resources for starting a prehospital whole blood program. Plus, get crucial insights on recognizing and treating sepsis.

This POD is perfect for EMS leaders and clinicians looking to up the ante on high quality EMS care in the streets! 🚨👩‍⚕️👨‍⚕️

Listen to the full podcast https://bit.ly/3RJ7nN6

The EMS P.O.D.: An Increase in Survival with Dr. Peter Antevy - JEMS: EMS, Emergency Medical Services - Training, Paramedic, EMT News Dr. Peter Antevy sits down with EMS P.O.D. host Douglas Randell to discuss whole blood administration and sepsis treatment in the field.

Don't always believe the metric because it may be measuring something you didn't even think about. 🏥

This paper and the associated commentary exposes why using a metric like "in-hospital mortality from sepsis" can be detrimental to safety-net hospitals.

Sepsis is one of the most deadly and costly conditions in hospitals, and government regulations aim to improve care. But are these regulations actually helping or harming?

If you got this far and are still interested in why using in-hospital mortality as a metric for quality is a mistake, read on and let's nerd out together!

📊 Key Points from the Commentary:

⦿ Government regulations, like SEP-1, were designed to improve sepsis care but haven't always led to better outcomes.
New York State's intensive sepsis program showed success by lowering mortality rates but came with high implementation costs. (Translation: High quality sepsis care isn't cheap.....and if you're a safety net hospital you're probably hanging on by a thread).

⦿ Safety-net hospitals, which serve the most vulnerable populations, struggle to meet these regulations due to financial constraints, widening health disparities.

⦿ A recent study found that safety-net hospitals had higher in-hospital mortality but not 30-day mortality, suggesting they may be unfairly penalized by current quality measures. (Translation: 30-day mortality was the same at both hospital types....but that information wasn't known until this study. The in-hospital mortality metric made the safety-net hospital look bad when it wasn't.....it just didn't have the resources it needed to provide other services)

⦿ Differences in palliative care and discharge practices contribute to these disparities, as safety-net hospitals have lower rates of DNR orders, palliative care, and hospice discharges.

🚨 So What are the Implications of using the wrong metric?
⦿ Current sepsis quality measures may not fairly represent patient outcomes at safety-net hospitals, potentially penalizing them unjustly.
⦿ A shift towards time-delineated mortality rates (e.g., 30-day mortality) could provide a fairer assessment.
⦿ Expanding access to palliative care and supporting under-resourced hospitals through collaborations and toolkits can help bridge the gap.

👉 Conclusion:
To truly improve sepsis care without widening health disparities, we must rethink how we measure and incentivize quality. Supporting safety-net hospitals with resources and fair metrics is crucial for equitable healthcare.

📚 Read the Full Study for More Insights:https://www.handtevy.com/wp-content/uploads/2024/06/JAMA-Sepsis-2024.pdf
📚 Read the Full Commentary:https://www.handtevy.com/wp-content/uploads/2024/06/JAMA-Sepsis-Commentary-2024.pdf

Your pediatric patient is having a seizure in the field. Do you know the right dose of benzodiazepine to administer? What is the consequence of not giving the right dose?

� Key Insights from a Recent Study:

� Study Overview:

A retrospective analysis of EMS encounters in the National EMS Information System from 2019 to 2021.
The study focused on children (