The Skeptics' Guide to EM

FEBRUARY 25, 2023

Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Reference: Cashen K, Reeder RW, Ahmed T, et al.

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Pediatric Emergency Playbook

MARCH 1, 2016

On arrival, he was in compensated shock, with tachycardia. Resuscitative Pearls Our goal here is damage control. Otherwise, resuscitate, identify the bleeding source, and slow or stop the bleeding with blood products or surgery. 2010 Nov;19(4):286-91. He decompensates and needs blood. Apply pressure whenever possible.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Taming the SRU

FEBRUARY 19, 2024

One such study of 263 patients without hypertensive emergencies treated in a resuscitation unit found that 40% of patients had a MAP difference ≥ 10 mmHg between IABP and NIBP measurements. A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Don't Forget the Bubbles

MAY 6, 2024

This multicentre retrospective cohort study looked at 202 children in California aged 1- 24 months who presented acutely between 2010 and 2021. The mean time to randomisation was 2 hours, which excludes the initial resuscitation window. However, this study did not include the acute resuscitation period or non-ventilated children.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Pediatric Emergency Playbook

AUGUST 1, 2017

2010; 26:769-781. 2010; 149(3):386-391. 2010; 45:1182-1186. J Emerg Med. 2012; 43(1):49-51. Martin V, Shaw-Smith C. Review of genetic factors in intestinal malrotation. Pediatr Surg Int. Nehra D, Goldstein AM. Intestinal malrotation: Varied clinical presentation from infancy through adulthood. Am J Emerg Med. 2012; 30:426-431.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

JUNE 26, 2023

But, they may present postnatally with cyanosis/hypoxaemia due to insufficient pulmonary blood flow, cardiogenic shock due to insufficient systemic blood flow, or both. The team start CPR, and this is emergently converted to extra-corporeal cardiopulmonary resuscitation via the open sternotomy wound.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

RebelEM

JANUARY 25, 2023

2010, (Ch) 92: p 1216-1227. Am Surg 2010; 76:687-691. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 Louis, Mosby, Inc.,

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Taming the SRU

OCTOBER 1, 2023

Observation: A 2010 systematic review of 3 RCTs found no difference in mortality, progression of PTX size, or length of hospital stay between chest tube and observation for stable trauma patients with occult PTX [33]. Unsuspected tension pneumothorax as a hidden cause of unsuccessful resuscitation. J Emerg Trauma Shock.

Fractures 95

Fractures COPD Hospitals Emergency Department 95

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

The latter 1950s and 1960s, quested for nerve gas defense studying expired air resuscitation and modern resuscitology; developing intensive care units. To me, it harkens a new scientific renaissance of resuscitation science, emergency care, and creating systems for care. 1950s & 1960s Resuscitation Research.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

PHEM Cast

SEPTEMBER 6, 2017

Qvigstad et al showed in again in Resuscitation in 2013, confirming inter-individual variation in effectiveness of CPR using ETCO2 as a surrogate for CO Trauma Deakin et al. (J. N Cardiopulmonary resuscitation: capnogram showing positive waveforms during each compression suggesting effective cardiac compression generating pulmonary blood.

CPR 52

CPR Resuscitation Operations Wellness 52

EMDocs

APRIL 22, 2024

However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). During this resuscitation two different ultrasound machines were used to capture images due to a malfunction with the first machine after initial images were captured. Am J Prev Med.

Ultrasounds 82

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 82

Downeast Emergency Medicine

APRIL 26, 2021

The primary outcome was 30-day mortality with secondary outcomes looking at 24 hour in-hospital mortality, blood resuscitation at 6 and 24 hours, incidence of multiorgan failure, ARDS, nosocomial infection, early seizures, PE/DVT, crystalloid resuscitation after 24 hours, and the incidence of coagulopathy. Lancet 2010; 376:23-32.[

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

Journal of Emergencies, Trauma and Shock, 3(1), 39. Reid, C (2011) Prehospital resuscitative hysterotomy op.cit. Geoff Jara-Almonte, MD and Hilary Fairbrother, MD // Editor: Alex Koyfman, MD Resuscitation of the Pregnant Trauma Patient – Pearls and Pitfalls www.emdocs.net 2/6/2015 Desjardins, G. Capriola, M. Weingart, S.,

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

The combination of abnormalities determines the category of pathophysiology: respiratory distress, respiratory failure, CNS or metabolic problem, shock, or cardiopulmonary failure. Does this child look volume depleted? Endocrine Emergencies - Could this be congenital adrenal hyperplasia with low sodium, high potassium, and shock?

Seizures 40

Seizures Sepsis Pediatrics Shock 40

RebelEM

MARCH 27, 2023

What They Did: Retrospective, observational cohort study in a single high-volume academic hospital The ED had a 5 bed area used for ongoing management and resuscitation of patients who clinically deteriorate while boarding or while actively undergo a workup in other sections of the ED. 2011 Feb 15; Epub 2010 Aug 27. J Crit Care.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

PEMBlog

JUNE 5, 2024

Epub 2010 Oct 29. You should also consider the possibility of quote unquote spinal shock. than it is spinal shock. Resuscitate with volume and blood. And hypotension, bradycardia, or temperature instability can result from hemorrhagic and or spinal shock. Ann Emerg Med. 2011 Aug;58(2):145-55. 2010.08.038.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

Pediatric Emergency Playbook

JANUARY 1, 2017

Assessing and managing children’s pain can be challenging, because they may not exhibit typically recognized signs and symptoms ( Srouji 2010 ). The Baker-Wong FACES Pain Rating scale ( Figure 1 ) was developed with feedback from children and has been validated for use in those 3 years of age and older ( Keck 1996 , Tomlinson 2010 ).

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Pediatric Emergency Playbook

JUNE 1, 2017

Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’. 2010; 12(3): 3–8. 2010 Oct 1;33(10):821-42.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

EB Medicine

SEPTEMBER 1, 2018

If EMS has placed bandages, leave them in place until antivenom and resuscitative equipment is ready. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Review of eastern coral snake ( Micrurus fulvius fulvius ) exposures managed by the Florida Poison Information Center Network: 1998-2010.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EB Medicine

AUGUST 6, 2019

Nachi: However, in 2010, the FDA approved the first DOAC, a real game-changer. Jeff: That is simply shocking! Jeff: For all agents, regardless of the DOAC, the initial resuscitation follows the standard principles of hemorrhage control and trauma resuscitation. Let’s also talk lab studies. should all be used as needed.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EB Medicine

JULY 8, 2019

Additionally, back in 2010, it was estimated that 6.6% Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. Nachi: It sure is, but maybe even more worrisome is the rising prevalence of obesity. While it was < 15% in 1990, by 2016 it reached 40%. million adults!!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

FEBRUARY 12, 2024

First, there can be a poor correlation between venous and arterial gases in states of shock, hemodynamic instability, or extremes of acid-base disturbances, due to poor cardiac output/circulatory failure impairing venous and arterial flow, with associated poor gas exchange as well as hypercapnia and acidemia at the tissue level (8).

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

RebelEM

MAY 15, 2024

Read More: Infectious Disease Society of America 2010 Clinical Practice Guidelines Life in the Fast Lane: Febrile Neutropaenia Uptodate: overview of neutropenic fever syndromes EMRAP: Risk stratification of neutropenic fever MDCalc: MASCC Score MDCalc: CISNE Score References: Ahn S, Rice TW, Yeung SJ, Cooksley T. Sepkowitz, K. Boeckh, M.

Infectious Diseases 104

Infectious Diseases Administration Sepsis Anaphylaxis 104

EMDocs

JANUARY 4, 2024

Cardiogenic shock and hypotension can occur (systolic heart failure with reduced ejection fraction.) 10,12 Refractory shock or malignant arrhythmias occur in < 5% of patients. 2010; 48(8):800-5 Robinson S. Comparison of Resuscitative Protocols for Bupropion Overdose Using Lipid Emulsion in a Swine Model. 2022; 55:232.e3-232.e4

Seizures 67

Seizures EKG/ECG Poisoning Shock 67

ACEP Now

NOVEMBER 7, 2023

Double sequential external defibrillation (DSED) is a technique in which rapid sequential shocks are placed from two defibrillators, with defibrillation pads in two planes, such as anterior-lateral and anterior-posterior. Improvement of out-of-hospital cardiac arrest survival rate after implementation of the 2010 resuscitation guidelines.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

EMDocs

DECEMBER 16, 2023

Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. Ice water immersion and iced peritoneal lavage are additional methods used to lower temperature but are more invasive or can prevent additional resuscitative efforts.

Hyperthermia / Hypothermia 69

Hyperthermia / Hypothermia EMS Stroke Seizures 69

EB Medicine

JANUARY 2, 2019

A 2010 Meta-Analysis found a NPV of 99.96% when an er doc identified an IUP on bedside ultrasound. Nachi: All unstable patients or those with suspected or proven ectopic or heterotopic pregnancies should be immediately resuscitated and taken for surgical intervention. So keep doing your bedside scans with confidence.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

Advanced Emergency Nursing from AENJ

SEPTEMBER 13, 2015

When: The patient needs airway control for resuscitation of mother or child, emergent surgery for maternal or fetal indications; block cannot be effected or would be unsafe. The concept of post-mortem caesarian delivery is being supplanted by ante -mortem resuscitative uterine extraction to save both mother and child.

Airway Management 40

Airway Management Resuscitation Critical Access Emergency Nursing 40