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Issue #4: The Latest in Critical Care, 6/12/23

PulmCCM

Induced hypothermia after cardiac arrest is also called “active temperature control” or “targeted temperature management.” Practicing medicine and lawsuits have a dose-response relationship: less than 10% of physicians under 40 reported being sued, compared to almost half of physicians over age 54.

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Heat-Related Illness

Pediatric Emergency Playbook

Pediatrics 2011; 128:e741. Hyperthermia. Casa DJ et al. The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations. J Athl Train. 2013 Jul-Aug; 48(4): 546–553. DeFranco MJ et al. Environmental issues for team physicians. Am J Sports Med. 2008 Nov;36(11):2226-37.

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Super Refractory Status Epilepticus

Don't Forget the Bubbles

2017 May 25;376(21):2011-2020. Hypothermia for Neuroprotection in Convulsive Status Epilepticus. Devinsky O, Cross JH, Laux L, Marsh E, Miller I, Nabbout R, Scheffer IE, Thiele EA, Wright S; Cannabidiol in Dravet Syndrome Study Group. Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. N Engl J Med. PMID: 28538134.

Seizures 111
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First10EM Journal Club: October 2022

Broome Docs

PMID: 36168956 Bottom line: Despite the significant imperfections of this trial, it is important data (as we lack data on hypothermia after inpatient cardiac arrest), and it adds to the growing body of evidence that suggests hypothermia provides no benefit. 2011 Dec 15;343:d7506. Multicentre prospective comparative study.

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SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC?

The Skeptics' Guide to EM

This has included things like therapeutic hypothermia ( SGEM#54 , SGEM#82 , SGEM#183 and SGEM#275 ), supraglottic devices ( SGEM#247 ), crowd sourcing CPR ( SGEM#143 and SGEM#306 ), and epinephrine ( SGEM#238 ). The crew is asking if they should transport the patient with resuscitation ongoing?

EMS 52
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Coffee and Cases Snippets: Don’t Leave Me In Suspense

Greater Sydney Area HEMS

– Concurrent traumatic injuries , along with hypothermia, hypoglycaemia, pain and fear can all stimulate maladaptive compensation, potentiating the above mechanisms. 2011, 22:77-86. . – Vagally-mediated bradycardia/hypotension , precipitating syncope and ultimately circulatory collapse. Get them down, right? 10.1016/j.wem.2010.10.008

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Multisystem Trauma in Children, Part Two: Massive Transfusion, Trauma Imaging, and Resuscitative Pearls

Pediatric Emergency Playbook

The Trauma Death Spiral Lethal triad of hypothermia, acidosis, and coagulopathy. Do everything you can to support perfusion and avoid the death spiral of hypothermia, coagulopathy, and acidosis. 2011 May;18(5):477-82. Puffer fish or blob: a hyperfibrinolytic tracing. That patient will needs clot-stablizer. Acad Emerg Med.