The Skeptics' Guide to EM

DECEMBER 7, 2018

You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). There was also no increase in survivors with good neurological outcomes with ACLS. published in Resuscitation 2011. Case: A 51-year-old man experiences a cardiac arrest on the street.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

Don't Forget the Bubbles

AUGUST 7, 2023

The controversy around what is ‘normal’ in infants’ and children’s vitals was demonstrated in a 2011 systematic review by Fleming et al. The study also did not assess outcomes for each patient, and as such, the impact on deviation from the normal range was not explored. Yes Was the outcome accurately measured to minimize bias?

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

EMDocs

DECEMBER 6, 2024

7 Workup other than serum iron concentration at 4 hours after ingestion not shown to accurately predict clinical outcomes or severity of toxicity. Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. Case Follow-up: The patient received a fluid resuscitation with 20 mL/kg bolus of normal saline.

Poisoning 75

Poisoning Fluid Resuscitation Seizures Resuscitation 75

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

This basically means rapid access to ACLS type resuscitation skills (intubation and intravenous drug therapy). It also did not show an increase in good neurologic outcome in the survivors (78.3% Resuscitation 2011 * Hagihara et al. vs. 5.1%, p=0.83). vs. 66.8%, p=0.73). JAMA 2009 * Jacobs et al.

CPR 52

CPR Academics Resuscitation Hospitals 52

RebelEM

MARCH 13, 2023

Nevertheless, mortality of prehospital traumatic cardiac arrest (TCA), and survivability with good neurologic outcome, remain the gold standards of trauma care in and out of the hospital and are effectively the criterion by which we measure outcomes in the trauma literature. Discussion: Dead On Scene: The 96.2% mortality rate and 43.5%

Basic Life Support 52

Basic Life Support EMS Outcomes Resuscitation 52

PHEM Cast

APRIL 10, 2016

It is worth noting, that with “Sepsis 3” many of these terms will become out-of-date – but validation work is required… The Rivers’ paper can be accessed here: [link] It was a single centre study which compared standard care with protocolised resuscitation packaged together as early goal-directed therapy (EGDT).

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

ACEP Now

OCTOBER 9, 2024

In the emergency department (ED), physicians face the challenge of making rapid decisions that can significantly impact patient outcomes. However, the persistence of tachycardia despite fluid resuscitation and dosing with lorazepam to help with his panic disorder raised concerns that warranted further investigation. 2003;22(3):465-466.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Ultrasounds Outcomes 52

PHEM Cast

APRIL 21, 2021

The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury. Resuscitation. 2011 Dec;82(12):1519-24. Epub 2011 Jul 2. Resuscitation. Click here to hear what our friends over at the Resus Room think about Airways 2 References (kindly shared by Rich) Davis DP et al.

Airway Management 40

Airway Management Resuscitation EMS Hospitals 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. trauma 2004) showed that end-tidal CO2 may be of value in predicting outcome from major trauma (19). O Capnogram showing rebreathing during inspiration.

CPR 52

CPR Resuscitation Operations Wellness 52

EMDocs

JANUARY 25, 2025

Management is directed based on underlying etiology, but consider fluid resuscitation, antipyretics, and antibiotics as indicated. 0000000000000305 Kazumi Y (2023) The Epidemiology and Outcomes of Leukopenia in Different Populations and Regions. 2011 Feb 15;52(4):e56-93. Curr Opin Hematol. 2017;24(1):46-53. doi:10.1097/MOH.0000000000000305

EMS 67

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 67

PulmCCM

SEPTEMBER 9, 2021

Sylvia Plath Background Implicit in resuscitation is speed. Yet in 2011 a landmark randomized, controlled trial measured the effect that an intravenous bolus had on mortality in children with severe febrile illness in 3 African countries. The primary outcome was 90-day survival. In total 19 secondary outcomes were evaluated.

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. This is a critical error that leads to poorer outcomes for patients in need of critical care. Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Don't Forget the Bubbles

SEPTEMBER 5, 2024

In this study, the Broselow tape had the best overall accuracy, with 50.7% (vs 30.88% for APLS 2011) of estimates occurring within 10% of measured weight and 80.0% (vs 55% for APLS 2011) estimates within 20% of measured weight. Obesity is considered a contributing factor for some musculoskeletal outcomes. years (IQR 2.5–14.2

Ultrasounds 52

Ultrasounds Research Emergency Department Outcomes 52

Dr. Smith's ECG Blog

JULY 14, 2023

A 40-something with persistent Ventricular Fibrillation presented after attempted prehospital resuscitation A 40-something with no previous cardiac history presented to the ED in persistent Ventricular Fibrillation after attempted prehospital resuscitation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

Resuscitation 97

Resuscitation EKG/ECG CPR Outcomes 97

Pediatric EM Morsels

JUNE 9, 2023

Of course, we all have a healthy respect for post-tonsillectomy hemorrhage and we like to talk about Damage Control Resuscitation. Gana, 2011 ] Endoscopy and other procedures Currently still debated, but reasonable to discuss additional options with your friendly Pediatric GI team. 2011 Jun;52(6):751-5. Call them early!

Pediatrics 152

Pediatrics Head Injuries Airway Management Administration 152

Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line. Conclusion Critical care resuscitation is stressful.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

EMDocs

JANUARY 29, 2024

Finally, anticipating and addressing known complications such as seizures, increased intracranial pressure, or cerebral edema with appropriate measures, including antiepileptic drugs or osmotic agents, is essential for improving patient outcomes. Lowering the MAP may mitigate these risks and possibly improve outcomes. doi: 10.1161/01.str.0000014509.11540.66.

Stroke 72

Stroke Outcomes EMS Seizures 72

Pediatric Emergency Playbook

AUGUST 1, 2017

2011; 364(3):255-264. Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. 2011; 29:1136-1140.:205-211. 2011; 523-527. Necrotizing Enterocolitis. N Eng J Med. Niño DF et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1 2x maintenance rate

Psychiatric 88

Psychiatric Seizures Emergency Department Pediatrics 88

EMDocs

JANUARY 4, 2024

Whole bowel irrigation: 3 Not routinely performed and limited evidence to support improved outcome in general. 2011; 109: 418-422. Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. Basic Clin Pharmacol Toxicol. Epub 2007 Sep 4.

Seizures 65

Seizures EKG/ECG Poisoning Shock 65

EMDocs

OCTOBER 5, 2024

Management 9-12 Patients such receive standard resuscitation care including: Antipyretics such as Tylenol (650-1000 mg PO), Ibuprofen (600 mg PO), or Toradol (15mg IV). IV fluid resuscitation as needed. 12 Complications Inadequate empiric therapy can lead to treatment delays and worse outcomes. Microb Drug Resist 2011; 17:267.

EMS 73

EMS Infectious Diseases Sepsis Hospitals 73

Dr. Smith's ECG Blog

JUNE 1, 2020

Classification of the morphologic type of VT may provide clues to etiology, outcome and treatment. He could not be resuscitated. — Figure-3: Comparison of ECG #1 with an example of PMVT, that I took from the October 12, 2013 post from Dr. Smith’s ECG Blog ( See text ). WHY CARE about QRS Morphology with VT?

EKG/ECG 52

EKG/ECG Resuscitation Shock Outcomes 52

Don't Forget the Bubbles

JUNE 10, 2024

Despite advancements in neonatal care, NEC remains a significant concern due to its association with adverse outcomes, including prolonged hospitalisation, the need for surgical intervention, and increased mortality rates. What is the pathophysiology of necrotising enterocolitis? How do you treat necrotising enterocolitis? Can we prevent NEC?

Pediatrics 40

Pediatrics Sepsis Fluid Resuscitation Outcomes 40

EMDocs

FEBRUARY 12, 2024

Trauma surgeons have traditionally relied on ABGs to assess acid-base status for overall prognostication of trauma injury severity and to screen for occult injury or malperfusion, as this might alter management and aggressive resuscitation. As previously noted, ABGs are not easily obtained (let alone in the critically ill trauma patient).

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

EB Medicine

JANUARY 2, 2019

With opportunities to improve outcomes for both the fetus and the mother, I’m confident that this episode will be worth your time. Nachi: For patient who have a threatened miscarriage in the first trimester, there is a 2-fold increased risk of subsequent maternal and fetal adverse outcomes.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

Mind The Bleep

FEBRUARY 27, 2024

There could be any number of reasons for this but some examples are: they have severe D&V and aren’t keeping fluids down, or because they are pre or post-op, or have presented very unwell and need fluid resuscitation. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. Boluses were given in 20-40ml/kg aliquots.

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

RebelEM

MAY 15, 2024

2011 Jun;153(6):773-9. Epub 2011 Apr 22 Coyne CJ, Le V, Brennan JJ, Castillo EM, Shatsky RA, Ferran K, Brodine S, Vilke GM. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america, Clinical Infectious Diseases, 2011, 52(4):e56-93.

Infectious Diseases 87

Infectious Diseases Administration Sepsis Anaphylaxis 87

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 67

Hyperthermia / Hypothermia EMS Stroke Seizures 67

Advanced Emergency Nursing from AENJ

MARCH 27, 2015

Her rejoinder was “I didn’t think to blow through the nose, but, boy, did I blow between the teeth! ” The nose in Early Modern Expired Air Resuscitation: Early teaching in expired-air resuscitation was three-fold. Few people now remember that a strong early proposal in the move for expired air resuscitation was Mouth to Nose.

Airway Management 40

Airway Management Resuscitation EMS CPR 40

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. In lower-resource settings, the evidence is stronger against a liberal approach to volume resuscitation. Andrews et al.

Dehydration 59

Dehydration Fluid Resuscitation Sepsis Resuscitation 59