The Skeptics' Guide to EM

JANUARY 9, 2021

Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

Pediatric Emergency Playbook

FEBRUARY 1, 2016

Resuscitative Thoracotomy in Children In a 40-year review of ED thoracotomy, Moore et al. REBOA If you have access to resuscitative endovascular balloon occlusion of the aorta or REBOA, this may be an option to temporize the child to get him to the relative control of the operating room. 2011 Dec;71(6):1869-72. Brenner et al.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Don't Forget the Bubbles

MAY 6, 2024

The data was collected from a cohort from 2011- 2015 (nearly ten years ago). 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. Is this truly reflective of the current population?

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

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). He is unsuccessfully shocked. published in Resuscitation 2011. A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 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. 2011 May;18(5):477-82. He decompensates and needs blood. Apply pressure whenever possible.

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Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Mind The Bleep

FEBRUARY 9, 2024

Because she would not be for intubation, they discuss resuscitation status because, naturally, care during- and post-arrest would involve airway support. They agree this patient should be for full resuscitation and any other organ support he may require. 2011 Dec;11(6):601-4. The patient and team agree to instate a u-DNACPR.

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 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

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. Jon-Emile S. Arguably, this might be mitigated by slower volume administration. hypotension; c.]

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

Pediatric Emergency Playbook

AUGUST 1, 2017

2011; 364(3):255-264. 2011; 29:1136-1140.:205-211. 2011; 523-527. 2011; 24: 552-561. Necrotizing Enterocolitis. N Eng J Med. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Management of childhood intussusception after reductiion by enema. Am J Emerg Med. Chien M et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

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 Academics Documentation/Coding 52

Pediatric Emergency Playbook

NOVEMBER 1, 2015

We have a few minutes to optimize, to resuscitate before we intubate. Etomidate is perfectly acceptable, but ketamine is actually a superior drug to etomidate in the rapid sequence intubation of children in septic shock. Types of shock mnemonic : this is how people COHDe – Cardiogenic, Obstructive, Hypovolemic, Distributive.

Shock 40

Shock Sepsis Airway Management Pediatrics 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. 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. Circulation.

Ultrasounds 81

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 81

PEMBlog

JUNE 5, 2024

Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. 2011 Aug;58(2):145-55. You should also consider the possibility of quote unquote spinal shock. than it is spinal shock. Resuscitate with volume and blood. MMWR Recomm Rep. 2012 Jan 13;61(RR-1):1-20.

Fractures 52

Fractures Pediatrics Radiology Radiology 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. Nguyen, H.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. Fundamentally, cardiogenic shock is an issue of decreased cardiac output. In the cath lab, the patient’s blood pressure remained low.

EKG/ECG 52

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 52

Pediatric Emergency Playbook

OCTOBER 1, 2016

It is important to note that 15% of necrotizing enterocolitis occurs in full-term babies; malrotation can present simply in shock, without initial overt bleed. Actively bleeding : radio-labeled red blood-cell scan (resuscitate and call your surgeons!) 2011 Mar;74(1):45-66. Acta Gastroenterol Belg. Garcia-Tsao G, Bosch J.

Pediatrics 52

Pediatrics Wellness Shock Resuscitation 52

Dr. Smith's ECG Blog

JUNE 1, 2020

Follow-Up to This Case: Although I did not learn specific details of this case — I did find out that this patient failed to respond to antiarrhythmic treatment and multiple shock attempts. He could not be resuscitated. — My sincere appreciation to Zhang Mingming ( of China ) for contributing this case.

EKG/ECG 52

EKG/ECG Resuscitation Shock Outcomes 52

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

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’. 2011; 2(1):70-72. 2011 Jan-Jun; 4(1): 81–83.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 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., mg/kg (of 0.1 mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric 88

Psychiatric Seizures Emergency Department Pediatrics 88

Taming the SRU

APRIL 26, 2023

Resuscitation 2020. Mil Med 2011. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis. Druyan A, Janovich R, Heled Y. Heatstroke.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

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 105

Infectious Diseases Administration Sepsis Anaphylaxis 105

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. 2011; 109: 418-422. Comparison of Resuscitative Protocols for Bupropion Overdose Using Lipid Emulsion in a Swine Model. Epub 2007 Sep 4.

Seizures 66

Seizures EKG/ECG Poisoning Shock 66

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. saline), however more research is needed in this area. [4]

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

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 68

Hyperthermia / Hypothermia EMS Stroke Seizures 68

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. Pressors where indicated for septic shock (typically Norepinephrine starting at 0.05 Microb Drug Resist 2011; 17:267.

EMS 74

EMS Infectious Diseases Sepsis Hospitals 74

Pediatric Emergency Playbook

JANUARY 1, 2017

neutropenia) ( Babl 2011 , Dokko 2014 ). Unexplained tachycardia may be the early signs of shock. 2011 Jun;27(6):496-9. Louis, Mo: Mosby; 2011. As clinicians we can target specific “stations” along the pain route to target the signal more effectively. Acad Emerg Med. 2013 Oct;20(10):1050-4. Pediatr Emerg Care.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

The Skeptics' Guide to EM

JUNE 15, 2018

Usually they just shock me and send me home.” It is like normal saline vs. Ringer’s lactate for fluid resuscitation, steroids vs. no steroids for sepsis, or Coke vs. Pepsi. Case: A 62-year-old Canadian is on vacation in up-state Michigan, and after a celebratory evening, presents to your emergency department with palpitations.

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 52

EB Medicine

JANUARY 2, 2019

Nachi: All unstable patients or those with suspected or proven ectopic or heterotopic pregnancies should be immediately resuscitated and taken for surgical intervention. Per a 2010 and 2011 Cochrane review, there is not evidence to recommend one antibiotic over another, so let your local antibiograms guide your treatment.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40