The Skeptics' Guide to EM

MAY 8, 2021

SGEM#50 looked at a RCT published in JAMA 2013 looking to see if a vasopressin, steroids, and epinephrine (VSE) protocol for IHCAs could improve survival with favorable neurologic outcome compared to epinephrine alone. Improving outcomes for patients with cardiac arrests has been an ongoing challenge in pre-hospital and in hospital medicine.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

EMDocs

JUNE 27, 2024

Critical Care Medicine 41(12):p A191, December 2013. 2013 Jan-Mar;16(1):91-5. Epub 2013 Aug 7. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 mg/kg, max 0.4

Pediatrics 76

Pediatrics EMS Dehydration Hospitals 76

Taming the SRU

AUGUST 27, 2024

Mortality rates related to bullous skin lesions are typically related to disruption of the skin barrier and include subsequent dehydration, electrolyte imbalances, hypothermia, increased metabolic needs, and secondary infection leading to bacteremia and/or sepsis. J Invest Dermatol 2013; 133:1197. Roujeau JC, Kelly JP, Naldi L, et al.

Emergency Department 82

Emergency Department Dehydration Burns Sepsis 82

Dr. Smith's ECG Blog

JANUARY 30, 2019

Alexandra Schick ( with edits by Dr. Smith ) of an elderly woman who was seen in the ED for altered mental status, hyperthermia, and the initial ECG shown above. This case provides an excellent example of a “pseudo-infarction” ECG produced by a hyperthermia-induced Brugada-1 ECG pattern.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

PEMBlog

JANUARY 17, 2024

Camargo, Clinical Trial: Comparative Effectiveness of Cephalexin Plus Trimethoprim-Sulfamethoxazole Versus Cephalexin Alone for Treatment of Uncomplicated Cellulitis: A Randomized Controlled Trial, Clinical Infectious Diseases, Volume 56, Issue 12, 15 June 2013, Pages 1754–1762, [link] Liu C, Bayer A, Cosgrove SE, et al. So what causes it?

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

ACEP Now

APRIL 3, 2024

Early work on TTM in 2002 showed benefit to cooling to 33 degrees Celsius, which subsequently influenced international resuscitation guidelines to recommend mild hypothermia at 32 degrees to 34 degrees Celsius in 2005. Adding nuance, this study also showed that the highest-severity arrests did not benefit from hypothermia.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

Don't Forget the Bubbles

JUNE 26, 2023

The JET is treated by deepening sedation (to minimise exogenous and endogenous catecholamines), optimizing electrolytes and active mild hypothermia. 2014;129(20):2013-2020. The LCOS is treated with careful IV fluid boluses and low-dose adrenaline. Ultimately, an amiodarone infusion is needed to control the rate. 2018;37(7):879-885.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

Pediatric Emergency Playbook

MARCH 1, 2016

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. 2013 Sep;184(1):352-7. 2013 Nov;206(5):655-60. 2013 Jun;48(6):1377-83. Puffer fish or blob: a hyperfibrinolytic tracing.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Don't Forget the Bubbles

AUGUST 4, 2024

Morris and colleagues investigated the efficacy of refrigerated gel packs for therapeutic hypothermia in neonatal retrieval. They used servo-controlled therapeutic hypothermia (versus passive hypothermia) and found no major difference in outcome. More studies on this topic will surely follow. Gallo Ruelas M, et al. 2024 Jul 8.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics Burns Sepsis 52

Dr. Smith's ECG Blog

MAY 6, 2019

Hypothermia. This definition was changed following an expert consensus panel in 2013 — so that at the present time, all that is needed to diagnose Brugada Syndrome is a spontaneous or induced Brugada-1 ECG pattern, without need for additional criteria. Acute febrile illness. Variations in autonomic tone. Ischemia/infarction.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia 52

Mind The Bleep

DECEMBER 19, 2023

In cases of hypothermia, re-warming can be done passively (with blankets), or active techniques can be implemented in severe cases. Similarly, body temperature should be assessed as this can reveal exposure to infections which may have precipitated DKA, or some patients may be hypothermic if they have been unconscious for some time.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

Don't Forget the Bubbles

JANUARY 10, 2024

These were presented as hazard ratios and included fever at presentation, previous transfusion ever, haemoglobinuria, malaria, sickle cell disease on enrolment, HIV, evidence of sepsis, malnutrition, shock, hypothermia, and dehydration. Geneva: World Health Organization; 2013. Were the study groups similar at the start of the trial?

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

The Skeptics' Guide to EM

JULY 3, 2021

Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. Background: Hypothermia has been a mainstay of post-arrest care after the publication of two trials in 2002 that both suggested a benefit. This gives a NNT of 4.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Outcomes Wellness 52

Dr. Smith's ECG Blog

JULY 22, 2023

This discussion comes from this previous post: Hyperthermia and ST Elevation Discussion Brugada Type 1 ECG changes are associated with sudden cardiac death (SCD) and the occurrence of ventricular dysrhythmias. Syncope and weakness were attributed to acute illness from influenza. The patient did well and was ultimately discharged home.

EKG/ECG 64

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Administration 64

Advanced Emergency Nursing from AENJ

SEPTEMBER 13, 2016

Research into post-arrest after-care, therapeutic hypothermia, reanimatology. October 20, 2013. Helped establish the Freedom House ambulance with paramedic level care. Expanding focus of resuscitation to include the brain: CPCR; CardioPulmonary Cerebral Resuscitation. " Nickson, Chris. [No Trimble, Tom, RN CEN. April 8, 2014.

Resuscitation 40

Resuscitation CPR Emergency Nursing Basic Life Support 40

Rural Doctors Net

AUGUST 30, 2013

Whilst we’ve ‘re-discovered’ balanced resuscitation (first described by Cannon back after WWI), there remains some limited controversy – listen to this 2013 take from Simon Carley at St. Of course any fluids given should be warmed to help avoid the lethal triad – acidosis, coagulopathy and hypothermia.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

Dr. Smith's ECG Blog

MAY 5, 2022

This definition was changed following an expert consensus panel in 2013 — so that at the present time, all that is needed to diagnose Brugada Syndrome is a spontaneous or induced Brugada-1 ECG pattern, without need for additional criteria. Panel B in Figure-5 illustrates the Brugada Type-2 or “Saddle-back” ECG pattern.

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52