PHEM Cast

APRIL 16, 2018

It might be better to consider traumatic cardiac arrest as a completely different disease eg LOST: Low Output State due to Trauma The 2015 European Resuscitation Council and UK Resuscitation Council Algorithms for Traumatic Cardiac Arrest: To read the whole ERC guideline on special circumstances cardiac arrest including trauma, click here.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Audrey’s academic interests include trauma and resuscitation. Audrey’s academic interests include trauma and resuscitation. The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest. Robert’s academic interests include research and evidence-based medicine.

Academics 52

Academics Resuscitation EMS Research 52

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 73

Stroke Outcomes EMS Seizures 73

PulmCCM

JANUARY 22, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

The Skeptics' Guide to EM

MAY 8, 2021

The resuscitation team arrives and ACLS protocols are continued. Improving outcomes for patients with cardiac arrests has been an ongoing challenge in pre-hospital and in hospital medicine. That RCT had 268 patients and demonstrated a better odds ratio for ROSC and survival to discharge with good neurologic outcome.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

PulmCCM

JANUARY 24, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

The Skeptics' Guide to EM

JUNE 24, 2017

They arrive quickly and take over the resuscitation. Two relatively small randomized control trials published in the NEJM showed that hypothermia post cardiac arrest resuscitation was neuroprotective ( Bernard et al and The Hypothermia after Cardiac Arrest Study Group ). By-standard CPR is started and EMS is called. Circulation 2016.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia CPR Resuscitation EMS 40

Don't Forget the Bubbles

AUGUST 7, 2023

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? 2013 Apr 1;131(4):e1150–7. Resuscitation Council UK. CASP checklist for Cohort studies Does this address a clearly focused issue?

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

EMDocs

JUNE 7, 2023

Further management and resuscitation were required, and she had a lengthy ICU stay of 21 days until she was extubated. 2013; 6:524. Published 2013 Dec 9. Indira M, Andrews MA, Rakesh TP: Incidence, predictors, and outcome of intermediate syndrome in cholinergic insecticide poisoning: a prospective observational cohort study.

Poisoning 84

Poisoning Airway Management Seizures PPE 84

Taming the SRU

SEPTEMBER 15, 2023

Limited availability of radiology-performed US services in certain hospitals, especially overnight Can avoid unnecessary anticoagulation in patients Reduce time in ED to disposition In terms of workflow, when there is suspicion for a DVT, you need to first calculate a Wells’ Score for a DVT If low/moderate risk, can start with a D-dimer prior to committing (..)

CPR 89

CPR Burns Airway Management Wellness 89

Advanced Emergency Nursing from AENJ

APRIL 29, 2015

Every five years, a conference determines the current state of the art for resuscitation recommendations. For babies born at term, it is best to begin resuscitation with room air rather than 100% oxygen. Emergency Medicine News: November 2013 - Volume 35 - Issue 11 - p 12–13. January 22, 2013 Shiang-Hu, Ang.

Resuscitation 40

Resuscitation Pediatrics Administration Emergency Nursing 40

PHEM Cast

APRIL 21, 2021

The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury. Resuscitation. Int J Emerg Med 6, 38 (2013). 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. 2011.06.028.

Airway Management 52

Airway Management Resuscitation EMS Hospitals 52

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. 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. Critical care and resuscitation, 11(1). Gelmann, D.,

Shock 59

Shock Resuscitation Ultrasounds Research 59

Don't Forget the Bubbles

MARCH 18, 2024

She receives fluid resuscitation, and you organise some tests to find out why she is so tired. Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome. Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). 4-year-old Stephanie presents with vomiting, diarrhoea, and lethargy. 2016 Jan 1;137(1).

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

Intensive Blog

MARCH 13, 2024

Everything ECMO 048: History of ECPR evidence and considerations for future research Author: Dr George Walker Peer reviewer: A/Prof Aidan Burrell Introduction The first recorded attempts to resuscitate patients were as early as 1530 where Swiss physician Paracelsus used fireplace bellows to reinflate the lungs of those who had stopped breathing.

CPR 130

CPR Resuscitation Outcomes Hospitals 130

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

The Injectable Orange

JUNE 20, 2017

The world is a strange place when we can’t do something so simple when it’s critical, but we do it so well when the outcomes are meaningless. doi: 10.1136/bmjopen-2013-003525 Lorello, G, Hicks, C et al. Mental practice: a simple tool to enhance team-based trauma resuscitation. 2013 Dec;26(6):699-706. doi: 10.1017/cem.2015.4.

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

Don't Forget the Bubbles

JUNE 26, 2023

The team start CPR, and this is emergently converted to extra-corporeal cardiopulmonary resuscitation via the open sternotomy wound. These cases illustrate some of the common issues associated with each shunt type, but what does the evidence say about outcomes? 2014;129(20):2013-2020. What is the best option for repair?

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

ACEP Now

APRIL 3, 2024

Targeted temperature management (TTM) for patients following cardiac arrest resuscitation has gone through several dosing iterations in the past two decades. Finally, the guidelines support active temperature management’s (though not necessarily hypothermia) role in improving post-arrest outcomes. degrees Celsius for 72 hours.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. Background Early recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

ST elevation (STE) in lead augmented vector right (aVR), coexistent with multilead ST depression, was endorsed as a sign of acute occlusion of the left main or proximal left anterior descending coronary artery in the 2013 STEMI guidelines. Knotts RJ, Wilson JM, Kim E, Huang HD, Birnbaum Y. BOTTOM Line from Today’s Case: As per Drs.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Don't Forget the Bubbles

NOVEMBER 29, 2023

Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. In studies including patients with trauma or Glasgow Coma Scale less than 8, intubation without sedation led to poorer neurological outcomes. 2013 Jan;31(1):222-6. Another attempt led to an oesophageal intubation.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 67

Sepsis Shock Resuscitation Fluid Resuscitation 67

RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

EB Medicine

AUGUST 6, 2019

In the end, they reported similar rates of recurrence and bleeding outcomes for acute treatment. Nachi: Though you can, in theory, test for plasma DOAC concentrations, such tests are not routinely indicated as levels don’t correspond to bleeding outcomes. of patients per year. Nachi: Next we have apixaban, tradename Eliquis.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EB Medicine

JULY 8, 2019

Jeff: Do note, however that 2013 guidelines do not recommend one procedure over another and leave that decision up to local surgical expertise, patient specific risk factors, and treatment goals. with generally good clinical outcomes including improved quality of life and reducing or staving off comorbidities. Obesity (Silver Spring).

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

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

Pediatric Emergency Playbook

AUGUST 1, 2017

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. 2013; 95(6): 474-477. Hirschsprung disease, associated syndromes and genetics: a review. J Med Genet 2008; 45:1. Hirschsprung's disease.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Taming the SRU

MARCH 11, 2024

Reducing the total ischemic time in patients with vascular injury is the single most important variable in improving outcomes and reducing the risk of amputation; an ischemic time of >8 hours is associated with amputation rates of up to 85%, compared with <20% in those with ischemic time of <8 hours (2). Sports Med Arthrosc.

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

EMDocs

SEPTEMBER 25, 2023

Still, there are those that believe that FPS is more of a physician-centered endpoint that does not fully reflect important patient-centric outcomes (16). Resuscitation 2013; 84(11): 1500 – 4. 2013): 71-78. References: Heffner AC et al. PMID: 23911630 Kim WY et al. Sakles, John C., ” Academic Emergency Medicine 20.1

Emergency Department 66

Emergency Department Soft Tissue Injuries Operations Airway Management 66

Pediatric Emergency Playbook

APRIL 1, 2016

We could use it to track treatment , and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults. Myopericarditis in Children: Elevated Troponin I Level Does Not Predict Outcome. Cardiology in the Young; 2013. 2013; 88(10): 1127–1140. 2013; 29:715-719. 23: 353–360.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Rural Doctors Net

AUGUST 30, 2013

Flooding him with crystalloid is going to dilute his clotting factors, make him hypothermic and potentially worsen outcomes. 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.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

Downeast Emergency Medicine

MARCH 13, 2022

Key Concepts Quickly rule out life-threatening emergencies that require immediate resuscitation. He has a past medical history significant for nephrolithiasis and cholecystitis and a past surgical history significant for a cholecystectomy in 2013. Case Outcome The abdominal CT showed uncomplicated diverticulitis!

Ultrasounds 52

Ultrasounds EKG/ECG Radiology Radiology 52

Dr. Smith's ECG Blog

JUNE 1, 2020

COMPARE ECG #1 with ECG #2: I think the easiest way to make the case for Pleomorphic VT is to compare the 2 tracings in Figure-3: I took ECG #2 in Figure-2, from the October 12, 2013 post in Dr. Smith’s ECG Blog. Classification of the morphologic type of VT may provide clues to etiology, outcome and treatment.

EKG/ECG 52

EKG/ECG Resuscitation Shock Outcomes 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

Here is another proven left main occlusion in a young woman who presented with sudden pulmonary edema, had this ECG recorded, then arrested and was resuscitated after 30 minutes of CPR: This has sinus tachycardia with RBBB and LAFB, and STE in V2-V6 as well as I, aVL This pattern could just as easily be seen in LAD occlusion.

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

RebelEM

MAY 15, 2024

Pathogens ( Gudiol 2013 ) : The pathogens responsible for neutropenic fever have changed over time. Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Clin Microbiol Infect 2013; 19:474 Klastersky J. Eur J Haematol 2005; 75:1. 2014;14:162.

Infectious Diseases 103

Infectious Diseases Administration Sepsis Anaphylaxis 103

EM Literature of Note

OCTOBER 14, 2024

“Lactated Ringer vs Normal Saline Solution During Sickle Cell Vaso-Occlusive Episodes” A “target trial emulation” providing observational evidence supporting the superiority of lactated ringers solution over normal saline for the resuscitation of patients being admitted with sickle cell crises.

Stroke 86

Stroke Emergency Department Resuscitation Best Practices 86