Don't Forget the Bubbles

NOVEMBER 29, 2023

Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. While some studies showed that CPRIC is associated with increased survival to hospital discharge, administering muscle relaxants during resuscitation increased mortality. 2013 Jan;31(1):222-6. Ben was awake but paralysed.

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Airway Management Emergency Department Resuscitation Psychiatric 135

The Trauma Pro

DECEMBER 19, 2023

J Trauma 74(1):84-91, 2013. I think we’ll have to look to our military colleagues to pull this one off! Reference: Better hemostatic profiles of never-frozen liquid plasma compared with thawed fresh frozen plasma.

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EMDocs

JANUARY 16, 2024

Hypothermic Arrest In general, hypothermic patients in cardiac arrest should be aggressively resuscitated. Patients can have excellent outcomes despite prolonged resuscitation. 2,3 If the patient meets criteria for resuscitation, they generally are not declared dead until their core temperature is above 32℃ (“warm and dead”).

Hyperthermia / Hypothermia 85

Hyperthermia / Hypothermia Resuscitation CPR EMS 85

ETM Course

JUNE 28, 2015

Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Survival of severe blunt trauma patients treated with resuscitative endovascular balloon occlusion of the aorta compared with propensity score-adjusted untreated patients. J Trauma Acute Care Surg 2013; 75(3): 506–11 5.

Hospitals 52

Hospitals Resuscitation Shock Military 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. 2013 Sep;184(1):352-7. Pediatrics.

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Resuscitation Pediatrics Fractures Emergency Department 40

Pediatric Emergency Playbook

MARCH 1, 2016

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. How Children are Different in Trauma In adults, we speak of “permissive hypotension” (also called “balanced resuscitation” or “damage control resuscitation”).

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

PHEM Cast

APRIL 27, 2023

: Anesthesia & Analgesia Blood pressure in trauma resuscitation: ‘pop the clot’ vs. ‘drain the brain’? – Wiles – 2017 – Anaesthesia Blood pressure management in trauma: from feast to famine?

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Resuscitation Shock Operations Hospitals 52

PHEM Cast

SEPTEMBER 19, 2016

Fanily presence during cardiopulmonary resuscitation. 2013: 368 (11): 1008-1018. The educational intervention “GRIEV_ING” improves the death notification skills of residents. Journal of Academic Emergency Medicine. 2005; 12: 296-301. Jabre P, Belpomme V, Azoulay E et al. The New England Journal of Medicine.

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Ambulance Services Resuscitation Academics 52

EMDocs

DECEMBER 1, 2024

Flea-Borne Typhus: Epidemiology Summary 2013-2019. Rosh Review Website Link References: Texas Department of State Health Services. Flea-Borne Typhus. Accessed August 19, 2024. California Department of Public Health. Accessed August 19, 2024. Centers for Disease Control and Prevention. Murine Typhus—United States, 2002. 2003;52(50):1209-1211.

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EMDocs

AUGUST 17, 2023

Additionally, 80% of patients in the control group required open label NE use indicating that NE was going to be needed in most of these patients regardless of initial resuscitation method. I will continue to reach for pressors early in resuscitation of the septic shock patient. vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

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Sepsis Shock Resuscitation Fluid Resuscitation 68

Ken Grauer, MD

OCTOBER 27, 2023

She was successfully resuscitated — with a post-arrest rhythm similar to that seen in Figure-1. Section 20 ( 54 pages = the " long " Answer ) from my ACLS-2013-Arrhythmias Expanded Version provides detailed discussion of WHAT th e AV Blocks are — and what they are not ! Cardiac cath did not reveal significant coronary disease!

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EKG/ECG Resuscitation Hospitals Wellness 257

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 Ultrasounds Shock CPR 52

PHEM Cast

JANUARY 4, 2017

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2013; 22: 468-477. Scenario based outdoor simulation in pre-hospital trauma care using a simple mannequin model. Patterson MD, Geis GL, Falcone RA, LeMaster T, Wears RL. BMJ Quality & Safety. Boet S, Bould MD, Layat Burn C, Reeves S.

Teamwork 52

Teamwork Burns Emergency Department Resuscitation 52

Northwestern EM Blog

APRIL 15, 2024

As with any high stress situation in resuscitation, it helps to fall back onto our ABCs, airway being of principle importance here. Resuscitating the tracheostomy patient in the ED. This is to minimize the risk of creating a false passage. Borrowed from: Morris, L.L., Whitmer, A., & McIntosh, E. Critical care nurse, 33 5 , 18-30.

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Emergency Department Resuscitation Pediatrics Outcomes 98

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).

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Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Taming the SRU

FEBRUARY 12, 2024

Discussion of Evidence for Management Initial management of DOAC overdose centers around establishing large-bore intravenous access and providing adequate resuscitation for hemodynamically unstable patients. This does not deviate from general resuscitation principles for acute hemorrhage. Blood Coagul Fibrinolysis. Apr; 30(3): 85–95.

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Administration Fractures Anaphylaxis Head Injuries 78

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

Pediatric Emergency Playbook

MARCH 1, 2017

Resuscitation. 2013 Sep 9;(9):CD010105. Supraglottic airway devices during neonatal resuscitation: an historical perspective, systematic review and meta-analysis of available clinical trials. Resuscitation. 2013 Jun;84(6):722-30. How much force is required to dislodge an alternate airway? Prehosp Emerg Care.

Airway Management 52

Airway Management Pediatrics Resuscitation Hospitals 52

PHEM Cast

JUNE 6, 2016

Resuscitation Council UK. Parry R, Asmussen T, Smith JE. Perimortem caesarean section. 2016; 33: 224-229. Clark SL, Cotton DB, Pivarnik JM et al.

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Resuscitation 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 Stroke 52

PHEM Cast

JULY 27, 2021

Crit Care Med 2013; 41: 1774-81. Kenji Inaba. 2015 Marik PE, Cavallazzi R. Does central venous pressure predict fluid responsiveness? An updated meta-analysis and a plea for some common sense. Cavallaro F, Sandroni C, Marano C, et al.

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Ultrasounds Fractures Resuscitation EMS 52

PHEM Cast

FEBRUARY 23, 2017

Prehospital Blood Product Resuscitation for Trauma. Scand J Trauma Resusc Emerg Med 21(Suppl1):S27, 2013. In patients with penetrating trauma permissive hypotension may remain useful for longer or at least until a patient can be differentiated and the bleeding controlled. Lots to think about! 2016 Jul;46(1):3–16.

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Blood Transfusions Head Injuries Resuscitation Radiology 52

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. Recent Clinical Evidence on Post-Arrest TTM The accumulated post-arrest care literature makes clear that careful fever avoidance following resuscitation is essential.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

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. Clin Toxicol (Phila) 51: 838, 2013. Avoid Further Exposure Avoid cholinergic agents that will exacerbate symptoms. BMC Res Notes.

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Poisoning Airway Management Seizures PPE 84

Mind The Bleep

DECEMBER 19, 2023

Therefore, they require fluid resuscitation to restore blood pressure, correct the ketonemia and electrolyte abnormalities, and oliguria. Throughout therapy it is important to monitor fluid input and urine output so that fluid resuscitation measures can be adjusted. It is also vital to do a fluid balance assessment. Marcdante, R.

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Dehydration Fluid Resuscitation Shock Resuscitation 98

EMDocs

OCTOBER 9, 2023

1 Though hydrocortisone is often included in ‘crash carts,’ the most recent consensus on cardiopulmonary resuscitation (CPR) has a weak recommendation against the use of corticosteroids during CPR. Published 2013 Aug 15. Given its mineralocorticoid properties, hydrocortisone is traditionally used for adrenal insufficiency.

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Basic Life Support CPR Fractures Emergency Department 82

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 Dehydration EMS Hospitals 76

PHEM Cast

DECEMBER 1, 2017

Pleural decompression and drainage during trauma reception and resuscitation. Initial Management and Resuscitation of Severe Chest Trauma. Emergency Medicine Journal , 22 (11), 788–789. link] Fitzgerald, M., Mackenzie, C. Marasco, S., Hoyle, R., & Kossmann, T. Injury , 39 (1), 9–20. link] Givens, M. Ayotte, K., & Manifold, C.

Academics 52

Academics Radiology Radiology Resuscitation 52

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

Pediatric Emergency Playbook

AUGUST 1, 2017

2013; 95(6): 474-477. 2013; 48:1789-1793. 2013; 44(1):53-57. Mercer AE, Phillips R. Can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to pyloromyotomy? Arch Dis Child. Pandya S, Heiss K, Pyloric Stenosis in Pediatric Surgery.Surg Clin N Am. Applegate KE.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

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 (..)

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CPR Burns Airway Management Wellness 88

Taming the SRU

MARCH 30, 2023

Background Early recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. and hepatic encephalopathy), advanced liver cirrhosis, atrial fibrillation, presence of ventricular dysrhythmia, use of pacemaker, and those with do-not-resuscitate orders. 1967;165(4):504-17.

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Shock Outcomes Sepsis Resuscitation 52

Emergency Medicine Ireland

JUNE 21, 2021

They even have a set of consensus guidelines published back in 2013 that provide a wonderful template for an exam answer even if they aren’t supported by the highest level evidence. If muscular tone is worsening things then get rid of it * optimise fluid resuscitation. So a few basics to start with. optimise perfusion.

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Fluid Resuscitation Resuscitation Wellness 52

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

Holbrook MD September 01, 2013 Umbilical Cord Prolapse and Other Cord Emergencies Marybeth Lore, MD Complications of Labor and Delivery by Jeanie Ward Pulmonary Embolism: Evaluation in the pregnant patient Journal of Emergencies, Trauma and Shock, 3(1), 39. Emergency medicine international, 2013. 2013) Trauma and Pregnancy.

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OB/GYN Ultrasounds Emergency Department Resuscitation 40

The Skeptics' Guide to EM

MAY 8, 2021

The resuscitation team arrives and ACLS protocols are continued. 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.

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Don't Forget the Bubbles

AUGUST 7, 2023

2013 Apr 1;131(4):e1150–7. Resuscitation Council UK. References Bonafide CP, Brady PW, Keren R, Conway PH, Marsolo K, Daymont C. Development of Heart and Respiratory Rate Percentile Curves for Hospitalized Children. Pediatrics. Gold DL, Mihalov LK, Cohen DM. Acad Emerg Med. 2014;21(11):1249–56. Emerg Med J. 2021 Feb;38(2):132–8.

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Taming the SRU

JANUARY 1, 2024

Establishing reliable vascular access is absolutely critical for ED patients requiring resuscitation, airway management, or medication administration. IOs can be used both for resuscitation, medication administration, and for laboratory testing, but there are a few important considerations. 2013 Jul;30(7):521–6. Emerg Med J.

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Emergency Department Ultrasounds Administration Burns 90