ETM Course

JUNE 28, 2015

Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Intra-Aortic Balloon Occlusion to Salvage Patients with Life-Threatening Hemorrhagic Shocks from Pelvic Fractures J Trauma 2010; 68(4): 942–8 (full article free text) 3. J Trauma Acute Care Surg 2013; 75(3): 506–11 5.

Hospitals 52

Hospitals Resuscitation Shock Military 52

Pediatric Emergency Playbook

JUNE 1, 2016

Do we recognize shock early enough? World wide, shock is a leading cause of morbidity and mortality in children, mostly for failure to recognize or to treat adequately. So, what is shock? Simply put, shock is the inadequate delivery of oxygen to your tissues. How do we prioritize our interventions? Pericardial Effusion?

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Shock Sepsis Pediatrics Ultrasounds 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

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 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Although told several times, the story of the development by Henning Ruben of the prototypical modern manual resuscitator, the self-refilling bag with unidirectional non-rebreathing valves which now dominate the world of resuscitation, is still not well-known. Czech Military resuscitation kit, 1969, mfr.

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Resuscitation Military Operations Emergency Nursing 40

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. 6 However, due to the vasoconstrictive effects, hydrocortisone may be useful in refractory shock. Published 2013 Aug 15.

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Basic Life Support CPR Fractures Emergency Department 108

Mind The Bleep

DECEMBER 19, 2023

Majority of DKA patients are in a fluid deficit and present acutely with shock. Therefore, they require fluid resuscitation to restore blood pressure, correct the ketonemia and electrolyte abnormalities, and oliguria. Signs of shock to be mindful for are tachycardia, hypotension, prolonged CRT, pallor, and a weak thready pulse.

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Dehydration Fluid Resuscitation Shock Resuscitation 98

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.

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Resuscitation Shock Ultrasounds CPR 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. Brenner et al.

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Resuscitation Pediatrics Fractures Emergency Department 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

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. 2013 Sep;184(1):352-7. 2013 Nov;206(5):655-60. 2013 Jun;48(6):1377-83.

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Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

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.

Blood Transfusions 52

Blood Transfusions Head Injuries Resuscitation Radiology 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 90

Taming the SRU

FEBRUARY 19, 2024

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. A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock.

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Shock Resuscitation Ultrasounds Research 59

Pediatric Emergency Playbook

APRIL 1, 2016

There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We should use lactate to detect occult shock. Children compensate so well for shock, that subtle tissue hypoxia may not be detected until later. 23: 353–360.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 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. 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. 2012; 92:527-39. Peters B et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 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

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. Phelan MD, Bradley D.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Don't Forget the Bubbles

JUNE 26, 2023

But, they may present postnatally with cyanosis/hypoxaemia due to insufficient pulmonary blood flow, cardiogenic shock due to insufficient systemic blood flow, or both. The team start CPR, and this is emergently converted to extra-corporeal cardiopulmonary resuscitation via the open sternotomy wound. 2014;129(20):2013-2020.

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Operations Research Hyperthermia / Hypothermia Hospitals 128

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. A comparison of the height of spontaneous breaths compared to the mechanical breaths is useful to assess spontaneous ventilation during weaning process.

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CPR Resuscitation Operations Shock 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

The latter 1950s and 1960s, quested for nerve gas defense studying expired air resuscitation and modern resuscitology; developing intensive care units. To me, it harkens a new scientific renaissance of resuscitation science, emergency care, and creating systems for care. 1950s & 1960s Resuscitation Research. 10/20/2013.

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Emergency Nursing EMS Resuscitation Military 40

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. 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.

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EKG/ECG Shock Sepsis Emergency Department 52

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.

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EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

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. Which artery?

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EKG/ECG Shock Emergency Department Wellness 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. He could not be resuscitated. — WHY CARE about QRS Morphology with VT?

EKG/ECG 52

EKG/ECG Resuscitation Shock Outcomes 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

The combination of abnormalities determines the category of pathophysiology: respiratory distress, respiratory failure, CNS or metabolic problem, shock, or cardiopulmonary failure. Does this child look volume depleted? Endocrine Emergencies - Could this be congenital adrenal hyperplasia with low sodium, high potassium, and shock?

Seizures 40

Seizures Sepsis Pediatrics Shock 40

ACEP Now

OCTOBER 10, 2023

Goal-directed resuscitation for patients with early septic shock. link] Published June 30, 2013. 2022;53(7):e282-e361. ARISE Investigators; ANZICS Clinical Trials Group; Peake SL, et al. N Engl J Med. 2014;371(16):1496-506. The adventure of the cardboard box. EMCrit website. Accessed September 17, 2023. Spiegel R.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

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’. 2013; 34(3):489-491. 2013; 34(4).

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

PEMBlog

JUNE 5, 2024

You should also consider the possibility of quote unquote spinal shock. than it is spinal shock. Resuscitate with volume and blood. And hypotension, bradycardia, or temperature instability can result from hemorrhagic and or spinal shock. Cervical spine injury patterns in children. Pediatrics. 2014 May;133(5):e1179-88.

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Fractures Pediatrics Radiology Radiology 52

Dr. Smith's ECG Blog

MAY 5, 2022

Fluid resuscitation was initiated. ST elevation in aVL with reciprocal ST depression in the inferior leads Shock, bradycardia, ST Elevation in V1 and V2. Physician also reads it as normal) Severe shock, obtunded, and a diagnostic prehospital ECG. On arrival in the ED, he was hypotensive with a systolic blood pressure in the 70s.

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

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. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause.

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Emergency Department Sepsis Operations Dehydration 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. An ideal resuscitation would allow parallel processing with a designated team leader and teams devoted to various tasks.

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Burns Hospitals Wellness Ambulance Services 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. 2013 Sep;26(9):965-1012.e15. J Am Soc Echocardiogr. doi: 10.1016/j.echo.2013.06.023. 2013.06.023. PMID: 23998693. Appleton C, Gillam L, Koulogiannis K. Cardiac Tamponade.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

EB Medicine

AUGUST 6, 2019

Jeff: That is simply shocking! Jeff: For all agents, regardless of the DOAC, the initial resuscitation follows the standard principles of hemorrhage control and trauma resuscitation. It may be given as a part of of a balanced massive transfusion resuscitation, but otherwise, at this time, there doesn’t seem to be a clear role.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

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).

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Emergency Department Resuscitation COPD Shock 98

RebelEM

MAY 15, 2024

Pathogens ( Gudiol 2013 ) : The pathogens responsible for neutropenic fever have changed over time. Clin Microbiol Infect 2013; 19:474 Klastersky J. Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Give appropriate fluids, vasopressors, and antibiotics. Why empirical therapy?

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101