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

Ken Grauer, MD

OCTOBER 27, 2023

She was successfully resuscitated — with a post-arrest rhythm similar to that seen in Figure-1. A cknowledgment : My appreciation to Hans Helseth ( from Minnesota, USA ) for the case and this tracing ( and CREDIT to Hans for his well-drawn laddergram that I have slightly modified ). = THANK YOU for your interest! =

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EKG/ECG Resuscitation Hospitals Wellness 257

Pediatric Emergency Playbook

FEBRUARY 1, 2016

Protocols work well for adults, but trauma in children requires that we exercise our clinical muscles just a bit more. Resuscitative Thoracotomy in Children In a 40-year review of ED thoracotomy, Moore et al. Resuscitative thoracotomy is for penetrating trauma with signs of life wthin 10-15 minutes of arrival. 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

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 90

CPR Burns Airway Management Wellness 90

Northwestern EM Blog

APRIL 15, 2024

1,2 As you have outlined, understanding both the chronicity of the tracheostomy as well as the indication for the procedure are key history when managing a displaced tube. As with any high stress situation in resuscitation, it helps to fall back onto our ABCs, airway being of principle importance here. Borrowed from: Morris, L.L.,

Emergency Department 98

Emergency Department Resuscitation Pediatrics Outcomes 98

Don't Forget the Bubbles

AUGUST 7, 2023

However, that guidance needs to take into account the influence of emotion, environment, body temperature, as well as the underlying disease process, on vital signs, especially in younger infants. 2013 Apr 1;131(4):e1150–7. Resuscitation Council UK. References Bonafide CP, Brady PW, Keren R, Conway PH, Marsolo K, Daymont C.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

Taming the SRU

MARCH 30, 2023

10.1186/s13613-020-00658-8 P: A total of 761 patients from two separate cohorts found to have septic shock I: Diastolic shock index C: Comparison to a variety of well adopted markers of morbidity and mortality, including systolic shock index, SOFA score, APACHE II score, lactate, etc. Ann Intensive Care 2020;10(1):41.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

The Skeptics' Guide to EM

MAY 8, 2021

He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR […] The post SGEM#329: Will Corticosteroids Help if…I Will Survive a Cardiac Arrest? He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR Safety Team. The resuscitation team arrives and ACLS protocols are continued.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

Don't Forget the Bubbles

JUNE 26, 2023

Too much pulmonary blood flow and we will see well-oxygenated blood ( SpO2 >85% ) but insufficient systemic blood flow (pallor/mottling, cool peripheries, delayed capillary refill time, weak pulses, hypotension, narrow pulse pressure) and hypoxia (lactic acidosis). 2014;129(20):2013-2020. This is the most nuanced aspect.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

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.

Emergency Department 92

Emergency Department Ultrasounds Administration Burns 92

EMDocs

JANUARY 29, 2024

However, other sources suggest that the optimal blood pressure target is not well established and may vary depending on the individual patient’s characteristics and the type of hemorrhagic transformation [7]. 2013 Jul;44(7):1846-51. Epub 2013 May 23. This includes intraparenchymal hemorrhage and subarachnoid hemorrhage (SAH).

Stroke 99

Stroke Outcomes EMS Seizures 99

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. Colonic decompression with endoscopy is at the extreme end of this and I’ll confess I’d probably plump for neostigmine well before that.

Fluid Resuscitation 52

Fluid Resuscitation Resuscitation Wellness 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. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

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

The Injectable Orange

JUNE 20, 2017

While well evaluated, you see the residents go back to the shop floor and struggle to apply any of the lessons that the group agreed had been take homes from the previous sim session. How do they do it so well?” doi: 10.1136/bmjopen-2013-003525 Lorello, G, Hicks, C et al. 2013 Dec;26(6):699-706. Well done”…….

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

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. H Spontaneously breathing carbon dioxide waveforms where phase III is not well delineated. I Dual capnogram in one lung transplantation patient.

CPR 52

CPR Resuscitation Operations Shock 52

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

All went well. 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. EMCrit.org.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). Resuscitation 2013; 84(11): 1500 – 4. 2013): 71-78. References: Heffner AC et al. PMID: 23911630 Kim WY et al.

Emergency Department 92

Emergency Department Soft Tissue Injuries Airway Management Operations 92

PulmCCM

JANUARY 22, 2024

This was in large part due to the recommendations from a task force of the International Liaison Committee on Resuscitation (ILCOR) , and their enshrinement in the American Heart Association’s 2005, 2010 and 2015 post-cardiac arrest management guidelines. that would create a rationale strong enough to justify the downsides of cooling?

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients. 2013; 29:715-719.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

PulmCCM

FEBRUARY 19, 2024

Well … no. Panelists called this “low certainty evidence from five before-after studies that this intervention may be associated with lower mortality and fewer unsuccessful resuscitation events.” Over six years of study (2007-2013): There were 83 MET calls activated by parents (~1.2

Hospitals 52

Hospitals Resuscitation Burns Documentation/Coding 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Advanced Emergency Nursing from AENJ

JULY 9, 2015

ü With foresight, plan for your alternatives based upon what you have now , until the patient can be brought safely to conventional resuscitation room settings. Flexibility of mind and skill bodes well. Wiget, Urs & Torres, Eric. Resuscitation, 56(1), 83-89. Video] Sep 15, 2013. Video] Nov 19, 2013.

Airway Management 40

Airway Management Pediatrics Resuscitation Emergency Nursing 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

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. Pleomorphic VT is less well known than the other morphologic forms of VT. He could not be resuscitated. —

EKG/ECG 52

EKG/ECG Resuscitation Shock Outcomes 52

Advanced Emergency Nursing from AENJ

NOVEMBER 20, 2014

It is not possible during acute resuscitation or at any time before a complete investigation, or even trial, to know who is innocent, guilty, or what occurred during the altercation. If you think your patient is the perpetrator, he may well be an innocent, or even an off-duty or undercover officer. Khoshdel, A. Modaghegh, M.

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

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.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Dr. Smith's ECG Blog

AUGUST 9, 2019

His comments/questions are inserted below the ECG: A 50-something woman presented with 3 days of intermittent chest pain that became worse on the day of presentation, with diaphoresis and radiation to the left arm, as well as abdominal pain. This is her ECG: An obvious STEMI, but which artery? American heart journal 2010;160:995-1003,e1-8.

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

PulmCCM

JANUARY 24, 2024

This was in large part due to the recommendations from a task force of the International Liaison Committee on Resuscitation (ILCOR) , and their enshrinement in the American Heart Association’s 2005, 2010 and 2015 post-cardiac arrest management guidelines. that would create a rationale strong enough to justify the downsides of cooling?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

Northwestern EM Blog

SEPTEMBER 12, 2022

It is well known that most hospitals in large population centers already operate at or near full capacity [4]. These patients are expected to decompensate within the hour but did not need immediate resuscitation [2]. Epub 2013 Mar 6. These patients are likely to need the vast majority of resources and staff. What did happen?

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Hazardous Materials 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

ACEP/McGraw-Hill, 2013. Part 15: Neonatal Resuscitation: 2010 American Heart Association Guidelines. Do a total body check. Heart disease or Hypovolemia - is there a history of congenital heart disease? Philadelphia, PA, Lipincott Williams & Wilkins, 2004. McGowan et al. Circulation. 2010;122:S909-S919. Okada PJ, Hicks B.

Seizures 40

Seizures Sepsis Pediatrics Shock 40

Rural Doctors Net

AUGUST 30, 2013

I’d raise here the concept of his ‘anticipated clinical course’ – he’s going to OT and has airway injury that will likely progress – so you might as well intubate on these grounds alone. Sure he’s got a traumatic amputation – your tourniquet has arrested the bleeding, but there may well be more blood loss.

Burns 52

Burns Hospitals Ambulance Services Wellness 52

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. 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.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

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.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

PEMBlog

JUNE 5, 2024

Infants can get a cervical spine injury during breech delivery or, unfortunately, during non accidental trauma as well. Resuscitate with volume and blood. In my experience, doing a neurologic exam is really difficult in the resuscitation area, especially when a patient is supine and has an immobilized c spine. Pediatrics.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

EB Medicine

AUGUST 6, 2019

Nachi: Well, I’m sure more of those studies are still coming. Nachi: Well that was a ton of information and background on the DOACs. Nachi: While measuring thrombin time is not routinely recommended, the result of thrombin time or dilute thrombin time does correlate well with dabigatran concentrations across normal ranges.

Emergency Department 40

Emergency Department Stroke Wellness Resuscitation 40