Don't Forget the Bubbles

MAY 10, 2023

Resuscitation is a team sport. Role stickers or role aprons with names on them are simple measures to highlight resuscitation roles. A study in Denmark in 2021 explored barriers to effective resuscitation in over 900 in-hospital resuscitations across six hospitals in Denmark. It was the most phenomenal resuscitation.

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RebelEM

SEPTEMBER 26, 2022

What They Did Single-center randomized controlled study design performed by the Department of Hepatology & Liver transplantation in New Delhi Study participants, investigator clinicians, data collectors, and data analysts were blinded Investigators recruited participants from February 27, 2016 – March 3, 2018.

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Resuscitation Blood Transfusions Outcomes Hospitals 52

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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EMDocs

DECEMBER 1, 2024

The disease is generally mild, but in untreated cases, it can lead to more severe outcomes, especially in patients with underlying conditions such as glucose-6-phosphate dehydrogenase deficiency. Even though the disease often resolves spontaneously, prompt antibiotic therapy is essential for optimal outcomes. 2016 Oct;29(5):433-9.

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Don't Forget the Bubbles

OCTOBER 7, 2024

Prolonged CPR should be considered as outcomes are generally good, even if asystole is the presenting rhythm. Judicious fluid resuscitation is critical; patients may become volume-deplete due to fluid loss/oedema secondary to burns. Volume resuscitation in patients with high-voltage electrical injuries. Wiley; 2016.

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The Skeptics' Guide to EM

MAY 25, 2019

Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. Clinical Question: What are the outcomes of trauma patients after REBOA placement? Date: May 23rd, 2019 Reference: Joseph et al.

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PHEM Cast

FEBRUARY 25, 2021

Prognostication Better outcomes: Rescued and BLS commenced < 5-10 min Children Those who have not aspirated Water temperature < 10 o C, core body temperature 33-35 o C Neurologically intact on arrival at hospital Minimum blood pH > 7.1, Resuscitation. New Engl J Med. 366: 2102–10. Tipton & Golden (2011). 82: 819-824.

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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.

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The Skeptics' Guide to EM

AUGUST 14, 2021

This was the ALPS randomized control trial published in NEJM 2016. The key result was that significantly fewer patients had a favorable neurologic outcome in the IO group compared to the IV group. ACLS ( SGEM#64 ), the use of mechanical CPR ( SGEM#136 ), and pre-hospital hypothermia ( SGEM#183 ).

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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? Resuscitation Council UK. NICE; 2016 [cited 2023 Mar 28]. Yes Was the cohort recruited in an acceptable way? Emerg Med J.

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EMDocs

DECEMBER 6, 2024

7 Workup other than serum iron concentration at 4 hours after ingestion not shown to accurately predict clinical outcomes or severity of toxicity. Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. Case Follow-up: The patient received a fluid resuscitation with 20 mL/kg bolus of normal saline.

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PHEM Cast

APRIL 10, 2016

March 2016. This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine; 2012 Jun 27;20(1):1–1. St Emlyns Induction podcast on Sepsis.

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RebelEM

JUNE 8, 2023

Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

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Administration Emergency Department Outcomes Documentation/Coding 98

EMDocs

JUNE 27, 2024

2016 Dec;91(12):1185-1190. Epub 2016 Oct 3. Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0

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The Skeptics' Guide to EM

DECEMBER 16, 2017

NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. There was no statistical difference in the primary outcome between 33C vs. 36C ( SGEM#82 ).

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The Injectable Orange

JUNE 20, 2017

References: Brazil, Spurr, Petrosoniak, Simulcast Episode 5, November 2016 – Put the Rubber to the Road [link] Life in the Fast Lane, Critical Care Compendium – In Situ Simulation, revised November 2016. Mental practice: a simple tool to enhance team-based trauma resuscitation. 2016 Mar;18(2):136-42. Eppich (2016).

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ACEP Now

OCTOBER 11, 2024

1,2 Clinical outcomes in submersion injuries are largely dependent on the degree of hypoxic injury experienced by the victim, making prehospital care of paramount importance. 3 Once the patient arrives in your emergency department, a rapid review of the patient’s status and results of resuscitative efforts should be performed.

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Taming the SRU

MAY 5, 2023

2016, Andrews, Semler et al. The CLASSIC trial is a randomized controlled trial conducted in the ICU setting which compared restrictive versus standard fluid strategies with a primary outcome of death by 90 days in patients with septic shock. Safety outcomes Serious adverse event occurrences were similar in both groups.

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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. 2016 Oct 10 [cited 2023 Nov 30];281(2):123–48. 2016 Jan;6(1):e009933. Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome. 2016 Jan 1;137(1). 2017 Sep 12 [cited 2023 Nov 30];archdischild-2016-311377.

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Dehydration Infectious Diseases Seizures Pediatrics 59

The Skeptics' Guide to EM

DECEMBER 2, 2017

You are the first physician to respond and you begin to resuscitate the patient. The American Heart Association ( AHA ) reports that were 209,000 IHCA arrests in 2016. From a patient oriented outcome perspective, more than 80% of adults with IHCA who do survive end up having a favorable neurologic outcome at discharge.

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Pediatric Emergency Playbook

AUGUST 1, 2017

2016; 13:590-600. Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Eur J Pediatr Surg 2016; 26:192. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. Necrotizing Enterocolitis. N Eng J Med. 2011; 364(3):255-264. Niño DF et al.

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EMDocs

JUNE 3, 2023

5 Initial Evaluation The key to the initial resuscitation of the unstable pelvic trauma patient is to rapidly identify and treat the most life-threatening pathology. 13 Massive transfusion protocols (MTP) are hallmarks of trauma resuscitation, and they are critical to the unstable pelvic fracture patient.

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Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. There is a subset of patients who, despite aggressive conventional resuscitation, have an inadequate hemodynamic response and develop refractory shock. Curr Opin Crit Care. 5) Kerns W.

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Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax, 1968-2016. Resuscitation. Eur Respir Rev. 2010;19(117):217-219.

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PHEM Cast

APRIL 21, 2021

The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury. Cochrane Database of Systematic Reviews 2016, Issue 11. Resuscitation. Resuscitation. J Trauma 2003; 54:444-453 Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscope attempts.

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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.,

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RebelEM

FEBRUARY 2, 2023

Small sample size limits the power of the study and increases margin of error A patient-oriented outcome such as mortality was not included Follow-up beyond disposition to evaluate hospitalization recurrences related to atrial fibrillation was not included. PMID: 36115743 Panchal, Ashish R., Circulation , 5 Nov.

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Dr. Smith's ECG Blog

MAY 13, 2017

Case 1: The outcome of this case is at the far bottom. JAMA Internal Med 2016 Dec 1.; A prolonged resuscitation ensued but the patient could not be resuscitated. The artery can close again with very bad outcomes. 176(12)1875-1876.] 0 0 1 33 191 MMRF 1 1 223 14.0 ECMO and cath lab were not available. What happened?

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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. 2016; 417: 54–56. We should use lactate to detect occult shock. Pediatr Cardiol. 2012; 33:1040–1045.

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Pediatrics Sepsis Shock Outcomes 52

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. 2016 Sep;117 Suppl 1:i9-i13. References: Heffner AC et al. PMID: 23911630 Kim WY et al. 2021): e12373. Kelly FE, Cook TM. Br J Anaesth.

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EB Medicine

OCTOBER 1, 2018

In 2014, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine started a task force, and by 2016, updated definitions were out again! Patient’s need adequate fluid resuscitation. Just a reminder that a history of CHF doesn’t preclude proper fluid resuscitation. Sepsis-3!!

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EB Medicine

JULY 8, 2019

While it was < 15% in 1990, by 2016 it reached 40%. Jeff: Resuscitation should be aimed at early fluid replacement with IV crystalloids for hypovolemic patients and packed RBC transfusions for patients presumed to be unstable from hemorrhage. Jeff: And we also have the AspireAssist siphon, which was approved in 2016.

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Emergency Department Sepsis Operations Dehydration 40

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: For more information on HIV and its management, check out the February 2016 issue of Emergency Medicine Practice , which covered this and more in depth.

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EMDocs

FEBRUARY 12, 2024

Trauma surgeons have traditionally relied on ABGs to assess acid-base status for overall prognostication of trauma injury severity and to screen for occult injury or malperfusion, as this might alter management and aggressive resuscitation. As previously noted, ABGs are not easily obtained (let alone in the critically ill trauma patient).

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Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1 2x maintenance rate

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EMDocs

DECEMBER 18, 2023

8 Based on multiple randomized controlled trials (RCTs), SSC 2021 guidelines suggest against using procalcitonin as a screening method to guide initiation of antibiotic therapy, as no difference in clinical outcomes was appreciated. 15 Two changes were elucidated in the 2021 SSC guidelines for fluid resuscitation.

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Sepsis Fluid Resuscitation Resuscitation Shock 66

Don't Forget the Bubbles

JULY 3, 2023

This retrospective cohort study compared pre- and post-guideline outcomes. Recalling and identifying anatomical landmarks for safe sites for thoracic decompression can be challenging in the pressurised, time-critical trauma resuscitation environment. Four hundred data sets were included, 54% belonging to female patients.

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