The Skeptics' Guide to EM

JUNE 24, 2017

Circulation 2016. Circulation 2016. 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 ).

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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 ).

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

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.

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

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.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

ACEP Now

NOVEMBER 7, 2023

8-12 A recent scoping review published in The American Journal of Emergency Medicine reviewed articles between 2016 and 2019, and found 18 observational studies, which failed to demonstrate sufficient evidence for widespread implementation of DSED. The primary outcome was survival to hospital discharge. Resuscitation.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

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.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

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 ).

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

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).

Head Injuries 52

Head Injuries Documentation/Coding Wellness Resuscitation 52

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.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

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.

Airway Management 40

Airway Management Resuscitation EMS Hospitals 40

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

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.

Emergency Department 52

Emergency Department Administration EMS Dehydration 52

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.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

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.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

RebelEM

NOVEMBER 30, 2023

This systematic review and meta-analysis attempts to elucidate whether a more conservative fluid resuscitation approach is warranted in volume sensitive sepsis patients, such as those with congestive heart failure (CHF). Outcomes: Primary Outcome: In-hospital mortality. Am J Emerg Med. 2023;73:34-39. 2.89, p = 0.01.

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Sepsis Fluid Resuscitation Resuscitation Administration 121

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.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

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

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 91

ACEP Now

APRIL 9, 2025

outcome of this is the removal of droperidol from the hospital formulary. It did so with varenicline on December 16, 2016 15 and canagliflozin on August 26, 2020. The realistic (or preferred?) Why does the boxed warning for droperidol still exist? Good questionI have not found an answer.

Emergency Department 52

Emergency Department Administration EKG/ECG Resuscitation 52

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.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. They looked at 119 adult patients from an (unspecified) number of trauma centres. to −0.5%]; P  = 0.03.).

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

RebelEM

MAY 15, 2024

Epub 2016 Dec 29. Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Time to antibiotics and outcomes in cancer patients with febrile neutropenia. Give appropriate fluids, vasopressors, and antibiotics. Ann Emerg Med. 2017 Jun;69(6):755-764.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

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.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

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.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

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.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation 52

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.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

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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Burns Fluid Resuscitation Shock Resuscitation 80

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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Military Resuscitation PPE Emergency Department 52

EMDocs

DECEMBER 16, 2023

Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. Ice water immersion and iced peritoneal lavage are additional methods used to lower temperature but are more invasive or can prevent additional resuscitative efforts.

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Hyperthermia / Hypothermia EMS Stroke Seizures 94

EMDocs

JANUARY 4, 2024

Whole bowel irrigation: 3 Not routinely performed and limited evidence to support improved outcome in general. Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine. 2016 May;181(5):482-7. Basic Clin Pharmacol Toxicol. 2011; 109: 418-422.

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

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.

Resuscitation 52

Resuscitation Hospitals Outcomes Wellness 52

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.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

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.

Dehydration 59

Dehydration Infectious Diseases Seizures Pediatrics 59

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.

Emergency Department 105

Emergency Department Hospitals Domestic Violence Pediatrics 105

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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EKG/ECG Resuscitation Wellness 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.

Emergency Department 92

Emergency Department Soft Tissue Injuries Airway Management Operations 92

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.

Hospitals 40

Hospitals CPR Resuscitation Documentation/Coding 40