The Skeptics' Guide to EM

FEBRUARY 11, 2024

Date: February 11, 2024 Guest Skeptic: Nirdosh Ashok Kumar, Emergency Medicine Specialist – Aga Khan University Hospital, Karachi, Pakistan. […] The post SGEM#430: De Do Do Do, De Dash, Dash DAShED – Diagnosing Acute Aortic Syndrome in the ED. She is received in the resuscitation room. EMJ Nov 2023. per 100,000. [4-8]

Emergency Department 130

Emergency Department Resuscitation Hospitals EKG/ECG 130

The Trauma Pro

SEPTEMBER 14, 2023

” This guideline was implemented in 2018-2019, and patients presenting before implementation were compared to those arriving after. Part of the resuscitation process for major trauma involves obtaining a chest X-ray. The 300cc threshold is determined by using Mergo’s formula for calculating the volume of a square prism.

Resuscitation 124

Resuscitation Hospitals Wellness 124

EMDocs

JANUARY 16, 2024

He subsequently walks out of the hospital with a normal neurologic exam two weeks after admission. Hypothermic Arrest In general, hypothermic patients in cardiac arrest should be aggressively resuscitated. Patients can have excellent outcomes despite prolonged resuscitation. Resuscitation. 2009;338:b2085.

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation CPR EMS 104

Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line. Conclusion Critical care resuscitation is stressful.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

Don't Forget the Bubbles

FEBRUARY 5, 2025

This should include early identification of life-threatening injuries, targeted fluid resuscitation using blood products, pain management, then eventual safeguarding and psychological support. Establish IV access for potential fluid resuscitation. You feel the patient needs fluid resuscitation. Administer O2 if necessary.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

Greater Sydney Area HEMS

FEBRUARY 20, 2024

The cohort of patients that require this intervention in the pre-hospital setting are likely to be the most critically unwell patients we encounter. Anesthesiology 2018; 128 : 38–43. [v] Right Brachiocephalic Vein Origin Access for the Resuscitation of Shocked Adult Trauma Patients. Medicine 2018; 97 : e13661.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

RebelEM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial [published online ahead of print, 2023 Oct 12].

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

[display_podcast] Date: September 21st, 2018 Reference: Kawano et al. Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. display_podcast] Date: September 21st, 2018 Reference: Kawano et al.

Basic Life Support 52

Basic Life Support Airway Management CPR Resuscitation 52

The Skeptics' Guide to EM

DECEMBER 7, 2018

Date: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. Date: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. published in Resuscitation 2011. He is unsuccessfully shocked.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

Don't Forget the Bubbles

JUNE 30, 2023

In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. This was a randomised controlled multisite study comparing resuscitation of trauma patients requiring massive transfusion using either 1:1::1 or 1:1:2 ratios of platelets to plasma to red blood cells. to −0.5%]; P  = 0.03.).

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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. Furthermore, 14.3%

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

The Skeptics' Guide to EM

MARCH 2, 2019

Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome. Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome. They had a difficult time getting a definitive airway pre-hospital. Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome.

Airway Management 52

Airway Management CPR Hyperthermia / Hypothermia Outcomes 52

The Skeptics' Guide to EM

FEBRUARY 17, 2018

[display_podcast] Date: February 14th, 2018 Reference: Alam N et al. Case: EMS is dispatched to a retirement […] The post SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis. display_podcast] Date: February 14th, 2018 Reference: Alam N et al. The Lancet Nov 2017. per hour (Kumar et al). .

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

The Skeptics' Guide to EM

MARCH 11, 2023

A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Reference: Smida et al.

Airway Management 52

Airway Management Basic Life Support CPR Resuscitation 52

Don't Forget the Bubbles

OCTOBER 7, 2024

Judicious fluid resuscitation is critical; patients may become volume-deplete due to fluid loss/oedema secondary to burns. If the hose is narrow, less water flows through (low current) References Electrocution and Electrical Injury – Emergency Management in Children; Children’s Health Queensland Hospital and Health Service Baird J.

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

Don't Forget the Bubbles

NOVEMBER 15, 2023

In a PICU setting, sodium can come from various sources (resuscitation fluids, IV drugs and infusions, enteral feed), not just the maintenance fluids we prescribe. There is growing interest in giving no maintenance fluid and using the input from drug infusions and resuscitative boluses only. Most drugs are chosen to be dissolved in 0.9%

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

The Skeptics' Guide to EM

FEBRUARY 2, 2019

The Lancet 2018. The Lancet 2018. Background: The liberal use of supplemental oxygen therapy in acutely ill adults has a long history in the hospital, but high-quality therapy supporting its practice is unclear. The Lancet 2018. Date: January 28th, 2019 Reference: Chu DK et al. This is Bob’s ninth visit to the SGEM.

Poisoning 52

Poisoning Administration Hospitals Sepsis 52

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. October 19, 2018. Given its mineralocorticoid properties, hydrocortisone is traditionally used for adrenal insufficiency.

Basic Life Support 101

Basic Life Support CPR Fractures Emergency Department 101

The Skeptics' Guide to EM

AUGUST 14, 2021

Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Date: August 12th, 2021 Reference: Daya et al.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

The Skeptics' Guide to EM

SEPTEMBER 1, 2018

[display_podcast] Date: August 22nd, 2018 Reference: Riskin A, Erez A, Foulk TA, et al. February 2017 Guest Skeptic: Dr. Simon McCormick is an Emergency Medicine Consultant from Northern Ireland who works in Rotherham Hospital in Yorkshire, England. display_podcast] Date: August 22nd, 2018 Reference: Riskin A, Erez A, Foulk TA, et al.

Pediatrics 52

Pediatrics Resuscitation Emergency Department Hospitals 52

ACEP Now

AUGUST 15, 2023

You may be ruminating on the unsuccessful resuscitation of a cardiac arrest in a young mother, all the notes to be done, or the dread of possibly missing something on the patients you signed out or discharged. The senior nurse who was the key lead in a resuscitation when you were occupied with a crash femoral central line.

Emergency Department 90

Emergency Department Military Resuscitation Wellness 90

ACEP Now

JUNE 21, 2023

14 On the contrary, hospitals may operationally and financially benefit from longer training lengths thus indirectly influencing curricula decisions. ultrasound and resuscitation procedures) may become a new standard for programs and require a longer training period. Ann Emerg Med. Jul 2022;80(1):74-83.e8. Ann Emerg Med. J Emerg Med.

EMS 114

EMS Academics Telemedicine Operations 114

The Skeptics' Guide to EM

JUNE 18, 2022

Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. Background: The use of fluids in trauma resuscitation has been studied in a number of trials in recent years. What do you advise him?

Shock 40

Shock Resuscitation Administration Emergency Department 40

Taming the SRU

FEBRUARY 12, 2024

She initially agreed to be transported to the hospital by ambulance, but jumped from the moving vehicle and was subsequently struck and pinned under the fuselage for 10-15 minutes. Hospital Course Based on the primary survey, no acute airway interventions were undertaken. BMC Pharmacol Toxicol. May 2; 19(1): 19. Schulman, S et al.

Administration 80

Administration Fractures Anaphylaxis Head Injuries 80

Taming the SRU

MAY 5, 2023

2018, Kuttab, Lykins et al. vs 42.1%), as were days alive outside of the hospital and days without life support (Meyhoff, Hjortrup et al. Sixty centers participated during the years 2018-2022. 2019, Evans, Rhodes et al. 2021, Im, Kang et al. vs 33.2%; OR, 0.42; 95% CI 0.32-0.55; 0.55; P < 0.0001) (Malbrain, Marik et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

ACEP Now

NOVEMBER 16, 2023

with 350,000 hospitalizations annually and a mortality rate of five to 10 percent. Fluid resuscitation should be initiated. However, a 2017 study of 34 patients suggests that balloon tamponade, when used as a bridge to EGD, improves patient mortality, with 59 percent of patients surviving to hospital discharge.

Best Practices 52

Best Practices Resuscitation Fluid Resuscitation Outcomes 52

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. 2018, November ). Therefore, the dosage would be: 0.05

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

The Skeptics' Guide to EM

AUGUST 26, 2018

[display_podcast] Date: August 25th, 2018 Guest Skeptic: Dr. Neil Parry is an Associate Professor of Surgery and Critical Care at Western University. He is the Medical Director of the Trauma Program for London Health Sciences Centre and the Site Chief of Surgery at Victoria Hospital.

Shock 40

Shock Administration Resuscitation Hospitals 40

PHEM Cast

APRIL 21, 2021

Resuscitation. The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis. Pre-hospital advanced airway management by anaesthetist and nurse anaesthetist critical care teams: a prospective observational study of 2028 pre-hospital tracheal intubations.

Airway Management 40

Airway Management Resuscitation EMS Hospitals 40

EM SIM Cases

MARCH 14, 2023

He is a staff physian at McMaster Children’s Hospital, scholar with the McMaster Education Research, Innovation and Theory (MERIT) program and Founding Program Director for the Pediatric Emergency Medicine subspecialty residency program. Pediatric resident resuscitation skills improve after RCDP training. Ericsson KA. Hunt et al.

CPR 52

CPR Resuscitation Pediatrics Academics 52

RebelEM

FEBRUARY 2, 2023

Average time control HR in the amiodarone group was on par with the study’s average ED length of stay Limitations: Single center, retrospective hospital study may not be able to produce generalizable results. 2018, PMID: 30571262 Gritsenko, Diana, et al. 2018, PMID: 30571262 Gritsenko, Diana, et al. 2, 2018, pp.

Emergency Department 52

Emergency Department Administration Dehydration EMS 52

Taming the SRU

JULY 24, 2023

He was transitioned to cefdinir and fluconazole for a full 7-day course of antibiotics and discharged from the hospital on day three, with instructions to follow up with general surgery for an outpatient cholecystectomy. Patients should be resuscitated as deemed appropriate. World J Emerg Surg 13, 9 (2018).

Ultrasounds 79

Ultrasounds Sepsis Radiology Radiology 79

Broome Docs

OCTOBER 31, 2022

2018 Sep 11;362:k3843. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. Breaking good news: an essential skill for avoiding too much medicine? doi: 10.1136/bmj.k3843. N Engl J Med. 2022 Sep 15;387(11):989-1000. Circulation.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 52

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. Arterial lines require specialized monitoring and nursing resources which are not available in all hospital settings. 2018 Mar;19(2):364-371.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Taming the SRU

APRIL 3, 2023

Cardiac Arrest in Pregnancy 1 in 30,000 pregnancies 800 maternal deaths globally Rates have nearly doubled between 1989 and 2009 Survival to hospital discharge after maternal in-hospital cardiac arrest 58.9% Do not transport to an alternative location.

Blood Transfusions 40

Blood Transfusions Fluid Resuscitation Resuscitation Stroke 40

Thinking Critical Care

JUNE 5, 2024

This applies to any hospitalized patients, whether in the ED, the wards or the ICU, so that’s why this year, the H and the R will spend the first day together doing all things VExUS and venous congestion, along with the corresponding workshops, again so that participants can leave with some actionable knowledge and skills.

Shock 59

Shock Hospitals Wellness Resuscitation 59

ACEP Now

MARCH 14, 2024

Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. Dr. Koo is faculty and an emergency physician at MedStar Washington Hospital Center in Washington, D.C., Mary’s Hospital in Leonardtown, Maryland. 2018 Nov;20(11):1-20.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52