EMDocs

JANUARY 16, 2024

Some authors recommend not starting chest compressions in hypothermia unless there is no organized cardiac activity (e.g., 2 In reality you may start compressions before you confirm that hypothermia was the primary cause of cardiac arrest. Obtaining a core temperature early in any arrest suspected to be from hypothermia is key.

Hyperthermia / Hypothermia 110

Hyperthermia / Hypothermia Resuscitation CPR EMS 110

Dr. Smith's ECG Blog

JANUARY 30, 2019

. -- Comment by K EN G RAUER, MD ( 1/30/2019 ): -- Superb presentation and discussion by Dr. Alexandra Schick ( with edits by Dr. Smith ) of an elderly woman who was seen in the ED for altered mental status, hyperthermia, and the initial ECG shown above.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

The Skeptics' Guide to EM

NOVEMBER 16, 2019

Date: November 6th, 2019 Reference: Lascarrou et al. NEJM Oct 2019 Guest Skeptic: Dr. Laura Melville (@lmelville535) is an emergency physician in Brooklyn, New York, is a part of the New York ACEP Research Committee, ALL NYC EM, and is the NYP-Brooklyn Methodist Resident Research Director. Reference: Lascarrou et al.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia EMS Research Documentation/Coding 40

PulmCCM

JANUARY 22, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival. Read on for details.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

Pediatric EM Morsels

AUGUST 9, 2024

We have previously discussed hypothermia presentations , GBS infections , and HSV infections. 2019, there were 1,875 and this trend has continued to increase (2,157 case in 2020; 2,855 cases in 2021). Fortunately, we have addressed many neonatal issues in the PedEMMorsels. Rates of congenital syphilis are increasing.

Hyperthermia / Hypothermia 154

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 154

PulmCCM

JUNE 12, 2023

Induced hypothermia after cardiac arrest is also called “active temperature control” or “targeted temperature management.” Elsevier boasted a 40% profit margin in 2019. Elsevier explained that their fees are justified to maintain open access (i.e. no paywalls) and because other publishers do it.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 105

Mind The Bleep

OCTOBER 29, 2024

Exposure Expose the patient in a systematic manner while keeping remaining body areas covered e.g. 1 limb at a time, to reduce the risk of hypothermia. 2019 Nov;34(4):276-281. Epub 2019 Nov 29. Assess pupillary reaction to light. Keep the patient warm using force air warmers such as Bairhugger. J Med Toxicol. Acute Crit Care.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Northwestern EM Blog

MAY 9, 2022

The most acute cause of death from NMS is hyperthermia, which is induced both by D2 receptor antagonism leading to rigidity and impaired thermoregulation from the striatum and hypothalamus. Any life-threatening hyperthermia should be treated immediately with an ice bath.[2] McGraw Hill; 2019. Juurlink JN. Antipsychotics.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Emergency Department 52

EMDocs

JUNE 25, 2024

Severely burned patients have impaired thermoregulation and are at risk of hypothermia. National Burn Repository 2019 Update, Report of data from 2009–2018. link] (2019). No role for prophylactic antibiotics in burn and inhalation injuries. May increase the risk of fungal infections and resistant organism.

Burns 98

Burns Fluid Resuscitation Resuscitation Poisoning 98

PulmCCM

JANUARY 24, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival. Read on for details.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

First described in 1953 ( by Dr. John Osborn ) — these Osborn waves are most commonly associated with significant hypothermia ( usually not seen until core temperature is below 90°F ). Instead of ST elevation that is commonly reported with hypothermia-induced Osborn waves — ECG #1 was remarkable for diffuse and profound ST depression.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia CPR EKG/ECG Resuscitation 40

Northwestern EM Blog

JUNE 16, 2024

Myocardial Infarction Medication Sinus node dysfunction Infectious Disease Hypothermia Metabolic Abnormalities (hypothyroidism, hyperkalemia, ect.) Hypothermia Moderate to severe hypothermia can cause significant bradycardia leading to hypotension. Hypothermia. Treatment includes permanent pacemaker placement [9].

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Infectious Diseases Stroke Poisoning 52

ACEP Now

APRIL 3, 2024

Early work on TTM in 2002 showed benefit to cooling to 33 degrees Celsius, which subsequently influenced international resuscitation guidelines to recommend mild hypothermia at 32 degrees to 34 degrees Celsius in 2005. Adding nuance, this study also showed that the highest-severity arrests did not benefit from hypothermia.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

RebelEM

MARCH 30, 2023

The TOMAHAWK (Desch 2021), COACT (Abella 2019), and PEARL (Lemkes 2019) trials examined patients with OHCA without ST elevation with a shockable rhythm, and investigators found no difference in delayed versus emergency angiogram. While the study provides interesting data, it’s underpowered, and we cannot draw firm conclusions.

Hospitals 62

Hospitals Outcomes EKG/ECG Resuscitation 62

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

had at least 2 potential etiologies for developing acute myocarditis: i ) Profound hypothermia ( core temperature = 90°F = 32.2°C I did recognize the S hark F in m orphology of dramatic ST elevation. Referring to Figure-1 — this 53-year old woman who presented in extremis with cardiogenic shock and an initial pH = 6.9, Our THANKS to Dr.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

The Skeptics' Guide to EM

MARCH 2, 2019

Date: February 26th, 2019 Reference: Benger et al. Date: February 26th, 2019 Reference: Benger et al. There is no evidence for a patient-oriented benefit with epinephrine ( SGEM#238 ), other ACLS drugs ( SGEM#64 ), pre-hospital therapeutic hypothermia ( SGEM#54 , SGEM#183 ), or mechanical CPR ( SGEM#136 ).

Airway Management 52

Airway Management CPR Hyperthermia / Hypothermia Outcomes 52

Don't Forget the Bubbles

JANUARY 24, 2024

2019 Apr;85(4):526-537. Epub 2019 Mar 8. Hypothermia for Neuroprotection in Convulsive Status Epilepticus. Clarkson BDS, LaFrance-Corey RG, Kahoud RJ, Farias-Moeller R, Payne ET, Howe CL. Functional deficiency in endogenous interleukin-1 receptor antagonist in patients with febrile infection-related epilepsy syndrome.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

Dr. Smith's ECG Blog

OCTOBER 12, 2024

Rather than loss of both a J wave and S wave — there is a "slur" ( J-point equivalent ) in lead V2 of ECG #2 ( See My Comment in the November 14, 2019 post for illustration of T-QRS-D ). Nicholson — there is no T-QRS-D ( T erminal QRS D istortion ).

EKG/ECG 116

EKG/ECG Documentation/Coding Emergency Department COPD 116

Don't Forget the Bubbles

AUGUST 12, 2024

There is weak evidence to suggest that moderate hypothermia (32-33 o C) can be used for ICP control in specialist settings. 2019 Apr;20(4):404]. Published 2019 Nov 27. This may involve prophylactic anticonvulsants, avoiding low or excessively high glucose levels, avoiding fever and maintaining a normal temperature. 2019;13:528.

Seizures 75

Seizures Pediatrics Emergency Department Ambulance Services 75

Greater Sydney Area HEMS

APRIL 26, 2023

– Concurrent traumatic injuries , along with hypothermia, hypoglycaemia, pain and fear can all stimulate maladaptive compensation, potentiating the above mechanisms. 2019, 119:1353-1365. . – Vagally-mediated bradycardia/hypotension , precipitating syncope and ultimately circulatory collapse. Get them down, right? .

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

Taming the SRU

AUGUST 27, 2024

Mortality rates related to bullous skin lesions are typically related to disruption of the skin barrier and include subsequent dehydration, electrolyte imbalances, hypothermia, increased metabolic needs, and secondary infection leading to bacteremia and/or sepsis. J Am Acad Dermatol 2019; 81:686.

Emergency Department 83

Emergency Department Dehydration Burns Sepsis 83

Pediatric Education

SEPTEMBER 3, 2023

Other states which could also affect sickling would be dehydration, acidosis, hypoxia and hyperthermia. A 2019 systematic review of SCT found that there is a risk for pulmonary embolism, proteinuria and chronic kidney disease (high-strength evidence).

Dehydration 40

Dehydration Hyperthermia / Hypothermia Pediatrics Military 40

Taming the SRU

APRIL 17, 2023

Patients typically present with tachycardia, mydriasis hyperthermia, altered mental status, anhidrosis, and urinary retention. Tapia López, Rosalinda (23 August 2019). Their toxic effects are caused by hyoscyamine and scopolamine. These atropine-like alkaloids produce an anticholinergic syndrome when smoked or ingested.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Anaphylaxis Pediatrics 52

Don't Forget the Bubbles

JUNE 30, 2023

Traditionally thought to result from the dilutional effects of massive transfusion, acidaemia or hypothermia, trauma-induced coagulopathy is now known to be triggered at the time of injury, long before these factors have developed or any medical intervention has taken place. 2019 Aug;31(4):683-687. Emerg Med Australas.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Dr. Smith's ECG Blog

MAY 6, 2019

Hypothermia. A partial list includes the following: Certain drugs ( antiarrhythmics; calcium channel blockers; ß-blockers; antianginals; psychotropic medications; alcohol; cocaine; other drugs ). Acute febrile illness. Variations in autonomic tone. Electrolyte imbalance ( hypokalemia; hyperkalemia ). Ischemia/infarction. Bradycardia.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia 52

Northwestern EM Blog

JANUARY 24, 2022

While the diagnosis of hypothyroidism can be delayed by lab results, clues to the diagnosis include thyroidectomy scar, non-pitting edema of the extremities, macroglossia, altered mental status, hypoglycemia and hypothermia. 2010; 36: 2019-2029. 2019; 155(1): 242. Intensive Care Medicine. 7) Manji F, Wierstra B, and Posadas J.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

These include ( among others ) — acute febrile illness — variations in autonomic tone — hypothermia — ischemia-infarction — malignant arrhythmias — cardiac arrest — and especially Hyperkalemia. Patients with such conditions that may transiently mimic the ECG findings of a Brugada-1 pattern are said to have Brugada Phenocopy.

EKG/ECG 52

EKG/ECG Fractures Hyperthermia / Hypothermia Wellness 52

EMDocs

DECEMBER 16, 2023

Broad-spectrum antibiotics (A) for septic shock are not inappropriate given the hyperthermia, tachycardia, and hypotension. Hyperthermia. As you attempt to examine the patient, he has a generalized, tonic-clonic seizure. What is your diagnosis, and what are your next steps in evaluation and management? 1 Fever is usually < 40C.

Hyperthermia / Hypothermia 96

Hyperthermia / Hypothermia EMS Stroke Seizures 96

EB Medicine

AUGUST 1, 2018

Nachi: Among metabolic abnormalities, patients can present with hyperthermia, hypoglycemia, hypokalemia, hyponatremia, and metabolic acidosis. An RCT is underway in Canada on the use of ondansetron versus haloperidol with an estimated completion of July 2019. Chronic use has also been linked to severe periodontitis.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Taming the SRU

APRIL 26, 2023

First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis. N Engl J Med 2019. Am Fam Physician 2019; 99:482. April 26, 2023) Acute Hyperthermia in the Emergency Department. Resuscitation 2020. Druyan A, Janovich R, Heled Y. Mil Med 2011. Epstein Y, Yanovich R.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Drug toxicity , especially diphenhydramine , which has sodium channel blocking effects, and also anticholinergic effects which may result in sinus tachycardia, hyperthermia, delirium, and dry skin. Annals of Noninvasive Electrocardiology 2019. 8, 2019 ) — ( Jan. 30, 2019 ) — many others. Hyperkalemia 2.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

The Skeptics' Guide to EM

MARCH 5, 2022

This includes therapeutic hypothermia for out-of-hospital cardiac arrest (OHCA), tranexamic acid (TXA) for epistaxis and electrolyte solutions for mild pediatric gastroenteritis. The definitions used for each level of evidence are as follows: An update was published by Fanaroff et al in JAMA 2019.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Research Pediatrics Outcomes 40

EMDocs

JUNE 27, 2024

2019 Jan 24;14:263-292. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

Pediatrics 98

Pediatrics Dehydration EMS Hospitals 98

Taming the SRU

JANUARY 5, 2025

Specificity: 90.7%) Exposure to a dopamine antagonist or withdrawal of a dopamine agonist in the prior 72 hours: 20 points Hyperthermia (>100.4 2019; 44(2): 327-334. mg/kg initially followed by 1mg/kg q6hrs Disposition NMS can be very severe and usually requires ICU level care. Nguyen H, Pan A, Smollin C, Cantrell LF, Kearney T.

Hyperthermia / Hypothermia 97

Hyperthermia / Hypothermia Dehydration Psychiatric Poisoning 97

EMDocs

JANUARY 6, 2025

Signs of malnutrition – which places patients at higher risk for infection – can include cachexia, muscular wasting, sunken eyes, redundant skin folds, edema, brittle skin and hair, bradycardia, hypotension, and hypothermia. Can J Surg J Can Chir. 2006;49(1):51-57. Ranking of the Largest Refugee-Hosting Countries as of 2023.;

Infectious Diseases 75

Infectious Diseases CDC PPE Rapid Diagnostic Testing 75