The Skeptics' Guide to EM

AUGUST 14, 2021

Date: August 12th, 2021 Reference: Daya et al. 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. Missy is also now the director […] The post SGEM#340: Andale, Andale Get An IO, IO for Adult OHCA?

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

Taming the SRU

JUNE 24, 2024

Follow this algorithm in patients with unstable bradycardia with acute heart failure, change in mental status, or concern for shock, physicians should start with atropine, 1 mg and may be continued every 3 to 5 minutes if effective. Resuscitation , Volume 181,2022,Pages 140-146,ISSN 0300-9572, [link] Scott Weingart, MD FCCM.

Advances Cardiac Life Support (ACLS) 90

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

The Skeptics' Guide to EM

JANUARY 9, 2021

Date: January 5th, 2021 Reference: Grunau et al. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest. Date: January 5th, 2021 Reference: Grunau et al. first appeared on The Skeptics Guide to Emergency Medicine.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

Greater Sydney Area HEMS

APRIL 15, 2023

At one of our recent education days we heard Dr Mark Russell and Dr Mark Newcombe deliver excellent presentations of cases which they had been involved in, involving resuscitative hysterotomy and neonatal resuscitation respectively. Resuscitate in air first, and use higher inflation pressures than you would with adults.

Hospitals 85

Hospitals Resuscitation Hyperthermia / Hypothermia Teamwork 85

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. A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Don't Forget the Bubbles

MAY 6, 2024

This multicentre retrospective cohort study looked at 202 children in California aged 1- 24 months who presented acutely between 2010 and 2021. The mean time to randomisation was 2 hours, which excludes the initial resuscitation window. However, this study did not include the acute resuscitation period or non-ventilated children.

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

Mind The Bleep

FEBRUARY 27, 2024

There could be any number of reasons for this but some examples are: they have severe D&V and aren’t keeping fluids down, or because they are pre or post-op, or have presented very unwell and need fluid resuscitation. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. saline), however more research is needed in this area. [4]

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

ACEP Now

APRIL 3, 2024

Targeted temperature management (TTM) for patients following cardiac arrest resuscitation has gone through several dosing iterations in the past two decades. Targeted temperature management (TTM) for patients following cardiac arrest resuscitation has gone through several dosing iterations in the past two decades. degrees Celsius.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2] NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. What are the most up-to-date guidelines for managing this patient?

Sepsis 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

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

ED ECMO

JANUARY 1, 2021

January 1, 2021: The year following COVID19 Global Pandemic brings us a new horizon – lets appreciate what has happened, learn from our mistakes and begin to look forward. The patient was resuscitated with REBOA and her pathology was fixed by an Iliac Artery stent placed in Interventional Radiology.

Shock 52

Shock Resuscitation Radiology Radiology 52

Don't Forget the Bubbles

MARCH 31, 2025

Sepsis is a significant cause of mortality in children, and fluid resuscitation is a key treatment strategy. It also emphasizes the need for better fluid management strategies, including early de-resuscitation in high-risk patients. 41% of patients with septic shock had MODS. Why does it matter? Am J Emerg Med. 2025.01.054.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. 2021, Jarczak, Kluge et al. 2021, Im, Kang et al. 2021, Im, Kang et al. N Engl J Med. 2023;388(6):499-510. 2019, Bauer, Gerlach et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

EMDocs

JANUARY 16, 2024

Hypothermic Arrest In general, hypothermic patients in cardiac arrest should be aggressively resuscitated. Patients can have excellent outcomes despite prolonged resuscitation. 2,3 If the patient meets criteria for resuscitation, they generally are not declared dead until their core temperature is above 32℃ (“warm and dead”).

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. In 2021, Evans and colleagues (1) compared adolescent mortality rates in adult, children’s and mixed major trauma centres across the UK. In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. Is he going to be OK? And it’s true.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Don't Forget the Bubbles

MAY 10, 2023

A shocked friend is being ushered out of the way. 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.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

EMDocs

JULY 17, 2023

However, routine labs, including a complete blood count and metabolic panel, can guide resuscitative efforts preoperatively and may identify clinically relevant abnormalities associated with obstruction, including electrolyte changes, renal injury from hypoperfusion, or anemia secondary to underlying malignancy. Published 2021 Apr 22.

Operations 98

Operations EMS Fluid Resuscitation Resuscitation 98

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.

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

EMDocs

APRIL 22, 2024

However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). During this resuscitation two different ultrasound machines were used to capture images due to a malfunction with the first machine after initial images were captured. Epub 2021 Mar 26.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

Taming the SRU

OCTOBER 1, 2023

Unsuspected tension pneumothorax as a hidden cause of unsuccessful resuscitation. J Emerg Trauma Shock. Resuscitation. Published 2021 Jun 24. Rojas R, Wasserberger J, Balasubramaniam S. Ann Emerg Med. 1983;12(6):411-412. doi:10.1016/s0196-0644(83)80502-2 Sharma A, Jindal P. 2008;1(1):34-41. Clin Pract Cases Emerg Med.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Taming the SRU

APRIL 26, 2023

Resuscitation 2020. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. West J Emerg Med 2021. J Intensive Care Med 2015. Douma MJ, Aves T, Allan KS, et al. Druyan A, Janovich R, Heled Y. Mil Med 2011. Epstein Y, Yanovich R. Heatstroke.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

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. Secondary Outcomes: Shock, ventricular tachycardia, and/or fibrillation within 48 hours after hospital admission.

Hospitals 66

Hospitals Outcomes EKG/ECG Resuscitation 66

Critical Care Now

APRIL 7, 2022

Notable is the patient’s feeling that their “heart stopped” or the sensation of an “electric shock”. The large benefit with using diltiazem is that there is no association with the “electric shock” or “heart stop” feeling that is synonymous with adenosine. Resuscitation. Updated 2021 Aug 11]. What is the Alternative?

Administration 52

Administration Resuscitation Shock Emergency Department 52

Downeast Emergency Medicine

APRIL 26, 2021

2021 Jan 1;32(1):37-43. The primary outcome was 30-day mortality with secondary outcomes looking at 24 hour in-hospital mortality, blood resuscitation at 6 and 24 hours, incidence of multiorgan failure, ARDS, nosocomial infection, early seizures, PE/DVT, crystalloid resuscitation after 24 hours, and the incidence of coagulopathy.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Dr. Smith's ECG Blog

MAY 5, 2022

Fluid resuscitation was initiated. ST elevation in aVL with reciprocal ST depression in the inferior leads Shock, bradycardia, ST Elevation in V1 and V2. Physician also reads it as normal) Severe shock, obtunded, and a diagnostic prehospital ECG. The November 27, 2021 post ( LA-RA reversal ). Another Shark Fin.

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

EMDocs

FEBRUARY 12, 2024

First, there can be a poor correlation between venous and arterial gases in states of shock, hemodynamic instability, or extremes of acid-base disturbances, due to poor cardiac output/circulatory failure impairing venous and arterial flow, with associated poor gas exchange as well as hypercapnia and acidemia at the tissue level (8).

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

EMDocs

JUNE 3, 2023

4 Patients with pelvic fractures are considered unstable when systolic blood pressure < 90mmHg and heart rate >120bpm, or in those with dyspnea, altered mental status, or skin findings of shock. 13 Massive transfusion protocols (MTP) are hallmarks of trauma resuscitation, and they are critical to the unstable pelvic fracture patient.

Fractures 64

Fractures Resuscitation Operations EMS 64

Intensive Blog

FEBRUARY 9, 2023

Vasopressors such as noradrenaline are often required (systemic vasodilation is common in hepatic failure). Disability- treat hypoglycaemia if present. Supportive care and monitoring Prioritise short-acting agents, avoid medications that accumulate in hepatic failure Usually ICU measures (e.g. Silibinin [link] Warrillow, S. Bellomo, R. 2014, Jan).

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

Don't Forget the Bubbles

FEBRUARY 17, 2025

He has had some additional episodes of hypotension post-intubation, which is treated with further volume resuscitation. Volume resuscitation has historically been the first-line therapy for patients in septic shock. congenital heart disease, septic cardiomyopathy), aggressive volume resuscitation (e.g.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

Don't Forget the Bubbles

NOVEMBER 18, 2024

Before considering fluid resuscitation or inotropes, it is essential to correct the infant’s body temperature. Check electrolytes and consider the diagnosis, especially if the infant shows signs of shock or has a family history suggestive of CAH. Hypothermia: Newborns, particularly preterm infants, are prone to hypothermia.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. Andrews et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Pediatric EM Morsels

MARCH 7, 2025

Military Application of Tranexamic Acid in TraumaEmergency Resuscitation (MATTERs) Study. It is excreted by urine so careful dosing is required if used in kidney disease. of IV form TXA [O’Neill 2020] Inexpensive ! 2011 Mar26;377(9771):1096-101, 1101.e1-2. PubMed: 21439633] Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ.

Pediatrics 231

Pediatrics Blood Transfusions Anaphylaxis Military 231

EMDocs

JUNE 27, 2024

2021 Sep;194(5):899-907. Epub 2021 Jul 15. -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 0.4 C or 100.4

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97

Taming the SRU

NOVEMBER 13, 2024

opiates or anticholinergics): Use initial nomogram and treat if initial level is above the treatment line. haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1 mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric 89

Psychiatric Seizures Emergency Department Pediatrics 89

Don't Forget the Bubbles

JULY 3, 2024

Infant Deaths After Texas’ 2021 Ban on Abortion in Early Pregnancy. Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis. Pediatr Infect Dis J. 2024 Jun 26. Risk Factors for Persistent Staphylococcus aureus Bacteremia in Children. Thornley EM, et al. 2024 Jun 21.

Pediatrics 105

Pediatrics Fluid Resuscitation Research Hospitals 105

EMDocs

MARCH 11, 2024

The clinical picture of this patient was consistent with hypovolemic shock secondary to acute cholera infection. Rehydration therapy for patients with cholera should include volume resuscitation and electrolyte repletion. Published online October 20, 2021. Laboratory testing was not immediately available. Accessed March 5, 2024.

Dehydration 111

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 111