Don't Forget the Bubbles

MARCH 31, 2025

This was a secondary analysis of the Management and Outcome of Fever in Children in Europe (MOFICHE) study. The primary outcome measure was SBI, and 1854 children included were diagnosed with an SBI. Sepsis is a significant cause of mortality in children, and fluid resuscitation is a key treatment strategy. Whats it about?

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

RebelEM

MAY 29, 2023

Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e. 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

RebelEM

APRIL 29, 2024

Critically ill patients requiring resuscitation often present with many challenges including the ability to secure safe, sterile, fast, and reliable intravenous (IV) access. This can often lead to significant delays in proper resuscitation. Studies reviewed landmark-based CVC compared to IO; using IJ, subclavian, and femoral CVC sites.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

EMDocs

JANUARY 11, 2025

If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Stercoral Colitis in the Emergency Department: A Retrospective Review of Presentation, Management, and Outcomes. Mathis, K. L., & Lindor, R. Annals of emergency medicine, 82(1), 3746.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

EMDocs

FEBRUARY 20, 2024

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. 2022 Sep 15;387(11):989-1000. Question:In adults with acute pancreatitis, does moderate fluid resuscitation compared to aggressive resuscitation reduce the development of moderately severe or severe pancreatitis? N Engl J Med. vs. 17.3%, aRR1.30 (0.78-2.18)

Fluid Resuscitation 98

Fluid Resuscitation Resuscitation Outcomes Hospitals 98

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

ACEP Now

JULY 7, 2023

2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity. Heart disease and stroke statistics-2022 update: A report from the American Heart Association. Resuscitation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Vitamin C did not improve outcomes among patients hospitalized with Covid-19.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

EMDocs

NOVEMBER 29, 2023

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. 2022 Sep 15;387(11):989-1000. Question:In adults with acute pancreatitis, does moderate fluid resuscitation compared to aggressive resuscitation reduce the development of moderately severe or severe pancreatitis? N Engl J Med. vs. 17.3%, aRR1.30 (0.78-2.18)

Fluid Resuscitation 93

Fluid Resuscitation Resuscitation Outcomes Hospitals 93

Taming the SRU

MARCH 27, 2024

Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial. In this study, the authors aim to assess the hemodynamic effects of prehospital high-dose glucocorticoid treatment in resuscitated comatose OHCA patients. Hill, J.

Resuscitation 99

Resuscitation CPR Outcomes Hospitals 99

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

EMDocs

NOVEMBER 29, 2023

Double-blind, placebo-controlled multicenter RCT Included 795 patients > 18 years admitted to the ICU with severe PNA Intervention: Hydrocortisone as a continuous infusion of 200 mg/day IV with a planned taper for 8 or 14 days compared to placebo Primary Outcome: All-cause mortality at 28 days Hydrocortisone 6.2% 2022 Aug;48(8):1009-1023.

Resuscitation 96

Resuscitation Outcomes EKG/ECG 96

Mind The Bleep

OCTOBER 29, 2024

Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% This includes adequate pain control, fluid resuscitation, and stabilization of any systemic complications. Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes. 2022 Mar 2;83(3):1-12.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

RebelEM

JULY 24, 2023

This approach has been shown to benefit patients when agents like propofol and midazolam are used. ( Russotto 2022 , Choi 2004 ). Outcomes: Primary: Postintubation hypotension (SBP < 100 mm Hg) 15 minutes post-intubation. However, there is scant evidence on the more common induction agents ketamine and etomidate. mg/kg 1.33

Resuscitation 98

Resuscitation Outcomes Emergency Department EMS 98

RebelEM

SEPTEMBER 19, 2022

Background: There are only two interventions that have been proven in the medical literature to improved outcomes in cardiac arrest: high-quality CPR and early defibrillation. Over the years, we as a scientific community have worked extensively to find other interventions that improve outcomes. Resuscitation 2022; 179: 9-17.

CPR 52

CPR Outcomes Resuscitation EMS 52

The Skeptics' Guide to EM

AUGUST 10, 2024

Background: In hemorrhagic stroke, the ABCs for resuscitation remain the same, but can also be categorized as: Airway Management: This is an important aspect for patients with a poor neurologic exam or those who are not protecting their airways. Reversal of Warfarin: Freeman et al. Blood Pressure Lowering:

Stroke 90

Stroke Airway Management Documentation/Coding Outcomes 90

Don't Forget the Bubbles

FEBRUARY 5, 2025

According to the latest figures (2022), there were approximately 6,000 recorded offences where a child was a victim of violence, including physical assault, sexual abuse, and homicide. Establish IV access for potential fluid resuscitation. You feel the patient needs fluid resuscitation. Auscultate, percuss and palpate chest.

Fluid Resuscitation 59

Fluid Resuscitation Domestic Violence Head Injuries Sexual Assault 59

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

Pediatric EM Morsels

JUNE 9, 2023

Of course, we all have a healthy respect for post-tonsillectomy hemorrhage and we like to talk about Damage Control Resuscitation. Epub 2022 Dec 26. Long-term Outcomes and Health Perceptions in Pediatric-onset Portal Hypertension Complicated by Varices. Semin Liver Dis. 2023 Feb;43(1):100-116. doi: 10.1055/s-0042-1759613.

Pediatrics 154

Pediatrics Head Injuries Airway Management Administration 154

ACEP Now

OCTOBER 10, 2023

Both INTERACT-2 and ATACH-2 showed no statistical difference in their primary outcome between intensively lowering the BP and a less-intensive strategy. 1,2 The 2022 AHA/ASA Guidelines give several recommendations on this topic. 3 The class (strength) of their recommendation is 2a/2b based upon Level B and Level C quality of evidence.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

ACEP Now

JUNE 21, 2023

2,3 In the 2021-2022 academic year, categorical (non-combined) EM residency lengths included 221 (80 percent) PGY 1-3 and 55 (20 percent) PGY 1-4 programs. The lack of differences in the observed outcomes do not suggest one EM training length is superior. 1 Curricula with non-EM internships (i.e., 11 What should we take away?

EMS 114

EMS Academics Telemedicine Operations 114

ACEP Now

OCTOBER 3, 2023

These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations. This document is an update of guidelines first published in 2000, and then updated in 2007.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

PulmCCM

NOVEMBER 6, 2023

open label) at 17 sites in Belgium in 2020-2022, 35% of those receiving plasma died at 28 days, vs. 45% of the usual care patients — a number needed to treat of 10 to save one life. The intervention is called resuscitative endovascular balloon occlusion of the aorta (REBOA). Thromboelastometry (e.g.,

Blood Transfusions 98

Blood Transfusions Operations Resuscitation Infectious Diseases 98

ED ECMO

DECEMBER 3, 2021

Below is the full editorial Zack and Alice did recently in the Journal of Resuscitation on the topic. It was born out of a fantastic German article centered looking at registry outcomes for PE and ECMO. Below is the full editorial Zack and Alice did recently in the Journal of Resuscitation on the topic.

Resuscitation 52

Resuscitation Outcomes 52

EMDocs

NOVEMBER 20, 2023

Initial patient assessment and hemodynamic resuscitation should be performed simultaneously. DOAC reversal Recommendation: For patients on DOACs, we suggest reversal for the small subset of patients who present with a life-threatening LGIB that does not respond to initial resuscitation and cessation of the anticoagulant alone.

Resuscitation 104

Resuscitation Fluid Resuscitation Hospitals Research 104

Don't Forget the Bubbles

MAY 10, 2023

In May 2022, Holly and Joe, two students on the joint QMUL and DFTB PEM MSc , created video presentations on human factors. Resuscitation is a team sport. Role stickers or role aprons with names on them are simple measures to highlight resuscitation roles. This lets the team leader focus on resuscitation. Ready your team.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

EMDocs

SEPTEMBER 7, 2023

2,10 Initial stabilization of DEG toxicity includes correcting acid-base abnormalities, electrolyte abnormalities, and volume resuscitation. Volume resuscitation as needed while adjusting for any developing acute kidney injury. Accessed August 2022. FDA Consumer Magazine , June 1981, [link] Accessed August 2022.

Poisoning 92

Poisoning CDC Administration Emergency Department 92

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.

Stroke 99

Stroke Outcomes EMS Seizures 99

The Skeptics' Guide to EM

JUNE 12, 2022

Date: June 12th, 2022 Reference: Finfer et al. Date: June 12th, 2022 Reference: Finfer et al. Background: There has been a longstanding debate about which intravenous fluid is the best for volume resuscitating critically ill patients. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults.

Fluid Resuscitation 53

Fluid Resuscitation Resuscitation Outcomes Administration 53

PulmCCM

JULY 3, 2023

Read in NEJM Targeted mild hypercapnia did not improve neurologic outcomes in patients resuscitated from out-of-hospital cardiac arrest (OHCA). In observational studies and a phase 2 randomized trial , mild hypercapnia was associated with improved outcomes or biomarkers, perhaps by improving cerebral oxygenation.

Airway Management 105

Airway Management Outcomes Hospitals Emergency Department 105

EMDocs

MAY 15, 2024

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. 2022 Aug;58:235-244. Epub 2022 Jun 11. Causes and outcomes of the acute chest syndrome in sickle cell disease. Hypervolemia – leads to pulmonary edema: Consider diuresis If euvolemic – start maintenance fluids of D5 in 0.45%NS

Blood Transfusions 103

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 103

RebelEM

SEPTEMBER 29, 2022

There are also potential harms to large volume fluid resuscitation including progression of pancreatitis and fluid overload with or without respiratory failure. Though the initial recommendation for aggressive fluid resuscitation was not based on substantial evidence, clinicians have been slow to pivot away from this approach.

Administration 52

Administration Fluid Resuscitation Resuscitation Outcomes 52

Broome Docs

MARCH 28, 2024

PMID: 38050078 Bottom line: High dose nitroglycerin seems to result in better outcomes in SCAPE, at least according to this small, single center, unblinded trial. 2022 Feb;52:85-91. Resuscitation. High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trial.

PPE 96

PPE Ultrasounds Resuscitation Emergency Department 96

EMDocs

JANUARY 4, 2024

Whole bowel irrigation: 3 Not routinely performed and limited evidence to support improved outcome in general. Accessed 12/18/2022. Accessed 12/18/2022. 2022; 55:232.e3-232.e4 Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine.

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

RebelEM

JUNE 8, 2023

2022 Sep 5. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose. Prior literature primarily focused on safety and medication errors, and while this study did the same, they also assessed variables associated with PDP response.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

EMDocs

MAY 28, 2024

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. 2022 Aug;58:235-244. Epub 2022 Jun 11. Causes and outcomes of the acute chest syndrome in sickle cell disease. Decreases splinting and improves tidal volumes. Bronchodilators Indicated for patients with wheezing, history of asthma.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Reference: Cashen K, Reeder RW, Ahmed T, et al.

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52