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 84

Hyperthermia / Hypothermia Resuscitation CPR EMS 84

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 94

Emergency Department Resuscitation COPD Shock 94

EM Literature of Note

MARCH 2, 2023

Data Dredging Coming Through: Heads Up Cardiopulmonary Resuscitation Does Not Improve Outcomes Are Two Shocks Better Than One? Finally, a Twitter thread with slides illustrating some of the top articles of 2022: 20 Papers in 20 Minutes from ACEM Spring Symposium Enjoy!

Emergency Department 52

Emergency Department Resuscitation Shock EMS 52

Mind The Bleep

DECEMBER 19, 2023

Majority of DKA patients are in a fluid deficit and present acutely with shock. Therefore, they require fluid resuscitation to restore blood pressure, correct the ketonemia and electrolyte abnormalities, and oliguria. Signs of shock to be mindful for are tachycardia, hypotension, prolonged CRT, pallor, and a weak thready pulse.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

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

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

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. 6 However, due to the vasoconstrictive effects, hydrocortisone may be useful in refractory shock. 2014;14(2):203-207. Corticosteroids.

Basic Life Support 82

Basic Life Support CPR Fractures Emergency Department 82

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. 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. You look around.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

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) 87

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 87

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

Shock 52

Shock Resuscitation Outcomes Fluid Resuscitation 52

JournalFeed

MARCH 26, 2022

The JournalFeed podcast for the week of March 21-25, 2022. For continued access to all the JournalFeed has to offer will require you to be a member as of April 4th, 2022. Check out journalfeed.org for details.

Documentation/Coding 40

Documentation/Coding Stroke Emergency Department Resuscitation 40

EMDocs

JUNE 27, 2024

2022 Jul 5;328(1):57-68. 2022 Aug;58:235244. Epub 2022 Jun 11. 2022 Aug;58:235-244. Epub 2022 Jun 11. -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 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

Pediatrics 75

Pediatrics EMS Dehydration Hospitals 75

RebelEM

MAY 29, 2023

septic shock). Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. Limited, small studies on its use in septic shock do not make a clear argument for use. Paper: Ibarra-Estrada, M et al. Crit Care 2023.

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

Don't Forget the Bubbles

JULY 3, 2024

Respiratory Syncytial Virus-Associated Hospitalizations in Children <5 Years: 2016-2022. Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis. Current practice in the care of children with functional constipation: What is the hold up? van der Zande JMJ, et al.

Pediatrics 105

Pediatrics Fluid Resuscitation Hospitals Research 105

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 2022 Jun 30.

Ultrasounds 82

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 82

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important. == MY Comment, by K EN G RAUER, MD ( 11/4 /2022 ): == Our thanks to Drs.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

ACEP Now

MARCH 14, 2024

Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. Click to enlarge.) Am J Emerg Med. 2008;26(4):413-418.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

ACEP Now

OCTOBER 10, 2023

1,2 The 2022 AHA/ASA Guidelines give several recommendations on this topic. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Goal-directed resuscitation for patients with early septic shock. N Engl J Med.

Outcomes 52

Outcomes Stroke Hospitals Emergency Department 52

ACEP Now

JULY 7, 2023

However, between four and five percent of cases of VT or VF will be refractory to standard management, with nonperfusing arrhythmia persisting despite repeated shocks. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator. Resuscitation. Resuscitation. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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 Hospitals Dehydration Research 96

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. Either approach in severe sepsis with shock seems reasonable.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

Taming the SRU

OCTOBER 1, 2023

Treasure Island (FL): StatPearls Publishing; November 28, 2022. Unsuspected tension pneumothorax as a hidden cause of unsuccessful resuscitation. J Emerg Trauma Shock. Resuscitation. doi:10.1136/thorax-2022-219784 Chee CB, Abisheganaden J, Yeo JK, et al. Rojas R, Wasserberger J, Balasubramaniam S. Ann Emerg Med.

Fractures 94

Fractures COPD Hospitals Emergency Department 94

EMDocs

MARCH 11, 2024

The clinical picture of this patient was consistent with hypovolemic shock secondary to acute cholera infection. 2 As of 2022 cholera was estimated to be responsible for over 4 million cases and 143,000 deaths each year, with a case fatality rate of 50% without timely and appropriate treatment. Published online November 14, 2022.

Dehydration 90

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 90

Taming the SRU

APRIL 13, 2023

2022 Pre-AeRATE Trial: use of HFNC for preoxygenation and apneic oxygenation showed no difference in lowest SpO2 during first intubation attempt when compared with usual care. EtOH, amphetamines, or cocaine) Prescription drugs (i.e. cuffed ETT) preloaded and intubate through the stoma if PPV needed Infection (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

The Skeptics' Guide to EM

JUNE 18, 2022

Date: June 18th, 2022 Reference: Crombie et al. Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. Date: June 18th, 2022 Reference: Crombie et al. What do you advise him?

Shock 40

Shock Resuscitation Administration Emergency Department 40

PulmCCM

NOVEMBER 17, 2023

Operating point guided resuscitation How do we make sense of this? The trick, I believe, lies in ‘operating point guided resuscitation’ [OPGR]. Put another way, because the OP is comprised of both P ra and CO/SV, both values are quantified or qualified at each step of resuscitation. Ultrasound J 2022, 14(1):36.

Operations 132

Operations Ultrasounds Resuscitation Blood Transfusions 132

RebelEM

DECEMBER 19, 2022

This procedure involves applying another set of pads attached to a second defibrillator to a patient and shocking them in hopes of terminating the rhythm. Background Information: Double external defibrillation (DED) is an intervention often used to treat refractory ventricular fibrillation (RVF). N Engl J Med.

EMS 52

EMS CPR Shock Resuscitation 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. 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.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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 54

Fractures Resuscitation Operations EMS 54

Dr. Smith's ECG Blog

JANUARY 8, 2024

She was briefly resuscitated and made it to the ED alive, long enough to have another ECG: This could be all due to RV strain or the STE in inferor leads could also be due to supply demand mismatch (type II STEMI) She was given 100 mg of tPA but arrested again and could not be resuscitated. The patient went into arrest pre-hospital.

EKG/ECG 75

EKG/ECG Resuscitation Hospitals EMS 75

EMDocs

JANUARY 4, 2024

Cardiogenic shock and hypotension can occur (systolic heart failure with reduced ejection fraction.) 10,12 Refractory shock or malignant arrhythmias occur in < 5% of patients. Accessed 12/18/2022. Accessed 12/18/2022. 2022; 55:232.e3-232.e4 Cardiotoxicity: Overdose can cause prolonged QRS and QTc intervals.

Seizures 66

Seizures EKG/ECG Poisoning Shock 66

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. Comment by K EN G RAUER, MD ( 11/28 /2022 ): = Today's case is remarkable for the presence of 2 important ECG findings: i ) Low Voltage ; and , ii ) Electrical Alternans.

EKG/ECG 52

EKG/ECG Ultrasounds Documentation/Coding COPD 52

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. Resuscitation. What is the Alternative?

Administration 52

Administration Resuscitation Shock Emergency Department 52

RebelEM

JUNE 8, 2023

2022 Sep 5. 2022 2022 Sep 5. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. Paper: Singer S, et al. The safety and efficacy of push dose vasopressors in critically ill adults. Am J Emerg Med. Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Dr. Smith's ECG Blog

OCTOBER 10, 2022

A 30-something woman with chest pain and h/o pulmonary hypertension due to chronic pulmonary emboli A 30-something with 8 hours of chest pain and an elevated troponin Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation. Interpretation of a post-resuscitation ECG can be extremely challenging. These include.

EKG/ECG 52

EKG/ECG Resuscitation Ultrasounds CPR 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.

Hyperthermia / Hypothermia 68

Hyperthermia / Hypothermia EMS Stroke Seizures 68