The Skeptics' Guide to EM

MAY 20, 2023

Date: May 10, 2023 Reference: Harhay MO, et al. Date: May 10, 2023 Reference: Harhay MO, et al. They started cardiopulmonary resuscitation (CPR) until EMS arrived. Upon arrival at the ED, your team promptly begins high quality CPR and manages to obtain return of spontaneous circulation. NEJM Evidence. NEJM Evidence.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics CPR Hospitals 52

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

Resuscitation 98

Resuscitation EKG/ECG CPR Outcomes 98

The Skeptics' Guide to EM

FEBRUARY 25, 2023

2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Pediatric Crit Care Med.

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52

The Skeptics' Guide to EM

FEBRUARY 3, 2023

Date: February 1, 2023 Reference: Wolfrum et al. Date: February 1, 2023 Reference: Wolfrum et al. The nurses started CPR immediately and place pads before you even arrived. Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. Circulation. first appeared on The Skeptics Guide to Emergency Medicine.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Documentation/Coding CPR 52

EMDocs

JANUARY 11, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association (AHA) and Neurocritical Care Society (NCS) released their 2023 Scientific Statement on the critical care management of post ROSC patients. 2023 Dec 1. Neurocrit Care. doi: 10.1007/s12028-023-01871-6. Epub ahead of print.

Seizures 97

Seizures Shock Infectious Diseases CPR 97

ACEP Now

APRIL 3, 2024

1,2 However, the European TTM1 trial in 2013 showed similar outcomes for those cooled to 33 degrees Celsius compared to 36 degrees Celsius, leading to a 2015 AHA class I recommendation of “cooling between 32 degrees Celsius-36 degrees Celsius.” 5,6 In 2021, the TTM2 trial was published. degrees Celsius for 72 hours.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

Intensive Blog

MARCH 13, 2024

However, as practice has been refined and populations of patients who may benefit have been identified 5 , the use of extracorporeal CPR (ECPR) has been rapidly growing. The Steps of CPR reported in the Journal of Iowa Medical Society in 1964 by Peter Safar. Image source: File:Steps of CPR-1964.jpg jpg – Wikimedia Commons.

CPR 130

CPR Resuscitation Hospitals Outcomes 130

RebelEM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study. Resus 2023.

CPR 145

CPR EMS Documentation/Coding Outcomes 145

RebelEM

AUGUST 21, 2023

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Epub 2023 Jun 15. Paper: Eastwood G, et al. N Engl J Med.

Hospitals 98

Hospitals Resuscitation Outcomes CPR 98

Don't Forget the Bubbles

JUNE 30, 2023

She was intubated at the scene and transported to your ED, with cardiopulmonary resuscitation (CPR) performed en route. Despite good quality CPR, there is no ROSC. Despite good quality CPR, there is no ROSC. Despite good quality CPR, there is no ROSC. Emergency Medical Services found her apneic and pulseless.

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

RebelEM

JUNE 1, 2023

Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. In theory, rapid identification of the underlying cause should improve outcomes by allowing clinicians to tailor management. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study.

Outcomes 145

Outcomes Resuscitation Hospitals CPR 145

Don't Forget the Bubbles

FEBRUARY 5, 2025

There is significant evidence in adults and developing in the paediatric population that TXA results in better outcomes if given early in patients with mild to moderate traumatic brain injury (TBI) and does not cause harm. Don’t Forget the Bubbles, 2023. link] Faculty of Forensic and Legal Medicine. TXA in head injuries.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

PulmCCM

JANUARY 29, 2024

AHA Updates its Cardiac Arrest Guidelines In December 2023, the American Heart Association published a “focused update” to its landmark guidelines for the management of cardiac arrest. Epinephrine remains the drug of choice during CPR Epinephrine remains the first-line therapy for cardiac arrest due to non-shockable rhythms (i.e.,

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

Stop and Think

JANUARY 10, 2024

Let’s do two topics on the RCT that I covered in my Top Ten Stories of 2023 piece. One scenario that doctors considered dire enough to use ECLS occurs when CPR does not work to restore circulation. They found no significant improvement in the primary endpoint of survival with a favorable neurologic outcome.

CPR 44

CPR Shock Outcomes Resuscitation 44

RebelEM

SEPTEMBER 14, 2023

to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% Did they get bystander CPR? The benefits of this strategy may be outweighed by the risk of the device-related complications (i.e. Zeymer HT et al. Control: 53.4%

Shock 136

Shock Outcomes Resuscitation Stroke 136

RebelEM

JANUARY 29, 2024

Clin Exp Emerg Med 2023. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE? Click here for Direct Download of the Podcast Paper: Aykan AC et al. Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7%

Stroke 136

Stroke Outcomes Hospitals Administration 136

EMDocs

JANUARY 16, 2024

Patients can have excellent outcomes despite prolonged resuscitation. 10 The score predicts the probability of survival to hospital discharge using a number of factors including CPR duration, serum potassium, core temperature, age, and suspected mechanism of hypothermia. link] Published February 12, 2023. Ann Emerg Med.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

RebelEM

SEPTEMBER 28, 2023

STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. Primary PCI: 95.7% Stents Placed: Pharmaco-Invasive Treatment: 97.4%

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138

Don't Forget the Bubbles

MAY 3, 2023

Published 2023 Feb 17. Results of this study showed that the use of low-dose insulin infusion led to similar clinical outcomes and fewer adverse events compared to the standard-dose insulin infusion. The Pediatric Bougie for the First Tracheal Intubation Attempt in Critically Ill Children [published online ahead of print, 2023 Feb 23].

CPR 52

CPR Airway Management Emergency Department Resuscitation 52

PulmCCM

JUNE 5, 2023

Read in Journal of Critical Care ECMO vs CPR for pre-hospital resuscitation after cardiac arrest. There was no significant difference in survival with a favorable neurologic outcome at 30 days (20% vs 16% nominally favoring the ECMO group, P=0.52) or at 6 months. makes me long for an adequately powered randomized trial. In the U.S.,

Advances Cardiac Life Support (ACLS) 96

Advances Cardiac Life Support (ACLS) Documentation/Coding CPR Shock 96

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

I sent it to 5 of my OMI friends without any clinical information or outcome and all 5 independently responded with exactly the same diagnosis: "reperfused inferior OMI". 3-vessel disease can make resuscitation very difficult, since CPR does not perfuse diseased vessels as well as one would like.

EKG/ECG 135

EKG/ECG Resuscitation CPR Emergency Department 135

Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. Persistent air-leak in spontaneous pneumothorax--clinical course and outcome. 10/2/2023 Iatrogenic: PTX caused by medical procedures or interventions.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

RebelEM

NOVEMBER 20, 2023

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]. 2023;e2320850. Outcome: Primary Outcome: All-cause mortality at 90 days.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

ACEP Now

OCTOBER 11, 2024

1,2 Clinical outcomes in submersion injuries are largely dependent on the degree of hypoxic injury experienced by the victim, making prehospital care of paramount importance. Optimally, bystander CPR, including the administration of rescue breaths, should be initiated prior to arrival of emergency medical services. South Med J.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation 52

Don't Forget the Bubbles

OCTOBER 7, 2024

Prolonged CPR should be considered as outcomes are generally good, even if asystole is the presenting rhythm. Philadelphia, PA: Elsevier; 2023:chap 130. Electrical Injury Guideline, Paediatrics for Healthcare Professionals, NHS Greater Glasgow and Clyde, 2023 May Waldmann, V., Chen P, Bukhman AK. In: Walls RM, ed.

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

Don't Forget the Bubbles

DECEMBER 5, 2023

2023 Oct 26;73(736):e850-e857. Roughly 30% of patients with ulcerative colitis are diagnosed as children or young adults, and this early diagnosis is associated with poorer long-term outcomes. The primary outcome measure was the time patients collected their repeat prescriptions, i.e. their adherence. Br J Gen Pract.

Resuscitation 111

Resuscitation Outcomes CPR Emergency Department 111

Dr. Smith's ECG Blog

FEBRUARY 18, 2025

He received CPR and was intubated. The patient's long term outcome is unknown. As I emphasized in My Comment in the February 27, 2023 post in Dr. Smith's ECG Blog some patients may develop everything except QRS widening. His heart rate dropped back into the 30s, and he arrested. mEq/L and the patient finally received 2 g IV.

EKG/ECG 63

EKG/ECG COPD CPR Administration 63

Dr. Smith's ECG Blog

MARCH 8, 2025

Angiography was technically challenging as the patient was receiving CPR, but the cardiologist suspected acute stent thrombosis and initiated cangrelor, although no repeat angiography was able to be obtained. Was her outcome to be expected for ostial RCA OMI? She was defibrillated perhaps 25 times. We will never know for certain.

EKG/ECG 75

EKG/ECG CPR Resuscitation Wellness 75

Don't Forget the Bubbles

JANUARY 6, 2025

Reviewed by: Mikaeel Jaffer Article 2: Does the duration of pre-hospital CPR affect neurological outcomes? Yasuda M, Amagasa S, Kashiura M, et alDuration of prehospital and in-hospital cardiopulmonary resuscitation and neurological outcome in paediatric out-of-hospital cardiac arrestEmergency Medicine Journal 2024;41:742-748.

Dislocations 59

Dislocations CPR Ultrasounds Resuscitation 59