EMDocs

FEBRUARY 20, 2024

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. Question:In adults with acute pancreatitis, does moderate fluid resuscitation compared to aggressive resuscitation reduce the development of moderately severe or severe pancreatitis? 2023 Mar 22;27(1):122. N Engl J Med. 2022 Sep 15;387(11):989-1000.

Fluid Resuscitation 83

Fluid Resuscitation Resuscitation Outcomes Hospitals 83

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. In January, Dutch investigators published results of the INCEPTION trial, in which extracorporeal cardiopulmonary resuscitation (CPR) or conventional CPR (standard advanced cardiac life support) were compared. odds ratio, 1.4;

CPR 45

CPR Shock Outcomes Resuscitation 45

EMDocs

NOVEMBER 29, 2023

2023 May 25;388(21):1931-1941. Included 584 patients > 18 years admitted to ICU with severe PNA based on IDSA/ATS criteria Primary Outcome: 60-day all-cause mortality Hydrocortisone 16% vs. placebo 18%, adjusted OR 0.90 (95% CI 0.57-1.40) 2023 Jul 8;27(1):274. 2023 May 31;27(1):212. #4: Resuscitation.

Outcomes 80

Outcomes Resuscitation EKG/ECG 80

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 102

Resuscitation Administration Emergency Department Hospitals 102

EMDocs

AUGUST 5, 2023

Spoon Feed A full-body CT protocol in resuscitated adults with out of hospital cardiac arrest (OHCA) more often – and more quickly – found the cause of arrest than standard of care CT but did not improve neurologically intact survival. Resuscitation. 2023 Jul;188:109785. Epub 2023 Apr 3. #2: 2023.109785.

Resuscitation 64

Resuscitation Outcomes Hospitals 64

EMDocs

JANUARY 13, 2024

Spoon Feed High-dose nitroglycerin improves outcomes in patients with sympathetic crashing acute pulmonary edema (SCAPE) without significant side effects when compared to low-dose nitroglycerin. 2023 Nov 28:emermed-2023-213285. doi: 10.1136/emermed-2023-213285. 2023 Nov 28:emermed-2023-213285. Emerg Med J.

Stroke 62

Stroke Shock Pediatrics Resuscitation 62

RebelEM

AUGUST 21, 2023

In response to this critical issue, the TAME Cardiac Arrest Trial has been launched as a definitive phase III multi-center randomized controlled trial for resuscitated cardiac arrest patients. Epub 2023 Jun 15. Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest. N Engl J Med.

Hospitals 97

Hospitals Resuscitation Outcomes CPR 97

Pediatric EM Morsels

SEPTEMBER 22, 2023

While we may allow permissive hypotension in damage control resuscitation of hemorrhagic shock, in neurogenic shock you should maintain an age-appropriate blood pressure. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. 5 th Edition. Neurogenic Shock. 2018.14.2.47.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

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. Banc-Husu, 2023 ] Cholestastis Inflammatory conditions Genetic and Metabolic diseases Pediatric cirrhotic liver disease has many complications. 2023 Feb;43(1):100-116. Keep patient comfortable.

Pediatrics 152

Pediatrics Head Injuries Airway Management Administration 152

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% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% The benefits of this strategy may be outweighed by the risk of the device-related complications (i.e.

Shock 133

Shock Outcomes Resuscitation Stroke 133

The Skeptics' Guide to EM

MARCH 11, 2023

Date: March 8, 2023 Reference: Smida et al. A Retrospective Nationwide Comparison of the iGel and King Laryngeal Tube Supraglottic Airways for Out-of-Hospital Cardiac Arrest Resuscitation. Date: March 8, 2023 Reference: Smida et al. Case: A paramedic crew responds to a 54-year-old male in cardiac arrest at a private residence.

Airway Management 52

Airway Management Basic Life Support CPR Resuscitation 52

EMDocs

NOVEMBER 29, 2023

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. Question:In adults with acute pancreatitis, does moderate fluid resuscitation compared to aggressive resuscitation reduce the development of moderately severe or severe pancreatitis? 2023 Mar 22;27(1):122. N Engl J Med. 2022 Sep 15;387(11):989-1000.

Fluid Resuscitation 66

Fluid Resuscitation Resuscitation Outcomes Hospitals 66

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

The Trauma Pro

OCTOBER 6, 2023

At the time, there was a debate about whether the procedure should be done immediately versus waiting until the patient was well-resuscitated. Although many of these injuries were managed within hours, a growing number were delayed by a few days to improve outcomes. 2023 Jun 28;15(6):e41078. Ann Surg 278:e848-e854, 2023.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

Emergency Medicine Journal

JUNE 20, 2024

The CRYOSTAT-2 randomised controlled trial (RCT), published in JAMA 1 in October 2023, is the largest transfusion trial to date in major trauma haemorrhage. 2 The primary outcome of all-cause mortality at 28 days was the same in both arms (26.1% vs 25.3%), with no difference in transfusion requirements or safety outcomes.

Administration 40

Administration Resuscitation Outcomes 40

Critical Care Now

JULY 7, 2024

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. 2023;e2320850. Reading Time: 3 minutes Jansen JO, Hudson J, Cochran C, et al.

Resuscitation 52

Resuscitation Military Outcomes Hospitals 52

EMDocs

SEPTEMBER 7, 2024

Laborator evaluation: CBC, CMP, lipase, type and screen, coagulation panel Treatment: 1-3 Resuscitation with blood products as necessary for hemodynamic stability. However, this patient’s response to fluid resuscitation, though only minimal to modest, indicates his ongoing bleeding is temporized with typical volume-mediated resuscitation.

EMS 73

EMS Fluid Resuscitation Resuscitation Radiology 73

JournalFeed

OCTOBER 21, 2023

The JournalFeed podcast for the week of Oct 18-20, 2023. However, they were also associated with a higher rate of adverse outcomes. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.

Sepsis 52

Sepsis Resuscitation Outcomes 52

Pediatric EM Morsels

JULY 28, 2023

The exact mechanism is not known… It was previously believed that it was due to rapid changes in serum osmolality during initial fluid resuscitation. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. or serum bicarbonate between 11-17 mmol/L Moderate : venous pH < 7.2

Fluid Resuscitation 245

Fluid Resuscitation Pediatrics Resuscitation Research 245

The Skeptics' Guide to EM

JUNE 22, 2024

December 2023 Guest Skeptic: Dr. Anireddy Reddy is a pediatric intensive care attending physician in the Department of Anesthesiology and Critical Care Medicine at Children’s Hospital of Philadelphia. Using the term “risk” implies that a negative outcome may or may not happen. While the term “benefits” implies a positive outcome.

Pediatrics 52

Pediatrics Outcomes Emergency Department Resuscitation 52

RebelEM

JULY 24, 2023

Ann Emerg Med 2023. Outcomes: Primary: Postintubation hypotension (SBP < 100 mm Hg) 15 minutes post-intubation. Exclusion: Intubation primarily performed with topical anesthesia, patients with missing data for the primary outcome, patient weight, etomidate/ketamine dose or preintubation hemodynamic status. mg/kg 1.33

Resuscitation 98

Resuscitation Outcomes Emergency Department EMS 98

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. vs SBP target <90mmHg which resulted in a mortality of 33.4%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7% Prehospital Tranexamic Acid for Severe Trauma.

Outcomes 102

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 102

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. The secondary outcome of mortality was not statistically different however numerically favored the early use of norepinephrine. This resulted in better shock control by 6hrs (76.1%

Sepsis 100

Sepsis Shock Resuscitation Outcomes 100

ACEP Now

OCTOBER 3, 2023

In April 2023, the third edition of the Brain Trauma Foundation’s evidence-based guidelines for the prehospital management of traumatic brain injury (TBI) was published in Prehospital Emergency Care. 2,3 TBI outcomes are profoundly linked to the timing and quality of care provided before patients reach the hospital.

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation EMS 98

EMDocs

FEBRUARY 12, 2024

It has been found that using pulse oximetry to obtain the SpO 2 /FiO 2 ratio could help facilitate earlier ARDS recognition as pulse oximetry is more readily available and less time consuming to obtain compared with ABG, and this has been incorporated into the new proposed 2023 definition of ARDS (12). proning patients, ECMO) (12).

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

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

ACEP Now

JUNE 21, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes including successful development of a niche in the specialty. 11 What should we take away?

EMS 114

EMS Academics Telemedicine Research 114

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. 2024 Feb 28:fetalneonatal-2023-326501. doi: 10.1136/archdischild-2023-326501. The primary outcome was the successful intubation on the second attempt. Of the 74.9%

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

RebelEM

AUGUST 7, 2023

This helps relieve agitation/pain while maintaining spontaneous breathing and airway reflexes allowing for adequate pre-oxygenation as well as facilitates other resuscitation interventions including IV access, vasopressors, fluids, etc. Anesth Analg 2023. that would not be possible in an agitated/combative patient.

Head Injuries 98

Head Injuries Outcomes Airway Management Burns 98

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. Clinical Question: Does therapeutic hypothermia provide any benefit in neurobehavioral outcomes and survival in out-of-hospital pediatric cardiac arrest?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics CPR Hospitals 52

Don't Forget the Bubbles

MAY 8, 2024

An interesting study (JAMA Pediatrics) shows the benefits of newborn screening for spinal muscular atrophy (SMA), as initiating disease-modifying therapy earlier improves clinical outcomes. These findings advocate for expanding newborn screening programs to enhance outcomes for children with SMA. 2024 Apr 25:archdischild-2023-326533.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

The Trauma Pro

SEPTEMBER 20, 2023

The primary outcome was mortality, and secondary outcomes included the need for surgery, fluid and blood infusions, and the use of a massive transfusion protocol. AAST 2023 Plenary paper #29. Researchers from the US Army performed a retrospective registry study on a sample of military casualties over four years.

Military 113

Military Blood Transfusions Outcomes Administration 113

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. Obviously, one also needs to address the cause of the shock, or any efforts in resuscitation will only bring a temporary improvement. Treasure Island (FL): StatPearls Publishing; January 30, 2023. After 40ml/kg of IV 0.9%

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Don't Forget the Bubbles

FEBRUARY 5, 2024

Their main outcome measure was the proportion of pictures inconsistent with current safety recommendations. 2024 Jan 12:archdischild-2023-326225. 2024 Jan 23:archdischild-2023-325984. Are sucking patterns and early spontaneous movements related to later developmental functioning outcomes? Anagnostou A, et al. 2024 Jan 13.

Pediatrics 52

Pediatrics Research Resuscitation Outcomes 52

Don't Forget the Bubbles

AUGUST 7, 2023

2023 Mar;59(3):480-486 Who were the patients? The study also did not assess outcomes for each patient, and as such, the impact on deviation from the normal range was not explored. Yes Was the outcome accurately measured to minimize bias? Resuscitation Council UK. cited 2023 Mar 19]. cited 2023 Mar 28].

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

Don't Forget the Bubbles

JUNE 30, 2023

Elsa was found face down in the family pool 20 minutes after last visual contact and was picked up without resuscitation. She was intubated at the scene and transported to your ED, with cardiopulmonary resuscitation (CPR) performed en route. Emergency Medical Services found her apneic and pulseless. C and remained pulseless.

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145