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. Crit Care 2023. septic shock). Limited, small studies on its use in septic shock do not make a clear argument for use. Paper: Ibarra-Estrada, M et al. 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

The Trauma Pro

SEPTEMBER 21, 2023

Whole blood is the new darling of trauma resuscitation. Assembling a unit of whole blood from the components it was broken down into produces an inferior product from the standpoint of resuscitation. Reference: Whole blood on the scene of injury improves clinical outcome of the bleeding trauma patient.

Resuscitation 113

Resuscitation Outcomes 113

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 135

Administration Outcomes Resuscitation Radiology 135

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 130

Shock Outcomes Resuscitation Stroke 130

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

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

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 94

Fluid Resuscitation Resuscitation Outcomes Hospitals 94

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.

Resuscitation 85

Resuscitation Outcomes EKG/ECG 85

EM Ottawa

NOVEMBER 27, 2023

2023 Oct 12:e2320850. Methodology: 2/5 Usefulness: 2/5 Jansen JO, et al. Editorial: Contemporary Adjuncts to Hemorrhage Control.

Emergency Department 58

Emergency Department Resuscitation Outcomes 58

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. Resuscitation. Resuscitation. Resuscitation. Resuscitation. Accessed June 16, 2023.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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 73

Resuscitation Outcomes Hospitals 73

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 88

Hospitals Resuscitation Outcomes CPR 88

Broome Docs

MARCH 28, 2024

doi: 10.1136/emermed-2023-213285. 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. 2023 Sep 21:ciad571. 2023 Sep 19:S0196-0644(23)00671-6. Resuscitation. 2023 Dec;193:109991. Emerg Med J.

PPE 96

PPE Ultrasounds Resuscitation Administration 96

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.

Blood Transfusions 104

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 104

RebelEM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. 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.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

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 77

Fluid Resuscitation Resuscitation Outcomes Hospitals 77

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

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 70

Stroke Shock Pediatrics Resuscitation 70

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 Operations 114

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 95

Sepsis Shock Resuscitation Outcomes 95

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. Background Early recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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

ACEP Now

MARCH 6, 2024

The Sisyphean task remains to try to keep up—and, in that vein—here is a light round of the emergency medicine literature from 2023. 4 Repeated trials have not shown alteplase to have any signal of better outcomes, nor tenecteplase to have an association with increased adverse events. How Best to Stop the Bleeding in Trauma?

Research 52

Research Airway Management Stroke Outcomes 52

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.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

RebelEM

JULY 17, 2023

Click here for Direct Download of the Podcast Paper: Knack SKS et al. The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum SOFA Score: A Randomized Clinical Trial.

Outcomes 90

Outcomes Administration Emergency Department Resuscitation 90

RebelEM

OCTOBER 2, 2023

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. Acad Emerg Med 2023. No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 Paper: Griffey RT et al. tests/hr (0.8 Traditional: 1.0

Operations 93

Operations Academics Outcomes Fluid Resuscitation 93

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 94

Head Injuries Airway Management Outcomes Burns 94

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

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 87

EMS Fluid Resuscitation Resuscitation Radiology 87

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". Resuscitative attempts were initiated quickly. There is ischemic ST depression in V4-V6. This is diagnostic of ACS; it appears to be a reperfused acute inferior OMI.

EKG/ECG 138

EKG/ECG Resuscitation CPR Emergency Department 138

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 Administration Outcomes 113

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

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 44

CPR Shock Outcomes Resuscitation 44

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

RebelEM

SEPTEMBER 23, 2024

You decide to intubate the patient after resuscitation. Proponents of its use often dismissed this effect of the drug as there had never been any evidence it impacted clinical outcomes. The Effect of Ketamine on Intracranial and Cerebral Perfusion Pressure and Health Outcomes: A Systematic Review. Intensive Care Med.

EMS 65

EMS Outcomes Resuscitation Wellness 65

EMDocs

JANUARY 11, 2025

If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. May 18, 2023) Stercoral Colitis: A Diagnostic Challenge and Therapeutic Approach in an Elderly Patient With Chronic Constipation. 2023 Oct;48(10):3050-3062. Epub 2023 Jun 27.

EMS 88

EMS Sepsis Shock Fluid Resuscitation 88

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