Ken Grauer, MD

DECEMBER 29, 2023

The ECG in Figure-1 — was obtained following successful resuscitation. A DDENDUM ( 12/30/2023 ) : The Audio Pearl below reviews the concept of "shark fin" ST elevation. — — E CG M edia P EARL # 73 ( 5:40 minutes Audio ) — Reviews the concept of " S hark F in" S T e levation and d epression as a sign of extensive acute infarction.

EKG/ECG 430

EKG/ECG Resuscitation Hospitals Wellness 430

Dr. Smith's ECG Blog

JULY 25, 2024

For clarity in Figure-1 — I've reproduced today's ECG — obtained following successful resuscitation of out-of-hospital cardiac arrest. As we have often emphasized on Dr. Smith's ECG Blog ( See My Comment in the March 1, 2023 post) — DSI does not indicate acute coronary occlusion! Figure-1: The initial ECG in today's case. —

Resuscitation 124

Resuscitation EKG/ECG CPR Shock 124

Taming the SRU

DECEMBER 17, 2024

Fluid management in the Emergency Department (ED) is crucial in the adequate resuscitation of the acutely ill and decompensating patient. Patients present to the ED with hypovolemia secondary to a plethora of causessome requiring IV fluid resuscitation and others requiring none. Updated 2023 Oct 22]. Fluid Management.

Dehydration 84

Dehydration Fluid Resuscitation Resuscitation Administration 84

Broome Docs

DECEMBER 9, 2023

2023 Nov 6. 2023 Nov 6. 2023 Oct 12. 2023 Aug;35(4):605-611. 2023 Aug 7:e233264. 2023 May 30:S1538-7836(23)00438-5. 2023 Nov;73:182-186. 2023 Mar 23;388(12):1092-1100. 2023 Jun 13:ciad357. 2023 Jul 1;402(10395):27-40. Roussel M, Teissandier D, Yordanov Y, et al. JAMA Intern Med.

Infectious Diseases 114

Infectious Diseases Emergency Department Stroke Pediatrics 114

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. 5 th Edition.

Shock 304

Shock Pediatrics Dislocations Hyperthermia / Hypothermia 304

Greater Sydney Area HEMS

NOVEMBER 4, 2023

This patient was intubated as part of resuscitation after drowning. This older child had a reduced GCS. The video shows significant regurgitation during laryngoscopy; likely swallowed blood and gastric contents. The airway is contaminated with seaweed, appearing as a green foreign body on laryngoscopy.

Airway Management 144

Airway Management Burns Operations Resuscitation 144

Dr. Smith's ECG Blog

JULY 14, 2023

A 40-something with persistent Ventricular Fibrillation presented after attempted prehospital resuscitation A 40-something with no previous cardiac history presented to the ED in persistent Ventricular Fibrillation after attempted prehospital resuscitation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

Resuscitation 98

Resuscitation EKG/ECG CPR Outcomes 98

ALiEM

NOVEMBER 3, 2023

2023.02.011 , PMID 36967275 Author information Chris Belcher, MD Editor, ALiEM AIR Series Assistant Professor and Assistant Program Director Department of Emergency Medicine University of Kentucky College of Medicine | Twitter | The post ALiEM AIR Series | Trauma 2023 Module appeared first on ALiEM. Ann Emerg Med. 2023;82(1):55-65.

Blood Transfusions 84

Blood Transfusions EMS Emergency Department Resuscitation 84

EMDocs

JANUARY 8, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline Updates for 2023 were just published. 2023 Dec 18. The post 2023 AHA Update on ACLS appeared first on emDOCs.net - Emergency Medicine Education. Circulation. doi: 10.1161/CIR.0000000000001194.

Seizures 98

Seizures Shock CPR Hyperthermia / Hypothermia 98

EMDocs

DECEMBER 1, 2024

2023 Oct 26;15(6):700-716. 2023 Oct 26;15(6):700-716. 2024 Jun 10;14(2):e185-e187. Blanton LS. Murine Typhus: A Review of a Reemerging Flea-Borne Rickettsiosis with Potential for Neurologic Manifestations and Sequalae. Infect Dis Rep. Civen R, Ngo V. Murine Typhus: An Unrecognized Suburban Vectorborne Disease. Clin Infect Dis.

EMS 105

EMS Infectious Diseases Shock Airway Management 105

ACEP Now

JANUARY 5, 2025

3 A three-pronged management approach provides a framework for addressing post-tonsillectomy bleeds: resuscitation, early ENT consultation with transport arrangements, and temporizing measures applied to control bleeding. Published November 2023. Clin Pract Cases Emerg Med. 2021;5(3):1-7. Helman A, Weingart S, Tillmann B.

Airway Management 98

Airway Management Operations Resuscitation Pediatrics 98

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 98

EMS Sepsis Shock Fluid Resuscitation 98

Ken Grauer, MD

SEPTEMBER 21, 2024

He could not be resuscitated. This is because clinicians ( including too many cardiologists ) have trouble accepting the fact that a young patient can have an acute MI ( See case discussion in the January 9, 2023 post in Dr. Smith's ECG Blog — with links at the bottom of this post to a series of more cases illustrating this phenomenon ).

EKG/ECG 296

EKG/ECG Resuscitation Outcomes Hospitals 296

Broome Docs

NOVEMBER 17, 2023

This is another lecture by the always amazing Dr Justin Morgenstern from the series of talks he delivered on his tour of Perth in September 2023. What is the best way to resuscitate and replace all those blood products in these severely unwell people? What is the […]

Resuscitation 130

Resuscitation 130

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. Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 The mortality rate for cerebral edema is 21%–24%.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

EMDocs

NOVEMBER 6, 2023

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. This post will focus on the key parts of the guideline that affect ED evaluation and management. COR 1, LOE C-LD.

Poisoning 115

Poisoning Hyperthermia / Hypothermia Seizures Administration 115

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 154

Pediatrics Head Injuries Airway Management Resuscitation 154

PulmCCM

DECEMBER 11, 2023

Read in NEJM ECMO provided no detectable benefit when applied to patients failing resuscitations from out-of-hospital cardiac arrests due to ventricular arrhythmias. INCEPTION trial ) Targeted mild hypercapnia did not improve neurologic outcomes in patients resuscitated from out-of-hospital cardiac arrest (OHCA).

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

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 Skeptics' Guide to EM

JUNE 15, 2024

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. You initiate standard, simultaneous assessment and resuscitation following the Advanced Trauma Life Support (ATLS) principles. Reference: Jansen et al.

Resuscitation 119

Resuscitation Patient Safety Operations Emergency Department 119

EMDocs

MARCH 18, 2025

Resuscitate prior to intubation. A 2023 RCT evaluated 100 stable patients with hemoptysis receiving TXA 500 mg IV or nebulized 3 times per day.Hemoptysis cessation at 30 minutes in 72.7% 2023 May;163(5):1176-1184. Avoid HOP killers: hypotension, hypoxemia, acidemia. of the nebulized-TXA arm vs 50.9% of the IV-TXA arm.

COPD 81

COPD Radiology Radiology PPE 81

The Skeptics' Guide to EM

JANUARY 13, 2024

Resuscitation 2023. Resuscitation 2023. Your EMS agency has equipped you with small-volume adult bag-valve masks (BVMs), the first responders have been utilizing a standard adult BVM thus far during the resuscitation. Your partner asks you which of the two BVMs you should use to continue the resuscitation.

Hospitals 109

Hospitals CPR Resuscitation Airway Management 109

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. AAST 2023, Plenary paper #28. Here’s another abstract with a promising title that suffers from low subject numbers.

Resuscitation 113

Resuscitation Outcomes 113

RebelEM

NOVEMBER 30, 2023

This systematic review and meta-analysis attempts to elucidate whether a more conservative fluid resuscitation approach is warranted in volume sensitive sepsis patients, such as those with congestive heart failure (CHF). Am J Emerg Med. 2023;73:34-39. What They Did: Researchers performed a systematic review and meta-analysis. Am J Emerg Med.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

RebelEM

JUNE 1, 2023

Resus 2023. Population: Patients successfully resuscitated from OHCA without a clear diagnosis on presentation who were stable for CT. Costs include actual cost of the scans as well as delaying other patients’ scans but also includes time taken away from resuscitation to move the patient to and from CT. Resus 2023.

Outcomes 145

Outcomes Resuscitation CPR Hospitals 145

EMDocs

JANUARY 25, 2025

Management is directed based on underlying etiology, but consider fluid resuscitation, antipyretics, and antibiotics as indicated. 0000000000000305 Kazumi Y (2023) The Epidemiology and Outcomes of Leukopenia in Different Populations and Regions. Updated 2023 Aug 23]. Dale DC, Bolyard AA. Curr Opin Hematol. 2017;24(1):46-53.

EMS 95

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 95

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. Crit Care 2023. septic shock). Limited, small studies on its use in septic shock do not make a clear argument for use. 95% CI 15.4 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

EMDocs

FEBRUARY 24, 2024

Epub 2023 Nov 3. #2: Spoon Feed Trauma patients who were resuscitated with whole blood compared to component therapy had improved 24-hour mortality and a decrease in the total amount of blood products needed for resuscitation. Epub 2023 Oct 4. #3: Am J Emerg Med. 2024 Jan;75:137-142. doi: 10.1016/j.ajem.2023.10.049.

Resuscitation 98

Resuscitation EKG/ECG 98

RebelEM

FEBRUARY 24, 2025

Mar 2023; PMID: 36983218 Feissel M, et al. Apr 2023; PMID: 37009935. lactate-targeted fluid resuscitation on regional, microcirculatory and hypoxia-related perfusion parameters in septic shock: a randomized controlled trial. Mar 2024; D erangedphysiology.com. Di Nicol P, et al. J Clin Med. Intensive Care Med. Muller L, et al.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

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

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. 2023 Jun 28;15(6):e41078. Ann Surg 278:e848-e854, 2023. This was a big procedure, with the possibility of several major complications, with postop paraplegia being one of them.

Head Injuries 147

Head Injuries Research Hospitals Resuscitation 147

EMDocs

APRIL 20, 2024

Spoon Feed This external validation compared the 2023 Duke-International Society for Cardiovascular Infectious Diseases Diagnostic (ISCVID) Criteria against various other criteria for diagnosing infective endocarditis (IE) and found the 2023 Duke-ISCVID Criteria had the best test characteristics. Epub 2023 Sep 19. #3:

Infectious Diseases 98

Infectious Diseases Pediatrics Resuscitation Hospitals 98

Intensive Care Network

AUGUST 15, 2023

The post SAS 2023 – 28th October 2023, Sydney appeared first on Intensive Care Network.

Teamwork 52

Teamwork Resuscitation 52

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 89

Resuscitation Outcomes Hospitals 89

Don't Forget the Bubbles

MARCH 31, 2025

2023 Nov;7(1):e002094. doi: 10.1136/bmjpo-2023-002094. Sepsis is a significant cause of mortality in children, and fluid resuscitation is a key treatment strategy. It also emphasizes the need for better fluid management strategies, including early de-resuscitation in high-risk patients. BMJ Paediatr Open. Whats it about?

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

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. Front Physiol 2023, 14:1230654.

Operations 132

Operations Ultrasounds Resuscitation Blood Transfusions 132

Ken Grauer, MD

FEBRUARY 18, 2023

Cardiopulmonary resuscitation was promptly started — but was unsuccessful. Given the rapid rate of AFib — the new bifascicular block ( = RBBB/LPHB ) — and the obvious extensive acute STEMI — it is unfortunate but not surprising that this patient could not be resuscitated.

EKG/ECG 195

EKG/ECG Resuscitation Wellness 195