The Bottom Line

JUNE 19, 2023

In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?

Administration 145

Administration Outcomes Shock 145

The Bottom Line

OCTOBER 18, 2023

In patients with trauma and critical bleeding who require activation of a major haemorrhage protocol, does the empiric administration of 3 pools of cryoprecipitate (6g fibrinogen) within 90 minutes of randomisation (and no more than 3 hours after injury) improve survival, compared to standard care?

Administration 140

Administration Operations Resuscitation 140

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. Some clinicians have advocated for early administration of 4-factor. Severe acute traumatic coagulopathy = PT >1.5

Administration 135

Administration Outcomes Resuscitation Radiology 135

Emergency Medicine News

DECEMBER 31, 2023

An abstract is unavailable.

Administration 105

Administration 105

Life in the Fast Lane

JUNE 12, 2024

Case study and review of dose, administration and indication for GTN nebuliser administration Kane Guthrie Nebulised GTN in the ED Nebulised GTN in the ED.

Administration 104

Administration 104

RebelEM

FEBRUARY 19, 2024

Historically the administration of vasopressors was restricted to central venous catheters (CVC) due to concerns for local tissue injury resulting from vasoconstriction if extravasation occurred from a peripheral IV. Peripheral Administration of Norepinephrine: A Prospective Observational Study. Paper: Yerke JR et al. CHEST 2024.

Administration 132

Administration Sepsis EMS Shock 132

EMCrit

JUNE 17, 2024

BSI is distinct from traditional rapid sequence intubation (RSI), since BSI involves the delivery of machine-initiated, pressure-controlled breaths following administration of sedation and paralytics. […] EMCrit Project by Josh Farkas.

Administration 124

Administration 124

The Trauma Pro

JANUARY 28, 2025

This is a decision that you and your hospital administration will have to work out. The average cost of a course of treatment in 2023 was $26,787 (ref 6). Can we justify such an expense if it doesn’t seem to save lives? At least until much, much better data comes along.

Administration 189

Administration Outcomes Hospitals 189

EB Medicine

MAY 1, 2024

Strayer, MD, author of the May 2024 Emergency Medicine Practice article, Current Concepts in Ketamine Therapy in the Emergency Department Diving Into Ketamine Use in Emergency Medicine Understanding Ketamine: From Origins to Emergency Use Exploring the Ketamine Brain Continuum Ketamine Dosing and Administration Techniques Combining Ketamine with (..)

Administration 114

Administration Emergency Department 114

Mount Sinai EM

OCTOBER 2, 2023

When to use it: Allows administration of medications/solutions that can potentially damage or sclerose peripheral vessels or cause peripheral damage if they extravasate out of the blood vessel into surrounding tissue. Fluid cannot be administered via the main hub.

Resuscitation 231

Resuscitation Fluid Resuscitation Administration Shock 231

Life in the Fast Lane

SEPTEMBER 3, 2023

Pramod Chandru Network Five: Emergency Medicine Conversations Network Five Emergency Medicine Conversations Episode 24 - an interview with Dr Amith Shetty on medical administration, leadership, and more!

Leadership 98

Leadership Administration Patient Safety Research 98

EM Ottawa

FEBRUARY 15, 2024

Physiology of the rapid sequence intubation Rapid sequence intubation (RSI) is the nearly simultaneous administration […] The post Ketamine and Etimodate: Into the Void appeared first on EMOttawa Blog.

Administration 126

Administration Resuscitation 126

The Skeptics' Guide to EM

NOVEMBER 30, 2024

Multiple studies have demonstrated how the administration of epinephrine can improve short-term outcomes, such as return of spontaneous circulation (ROSC). One critical consideration in prehospital epinephrine administration is the method of vascular access. Epinephrine has long been a cornerstone in the management of OHCA.

Administration 89

Administration CPR Airway Management Outcomes 89

RebelEM

JANUARY 18, 2024

Time to antibiotic therapy (from triage, not from onset of infection) has become a quality metric to improve the time to administration of these medications. Prehospital Administration of Broad-Spectrum Antibiotics for Sepsis Patients: A Systematic Review and Meta-Analysis. Paper: Varney J et al. to 0.97; p = 0.02 to 2.07; p = 0.91

Sepsis 129

Sepsis Hospitals Administration Outcomes 129

Pediatric EM Morsels

SEPTEMBER 22, 2023

Crystalloid may help, but neurogenic shock may not respond to fluid administration. Treatment Cautious crystalloid infusion This can lead to worsening anemia and coagulopathy in polytrauma patients with hemorrhage and may increase spinal cord edema. Alpha 1 agonists are necessary to maintain appropriate blood pressure.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

Pediatric EM Morsels

JULY 19, 2024

Soak the gauze with epinephrine (1:10,000) or TXA (our THIRD route of administration) Apply pressure laterally to the tonsillar fossa with the gauze covered Magill forceps. . < 25 kg = 250 mg up to 3x > 25 kg = 500 mg up to 3x Direct Pressure Always the best way to stop bleeding. Don’t await for fancy meds to arrive from pharmacy.

Airway Management 286

Airway Management Pediatrics Wellness Operations 286

RebelEM

OCTOBER 30, 2023

The optimal approach to fibrinogen administration in massive hemorrhage protocols is unknown. Most major hemorrhage protocols give a balanced transfusion of PRBCs, FFP, and platelets in ratios approaching concentrations found in whole blood. Fibrinogen products may also be needed to stabilize clots and stem bleeding. Paper: Davenport R et al.

Administration 123

Administration Blood Transfusions Outcomes Hospitals 123

The Trauma Pro

DECEMBER 6, 2024

Evidence shows that it is a repository for the gut microbiome, which can help repopulate the colon with bacteria after a serious insult like prolonged antibiotic administration. The appendix is not the useless vestigial structure we initially thought. Unnecessary removal may ultimately interfere with gut health and disease. Sure, at any time.

Operations 147

Operations Administration Wellness 147

Emergency Live

MARCH 1, 2024

This event can occur during treatments such as chemotherapy, administration of contrast fluids, […] The post The Extravasation: An Essential Guide appeared first on Emergency Live.

Administration 98

Administration 98

The Trauma Pro

JANUARY 4, 2024

These criteria have not yet been evaluated prospectively or coupled with the administration of chemoprophylaxis. However, there is much less information available regarding pediatric trauma. High-risk criteria for pediatric VTE after trauma have recently been released. They studied VTE events within 30 days and bleeding complications.

Pediatrics 162

Pediatrics Administration 162

Taming the SRU

DECEMBER 17, 2024

This article serves to briefly discuss IV fluids administration in the ED and the instances where they are not indicated. IV fluid administration was more associated with phlebitis. Considering the nationwide IV fluid shortage, judicious use of fluids is imperative. A systematic review by Freedman et al.

Dehydration 83

Dehydration Fluid Resuscitation Administration Resuscitation 83

The Trauma Pro

DECEMBER 20, 2024

The reversal effect of Andexxa begins to wear off two hours after administration and is gone by four hours. So, we don’t really know how useful it is when treating bleeding after DOAC administration. Unfortunately, it’s much more complicated than that. The half-life of apixaban is even longer, 12 hours.

Head Injuries 113

Head Injuries Administration Hospitals 113

Emergency Live

DECEMBER 20, 2023

An overnight explosion causes death and destruction in the capital of Guinea The Disaster: A Night of Terror In the early hours of December 18, Conakry, the capital of Guinea, was rocked by a powerful explosion followed by a devastating fire at the main fuel depot of the Guinean Petroleum Company, located in the administrative […] The post Conakry, (..)

Administration 105

Administration 105

RebelEM

JUNE 8, 2023

The retrospective design of this study omitted assessment of ventricular dysrhythmias related to push dose pressor administration, as they were reliant on information in the EMR. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 97

Administration Emergency Department Outcomes Documentation/Coding 97

Science Based Medicine

FEBRUARY 14, 2024

I have seen first hand how one or a few true believers can promote so-called alternative medicine at their institutions, meeting little resistance from colleagues and administrators […] The post Mayo Clinic Promotes Reiki first appeared on Science-Based Medicine.

Administration 104

Administration 104

Total Medical ComplianceHIPAA

DECEMBER 16, 2024

Disclosures for judicial and administrative proceedings. Disclosures for law enforcement purposes. Disclosures about decedents to coroners and medical examiners.

Administration 105

Administration Operations 105

Taming the SRU

FEBRUARY 7, 2024

For blood product administration, PROPPR showed that 1:1:1 platelet, plasma, and pRBC administration led to earlier hemostasis along with less death due to blood loss and whole blood compared to separate blood product administration led to decreased death at 24 hours.

Administration 98

Administration PPE Ultrasounds Poisoning 98

ALiEM

MARCH 5, 2024

Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. The Aspirin Story – from Willow to Wonder Drug. British Journal of Haematology. 2017;177(5):674-683. PMID: 28106908. Schmid B, Kötter I, Heide L.

Hyperthermia / Hypothermia 114

Hyperthermia / Hypothermia Anaphylaxis Poisoning Administration 114

Emergency Live

JANUARY 30, 2024

Italy Witnesses Significant Progress in the Fight Against Cancer The mRNA Vaccine Revolution In a significant breakthrough in the battle against melanoma, Italy has witnessed the administration of the first dose of an innovative mRNA vaccine.

Administration 98

Administration 98

PDC Healthcare

JUNE 8, 2023

Food and Drug Administration (FDA) published updates to their mammography regulations to facilitate better reporting of information and an improved experience for patients. In March of 2023, the U.S.

Administration 98

Administration Patient Safety 98

Emergency Live

JANUARY 12, 2024

Specific training for the type of […] The post The path to becoming a rescue helicopter pilot appeared first on Emergency Live.

Administration 98

Administration EMS 98

ACEP Now

OCTOBER 13, 2023

An official reason for the closure was not immediately available from the hospital administration, but residents there said they were told the surprise move was likely because of financial reasons. “We

Patient Safety 132

Patient Safety Administration Emergency Department EMS 132

The Trauma Pro

SEPTEMBER 15, 2023

Many centers have adopted 2-3 days to delay administration of low molecular weight heparin in patients with solid organ injury. The AAST initiated a prospective multi-institutional trial comparing early ( < 48 hours after admission) and late (>48 hours) administration of prophylactic agents.

Administration 113

Administration Fractures Wellness 113

PulmCCM

NOVEMBER 7, 2024

For out-of-hospital cardiac arrest in particular, intravenous access can be difficult to establish, delaying the administration of epinephrine and other drugs and possibly worsening outcomes. During cardiac arrest, every second matters (at least potentially).

Resuscitation 98

Resuscitation Administration Hospitals Outcomes 98

EMDocs

NOVEMBER 6, 2023

Naloxone administration may reverse respiratory arrest, preventing progression to cardiac arrest. Standard advanced life support with the addition of administration of sodium bicarbonate is appropriate for the treatment of life-threatening dysrhythmias caused by cocaine or other sodium channel blockers. COR 2a, LOE B-NR.

Poisoning 101

Poisoning Hyperthermia / Hypothermia Seizures Administration 101

First 10 EM

OCTOBER 15, 2023

One of those trials – CRYOSTAT-2 – was just published, and adds important information about the role of empiric fibrinogen administration (in the form of cryoprecipitate) in trauma patients. In the massive hemorrhage deep dive, I mentioned that there were a number of large trials in the works that would further define practice.

Administration 95

Administration EMS 95

Emergency Live

AUGUST 30, 2023

With the recent update from the National Oceanic & Atmospheric Administration (NOAA) indicating an […] The post How Drones Are Revolutionizing Disaster Response in the Caribbean appeared first on Emergency Live.

Administration 95

Administration 95