Don't Forget the Bubbles

OCTOBER 18, 2024

Midlines are preferred over routine peripheral cannulas for IV drug administration lasting more than four days. They are not suitable for CT contrast administration. Ensure the guide wire is removed before the line is fixed and sharps are disposed of appropriately. Why do we use midlines in paediatrics?

Administration 89

Administration Pediatrics Ultrasounds Burns 89

RebelEM

APRIL 29, 2024

In cardiac arrest, a delay in IV access subsequently results in a delay in epinephrine administration. Intravenous vs intraosseous adrenaline administration in cardiac arrest: A protocol for systematic review and meta-analysis. Resuscitation. 2012 PMID: 21893125. 9 Zhang W et al. Medicine (Baltimore). PMID: 33350794 10 Meilandt C.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

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. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e. 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

Taming the SRU

JANUARY 1, 2024

Establishing reliable vascular access is absolutely critical for ED patients requiring resuscitation, airway management, or medication administration. Contraindications for USGIV are the same as for any PIV: overlying skin infection, AV fistula in the extremity, previous surgery impacting vasculature, proximal trauma, or burns.

Emergency Department 92

Emergency Department Ultrasounds Administration Burns 92

Taming the SRU

MAY 11, 2024

3% HTS appears to be safe for peripheral IV administration and does not require a central line. The available data does not support any benefit of administration of hyperosmolar therapy in the setting of a TBI. When administered IM, midazolam administration appears superior in terms of time to sedation (Nobay et al.).

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

EMDocs

AUGUST 17, 2023

The study was performed when Surviving Sepsis Campaign Guidelines were used, so it was more common to see large volume fluid administration in the setting of sepsis. vs 48.4% (OR 3.4, 5.53) Takeaways: Positive trial => there was a statistically significant rate of shock control attained with the treatment arm.

Sepsis 86

Sepsis Shock Resuscitation Fluid Resuscitation 86

ALiEM

FEBRUARY 20, 2024

Here is the patient’s EKG after administration of a 300 mEq sodium bicarbonate showing significant improvement of the cardiac sodium channel blockade as evidenced by a narrower QRS complex. Bruccoleri RE, Burns MM. What are other agents that block cardiac socium channels? Acute Card Care. 2013 Dec;15(4):90-2. Epub 2013 Nov 7.

Shock 73

Shock EKG/ECG Poisoning Burns 73

RebelEM

AUGUST 7, 2023

Traditional RSI entails preoxygenation followed by near-simultaneous administration of an induction agent followed by a neuromuscular blocker. Rapid sequence intubation can be modified for patients who are agitated or combative and not tolerating standard preoxygenation.

Head Injuries 96

Head Injuries Airway Management Outcomes Burns 96

EMDocs

NOVEMBER 27, 2023

Progression of systemic disease despite steroid administration can be managed with the addition of IVIG and consideration of plasmapheresis, immunosuppressive agents (cyclophosphamide, cyclosporin, etc.), and/or N-acetylcysteine (NAC).

EMS 91

EMS Sepsis Burns EKG/ECG 91

Don't Forget the Bubbles

FEBRUARY 5, 2025

E.g. burns, neurosurgery, interventional radiology. Excessive IV fluid administration should be avoided due to the risk of acidosis, coagulopathy and electrolyte disturbance – all of which evidence shows significantly increased mortality. What GCS would the administration be recommended for? Stabbings in Adolescents.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

RebelEM

JUNE 26, 2024

Definition: A serum potassium level > 5.5 patients can jump from peaked T waves to sine wave) Management Basics: ABCs, IV, O 2 , Cardiac Monitor and, 12-lead EKG Identify + treat underlying cause of hyperkalemia (i.e. rhabdomyolysis -> hydration) Remove inciting factors (i.e. furosemide) Dialysis for anuric patients (i.e.

EKG/ECG 58

EKG/ECG Administration Burns EMS 58

33 Charts

FEBRUARY 7, 2022

Without the Circle of Safety clinicians burn their emotional energy protecting themselves from an assault of administrative tasks and mushrooming clinical demands. The healthcare world is filled with danger. At any given point there are forces working to corrupt our ability to do our job.

Leadership 52

Leadership Burns Administration Hospitals 52

Don't Forget the Bubbles

JUNE 30, 2023

Tranexamic acid administration to pediatric trauma patients in a combat setting: the pediatric trauma and tranexamic acid study (PED-TRAX). Epub 2019 Oct 14. Erratum in: Lancet. 2019 Nov 9;394(10210):1712. PMID: 31623894; PMCID: PMC6853170. Eckert MJ, Wertin TM, Tyner SD, Nelson DW, Izenberg S, Martin MJ. J Trauma Acute Care Surg.

Head Injuries 145

Head Injuries Seizures Pediatrics Outcomes 145

EMDocs

OCTOBER 25, 2024

Progression of systemic disease despite steroid administration can be managed with the addition of IVIG and consideration of plasmapheresis, immunosuppressive agents (cyclophosphamide, cyclosporin, etc.), and/or N-acetylcysteine (NAC).

Sepsis 91

Sepsis Burns EKG/ECG EMS 91

Critical Care Now

APRIL 21, 2022

Outcomes of sustained low-efficiency dialysis versus continuous renal replacement therapy in critically ill adults with acute kidney injury: a cohort study. BMC Nephrol 2015;16:127.

Burns 52

Burns Administration Outcomes Hospitals 52

RebelEM

MARCH 23, 2023

and IM, and the physician was able to choose the method of administration. This study differed in that the phenobarbital administration was administered in a symptom-triggered protocol as opposed to a bolus. Buell D, Filewod N, Ailon J, Burns KEA. Both groups received symptom-triggered lorazepam per institutional protocol.

Emergency Department 52

Emergency Department Outcomes Burns Hospitals 52

EMDocs

OCTOBER 21, 2023

15 Treatment: Several treatment modalities have been described for BAO, including intravenous thrombolysis (IVT) which involves systemic administration of agents such as TNK or tPA, intra-arterial thrombolysis (IAT) via microcatheter at thrombus site, or mechanical endovascular thrombectomy (EVT). link] Burns JD, Rindler RS, Carr C, et al.

EMS 93

EMS Stroke Outcomes Hospitals 93

Northwestern EM Blog

JANUARY 24, 2022

At those levels, bicarbonate administration has not been shown to improve cardiac output, MAP or pressor response. For example, a patient in cardiogenic shock will likely worsen with the administration of fluids and the wrong vasopressors. A loading dose of 100mg IV should be given, followed by 50mg every 6 hours thereafter.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Dr. Smith's ECG Blog

OCTOBER 26, 2011

In spite of aggressive questioning, he denied chest pain, but he did tell one triage nurse that he had had some chest burning, and so he underwent an ECG: There are deep Q-waves and QS-waves in precordial leads V2-V3, with a bit of R-wave left in V4. He had been awakened by cough at 3 AM 2 days earlier. Circulation 1999;99(15):1972-7.

EKG/ECG 52

EKG/ECG Burns Administration Outcomes 52

SheMD

APRIL 26, 2023

I was way past burned out. Have guest speakers implemented in the curriculum speak about their infertility journey not only to inform both male and female trainees, but to allow trainees who may be suffering in silence feel more empowered to face administration with their struggle and take the mental health break they deserve.

Leadership 52

Leadership Burns Research Administration 52

ACEP Now

AUGUST 9, 2024

This excruciating pain is described by many victims as a continuous burning, tingling, and numbness. Antibiotics are broadly recommended for wounds that appear infected; prophylactic antibiotic administration is contested except with deep punctures, wounds contaminated with material, or those with significant tissue insult.

Poisoning 52

Poisoning Burns Seizures Fractures 52

Sensible Medicine

MAY 31, 2023

Barely thirty years old, and she had just burned her last bridge and had nowhere to go. She had been admitted for worsening suicidal behavior, which was a recurring problem for her, along with her tendency toward wild and rapid swings of mood, reckless impulsivity, and overall difficulty getting along with people.

Psychiatric 95

Psychiatric Hospitals Wellness Military 95

ACEP Now

JULY 7, 2023

She was kept upright until immediately before paralytic administration. Burns B, Habig K, Eason H, Ware S. The non-rebreather was increased to 15 L per minute without initial bag-valve mask assistance due to concern for worsening an already aspirated airway. Ann Am Thoracic Soc. 2017;14(3):368-375. 2016;35(1):28-32.

Airway Management 45

Airway Management EMS Burns Operations 45

The Skeptics' Guide to EM

SEPTEMBER 26, 2020

Case: A 34-year-old male presents to the emergency department with burning epigastric pain after eating two hours ago. Secondary Outcomes: Medication palatability (taste, bitterness, texture, and overall acceptability) using a VAS, change in pain score 60 minutes post administration and adverse events. AEM Sept 2020.

Emergency Department 52

Emergency Department Burns Outcomes Administration 52

Pediatric Emergency Playbook

JANUARY 1, 2017

CRIES is a 10-point scale, using a physiologic basis similar to APGAR: Crying; Requires increased oxygen administration (distress and breath-holding); Increased vital signs; Expression; and Sleeplessness ( Krechel 1995 ). Once the pain is controlled, less frequent administration of medications, with frequent reassessments, are indicated.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

EMDocs

NOVEMBER 4, 2024

21 Case: A 40-year-old male presents to the ED with a burning epigastric pain that has been worsening over the past week. Pain can be gnawing, aching, burning, and located in the upper abdomen. Tension headaches are characterized by bilateral location and mild to moderate intensity. Pain can be improved or exacerbated with meals.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

Sensible Medicine

MARCH 4, 2025

Swedish snus is vastly safer than cigarettes and the FDA recently authorized the sale of heat-not-burn tobacco (HNB), e-cigarettes/vapor, and nicotine pouches as “appropriate for the protection of the public health.” Estimating deaths due to nicotine vaping is difficult, because most vapers are current and former smokers.

CDC 131

CDC Research Documentation/Coding Leadership 131

Taming the SRU

JUNE 6, 2023

Disposition Indications for admission GCS<15, focal neurological deficits, seizures Intractable vomiting Significant Abnormal CT results Discharge criteria Normal GCS, exam Caregiver at home Certain abnormal CT Isolated & non-depressed calvarial skull fractures <1cm diameter of solitary cerebral contusions <1cm width of epidural or (..)

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

EMDocs

JANUARY 20, 2025

Since then, at least three separate meta-analyses 20-22 have found that on the whole, a restrictive fluid administration approach (variously defined) is at least as effective and possibly better than a liberal approach. It may be reasonable to consider IV fluid administration in patients with moderate dehydration or prolonged vomiting.

Dehydration 73

Dehydration Fluid Resuscitation Sepsis Resuscitation 73

EMDocs

FEBRUARY 8, 2025

Routine versus selective antifungal administration for control of fungal infections in patients with cancer. COPD, cystic fibrosis), HIV/AIDS, cancer, immunosuppressed (i.e. million patients with acute IFIs per year globally 3 >1.5 neoformans mortality: 41-61% (2023) 1,3 Invasive Cryptococcus spp. mortality: 42-63% 5 Invasive Candida spp.

Infectious Diseases 65

Infectious Diseases EMS COPD Research 65

Sensible Medicine

MARCH 1, 2025

In 1994, the Federal government capped administrative rates at 26%. Their facilities rate is 43% and the administrative rate is 26%, equaling 69%. It is hard not to conclude that these changes were a slash and burn operation or, more aptly, an operation to remove a nose to spite a face. That cap is still in effect.

Burns 134

Burns Academics Research Operations 134

EMDocs

MARCH 14, 2024

7 During the Trump administration, the Centers for Medicare and Medicaid Services (CMS) approved several Medicaid plan waivers that would allow states (e.g. link] Williams E, Rudowitz R, Burns A. An Overview of Medicaid Work Requirements: What Happened Under the Trump and Biden Administrations? Idaho, Oklahoma, Nebraska).

Administration 99

Administration Outcomes Burns Operations 99