EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Be careful with excessive medication administration.

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation CPR EMS 84

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. Sodium bicarbonate administration will increase the pH. *

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52

Taming the SRU

FEBRUARY 12, 2024

HISTORY OF PRESENT ILLNESS A female in her 30s arrives to the emergency department via emergency medical services. She arrives in the emergency department agitated and unable to answer questions appropriately. This does not deviate from general resuscitation principles for acute hemorrhage.

Administration 78

Administration Fractures Anaphylaxis Head Injuries 78

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

EMDocs

SEPTEMBER 7, 2023

2 Laboratory assays for DEG are not widely available and have long turn-around-times, thus have limited utility in diagnosis in the emergency department. 2 Administration of an alcohol dehydrogenase (ADH) inhibitor, such as fomepizole, is recommended in suspected or known DEG poisoning. JAMA , vol. 15, 15 Apr.

Poisoning 66

Poisoning CDC Administration Emergency Department 66

Taming the SRU

JULY 2, 2023

End-Tidal CO2 monitoring has a variety of uses in the Emergency Department. An abrupt increase in end-tidal is an indicator of the return of spontaneous circulation (however this can also represent recent administration of bicarbonate). Capnography in the emergency department: a review of uses, waveforms, and limitations."

Emergency Department 86

Emergency Department Pediatrics CPR Administration 86

The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Guest Skeptic: Dr. Max Hockstein trained as an Emergency Medicine physician at University of Texas Southwestern and is finishing his Intensive Care fellowship at Emory. Case: It’s another day in your emergency department (ED).

Sepsis 52

Sepsis Shock Resuscitation Outcomes 52

Northwestern EM Blog

MAY 9, 2022

There is no gold standard with respect to its definition, and it requires a medication history (which we typically don't do very well in the emergency department). Therefore, fluid resuscitation and maintenance are important. NMS is hard to diagnose because it's rare. A tricky cause of NMS is the removal of a dopamine agonist.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Administration 52

EMDocs

JANUARY 17, 2024

When emergency medical services (EMS) arrived, she was in asystole with an empty, recently full, bottle of benzonatate 100 mg capsules. She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). Upon ED arrival, she had a heart rate (HR) of 160 and blood pressure (BP) of 80s/40s.

Poisoning 67

Poisoning Seizures Pediatrics EMS 67

EB Medicine

SEPTEMBER 1, 2018

Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

The Skeptics' Guide to EM

JANUARY 25, 2020

His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. Case: A 60-year-old male is […] The post SGEM#281: EM Docs Got an AmbuBag – The PreVent Trial first appeared on The Skeptics Guide to Emergency Medicine. He has worsening work of breathing and a decreasing level of consciousness.

EMS 40

EMS Airway Management Administration Resuscitation 40

EB Medicine

AUGUST 6, 2019

Make sure to get the name, dose, and time of last administration of any DOAC. Jeff: For all agents, regardless of the DOAC, the initial resuscitation follows the standard principles of hemorrhage control and trauma resuscitation. Nachi: Extremely important to identify DOAC use early. Nachi: So I think that rounds out testing.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

ACEP Now

MARCH 6, 2024

The PATCH-Trauma trial took a critical look at TXA in major trauma in the advanced trauma systems of Australia and found a mixed result: a slightly greater number of patients were still alive six months following TXA administration, but there was no difference in survival with a good functional outcome. N Engl J Med. 2023;389(2):127-136.

Research 52

Research Airway Management Stroke Outcomes 52

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Case: You’re working a shift in a rural emergency department when a 68-year-old man presents with a two-day course of worsening cough, shortness of breath, and fever. In acutely ill adults, this same concept is not yet as widespread and liberal administration is still common place. This is Bob’s ninth visit to the SGEM.

Administration 52

Administration Poisoning Hospitals Outcomes 52

Don't Forget the Bubbles

JULY 3, 2023

This time we have our first group of colleagues from Birmingham Children’s Hospital Emergency Department. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Am J Hematol.

Emergency Department 105

Emergency Department Hospitals Domestic Violence Pediatrics 105

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Guest Skeptic: Dr. Rory Spiegel (@EMNerd_) is a clinical instructor at University of Maryland, a recent graduate of Stony Brook’s Resuscitation Fellowship, and a current Critical Care fellow at University of Maryland. Over the course of his emergency department stay he has escalating vasopressor requirements. NEJM January 2018.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

The Skeptics' Guide to EM

FEBRUARY 17, 2018

It has been reported that over half of patients with sepsis arrive to the emergency department via ambulance [1]. There are studies showing that early recognition and prehospital administration of antibiotics are associated with increased survival rates [2-4]. Reference: Alam N et al.

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

Taming the SRU

JANUARY 1, 2024

Establishing reliable vascular access is absolutely critical for ED patients requiring resuscitation, airway management, or medication administration. IOs can be used both for resuscitation, medication administration, and for laboratory testing, but there are a few important considerations. Ann Emerg Med.

Emergency Department 90

Emergency Department Ultrasounds Administration Burns 90

EMDocs

JUNE 7, 2023

Case Follow-up: The patient required benzodiazepine administration for seizure management and subsequent intubation for airway protection. Further management and resuscitation were required, and she had a lengthy ICU stay of 21 days until she was extubated. She is speaking one word at a time and constantly coughing. BMC Res Notes.

Poisoning 83

Poisoning Airway Management Seizures PPE 83

RebelEM

SEPTEMBER 29, 2022

Background: Standard emergency department management of acute pancreatitis has focused on aggressive hydration, analgesia and investigation for an underlying reversible cause (eg gallstones). Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Article: de-Madaria E et al.

Administration 52

Administration Fluid Resuscitation Resuscitation Outcomes 52

EMDocs

JULY 17, 2023

3,14 There are currently no good studies of enteric or rectal contrast administration in the evaluation of LBO and there are no society recommendations for its use. Bowel perforation demonstrated by CT, hard signs of peritonitis, or an overall toxic appearance warrant emergent surgical consultation.

Operations 77

Operations EMS Fluid Resuscitation Resuscitation 77

RebelEM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). Amiodarone versus digoxin for acute rate control of atrial fibrillation in the emergency department. Am J Emerg Med. Am J Emerg Med. 2022 Sep 7.

Emergency Department 52

Emergency Department Administration EMS Dehydration 52

Northwestern EM Blog

JULY 15, 2024

Edmonson and Adler for this infographic that concisely emphasizes key concepts for the recognition and initial management of acute respiratory distress syndrome (ARDS) in the Emergency Department. Initial Resuscitation in ARDS [NUEM Blog. 2024, Jul 15). Expert Commentary by Esposito, AJ.

Resuscitation 98

Resuscitation Emergency Department Burns Sepsis 98

EMDocs

JANUARY 29, 2024

Introduction: Neurologic emergencies are common in the Emergency Department (ED), and blood pressure management is critical to immediate management. hypertensive emergency, need for thrombolytic administration) [1]. His blood pressure (BP) is 220/120 mmHg.

Stroke 73

Stroke Outcomes EMS Seizures 73

Don't Forget the Bubbles

NOVEMBER 29, 2023

You are the Paediatric doctor on call and receive a call for an incoming patient to the emergency department. Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. Pediatric Endotracheal Intubations for Airway Management in the Emergency Department.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. 2022 Aug 27;14(8):e28481.

Ultrasounds 82

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 82

ACEP Now

JULY 7, 2023

Otolaryngology (ENT) was emergently consulted and the patient was brought to a resuscitation bay because of worry concerning possible aspiration secondary to posterior epistaxis, requiring further airway stabilization. She was kept upright until immediately before paralytic administration. Acad Emerg Med. BioMed Res Int.

Airway Management 59

Airway Management EMS Burns Administration 59

EMDocs

JUNE 12, 2024

Calcium and resuscitation Severely injured trauma patients are commonly hypocalcemic. Giancarelli et al found that 97% of patients who underwent massive transfusion protocols during trauma resuscitation were hypocalcemic (iCa < 1.1 Prehospital Ca administration reduces risk of hypoCa on arrival (70% vs. 28%). Am J Emerg Med.

Hyperthermia / Hypothermia 89

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 89

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 98

Administration Emergency Department Outcomes Documentation/Coding 98

Broome Docs

MARCH 28, 2024

A non-inferiority randomized controlled trial comparing nebulized ketamine to intravenous morphine for older adults in the emergency department with acute musculoskeletal pain. Resuscitation. Peripheral Administration of Norepinephrine: A Prospective Observational Study. Kampan S, Thong-On K, Sri-On J. Age Ageing.

PPE 107

PPE Ultrasounds Resuscitation Administration 107

EM Updates

JUNE 15, 2021

Maimonides Medical Center (MMC) is Brooklyn’s largest hospital, an academic quaternary care center with, in normal times, 711 total beds, 66 intensive care beds, and an Emergency Department that treats approximately 120,000 patients per year. and Emergency Medicine residents, in 12 hour shifts.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Dr. Smith's ECG Blog

MAY 19, 2020

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). The gold standard technique for diagnosing coronary spasm is administration of high-dose intracoronary acetylcholine boluses with the response evaluated by invasive contrast angiography.

CPR 52

CPR EKG/ECG Shock Ultrasounds 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

SEPTEMBER 25, 2023

Introduction: Since the late 1990s, RSI has been the gold standard of emergency intubations (5). First described in 1970, RSI with the near-simultaneous administration of a sedative agent and NMBA has been shown to have increased first-pass success compared with intubation facilitated by a sedative alone (6,7). Int J Emerg Med.

Emergency Department 65

Emergency Department Soft Tissue Injuries Operations Airway Management 65

RebelEM

JULY 17, 2023

Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of an induction agent and a neuroblocking agent in quick succession. appeared first on REBEL EM - Emergency Medicine Blog.

Outcomes 97

Outcomes Administration Emergency Department Resuscitation 97

The Skeptics' Guide to EM

JUNE 18, 2022

Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. first appeared on The Skeptics Guide to Emergency Medicine. Date: June 18th, 2022 Reference: Crombie et al. What do you advise him?

Shock 40

Shock Resuscitation Administration Emergency Department 40

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. There is a subset of patients who, despite aggressive conventional resuscitation, have an inadequate hemodynamic response and develop refractory shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52