EMDocs

JUNE 29, 2024

Resuscitation. 2: Nebulized vs IV Sub-dissociative Ketamine for Pain Spoon Feed Ketamine has been shown to be efficacious in managing acute pain conditions in the emergency department (ED), and this study showed equal efficacy between nebulized and intravenous administration of sub-dissociative ketamine (IV-SDK). . #2:

Shock 94

Shock Emergency Department Resuscitation Administration 94

ALiEM

JULY 22, 2023

You have a severely dehydrated patient with a peripheral IV line, requiring urgent fluid resuscitation. You can not seem to find your pressure infusion cuff to squeeze the IV bag and accelerate fluid administration. However, the crystalloid fluids are not flowing freely. The fluids should flow more rapidly with gravity alone.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Emergency Department Resuscitation 96

The Trauma Pro

AUGUST 15, 2023

Two sets of documentation are crucial: accurate records of blood product administration (on the trauma flow sheet), and documentation of just about everything else (in the blood bank). In the emergency department, the surgeon or emergency physician can do this. Coolers get delivered, products get transfused.

Documentation/Coding 130

Documentation/Coding Best Practices Resuscitation Emergency Department 130

The Trauma Pro

JUNE 30, 2023

Typically, hospital administrators pressure trauma programs to adopt an eTFS at some point after implementing the hospital-wide use of an electronic health record (EHR). Epic Systems became the first, and hospital administrators eventually became aware of it. The biggest question is, why does your hospital want you to use it?

Hospitals 100

Hospitals Administration Resuscitation Best Practices 100

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

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 Dehydration EMS 52

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

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 Emergency Department Resuscitation Administration 97

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 81

Administration Fractures Anaphylaxis Head Injuries 81

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 Administration 52

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

PHEM Cast

APRIL 10, 2016

It is worth noting, that with “Sepsis 3” many of these terms will become out-of-date – but validation work is required… The Rivers’ paper can be accessed here: [link] It was a single centre study which compared standard care with protocolised resuscitation packaged together as early goal-directed therapy (EGDT).

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

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

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.

Poisoning 52

Poisoning Administration Hospitals Sepsis 52

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

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

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

Don't Forget the Bubbles

OCTOBER 2, 2024

A previously well 6-year-old boy is brought into the emergency department at a major trauma centre via HEMS following a road traffic accident, in which he was hit by a car while crossing the road. No studies involving mannitol administration met the foundation’s inclusion criteria. A full primary survey is carried out.

Administration 49

Administration Pediatrics Outcomes Research 49

Taming the SRU

APRIL 10, 2023

HOSPITAL COURSE The patient was initially found to be hypotensive in the Emergency Department with a blood pressure of 87/58 mmHg. Patient remained hypotensive after fluid resuscitation and was admitted to the CVICU for management. J-point elevation in leads I, II, III, aVF, V5, V6. Lab workup was remarkable for a troponin of 0.10

EKG/ECG 52

EKG/ECG Fluid Resuscitation Administration Emergency Department 52

RebelEM

DECEMBER 19, 2022

trying harder and longer knowing they are enrolled in this study) Use of two different models of defibrillators may negatively impact the internal validity of this pilot study Certain baseline characteristics were not balanced, such as: prehospital intubation and Epinephrine administration. N Engl J Med.

EMS 52

EMS CPR Shock Resuscitation 52

EM Literature of Note

JANUARY 9, 2022

Saline Solution on Mortality in Critically Ill Patients No patient-oriented difference in outcomes regardless of fluid choice, although resuscitation volumes were not excessive. link] Outpatient Management of Patients Following Diagnosis of Acute Pulmonary Embolism Of the few low-risk patients with PE managed as outpatients in the U.S.,

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 40

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 98

Stroke Outcomes EMS Seizures 98

Pediatric Emergency Playbook

AUGUST 1, 2017

One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain. Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. Ann Emerg Med. Pediatrics.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

SEPTEMBER 5, 2024

Am J Emerg Med. Children with complex medical conditions are at higher risk of morbidity and mortality, and this may be compounded by inaccurate weight estimation and leading to inaccurate medication dose administration. 2024 Aug;82:26-32. doi: 10.1016/j.ajem.2024.04.053. 2024.04.053. Epub 2024 May 3. PMID: 38759251. What’s it about?

Ultrasounds 52

Ultrasounds Research Emergency Department Outcomes 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

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 45

Airway Management EMS Burns Operations 45

Don't Forget the Bubbles

NOVEMBER 1, 2023

This month, Bubble Wrap has teamed up with Sheffield Children’s Hospital Emergency Department to have a look at what’s new in paediatric literature. This is not always feasible in an acute resuscitation scenario. Lactate as a screening tool for critical illness in a pediatric emergency department.

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

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 Burns Emergency Department Sepsis 98

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

ACEP Now

APRIL 9, 2025

CDPH still insists that following the Food and Drug Administrations (FDA) package insert is the gold standard when it comes to medical practice. Dr. Seng has been a practicing Emergency Medicine physician for 12 years and works at several community and academic departments across Central California. Food and Drug Administration.

Emergency Department 52

Emergency Department Administration EKG/ECG Resuscitation 52

EMDocs

DECEMBER 6, 2024

In 1997, the Food and Drug Administration (FDA) mandated unit-dose packaging for all iron-containing products with more than 30 milligrams of elemental iron. Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. Basic assessment: airway, breathing, circulation. Antiemetics as needed.

Poisoning 97

Poisoning Fluid Resuscitation Seizures Resuscitation 97

EMDocs

DECEMBER 18, 2023

13,14 Fluids Fluid resuscitation is a mainstay of sepsis therapy, as the condition is commonly associated with both absolute and relative hypovolemia. 15 Two changes were elucidated in the 2021 SSC guidelines for fluid resuscitation. The patient currently resides at a skilled nursing facility.

Sepsis 90

Sepsis Fluid Resuscitation Resuscitation Shock 90

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

MARCH 18, 2025

Resuscitate prior to intubation. TXA administration should not delay other interventions. Bronchoscopy (Pulmonology/critical care): Used in intubated patients, those too unstable for CT despite resuscitation, or if the source of bleeding is not clear despite other imaging (CT). Am J Emerg Med. Am J Emerg Med.

COPD 81

COPD Radiology Radiology PPE 81

Don't Forget the Bubbles

MARCH 31, 2025

The value of white blood cell count in predicting serious bacterial infections in children presenting to the emergency department: a multicentre observational study Archives of Disease in Childhood 2025;110:191196. Sepsis is a significant cause of mortality in children, and fluid resuscitation is a key treatment strategy.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

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 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109