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. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 139

Administration Outcomes Resuscitation Radiology 139

RebelEM

NOVEMBER 30, 2023

For those with sepsis, the administration of intravenous fluids (IVF) at the volumes recommended in the Surviving Sepsis Campaign (SSC) requires careful consideration of an individual’s chronic medical conditions and subsequent sensitivity to IVF. Studies without a clear timeframe for fluid administration. Am J Emerg Med.

Sepsis 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

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 94

Poisoning Fluid Resuscitation Seizures Resuscitation 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

SEPTEMBER 21, 2024

Chris Root is an emergency medicine and emergency medicine service (EMS) physician at the University of New Mexico, Albuquerque. Chris completed his emergency medicine residency and EMS fellowship at UNM. On arrival, you find a 35-year-old male, pulseless and apneic with cardio-pulmonary resuscitation (CPR) in progress by a bystander.

Hospitals 103

Hospitals CPR EMS Outcomes 103

Taming the SRU

FEBRUARY 7, 2024

AirCare - Derm Emergencies - R4 Capstone - Landmarks of EM - Global Health - Toxicology Aircare Grand ROunds WITH Drs.

PPE 98

PPE Administration Ultrasounds Poisoning 98

RebelEM

SEPTEMBER 29, 2022

There are also potential harms to large volume fluid resuscitation including progression of pancreatitis and fluid overload with or without respiratory failure. Though the initial recommendation for aggressive fluid resuscitation was not based on substantial evidence, clinicians have been slow to pivot away from this approach.

Administration 52

Administration Fluid Resuscitation Resuscitation Outcomes 52

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch.

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation CPR EMS 104

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. appeared first on REBEL EM - Emergency Medicine Blog. septic shock). NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

Taming the SRU

MAY 11, 2024

r1 clinical knowledge - r4 capstone - research grand rounds - the art of em - Community corner - PEM Lecture r1 Clinical knowledge: transplant complications WITH dr. gabor Time-sensitive peri-transplant emergencies: Bleeding fistula- stop the bleed. Assessed and provided feedback of pediatric resuscitations based on video review.

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

EMDocs

SEPTEMBER 6, 2023

Resuscitate and administer antibiotics. Reference: EM@3AM – Heat Stroke Case 2: 40-year-0ld female feels unwell but no other specific complaints. IV fluids administrated, IV vancomycin and piperacillin-tazobactam. Start resuscitation early with vasopressors, antibiotics. Complete primary and secondary survey.

Anaphylaxis 90

Anaphylaxis Shock Sepsis Stroke 90

RebelEM

JUNE 19, 2023

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? This should continue to make TXA part of standard trauma resuscitation while additional studies are performed.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

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. Castillo, 2019 ] Somatostatin (or its analogues, like Octreotide) Guidelines do recommend this… There is great variability in its administration, though. Call them early! Hepatology. doi: 10.1002/hep.21907.

Pediatrics 154

Pediatrics Head Injuries Airway Management Administration 154

American Medical Compliance

FEBRUARY 15, 2023

Congress established the Occupational Safety and Health Administration (OSHA), with the purpose of creating safe and health conscience work conditions. Passing the exam will qualify the individual for an assisted living administrator certificate. Furthermore, OSHA estimates that 5.6 The specific requirements of the exam vary.

EMS 52

EMS Administration Infectious Diseases Operations 52

EMDocs

AUGUST 17, 2023

Additionally, 80% of patients in the control group required open label NE use indicating that NE was going to be needed in most of these patients regardless of initial resuscitation method. I will continue to reach for pressors early in resuscitation of the septic shock patient. Today we look at the CENSER trial. vs 48.4% (OR 3.4,

Sepsis 86

Sepsis Shock Resuscitation Fluid Resuscitation 86

ACEP Now

OCTOBER 3, 2023

The GCS should be measured after airway, breathing, and circulation are assessed, after a clear airway is established, and after necessary ventilatory or circulatory resuscitation has been performed. The guidelines also address issues related to EMS provider skill level, transportation modality, and destination for the patient.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 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. It is possible that the induction agent used could play an important. Read more

Outcomes 93

Outcomes Emergency Department Administration Resuscitation 93

EMDocs

APRIL 10, 2024

Authors: Alex Rogers, MD (EM Resident Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX); J.D. While not specifically reviewed in this post, check out the methemoglobinemia tox card for more information about one of the other known events that can occur with local anesthetic administration.

Advances Cardiac Life Support (ACLS) 109

Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 109

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Operations 86

Operations Radiology Radiology Fluid Resuscitation 86

ACEP Now

NOVEMBER 7, 2024

In 2015, it introduced Basic Life Support (BLS) training and certification for EMS personnel. Scientific Rigor Red Cross resuscitation courses closely align with the International Liaison Committee on Resuscitation (ILCOR) recommendations. It also offers a comprehensive “CPR for the Professional Rescuer” course.

Advances Cardiac Life Support (ACLS) 74

Advances Cardiac Life Support (ACLS) Military CPR Basic Life Support 74

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4 Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4 Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4 Liberal: 14.9%

Sepsis 99

Sepsis Shock Resuscitation Outcomes 99

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

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. Date: January 9th, 2020 Reference: Casey et al. Reference: Casey et al.

EMS 40

EMS Airway Management Administration Resuscitation 40

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. When emergency medical services (EMS) arrived, she was in asystole with an empty, recently full, bottle of benzonatate 100 mg capsules. PubMed PMID: 35790679; PubMed Central PMCID: PMC9492832.

Poisoning 81

Poisoning Seizures Pediatrics EMS 81

EMDocs

SEPTEMBER 7, 2023

2 Administration of an alcohol dehydrogenase (ADH) inhibitor, such as fomepizole, is recommended in suspected or known DEG poisoning. 2,10 Initial stabilization of DEG toxicity includes correcting acid-base abnormalities, electrolyte abnormalities, and volume resuscitation. JAMA , vol. 15, 15 Apr. link] Robinson, Corie N.,

Poisoning 84

Poisoning CDC Administration Emergency Department 84

The Skeptics' Guide to EM

MAY 21, 2017

Case: A 45-year-old male arrives via emergency medical services (EMS) complaining that he wants to be discharged. EMS states they found him unresponsive and with paraphernalia consistent with intravenous heroin use. After naloxone administration he is alert and oriented times three with a normal pulse oximetry and clear lung fields.

Emergency Department 52

Emergency Department Administration Academics EMS 52

The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Max is then going to Georgetown to be an attending in both EM and ICU. Date: June 2nd, 2020 Reference: Permpikul et al. Respir Crit Care Med 2019.

Sepsis 52

Sepsis Shock Resuscitation Administration 52

Cook County EM Blog

MAY 29, 2023

As resuscitation measures are underway, you obtain collateral from EMS and parents. Upon EMS arrival, the patient was in cardiac arrest. EMS shows you the prescription bottle with a handful of capsules remaining. Food and Drug Administration (FDA). Early consultation with the poison center is prudent. 28 June 2019.

Seizures 52

Seizures Administration Resuscitation Poisoning 52

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. that would not be possible in an agitated/combative patient.

Head Injuries 96

Head Injuries Airway Management Outcomes Burns 96

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

Case: You are the medical director of an EMS system in a large city deciding on whether to respond to all out of hospital cardiac arrests (OHCA) with ACLS capabilities, or if resources should be directed to those candidates for extracorporeal CPR. You need to recognize an arrest and activate your EMS system. JAMA 2009 * Jacobs et al.

CPR 52

CPR Academics Resuscitation Hospitals 52

The Skeptics' Guide to EM

JUNE 12, 2022

Case: A 62-year-old man is brought in by EMS from home with lethargy and hypotension. Background: There has been a longstanding debate about which intravenous fluid is the best for volume resuscitating critically ill patients. Blood pressure is 85/50 mmHg. You wonder which IV fluid should you order? Reference: Finfer et al.

Fluid Resuscitation 53

Fluid Resuscitation Resuscitation Outcomes Administration 53

RebelEM

OCTOBER 2, 2023

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. appeared first on REBEL EM - Emergency Medicine Blog. However, it is unclear if all degrees (mild, moderate, severe) of DKA require the same intensive treatment. Acad Emerg Med 2023.

Operations 97

Operations Academics Outcomes Fluid Resuscitation 97

PHEM Cast

APRIL 10, 2016

And from our buddies at HEFT EM CAST: [link] A bit more detail covering some of the research in an easy to understand way. An amazing podcast on the subject can be found at SMART EM: SMART Testing: Back to Basics As always, any feedback, comments etc. St Emlyns Induction podcast on Sepsis. March 2016. Scand J Trauma Resusc Emerg Med.

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. Background: The use of fluids in trauma resuscitation has been studied in a number of trials in recent years. What do you advise him?

Shock 40

Shock Resuscitation Administration Emergency Department 40

The Skeptics' Guide to EM

FEBRUARY 17, 2018

Case: EMS is dispatched to a retirement […] The post SGEM#207: Ahh (Don’t) Push It – Pre-Hospital IV Antibiotics for Sepsis. Case: EMS is dispatched to a retirement home. Other serious time-dependent conditions such as myocardial infarction and trauma have been improved significantly with emergency medical services (EMS).

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

RebelEM

FEBRUARY 2, 2023

This could have biased the results in favor of amiodarone as we’ve covered this before on REBEL EM before The IV amiodarone group required less additional HR control agents to control increased heart rate. Clinical Bottom Line: Numerically, amiodarone may be a better medication for rate and rhythm control. References Mason JM, et al.

Emergency Department 52

Emergency Department Administration Dehydration EMS 52

EMDocs

JANUARY 29, 2024

Authors: Sameer Desai, MD (EM Attending Physician, University of Kentucky); Omar Abbas Ahmed Malik, MBBS (Patients’ Aid Foundation, Jinnah Postgraduate Medical Center) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine in St.

Stroke 91

Stroke Outcomes EMS Seizures 91