ACEP Now

JANUARY 5, 2025

3 A three-pronged management approach provides a framework for addressing post-tonsillectomy bleeds: resuscitation, early ENT consultation with transport arrangements, and temporizing measures applied to control bleeding. Dr. Helman is an emergency physician at North York General Hospital in Toronto.

Airway Management 98

Airway Management Operations Resuscitation Pediatrics 98

EMDocs

DECEMBER 1, 2024

Treatment significantly shortens the duration of illness, and early initiation of therapy can prevent severe complications and reduce the length of hospitalization. Food and Drug Administration. However, some experts recommend doxycycline even in pregnant patients. pregnant patients). Emerg Infect Dis. 2017;23(8):1268-1273.

EMS 104

EMS Infectious Diseases Shock Airway Management 104

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

ACEP Now

DECEMBER 6, 2024

Before nitroglycerin (NTG) could be administered, the patient became unresponsive and was transferred to the resuscitation bay, where the monitor revealed a ventricular fibrillation arrest. Repeat ECG following return of spontaneous circulation after administration of intravenous nitroglycerin. Click to enlarge.)

Resuscitation 98

Resuscitation EKG/ECG Documentation/Coding COPD 98

The Trauma Pro

AUGUST 15, 2023

One of the most creative solutions I’ve seen is the use of a hospital security officer. They know the hospital layout cold, including that obscure corner where the blood bank is located. Think about it. And there are plenty around all the time! Documentation is critically important, both in the trauma bay and the blood bank.

Documentation/Coding 130

Documentation/Coding Best Practices Resuscitation Emergency Department 130

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 11, 2025

If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Therefore, administration of IV morphine (A) would not be recommended. What is the best next step in management? Additionally, pain typically improves with relief of impaction.

EMS 97

EMS Sepsis Shock Fluid Resuscitation 97

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Reference: Cashen K, Reeder RW, Ahmed T, et al.

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52

EMDocs

NOVEMBER 20, 2023

Initial patient assessment and hemodynamic resuscitation should be performed simultaneously. DOAC reversal Recommendation: For patients on DOACs, we suggest reversal for the small subset of patients who present with a life-threatening LGIB that does not respond to initial resuscitation and cessation of the anticoagulant alone.

Resuscitation 103

Resuscitation Fluid Resuscitation Hospitals Research 103

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. vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 92

Sepsis Shock Resuscitation Fluid Resuscitation 92

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. RSI inherently carries with it risks of complications such as post-intubation hypotension and cardiac arrest in the most extreme cases.

Outcomes 97

Outcomes Emergency Department Resuscitation Administration 97

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

Don't Forget the Bubbles

NOVEMBER 15, 2023

Currently, the administration of water for the paediatric population is based on the Holliday-Segar formula (100ml/kg/day for the first 10kg of weight, 50ml/kg/day for the second 10kg of weight and 20ml/kg/day for weight over 20kg). As well as considering volume, hyponatraemia is a harmful consequence of incorrect administration of fluids.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

The Trauma Pro

AUGUST 18, 2023

What happens next varies by hospital. The Broxton tool covers all the basics and includes some additional data points that cover activation criteria, TXA administration, and administration of uncrossmatched blood. Typically, one of the blood bank supervisors or a pathologist then compiles and reviews this data.

Administration 100

Administration Operations Hospitals Wellness 100

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. Clearly something infectious is going on and you wonder if starting antibiotics on route to the hospital would help? Jenn Doyle is a paramedic educator at Middlesex-London Paramedic Service.

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 40

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 92

Operations Radiology Radiology Fluid Resuscitation 92

Taming the SRU

FEBRUARY 12, 2024

She initially agreed to be transported to the hospital by ambulance, but jumped from the moving vehicle and was subsequently struck and pinned under the fuselage for 10-15 minutes. Hospital Course Based on the primary survey, no acute airway interventions were undertaken.

Administration 81

Administration Fractures Anaphylaxis Head Injuries 81

RebelEM

OCTOBER 2, 2023

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. Mild to moderate DKA represents a subgroup of patients that often require admission to the ICU due to hospital policies not allowing insulin infusions outside of this clinical setting. tests/hr (0.8

Operations 102

Operations Academics Fluid Resuscitation Outcomes 102

ACEP Now

NOVEMBER 7, 2024

Despite the broad acceptance of Red Cross certifications by national accrediting bodies, state agencies, and thousands of hospitals and clinics, some medical centers, nursing schools, and community colleges have policies that do not recognize both organizations’ certifications. All three leverage the latest educational methodologies.

Advances Cardiac Life Support (ACLS) 74

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

University of Maryland CC Project

JANUARY 31, 2024

The topic of their lecture today is their recently published article in CHEST: “Use and Outcomes of Peripheral Vasopressors in Early Sepsis-Induced Hypotension Across Michigan Hospitals: A Retrospective Cohort Study”. Their article can be found here: [link]

Administration 40

Administration Sepsis Research Outcomes 40

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. Significant effort has been placed on the administration of IV crystalloids to address concerns for hypovolemia in septic shock.

Sepsis 52

Sepsis Shock Resuscitation Administration 52

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

Prehospital advanced cardiac life support for out-of-hospital cardiac arrest: a cohort study. Prehospital advanced cardiac life support for out-of-hospital cardiac arrest: a cohort study. This basically means rapid access to ACLS type resuscitation skills (intubation and intravenous drug therapy). Academic Emergency Medicine.

CPR 52

CPR Academics Resuscitation Hospitals 52

Emergency Medicine Education

JULY 21, 2022

Resuscitation journal also published another study on effect of calcium in OHCA, which it did not support calcium administration in OHCA JAMA Resuscitation

Resuscitation 40

Resuscitation Administration Hospitals 40

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Background: The liberal use of supplemental oxygen therapy in acutely ill adults has a long history in the hospital, but high-quality therapy supporting its practice is unclear. In acutely ill adults, this same concept is not yet as widespread and liberal administration is still common place. The Lancet 2018.

Poisoning 52

Poisoning Administration Hospitals Sepsis 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 98

Head Injuries Airway Management Outcomes Burns 98

Mind The Bleep

DECEMBER 19, 2023

Therefore, they require fluid resuscitation to restore blood pressure, correct the ketonemia and electrolyte abnormalities, and oliguria. Throughout therapy it is important to monitor fluid input and urine output so that fluid resuscitation measures can be adjusted. It is also vital to do a fluid balance assessment. 2018, November ).

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

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

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

AED Leader

DECEMBER 2, 2024

Furthermore, regular maintenance and training in cardiopulmonary resuscitation (CPR) techniques significantly enhance the potential effectiveness of AEDs in emergencies. The American Heart Association and European Resuscitation Council emphasize the importance of early defibrillation. Verify that the device is set to do this regularly.

CPR 52

CPR Basic Life Support Resuscitation Hospitals 52

EMDocs

JANUARY 8, 2024

Routine administration of calcium for treatment of cardiac arrest is not recommended. We recommend hospitals develop protocols for postarrest temperature control. COR 2b, LOE B-R. For patients with OHCA, use of steroids during CPR is of uncertain benefit. COR 2b, LOE C-LD. COR 3, No benefit, LOE B-R. COR 1, LOE B-NR. COR 1, LOE B-NR.

Seizures 98

Seizures Shock CPR Hyperthermia / Hypothermia 98

The Skeptics' Guide to EM

JANUARY 25, 2020

His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. Case: A 60-year-old male is in your emergency department with sepsis from pneumonia. Reference: Casey et al.

EMS 40

EMS Airway Management Administration Resuscitation 40

RebelEM

DECEMBER 19, 2022

The authors sought to answer whether double defibrillation and/or vector change defibrillation lead to a greater number of RVF patients surviving to hospital discharge when compared to standard defibrillation therapy. Now that same group has published the results of their full randomized control trial.

EMS 52

EMS CPR Shock Resuscitation 52

RebelEM

FEBRUARY 2, 2023

Average time control HR in the amiodarone group was on par with the study’s average ED length of stay Limitations: Single center, retrospective hospital study may not be able to produce generalizable results. The average time to control HR in the IV amiodarone was 1.7h, which is usually the average time for disposition from the ED.

Emergency Department 52

Emergency Department Administration Dehydration EMS 52

The Skeptics' Guide to EM

AUGUST 26, 2018

He is the Medical Director of the Trauma Program for London Health Sciences Centre and the Site Chief of Surgery at Victoria Hospital. He is the Medical Director of the Trauma Program for London Health Sciences Centre and the Site Chief of Surgery at Victoria Hospital.

Shock 40

Shock Resuscitation Administration Hospitals 40

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. Her oxygen requirement decreased throughout her hospitalization. Diagnostics WBC : 8.6

EKG/ECG 52

EKG/ECG Fluid Resuscitation Administration Emergency Department 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] Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation An RCT showing no advantage to routine immediate angiography in non-STEMI OHCA.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 40

EMDocs

JANUARY 29, 2024

hypertensive emergency, need for thrombolytic administration) [1]. Case Resolution: In addition to standard measures for resuscitation, the patient is started on a nicardipine drip to target an SBP < 160 mmHg and neurosurgery is urgently consulted. American Heart Association/American Stroke Association. 2022 Jul;53(7):e282-e361.

Stroke 98

Stroke Outcomes EMS Seizures 98