EM Literature of Note

JANUARY 9, 2022

A Chilling Conclusion to the Hypothermia Debate? link] Effect of Moderate vs Mild Therapeutic Hypothermia on Mortality and Neurologic Outcomes in Comatose Survivors of Out-of-Hospital Cardiac Arrest 31°C was no better than 34°C for improving neurologic outcomes following OHCA. Stylet, No?

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 40

Don't Forget the Bubbles

MAY 17, 2023

Video laryngoscopy-assisted less-invasive surfactant administration quality improvement initiative. To feed or not to feed during therapeutic hypothermia in asphyxiated neonates: a systematic review and meta-analysis. A Health System-Initiated Intervention to Remediate Homes of Children With Asthma. Strane D, et al. Pediatrics.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Mind The Bleep

DECEMBER 19, 2023

In cases of hypothermia, re-warming can be done passively (with blankets), or active techniques can be implemented in severe cases. Similarly, body temperature should be assessed as this can reveal exposure to infections which may have precipitated DKA, or some patients may be hypothermic if they have been unconscious for some time.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

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.

EMS 52

EMS CPR Shock Resuscitation 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

These include ( among others ) — acute febrile illness — variations in autonomic tone — hypothermia — ischemia-infarction — malignant arrhythmias — cardiac arrest — and especially Hyperkalemia. This appears to be immediately beneath the sternal fracture.

EKG/ECG 52

EKG/ECG Fractures Hyperthermia / Hypothermia Wellness 52

EMDocs

JANUARY 16, 2024

Some authors recommend not starting chest compressions in hypothermia unless there is no organized cardiac activity (e.g., 2 In reality you may start compressions before you confirm that hypothermia was the primary cause of cardiac arrest. Obtaining a core temperature early in any arrest suspected to be from hypothermia is key.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

EMDocs

FEBRUARY 15, 2024

3-6 Clinical Presentation: Symptoms include altered mental status, tachycardia, hyperthermia, urinary retention, mydriasis, blurred vision, dry skin, hallucinations. Anticholinergic toxicity has overlap with other toxicological causes of hyperthermia which are reviewed here: Hyperthermia in the Toxicological Setting.

Hyperthermia / Hypothermia 111

Hyperthermia / Hypothermia Poisoning Seizures COPD 111

Don't Forget the Bubbles

FEBRUARY 5, 2025

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. In the bleeding trauma patient, fluid resuscitation aims to avoid the diamond of death (acidosis, coagulopathy, hypothermia and hypocalcaemia).

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

ALiEM

MARCH 5, 2024

With severe toxicity, patients can have altered mental status, seizures, hyperthermia, and pulmonary edema. Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. Pharmacokinetics of salicin after oral administration of a standardised willow bark extract. British Journal of Haematology.

Hyperthermia / Hypothermia 114

Hyperthermia / Hypothermia Anaphylaxis Poisoning Administration 114

EMDocs

JUNE 12, 2024

Previous triad of death = hypothermia, acidosis, and coagulopathy. Liver dysfunction, secondary cirrhosis, critical illness, trauma, and hypothermia reduce citrate metabolism. Hypothermia also leads to hypoCa. Prehospital Ca administration reduces risk of hypoCa on arrival (70% vs. 28%). Target an ionized Ca level over 1.2

Hyperthermia / Hypothermia 106

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 106

Northwestern EM Blog

MAY 9, 2022

The most acute cause of death from NMS is hyperthermia, which is induced both by D2 receptor antagonism leading to rigidity and impaired thermoregulation from the striatum and hypothalamus. Any life-threatening hyperthermia should be treated immediately with an ice bath.[2] References 1. Institute for Safe Medication Practices.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Emergency Department 52

EMDocs

JUNE 25, 2024

For large burns, consider albumin to lower total volume administration and improve urine output. Severely burned patients have impaired thermoregulation and are at risk of hypothermia. It may interfere with lab tests (obtain labs prior to administration). Fluid choice: If traumatic injury and bleeding, administer blood products.

Burns 96

Burns Fluid Resuscitation Resuscitation Poisoning 96

RebelEM

JUNE 19, 2023

This balance is upset in trauma by loss of blood and factors, acidosis, hypothermia and the inflammatory cascade. 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?

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

ACEP Now

OCTOBER 11, 2024

Optimally, bystander CPR, including the administration of rescue breaths, should be initiated prior to arrival of emergency medical services. Oxygen administration, with or without ventilatory support, is the mainstay of treatment. Fluid resuscitation will likely be warranted, and with crystalloid solution is most appropriate.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation 52

ACEP Now

OCTOBER 3, 2023

Prehospital administration of TXA therapy is not generally and widely indicated for the prophylactic treatment of suspected ICH or elevated ICP at this time. References Lulla A, et al. Prehospital Guidelines for the management of traumatic brain injury – 3rd edition.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation Pediatrics 98

Dr. Smith's ECG Blog

JULY 22, 2023

This discussion comes from this previous post: Hyperthermia and ST Elevation Discussion Brugada Type 1 ECG changes are associated with sudden cardiac death (SCD) and the occurrence of ventricular dysrhythmias. Syncope and weakness were attributed to acute illness from influenza. The patient did well and was ultimately discharged home.

EKG/ECG 92

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 92

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

EB Medicine

AUGUST 1, 2018

Also, be aware that there are various formulations of cannabis that allow for different routes of administration. Basically, any way you can imagine, it seems like a route of administration has been explored. On the longer end, rectal cannabis administration can take up to 8 hours to reach peak plasma concentrations.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Thinking Critical Care

MAY 18, 2023

In the UK the Committee for Safety of Medicines merely drew attention to potential hazards of etomidate administration. 10.1056/NEJM198411013111801 [13] I became the first researcher to report measurements of cerebral blood flow and cerebral metabolic rate for oxygen during cardiac surgery with induced hypothermia on cardiopulmonary bypass.

Shock 40

Shock Research Sepsis Resuscitation 40

Dr. Smith's ECG Blog

MAY 5, 2022

A Brugada-1 pattern may either be observed spontaneously ( with leads V1 and/or V2 positioned normally — or positioned 1 or 2 interspaces higher than usual ) — or — a Brugada-1 pattern may be observed on provocative drug testing after IV administration of a sodium-channel blocking agent such as ajmaline, flecainide or procainamide.

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

Intensive Blog

FEBRUARY 9, 2023

The timeframe for administration of charcoal post Amanita phalloides poisoning may be up to 48 hours 9. It refers to hypernatraemia, hyperventilation, haemodialysis, and induced hypothermia. Hypothermia Aiming for a lower core temp (35 o C) reduces cerebral metabolic rate and cerebral blood flow.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

Don't Forget the Bubbles

NOVEMBER 18, 2024

Hypothermia: Newborns, particularly preterm infants, are prone to hypothermia. It is generally safe for short-term peripheral administration, but central access is preferred for prolonged use to minimise the risk of tissue necrosis. Low doses can be given peripherally; however, central administration is preferred.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Don't Forget the Bubbles

MARCH 24, 2025

Because Dexmed can blunt these responses, they are particularly vulnerable to hypothermia during its use. As a result, its oral bioavailability is only about 16% , making oral administration impractical and ineffective. Careful temperature monitoring and management are essential. How is Dexmedetomidine administered?

Pediatrics 59

Pediatrics Emergency Department Research Hyperthermia / Hypothermia 59

Dr. Smith's ECG Blog

JANUARY 13, 2025

Drug toxicity , especially diphenhydramine , which has sodium channel blocking effects, and also anticholinergic effects which may result in sinus tachycardia, hyperthermia, delirium, and dry skin. Hypothermia. Hyperkalemia 2. Other drugs with sodium channel blockade: Tricyclic antidepressants. Ischemia or infarction. Cardiac arrest.

Hyperthermia / Hypothermia 70

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 70

Taming the SRU

JUNE 6, 2023

mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5

Documentation/Coding 65

Documentation/Coding Seizures Psychiatric Wellness 65

Taming the SRU

AUGUST 25, 2023

to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2

Seizures 76

Seizures Fractures EKG/ECG Resuscitation 76