The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. On arrival, you find a 35-year-old male, pulseless and apneic with cardio-pulmonary resuscitation (CPR) in progress by a bystander. Clinical Question: Is naloxone administration in undifferentiated OHCA associated with survival to hospital discharge?

Hospitals 104

Hospitals CPR EMS Outcomes 104

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

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, 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

EMDocs

JUNE 29, 2024

Spoon Feed This secondary analysis of the DOSE VF trial found that DSED (dual sequence external defibrillation) was the superior strategy for obtaining ROSC and functional neurologic outcome regardless of whether the patient was in recurrent VF or shock-refractory VF after three standard defibrillation shocks. Resuscitation.

Shock 95

Shock Emergency Department Administration Resuscitation 95

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 Administration Resuscitation 97

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! Semin Liver Dis.

Pediatrics 154

Pediatrics Head Injuries Airway Management Administration 154

RebelEM

JUNE 8, 2023

Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose. In other words these were pre-made syringes and not mixed at the bedside.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. Obviously, one also needs to address the cause of the shock, or any efforts in resuscitation will only bring a temporary improvement. Myth busting: Is peripheral administration safe? After 40ml/kg of IV 0.9%

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

EMDocs

SEPTEMBER 7, 2024

Laborator evaluation: CBC, CMP, lipase, type and screen, coagulation panel Treatment: 1-3 Resuscitation with blood products as necessary for hemodynamic stability. However, this patient’s response to fluid resuscitation, though only minimal to modest, indicates his ongoing bleeding is temporized with typical volume-mediated resuscitation.

EMS 97

EMS Fluid Resuscitation Resuscitation Radiology 97

RebelEM

OCTOBER 2, 2023

Background: DKA is traditionally treated with fluid resuscitation, electrolyte replacement, and intravenous infusions of insulin. No statistical differences in safety between groups Operational Impact Median ED LOS (PRIMARY OUTCOME): SQuID: 8.9hrs (6.5 tests/hr (0.8 Traditional: 1.0 tests/hr (0.8 Pre-Intervention: 1.0 tests/hr (0.9

Operations 102

Operations Academics Fluid Resuscitation Outcomes 102

The Trauma Pro

SEPTEMBER 20, 2023

The primary outcome was mortality, and secondary outcomes included the need for surgery, fluid and blood infusions, and the use of a massive transfusion protocol. Researchers from the US Army performed a retrospective registry study on a sample of military casualties over four years.

Military 113

Military Blood Transfusions Administration Outcomes 113

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 104

Resuscitation Fluid Resuscitation Hospitals Research 104

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

Taming the SRU

NOVEMBER 21, 2023

The time from diagnosis to treatment does not affect outcomes in patients with AML. Management IVF resuscitation: will want to give at least 20 cc/kg bolus, however there has been some discussion about doing this in two 10 cc/kg boluses to avoid cerebral edema (as noted below, recent evidence has not supported this).

Pediatrics 91

Pediatrics EKG/ECG Resuscitation Dehydration 91

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. increase in MAP).

Sepsis 52

Sepsis Shock Resuscitation Administration 52

Don't Forget the Bubbles

NOVEMBER 15, 2023

One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. In a PICU setting, sodium can come from various sources (resuscitation fluids, IV drugs and infusions, enteral feed), not just the maintenance fluids we prescribe. What do we need to give?

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

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

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

The Skeptics' Guide to EM

JUNE 12, 2022

Background: There has been a longstanding debate about which intravenous fluid is the best for volume resuscitating critically ill patients. saline, that may be partly driven by kidney injury associated with the administration of high-chloride content IV fluids. Blood pressure is 85/50 mmHg. You wonder which IV fluid should you order?

Fluid Resuscitation 53

Fluid Resuscitation Resuscitation Outcomes Administration 53

EMDocs

JANUARY 29, 2024

hypertensive emergency, need for thrombolytic administration) [1]. Finally, anticipating and addressing known complications such as seizures, increased intracranial pressure, or cerebral edema with appropriate measures, including antiepileptic drugs or osmotic agents, is essential for improving patient outcomes.

Stroke 99

Stroke Outcomes EMS Seizures 99

Emergency Medicine Journal

JUNE 20, 2024

In this international study across all major trauma centres in the UK and one Level 1 centre in the USA, 1604 bleeding trauma patients were enrolled to receive either standard of care resuscitation (STD), or the early empirical administration of a high dose (three pools) of cryoprecipitate (CRYO) in addition to standard of care.

Administration 40

Administration Resuscitation Outcomes 40

The Skeptics' Guide to EM

FEBRUARY 2, 2019

The SGEM Bottom Line was that the routine administration of supplemental oxygen in patients with suspected or confirmed acute myocardial infarction who are not hypoxic does not appear to provide a patient-oriented benefit. In acutely ill adults, this same concept is not yet as widespread and liberal administration is still common place.

Poisoning 52

Poisoning Administration Hospitals Sepsis 52

Don't Forget the Bubbles

OCTOBER 2, 2024

As the resuscitation continues, his heart rate falls, his respiratory effort becomes increasingly irregular and his systolic blood pressure rises. Moderate-quality evidence is available for bolus administration of hypertonic saline, while only low-quality evidence supports continuous administration. 2023 [cited 2024 Apr 10].

Administration 49

Administration Pediatrics Outcomes Research 49

JournalFeed

OCTOBER 29, 2022

WATEFALL RCT Spoon Feed Conservative fluid administration in patients with acute pancreatitis can achieve similar clinical outcomes compared with aggressive resuscitation, with less risk of volume overload. However, with a possible signal of long term benefit, I will keep prescribing steroids in these patients.

Administration 40

Administration Resuscitation Outcomes 40

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. Secondary Outcome: The incidence of severe hypoxemia (oxygen saturation of less than 80%). . Reference: Casey et al.

EMS 40

EMS Airway Management Administration Resuscitation 40

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

This basically means rapid access to ACLS type resuscitation skills (intubation and intravenous drug therapy). It also did not show an increase in good neurologic outcome in the survivors (78.3% Intravenous drug administration during out-of-hospital cardiac arrest: A randomized trial. Resuscitation 2011 * Hagihara et al.

CPR 52

CPR Academics Resuscitation Hospitals 52

EMDocs

JANUARY 8, 2024

Magnesium does not improve ROSC, survival, or neurologic outcomes, no matter the presenting rhythm (Level 3: no benefit). Routine administration of calcium for treatment of cardiac arrest is not recommended. COR 2b, LOE B-R. For patients with OHCA, use of steroids during CPR is of uncertain benefit. COR 2b, LOE C-LD. Circulation.

Seizures 98

Seizures Shock CPR Hyperthermia / Hypothermia 98

AED Leader

DECEMBER 2, 2024

Furthermore, regular maintenance and training in cardiopulmonary resuscitation (CPR) techniques significantly enhance the potential effectiveness of AEDs in emergencies. Rapid treatment is vital to improve survival outcomes. Cardiac arrests can happen anywhere, from public spaces to private homes.

CPR 52

CPR Basic Life Support Resuscitation Hospitals 52

PHARM

JUNE 6, 2023

Patients > 55 years old; pre-PHEA tachycardia; multi-system injuries; and intravenous crystalloid administration before arrival of the HEMS team were the variables significantly associated with PIH. The variables significantly associated with PIH only account for a small proportion of the observed outcome.

Resuscitation 40

Resuscitation Administration Outcomes 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

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

RebelEM

FEBRUARY 2, 2023

Small sample size limits the power of the study and increases margin of error A patient-oriented outcome such as mortality was not included Follow-up beyond disposition to evaluate hospitalization recurrences related to atrial fibrillation was not included. Therefore, no definitive conclusions can be made about this trial.

Emergency Department 52

Emergency Department Administration EMS Dehydration 52

The Skeptics' Guide to EM

FEBRUARY 17, 2018

There are studies showing that early recognition and prehospital administration of antibiotics are associated with increased survival rates [2-4]. Now we have better evidence with the publication of the first prospective, randomized study investigating the effects of early antibiotic administration in patients with suspected sepsis.

Sepsis 40

Sepsis Hospitals Fluid Resuscitation Administration 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. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018. NEJM January 2018.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

EM Literature of Note

JANUARY 9, 2022

The Annals of Emergency Medicine Podcast continues apace, with free monthly updates from the original research published in the journal: iTunes Link SoundCloud Link Likewise, the Annals of Emergency Medicine Journal Club has published several monthly installments: Predicting Outcomes in Pediatric Pneumonia: Are We Omnipotent or Incompetent?

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 40

RebelEM

JANUARY 25, 2023

Small bowel obstruction: Outcome and cost implications of admitting service. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 BET 1: Is Routine Nasogastric Decompression Indicated in Small Bowel Occlusion?

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Pediatric Emergency Playbook

AUGUST 1, 2017

Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. Plasma levels of lidocaine following nebulized aerosol administration. J Med Genet 2008; 45:1. Arshad A, Powell C, Tighe MP. Pediatrics.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52