Broome Docs

NOVEMBER 17, 2024

Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. 2024 Aug;201:110266. doi: 10.1016/j.resuscitation.2024.110266.

Administration 61

Administration Resuscitation Radiology Radiology 61

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. mcg/kg IV may be considered, especially if von Willebrand disease is suspected.

Airway Management 98

Airway Management Operations Resuscitation Pediatrics 98

EM Ottawa

FEBRUARY 15, 2024

We’re increasingly cognizant of the physiological importance of maintaining specific hemodynamics during resuscitation. Physiology of the rapid sequence intubation Rapid sequence intubation (RSI) is the nearly simultaneous administration […] The post Ketamine and Etimodate: Into the Void appeared first on EMOttawa Blog.

Administration 126

Administration Resuscitation 126

Pediatric EM Morsels

JULY 28, 2023

The exact mechanism is not known… It was previously believed that it was due to rapid changes in serum osmolality during initial fluid resuscitation. Glucose > 200 mg/dL Moderate or Large Ketonuria The severity of DKA is categorized by the degree of acidosis Mild : venous pH < 7.3 The mortality rate for cerebral edema is 21%–24%.

Fluid Resuscitation 246

Fluid Resuscitation Pediatrics Resuscitation Research 246

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

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

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

EMDocs

DECEMBER 1, 2024

Food and Drug Administration. Emerg Infect Dis. 2017;23(8):1268-1273. doi:10.3201/eid2308.161861 Cross R, Ling C, Day NP, McGready R, Paris DH. Revisiting doxycycline in pregnancy and early childhood–time to rebuild its reputation? Expert Opin Drug Saf. 2016;15(3):367-82. Doxycycline Capsules USP. January 2022. Available at: [link].

EMS 101

EMS Infectious Diseases Shock Airway Management 101

Pediatric EM Morsels

SEPTEMBER 22, 2023

Crystalloid may help, but neurogenic shock may not respond to fluid administration. While we may allow permissive hypotension in damage control resuscitation of hemorrhagic shock, in neurogenic shock you should maintain an age-appropriate blood pressure. Alpha 1 agonists are necessary to maintain appropriate blood pressure.

Shock 304

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 304

Emergency Medicine Education

NOVEMBER 3, 2024

I personally believe that having a secure line, whether a peripheral IV or central line, is essential for resuscitating a patient. A recent article in NEJM highlighted that the drug administration route—IV versus IO—matters in terms of successful resuscitation, return of spontaneous circulation (ROSC), and favorable neurological outcomes.

Resuscitation 40

Resuscitation Administration Outcomes 40

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

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

JUNE 12, 2024

Calcium and resuscitation Severely injured trauma patients are commonly hypocalcemic. Giancarelli et al found that 97% of patients who underwent massive transfusion protocols during trauma resuscitation were hypocalcemic (iCa < 1.1 Prehospital Ca administration reduces risk of hypoCa on arrival (70% vs. 28%). Am J Emerg Med.

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 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

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. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e.

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

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

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 94

EMS Sepsis Shock Fluid Resuscitation 94

EMDocs

JUNE 25, 2024

Fluid resuscitation target and fluid Fluid resuscitation is one of the most important parts of management; goal is to increase intravascular volume and ensure end organ perfusion. Calculating fluid resuscitation: Parkland formula: 4 mL X % TBSA X weight in kilograms. IOs and central lines are also options. Avoid normal saline.

Burns 92

Burns Fluid Resuscitation Resuscitation Poisoning 92

The Bottom Line

OCTOBER 18, 2023

In patients with trauma and critical bleeding who require activation of a major haemorrhage protocol, does the empiric administration of 3 pools of cryoprecipitate (6g fibrinogen) within 90 minutes of randomisation (and no more than 3 hours after injury) improve survival, compared to standard care?

Administration 140

Administration Operations Resuscitation 140

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). One best practice to consider: a highly trained trauma resuscitation nurse or advanced practice provider (APP) can run the MTP from the sidelines.

Documentation/Coding 130

Documentation/Coding Best Practices Resuscitation Emergency Department 130

Taming the SRU

MAY 11, 2024

Be careful with fluid resuscitation in renal transplant patients who can be at risk for volume overload. Validity Evidence for a Team-Leading Assessment Tool in Pediatric Emergency Resuscitation Using Video Review (Hartwell et al.) Assessed and provided feedback of pediatric resuscitations based on video review.

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

Don't Forget the Bubbles

FEBRUARY 5, 2025

This should include early identification of life-threatening injuries, targeted fluid resuscitation using blood products, pain management, then eventual safeguarding and psychological support. Establish IV access for potential fluid resuscitation. You feel the patient needs fluid resuscitation. Administer O2 if necessary.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

Taming the SRU

FEBRUARY 7, 2024

For blood product administration, PROPPR showed that 1:1:1 platelet, plasma, and pRBC administration led to earlier hemostasis along with less death due to blood loss and whole blood compared to separate blood product administration led to decreased death at 24 hours.

PPE 98

PPE Administration Ultrasounds Poisoning 98

EMDocs

JANUARY 16, 2024

Hypothermic Arrest In general, hypothermic patients in cardiac arrest should be aggressively resuscitated. Patients can have excellent outcomes despite prolonged resuscitation. 2,3 If the patient meets criteria for resuscitation, they generally are not declared dead until their core temperature is above 32℃ (“warm and dead”).

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation CPR EMS 104

EMDocs

NOVEMBER 6, 2023

Naloxone administration may reverse respiratory arrest, preventing progression to cardiac arrest. Standard advanced life support with the addition of administration of sodium bicarbonate is appropriate for the treatment of life-threatening dysrhythmias caused by cocaine or other sodium channel blockers. COR 2a, LOE B-NR.

Poisoning 112

Poisoning Hyperthermia / Hypothermia Seizures Administration 112

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.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Emergency Department Administration 96

Advanced Emergency Nursing from AENJ

MAY 27, 2014

This is the fourth part of our series on "Early Modern Resuscitation." " Part I: Oral Airways, early resuscitation, and recognition of airway care. The select bibliography will provide ample links to extend your reading. “Carbon Dioxide Resuscitation?” You think to yourself, “ What could that be?” In 1927, H.W.

Resuscitation 40

Resuscitation Poisoning Research Administration 40

The Trauma Pro

JULY 10, 2023

Once this occurs, the entire record is suspect and will not represent the true flow of the resuscitation. During chart reviews, I have seen numerous examples of fluids, vital signs, and drug administration recorded well after the patient has been declared dead!

Resuscitation 100

Resuscitation Radiology Radiology Operations 100

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

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% 2021;25(1):146.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

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: 2024.110186.

Shock 89

Shock Emergency Department Administration Resuscitation 89

EMDocs

SEPTEMBER 6, 2023

Resuscitate and administer antibiotics. IV fluids administrated, IV vancomycin and piperacillin-tazobactam. Start resuscitation early with vasopressors, antibiotics. Complete primary and secondary survey. Start cooling as quickly as you can, and stop at 102. ROS unremarkable. Labs demonstrate critical illness.

Anaphylaxis 90

Anaphylaxis Shock Sepsis Stroke 90

PulmCCM

NOVEMBER 17, 2023

shows blood administration with a direct linear relationship between Pra and CO/VR; only Pmsf is varied here. Operating point guided resuscitation How do we make sense of this? The trick, I believe, lies in ‘operating point guided resuscitation’ [OPGR]. OP is operating point. See text for details.

Operations 132

Operations Ultrasounds Resuscitation Blood Transfusions 132

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!

Pediatrics 154

Pediatrics Head Injuries Airway Management Administration 154

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, A Randomized Trial.

Sepsis 86

Sepsis Shock Resuscitation Fluid Resuscitation 86

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

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? Case: You are working as a paramedic, and you respond to a cardiac arrest.

Hospitals 103

Hospitals CPR EMS Outcomes 103

Don't Forget the Bubbles

NOVEMBER 29, 2023

Tragically, several attempts at resuscitation upon arrival at the emergency department were unsuccessful. While some studies showed that CPRIC is associated with increased survival to hospital discharge, administering muscle relaxants during resuscitation increased mortality. Another attempt led to an oesophageal intubation.

Airway Management 135

Airway Management Emergency Department Resuscitation Psychiatric 135