PulmCCM

APRIL 14, 2025

Because SEP-1 was enacted by CMS’s administrative fiat, no randomized trials have been performed before or since to gauge its effectiveness. fluid administration, blood culture and lactate collection, and antibiotics, delivered in the first 3 hours. Five did not report on the association between bundle compliance and mortality.

Sepsis 52

Sepsis Infectious Diseases Administration Shock 52

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.

Resuscitation 127

Resuscitation Administration 127

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 105

EMS Infectious Diseases Shock Airway Management 105

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

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

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

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

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 98

EMS Sepsis Shock Fluid Resuscitation 98

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

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

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 116

Poisoning Hyperthermia / Hypothermia Seizures Administration 116

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 96

Shock Emergency Department Resuscitation Administration 96

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 Resuscitation 96

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 94

Sepsis Shock Resuscitation Fluid Resuscitation 94

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

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 Resuscitation 154

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 104

Hospitals CPR EMS Outcomes 104

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 98

EMS Fluid Resuscitation Resuscitation Radiology 98

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 105

Resuscitation Fluid Resuscitation Hospitals Research 105

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

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 98

Outcomes Emergency Department Resuscitation Administration 98

Taming the SRU

NOVEMBER 21, 2023

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). While we are often cautious with IVF, volume and rate of fluid administration does not cause cerebral edema.

Pediatrics 91

Pediatrics EKG/ECG Resuscitation Dehydration 91

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

Taming the SRU

JANUARY 1, 2024

Establishing reliable vascular access is absolutely critical for ED patients requiring resuscitation, airway management, or medication administration. IOs can be used both for resuscitation, medication administration, and for laboratory testing, but there are a few important considerations. 2016 Dec 14;20(1):102.

Emergency Department 92

Emergency Department Ultrasounds Administration Burns 92

ACEP Now

NOVEMBER 7, 2024

Scientific Rigor Red Cross resuscitation courses closely align with the International Liaison Committee on Resuscitation (ILCOR) recommendations. Major resuscitation organizations worldwide meet in this forum to share knowledge and best practices. 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

Elizabeth Munroe, MD, MSc is a clinical instructor and post-doctoral research fellow in the dvision of Pulmonary and Critical Care Medicine at the University of Michigan. Hayley Gershengorn, MD, FCCM, ATSF is a professor of clinical medicine in the Division of Pulmonary, Critical Care, and Sleep Medicine at the University.

Administration 40

Administration Sepsis Research Outcomes 40

EMDocs

NOVEMBER 1, 2023

6 Treatment : Airway Definitive airway management should be performed in those with respiratory distress with attention to appropriate resuscitation started beforehand in the setting of potential distributive shock from mediastinitis. 4 Fluid resuscitation and vasopressor use as appropriate. 5 Consider antifungal administration.

Operations 94

Operations Radiology Radiology Fluid Resuscitation 94

Taming the SRU

FEBRUARY 12, 2024

Given her intracranial hemorrhages, significant attempts were made to improve coagulation including administration of IV vitamin K, 3 units of fresh frozen plasma, and administration of four-factor prothrombin complex concentrate (PCC, Kcentra). This does not deviate from general resuscitation principles for acute hemorrhage.

Administration 80

Administration Fractures Anaphylaxis Head Injuries 80

The Trauma Pro

AUGUST 18, 2023

The Broxton tool covers all the basics and includes some additional data points that cover activation criteria, TXA administration, and administration of uncrossmatched blood. Click here to check it out. The Australian tool is much more robust with more data points that make a lot of sense. You can download a copy by clicking here.

Administration 100

Administration Operations Hospitals Wellness 100

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 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

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.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

The Trauma Pro

SEPTEMBER 20, 2023

Here are the factoids: A total of 300 patients were identified, nearly equally split between room temp platelets and cold-stored Demographics of the two groups were similar, but the ISS was somewhat higher in the cold-stored platelet group S ignificantly fewer cold-stored platelet patients underwent surgery (13% vs. 24%) Survival was the same at 87-88% (..)

Military 113

Military Blood Transfusions Administration Outcomes 113

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