ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

RebelEM

NOVEMBER 30, 2023

This systematic review and meta-analysis attempts to elucidate whether a more conservative fluid resuscitation approach is warranted in volume sensitive sepsis patients, such as those with congestive heart failure (CHF). Am J Emerg Med. 2023;73:34-39. What They Did: Researchers performed a systematic review and meta-analysis.

Sepsis 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

EMDocs

SEPTEMBER 19, 2023

Episode 86: Tricky Cases Part 2 Case 3: 56-year-old female with history of seizures, actively seizing, EMS called. Patient seized for approximately 20 minutes prior to EMS arrival. Airway plan discussed with resuscitation team. This document covers high sensitivity troponin, risk disposition pathways, and STEMI equivalents.

Seizures 90

Seizures Documentation/Coding EKG/ECG Emergency Department 90

Taming the SRU

DECEMBER 8, 2023

EMS had reported she had coded en route. ED providers should be familiar with several extraction techniques for foreign bodies in the external auditory canal including the use of manual extractors, irrigation, and other methods such as adhesives and acetone. She regained pulses with warming on arrival.

Hyperthermia / Hypothermia 88

Hyperthermia / Hypothermia Head Injuries Resuscitation Documentation/Coding 88

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Although told several times, the story of the development by Henning Ruben of the prototypical modern manual resuscitator, the self-refilling bag with unidirectional non-rebreathing valves which now dominate the world of resuscitation, is still not well-known. Czech Military resuscitation kit, 1969, mfr.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

Taming the SRU

MAY 11, 2024

r1 clinical knowledge - r4 capstone - research grand rounds - the art of em - Community corner - PEM Lecture r1 Clinical knowledge: transplant complications WITH dr. gabor Time-sensitive peri-transplant emergencies: Bleeding fistula- stop the bleed. Assessed and provided feedback of pediatric resuscitations based on video review.

Administration 92

Administration Resuscitation Fluid Resuscitation Research 92

The Skeptics' Guide to EM

AUGUST 10, 2024

Case: A 65-year-old man is brought into the emergency department (ED) by emergency medical services (EMS) after his family saw him slump over at the dinner table. A code stroke is activated, and a CT head shows a left basal ganglia hemorrhage with no vascular lesions on CT angiography.

Stroke 86

Stroke Airway Management Documentation/Coding Outcomes 86

EM Ottawa

DECEMBER 28, 2023

There is a well-documented correlation amongst EMS and adult ED physicians who provide less pediatric care to […] The post Pediatric Traumatic Cardiac Arrest appeared first on EMOttawa Blog. Pediatric trauma is a high acuity but low frequency event (2).

Pediatrics 83

Pediatrics Documentation/Coding EMS Wellness 83

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. Macroscopic T-Wave Alternans: A Red Flag for Code Blue. J Am Coll Cardiol. 2006 Jan 17;47(2):269-81.

EKG/ECG 132

EKG/ECG Documentation/Coding Psychiatric EMS 132

EMDocs

JUNE 22, 2023

Remember that while mistakes in resuscitation are often dissected and analyzed, it is equally crucial to acknowledge and celebrate the moments of impeccable execution, where lives are saved and hope is restored. He is on a vasopressin infusion now after the four unit bolus from the initial resuscitation. Should be here in 5 minutes.”

Resuscitation 98

Resuscitation Ultrasounds Critical Access Radiology 98

PHEM Cast

DECEMBER 12, 2016

pdf Equipment required for resuscitative thoracotomy: Surface anatomy: Appearance of pericardial clot A foley catheter being used to fill a cardiac wound – note how easily this could be pulled out. An open chest with aortic compression Simulation of resuscitative thoracotomy by London HEMS team. Resuscitation; 2011: 1194-1197

Military 52

Military Resuscitation Emergency Department Documentation/Coding 52

Emergency Medicine Cases

MAY 23, 2017

This is the first ever video podcast on EM Cases with Jordan Chenkin from EMU Conference 2017 discussing how to optimize three aspects of cardiac arrest care: persistent ventricular fibrillation, optimizing pulse checks and PEA arrest, with code team videos contrasting the ACLS approach to an optimized approach.

Documentation/Coding 52

Documentation/Coding EMS Ultrasounds Resuscitation 52

The Skeptics' Guide to EM

MAY 8, 2021

He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR […] The post SGEM#329: Will Corticosteroids Help if…I Will Survive a Cardiac Arrest? He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR Safety Team. The resuscitation team arrives and ACLS protocols are continued.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

RebelEM

SEPTEMBER 26, 2022

Rezaie, MD (Twitter: @srrezaie ) The post TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding appeared first on REBEL EM - Emergency Medicine Blog. Significant coagulopathy: INR > 1.8 Guest Post By: Cheng Ng, MD PGY-1, Emergency Medicine Resident Nuvance Health, Poughkeepsie, New york Email : cheng.ng@nuvancehealth.org

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

Northwestern EM Blog

SEPTEMBER 26, 2022

It is well-documented that ED physicians have historically high rates of burnout compared to other specialties as well as a high incidence of post-traumatic stress disorder (PTSD) compared to the general population. PTSD is 2 times more prevalent in physicians (14.8%), with EM resident physicians falling in the range from 11.9%-21.5%.

Resuscitation 52

Resuscitation Emergency Department Academics Wellness 52

Advanced Emergency Nursing from AENJ

NOVEMBER 27, 2017

AHA gives focused recommendations ​. ​ ​​ The International Liaison Committee on Resuscitation (ILCOR) has for some years been meeting and agreeing upon resuscitation practices every five years; in addition to which there is the necessary slack time before and after each meeting to produce and disseminate the newly appropriate course materials.

CPR 40

CPR Basic Life Support Resuscitation Pediatrics 40

RebelEM

JUNE 8, 2023

Rezaie, MD (Twitter: @srrezaie ) The post The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults appeared first on REBEL EM - Emergency Medicine Blog. Am J Emerg Med. 2016; PMID: 27720568 Guest Post By: Courney Knieriem, MD PGY-1, Emergency Medicine Resident RWJBH Community Medical Center, Toms River, NJ Courtneyknieriem.md@rutgers.edu

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

The Skeptics' Guide to EM

DECEMBER 2, 2017

Case: You are working a regular shift in the emergency department when you hear a code blue called. You are the first physician to respond and you begin to resuscitate the patient. SGEM#64 : Classic EM Papers (OPALS Study) * SGEM#136 : CPR – Man or Machine?

Hospitals 40

Hospitals CPR Resuscitation Documentation/Coding 40

PHEM Cast

APRIL 21, 2021

Guidance documents College of Paramedics Statement on Intubation, available here. Difficult prehospital endotracheal intubation – predisposing factors in a physician based EMS. Resuscitation. Difficult prehospital endotracheal intubation – predisposing factors in a physician based EMS. Resuscitation.

Airway Management 40

Airway Management Resuscitation EMS Hospitals 40

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

The latter 1950s and 1960s, quested for nerve gas defense studying expired air resuscitation and modern resuscitology; developing intensive care units. To me, it harkens a new scientific renaissance of resuscitation science, emergency care, and creating systems for care. 1950s & 1960s Resuscitation Research.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Taming the SRU

JULY 31, 2024

However, believers in this superstition will perceive crazier shifts if the word is uttered so you probably shouldn’t say it, or use cautiously Full moons have no impact on ED, EMS, or HEMS volumes or acuity. Nice people are not more likely to get cancer.

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

Northwestern EM Blog

SEPTEMBER 12, 2022

In most events, hospitals have communication with EMS personnel that are on scene allowing them to have some sort of estimation of the scale of the event and type of disaster encountered. This can be gauged by the type of disaster encountered and with assistance from EMS personnel at the scene. How much staff is needed? EPM , 5 Apr.

Mass Casualty Incidents 52

Mass Casualty Incidents EMS Hospitals Hazardous Materials 52

Taming the SRU

MAY 30, 2023

Generally accepted (and some airlines spell it out) that they are assuming the liability even for you helping Documentation: To protect yourself (and the airline), will/should make documentation of what happened. Smith Quick Facts regarding In-Flight Emergencies: 2.75 Respiratory symptoms: 12.1% Nausea and vomiting: 9.5%

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

RebelEM

MARCH 27, 2023

What They Did: Retrospective, observational cohort study in a single high-volume academic hospital The ED had a 5 bed area used for ongoing management and resuscitation of patients who clinically deteriorate while boarding or while actively undergo a workup in other sections of the ED. J Crit Care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm. Emerg Med Pract.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Dr. Smith's ECG Blog

JULY 24, 2018

They stated that the patient was coded for 20 minutes, including multiple doses of epinephrine, and they also gave glucose, calcium, and bicarb. As stated above, resuscitation included epinephrine, calcium, and bicarb. His neurologic exam was excellent given reported 20-30 minutes of intra-arrest resuscitation.

EKG/ECG 52

EKG/ECG Dehydration Resuscitation Documentation/Coding 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

Written by Pendell Meyers Family of an elderly woman with many comorbidities called EMS when she suddenly experienced shortness of breath, nausea, vomiting, and near syncope. A 12 lead ECG was obtained by EMS and is shown below: What do you think? Code STEMI was activated.

EKG/ECG 52

EKG/ECG Shock EMS Documentation/Coding 52

Advanced Emergency Nursing from AENJ

NOVEMBER 20, 2014

It is critically important to document the physical findings in a plain-seeing, plain-speaking, non-judgmental manner that will not color or taint future investigations. Accurate time entries are important to document. Natural psycho-physiological responses may alter perceptions during the life-threatening event.

Military 40

Military Forensics Documentation/Coding Emergency Nursing 40

Advanced Emergency Nursing from AENJ

JULY 9, 2015

Pull out the manikins (or use a volunteer; BVM only) and run some awkward codes! ü With foresight, plan for your alternatives based upon what you have now , until the patient can be brought safely to conventional resuscitation room settings. Resuscitation, 56(1), 83-89. YouTube.com [Time=33’11” Presentation] EMS World.

Airway Management 40

Airway Management Pediatrics Resuscitation Emergency Nursing 40

EM Updates

JUNE 15, 2021

Any patient requiring high acuity care not thought to be infected with coronavirus was cared for in a different area that had previously been a low acuity zone, but which was subsequently equipped for resuscitation. and Emergency Medicine residents, in 12 hour shifts. Clinical testing and treatment protocols changed almost every day.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

EB Medicine

OCTOBER 1, 2018

And sepsis-3 redefined septic shock as “hypotension not responsive to fluid resuscitation” with the added requirement of vasopressors to maintain a MAP greater than or equal to 65 and with a lactate > 2. Jeff : I’m an EMS fellow, what can I say… Anyway, on to my favorite section -- prehospital care. So quite a few changes!

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Taming the SRU

FEBRUARY 22, 2023

EMS Grand Rounds with Dr. Connelly - R4 Case Follow up with Dr. Broadstock - R1 Clinical Knowledge: Vitamin Deficiencies WITH Dr. de Castro - Lecture R3 Small Groups Tox,Tasks,Rashes WITH Dr. Fabiano, Dr. Kein, and Dr. Martella4 - Palliative Medicine Consultation WITH Dr. Kiser EMS Grand Rounds WITH Dr. ConnelLy What I learned in my time with Sydney (..)

Hospice 40

Hospice EKG/ECG Resuscitation Seizures 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Cardiology emergently came down to see the patient and took her immediately to the cath lab for a pericardiocentesis (if the cardiologist and cath lab had not been immediately available, then the EM team would have needed to perform pericardiocentesis). A pericardiocentesis was performed by the subxiphoid approach with fluoroscopy.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

EB Medicine

AUGUST 6, 2019

Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Jeff: For all agents, regardless of the DOAC, the initial resuscitation follows the standard principles of hemorrhage control and trauma resuscitation. Let’s move into the treatment section.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EB Medicine

JULY 8, 2019

Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Most EM training programs certainly emphasize the importance of the the pelvic exam for women with lower abdominal pain, but some recent papers have questioned its role. Jeff: True.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40