Taming the SRU

MARCH 27, 2024

Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial. In this study, the authors aim to assess the hemodynamic effects of prehospital high-dose glucocorticoid treatment in resuscitated comatose OHCA patients. Hill, J.

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Resuscitation Outcomes CPR Hospitals 98

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. Over the past few years, there has been an increase in emergency department (ED) volumes and lengths of stay. This is a critical error that leads to poorer outcomes for patients in need of critical care.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line. Conclusion Critical care resuscitation is stressful.

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Leadership Resuscitation Teamwork Patient Safety 105

RebelEM

JULY 24, 2023

Population: Patients > 14 years of age who underwent RSI with either etomidate or ketamine from the National Emergency Airway Registry (NEAR). Outcomes: Primary: Postintubation hypotension (SBP < 100 mm Hg) 15 minutes post-intubation. Emerg Med J. Independent variable studied: Etomidate and ketamine drug dose.

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Resuscitation Outcomes Emergency Department EMS 98

The Skeptics' Guide to EM

APRIL 27, 2024

Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care. first appeared on The Skeptics Guide to Emergency Medicine. Prehospital Emergency Care. Prehospital Emergency Care. February 2024.

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Resuscitation Airway Management EMS Outcomes 74

Don't Forget the Bubbles

JUNE 30, 2023

The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. They looked at 119 adult patients from an (unspecified) number of trauma centres. to −0.5%]; P  = 0.03.).

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Resuscitation Operations Sepsis Pediatrics 139

Critical Care Now

JULY 14, 2024

This week’s article, by Heuts et al, titled “Extracorporeal cardiopulmonary resuscitation versus standard treatment for refractory out-of-hospital cardiac arrest: a Bayesian meta-analysis” is a fresh take on the issue. Now, before we dive into the weeds, we need to establish what exactly a Bayesian meta-analysis is.

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Resuscitation Outcomes CPR Sepsis 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.

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Outcomes Administration Emergency Department Resuscitation 98

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS).

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Hyperthermia / Hypothermia Resuscitation CPR EMS 85

RebelEM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). Amiodarone versus digoxin for acute rate control of atrial fibrillation in the emergency department. Am J Emerg Med. Am J Emerg Med. 2022 Sep 7.

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Emergency Department Administration EMS Dehydration 52

RebelEM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial [published online ahead of print, 2023 Oct 12].

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Resuscitation Operations Outcomes Hospitals 91

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.

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Shock Emergency Department Administration Resuscitation 70

PulmCCM

NOVEMBER 6, 2023

Uncertainty has persisted about the ideal blood transfusion strategy to resuscitate and support trauma victims as they are prepared to undergo surgical and other mechanical interventions to achieve hemostasis. The intervention is called resuscitative endovascular balloon occlusion of the aorta (REBOA). Thromboelastometry (e.g.,

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Blood Transfusions Operations Resuscitation Infectious Diseases 98

EMDocs

JUNE 12, 2024

HypoCa is common in trauma patients and is associated with poor outcomes. 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 Am J Emerg Med.

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Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 89

Broome Docs

MARCH 28, 2024

Emerg Med J. PMID: 38050078 Bottom line: High dose nitroglycerin seems to result in better outcomes in SCAPE, at least according to this small, single center, unblinded trial. Resuscitation. High-dose versus low-dose intravenous nitroglycerine for sympathetic crashing acute pulmonary edema: a randomised controlled trial.

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PPE Ultrasounds Resuscitation Administration 107

EM Updates

JUNE 15, 2021

Maimonides Medical Center (MMC) is Brooklyn’s largest hospital, an academic quaternary care center with, in normal times, 711 total beds, 66 intensive care beds, and an Emergency Department that treats approximately 120,000 patients per year. and Emergency Medicine residents, in 12 hour shifts.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Taming the SRU

MARCH 11, 2024

of all orthopedic injuries and may be difficult to recognize if the dislocation spontaneously reduces prior to care in the Emergency Department, which may occur in upwards of 50% of cases (3). 4) This classification system is more specific but may be impractical to use in an Emergency Department setting. No open wound.

Dislocations 107

Dislocations Emergency Department Fractures Operations 107

Northwestern EM Blog

APRIL 15, 2024

“Tracheostomy: Epidemiology, Indications, Timing, Technique, and Outcomes.” Tracheotomy outcomes and complications: a national perspective. While most of the immediate complications of tracheostomy will occur in the ICU, these patients still frequent our emergency department with and without tracheostomy related emergencies.

Emergency Department 98

Emergency Department Resuscitation Pediatrics Outcomes 98

The Skeptics' Guide to EM

AUGUST 10, 2024

He is an assistant professor in Emergency Medicine, Neurology, and Neurosurgery at the School of Medicine at the University of Washington. 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.

Stroke 69

Stroke Airway Management Outcomes Documentation/Coding 69

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. Resuscitative attempts were initiated quickly.

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EKG/ECG Resuscitation CPR Emergency Department 137

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.

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Administration Emergency Department Outcomes Documentation/Coding 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

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Military Resuscitation Emergency Department Documentation/Coding 52

PulmCCM

JULY 3, 2023

emergency departments and ICUs were randomized to undergo either DL or VL for intubation. More than 90% of the intubations were performed by emergency medicine residents (~70%) or critical care fellows (~23%). At six months of followup, there was no difference in the rate of good neurologic outcome (43.5%

Airway Management 105

Airway Management Outcomes Hospitals Emergency Department 105

The Skeptics' Guide to EM

MAY 25, 2019

Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. Guest Skeptic: Dr. Robert Edmonds is an emergency physician in the US Air Force in Virginia. Nationwide Analysis of Resuscitative Endovascular Balloon Occlusion of the Aorta in Civilian Trauma. JAMA Surgery March 2019.

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Military Resuscitation PPE Emergency Department 52

Northwestern EM Blog

SEPTEMBER 26, 2022

Written by: Diana Halloran (NUEM ‘24) & Andrew Long (NUEM ‘25) Edited by: Nick Wleklinski (NUEM ‘22) Expert Commentary by : John Bailitz, MD Introduction The Emergency Department is a challenging work environment for a variety of reasons. Any team member of the resuscitation may lead the hot debrief.

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Resuscitation Emergency Department Academics Wellness 52

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. The primary outcome was the successful intubation on the second attempt. Secondary outcomes included tracheal intubation adverse events (TIAEs) or severe desaturation.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Guest Skeptic: Dr. Max Hockstein trained as an Emergency Medicine physician at University of Texas Southwestern and is finishing his Intensive Care fellowship at Emory. Case: It’s another day in your emergency department (ED).

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Sepsis Shock 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. We present a case of refractory ventricular fibrillation resuscitation due to coronary vasospasm from recent amphetamine use with IV NTG.

Resuscitation 52

Resuscitation EKG/ECG Documentation/Coding COPD 52

The Skeptics' Guide to EM

SEPTEMBER 3, 2017

EmergeNcy Department use of Apneic Oxygenation versus usual care during rapid sequence intubation: A randomized controlled trial (The ENDAO Trial). Guest Skeptic: Dr. Rory Spiegel is a clinical instructor at University of Maryland and a recent graduate of Stony Brook’s Resuscitation Fellowship. Reference: Caputo et al.

Emergency Department 52

Emergency Department Resuscitation Operations EMS 52

Critical Care Now

JULY 7, 2024

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. Reading Time: 3 minutes Jansen JO, Hudson J, Cochran C, et al. 2023;e2320850.

Resuscitation 52

Resuscitation Military Outcomes Hospitals 52

RebelEM

SEPTEMBER 29, 2022

Background: Standard emergency department management of acute pancreatitis has focused on aggressive hydration, analgesia and investigation for an underlying reversible cause (eg gallstones). Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Article: de-Madaria E et al. cherry picking results).

Administration 52

Administration Fluid Resuscitation Resuscitation Outcomes 52

The Skeptics' Guide to EM

NOVEMBER 23, 2019

Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs. AEM November 2019 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine. Reference: Daley et al.

Ultrasounds 52

Ultrasounds Emergency Department Academics Outcomes 52

Don't Forget the Bubbles

AUGUST 7, 2023

This prospective cohort study included patients between 0-16 years old, who presented to one of four NHS hospital sites in Greater Manchester (a large metropolitan area in the North of England), consisting of an Urgent Care Centre and three Emergency Departments. Yes Was the outcome accurately measured to minimize bias?

Sepsis 98

Sepsis Pediatrics Urgent Care Emergency Department 98

The Skeptics' Guide to EM

MARCH 2, 2019

Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome. Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome. Case: EMS arrive to your emergency department with a 68-year-old man post cardiac arrest patient. Date: February 26th, 2019 Reference: Benger et al.

Airway Management 52

Airway Management CPR Hyperthermia / Hypothermia Outcomes 52

Emergency Medicine Journal

DECEMBER 22, 2023

Game changer—this paper could/should change practice.

Resuscitation 40

Resuscitation Emergency Department Outcomes 40

EM Literature of Note

MARCH 2, 2023

First, and not least, the Annals of Emergency Medicine Podcast , the Ryan and Rory Show, recapping the articles from each month’s issue, available for free on your choice of streaming platforms: Apple Podcasts Google Podcasts Soundcloud Then, there’s always something to learn from ACEP Now!

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Emergency Department Resuscitation Shock EMS 52