Dr. Smith's ECG Blog

JULY 25, 2024

EMS arrived and found him in Ventricular Fibrillation (VF). For clarity in Figure-1 — I've reproduced today's ECG — obtained following successful resuscitation of out-of-hospital cardiac arrest. This patient was witnessed by bystanders to collapse. They started CPR. He was defibrillated into VT.

Resuscitation 126

Resuscitation EKG/ECG CPR Shock 126

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. August 20, 2024 Guest Skeptic: Dr. Chris Root is an emergency medicine and emergency medicine service (EMS) physician at the University of New Mexico, Albuquerque. Chris completed his emergency medicine residency and EMS fellowship at UNM.

Hospitals 104

Hospitals CPR EMS Outcomes 104

EMDocs

OCTOBER 19, 2024

We’ll keep it short, while you keep that EM brain sharp. 2][3] Management/Disposition ABCs and resuscitation if indicated Assessment for need of definitive airway is imperative as rate of intubation is high (38-100%) in various studies. [2][3][9] Hospital Pediatrics. Bacterial Tracheitis: Report of Eight New Cases and Review.

EMS 108

EMS Pediatrics Sepsis Airway Management 108

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. Special thanks to Dr. Kevin Wasko, guest expert on the EM Cases podcast on this topic, who inspired this column.

Airway Management 98

Airway Management Operations Resuscitation Pediatrics 98

ACEP Now

JUNE 21, 2023

emergency medicine (EM) residency training length has been a decades-long dilemma: four vs. three years. First, is three years enough time to become an EM physician? But critical questions remain unanswered when it comes to specialization, career trajectory, and actual competence as an EM physician. 11 What should we take away?

EMS 114

EMS Academics Telemedicine Operations 114

EMDocs

JULY 13, 2024

We’ll keep it short, while you keep that EM brain sharp. This patient appears septic and recently underwent a cesarean section delivery, which makes hospital admission and parenteral antibiotics the better choice for management. The post EM@3AM: Endometritis appeared first on emDOCs.net - Emergency Medicine Education.

OB/GYN 84

OB/GYN EMS Sepsis Fluid Resuscitation 84

RebelEM

AUGUST 21, 2023

In response to this critical issue, the TAME Cardiac Arrest Trial has been launched as a definitive phase III multi-center randomized controlled trial for resuscitated cardiac arrest patients. Mild Hypercapnia or Normocapnia after Out-of-Hospital Cardiac Arrest. Paper: Eastwood G, et al. N Engl J Med. Epub 2023 Jun 15.

Hospitals 92

Hospitals Resuscitation Outcomes CPR 92

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. Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. February 2024.

Resuscitation 92

Resuscitation Airway Management EMS Outcomes 92

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 6, 2024

Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. Case Follow-up: The patient received a fluid resuscitation with 20 mL/kg bolus of normal saline. Iron Ingestion: an Evidence-Based Consensus Guideline for Out-of-Hospital Management. Basic assessment: airway, breathing, circulation.

Poisoning 96

Poisoning Fluid Resuscitation Seizures Resuscitation 96

Emergency Medicine Cases

JUNE 15, 2020

In this EM Cases Best Case Ever podcast, Dr. Kari Sampsel, Emergency Physician at Ottawa Hospital and Assistant Professor at University of Ottawa, Medical Director of Sexual Assault and Partner Abuse Care Program guides us through an example of a perimortem C-section - a resuscitative hysterotomy at Janus General.

Sexual Assault 52

Sexual Assault Resuscitation EMS Hospitals 52

RebelEM

JUNE 1, 2023

Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC. Population: Patients successfully resuscitated from OHCA without a clear diagnosis on presentation who were stable for CT. Excluded: Obvious cause for OHCA prior to SDCT or on hospital arrival.

Outcomes 144

Outcomes Resuscitation Hospitals CPR 144

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). Outcomes: Primary Outcome: In-hospital mortality. Am J Emerg Med. 2023;73:34-39. 2.89, p = 0.01.

Sepsis 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch.

Hyperthermia / Hypothermia 106

Hyperthermia / Hypothermia Resuscitation CPR EMS 106

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Resuscitation. Resuscitation. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Emergency Medicine Cases

MAY 21, 2019

Things like inaccurate estimation of burn size, unnecessary endotracheal intubation, over- and under-estimation of fluid resuscitation volumes, inadequate analgesia and inappropriate wound dressings are just some of the issues where a small change to ED practice patterns could have a huge impact on patient care.

Airway Management 52

Airway Management Burns Resuscitation Fluid Resuscitation 52

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. It also reduced length of stay in ICU and hospital without adverse effects. septic shock). NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

The Skeptics' Guide to EM

JANUARY 9, 2021

Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

This was written by Magnus Nossen, from Norway, with comments and additions by Smith A 50 something smoker with no previous medical hx contacted EMS due to acute onset chest pain. Upon EMS arrival the patient appeared acutely ill and complained of chest pain. Resuscitation efforts were undertaken. How do you interpret the ECG?

EKG/ECG 134

EKG/ECG Resuscitation Academics EMS 134

ACEP Now

OCTOBER 3, 2023

The GCS should be measured after airway, breathing, and circulation are assessed, after a clear airway is established, and after necessary ventilatory or circulatory resuscitation has been performed. There are at least 600 TBI-related hospitalizations and 175 TBI-related deaths per day.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

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

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].

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

RebelEM

MARCH 30, 2023

Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. Article: How-Berlemont C, Lamhaut L, Diehl J, et al. 1.15; P= 0.32 1.15; P= 0.31

Hospitals 59

Hospitals Outcomes EKG/ECG Resuscitation 59

RebelEM

JUNE 19, 2023

Primary Results Patients enrolled from 15 emergency medical services at 21 hospitals across 3 countries over 7 years. The study is relatively small (CRASH2 enrolled > 20,000 patients); just 1300 patients from 21 hospitals over 7 years. appeared first on REBEL EM - Emergency Medicine Blog. This may dilute any effect of TXA.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

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. Today we look at the CENSER trial. vs 48.4% (OR 3.4,

Sepsis 88

Sepsis Shock Resuscitation Fluid Resuscitation 88

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4 Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4 Liberal: 14.9% Estimated Difference: -0.9%; 95% CI 04.4 Liberal: 14.9%

Sepsis 99

Sepsis Shock Resuscitation Outcomes 99

RebelEM

SEPTEMBER 14, 2023

At our institution patients do not go for diagnostic heart catheterization and then get put on ECMO, they are initiated on ECMO during the time of their initial resuscitation and then go for heart catheterization once they are stabilized. Control: 53.4% D ECLS: 18.2% Control 8.7% Control 38.0% Control: 49.0% RR 0.98; 95% CI 0.80 Control 3.8%

Shock 133

Shock Outcomes Resuscitation Stroke 133

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

Don't Forget the Bubbles

JUNE 30, 2023

In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. This was a randomised controlled multisite study comparing resuscitation of trauma patients requiring massive transfusion using either 1:1::1 or 1:1:2 ratios of platelets to plasma to red blood cells. to −0.5%]; P  = 0.03.).

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

RebelEM

JULY 17, 2023

PMID: Clinical Question: Does a single dose of ketamine or etomidate used for rapid sequence intubation (RSI) of critically adults in the ED impact the SOFA score within 3 days of hospitalization? appeared first on REBEL EM - Emergency Medicine Blog.

Outcomes 93

Outcomes Emergency Department Administration Resuscitation 93

Taming the SRU

MARCH 30, 2024

Emergency Critical Care Center (EC3) at the University of Michigan: Dedicated critical care unit within the emergency department that was created to improve access to timely, high-quality critical care after identifying a gap in emergency care delivery for patients Reduced risk-adjusted 30 day mortality among all ED patients, lower ICU admission rates (..)

Hyperthermia / Hypothermia 95

Hyperthermia / Hypothermia Leadership Emergency Department Seizures 95

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Annals of EM May 2018 Guest Skeptic: Andrew Merelman is a critical care paramedic and first year medical student at Rocky Vista University in Colorado.

Basic Life Support 52

Basic Life Support Airway Management CPR Resuscitation 52

Emergency Medicine Cases

JANUARY 2, 2023

Understanding why ETCO2 is recommended in cardiac arrest with Swami, practical steps to organ donation in the ED with Dr. Andrew Healy, using your hospital food court to treat paraphimosis, rectal prolapse and food bolus obstruction with Dr. Sarah Foohey, QI Corner with Dr. Tahara Bhate, 4 Medicolegal Myths with Dr. Jennifer C.

EMS 52

EMS Hospitals Pediatrics Resuscitation 52

The Skeptics' Guide to EM

OCTOBER 22, 2022

Head and thorax elevation during cardiopulmonary resuscitation using circulatory adjuncts is associated with improved survival. Resuscitation 2022 Guest Skeptic: Clay Odell is a Paramedic, Firefighter, and registered nurse (RN). Resuscitation 2022 Guest Skeptic: Clay Odell is a Paramedic, Firefighter, and registered nurse (RN).

CPR 52

CPR Hyperthermia / Hypothermia Resuscitation EMS 52

EMDocs

SEPTEMBER 15, 2023

3: Handy EMS OHCA Handoff Checklist Spoon Feed In this video review, information contained in out-of-hospital cardiac arrest (OHCA) patient handoffs was highly variable, which is an area for quality improvement and standardization. Resuscitation. J Thromb Haemost. 2023 Jul 20:S1538-7836(23)00573-1. doi: 10.1016/j.jtha.2023.07.011.

Pediatrics 79

Pediatrics Emergency Department Resuscitation EMS 79

ACEP Now

NOVEMBER 7, 2024

Despite the broad acceptance of Red Cross certifications by national accrediting bodies, state agencies, and thousands of hospitals and clinics, some medical centers, nursing schools, and community colleges have policies that do not recognize both organizations’ certifications. All three leverage the latest educational methodologies.

Advances Cardiac Life Support (ACLS) 74

Advances Cardiac Life Support (ACLS) Military CPR Basic Life Support 74