Taming the SRU

DECEMBER 8, 2023

Most cases are sporadic, 20% occur among travelers Outbreaks can occur within buildings, workplaces, hospitals Accounts for 1-10% of CAP, co-infection uncommon Consider sending Legionella testing, or treating empirically Treatment requires at least 5 days of fluoroquinolone or macrolide (levofloxacin or azithromycin recommended)

Hyperthermia / Hypothermia 88

Hyperthermia / Hypothermia Head Injuries Resuscitation Documentation/Coding 88

The Skeptics' Guide to EM

DECEMBER 16, 2017

Hypothermia for Neuroprotection in Convulsive Status Epilepticus. NEJM Dec 2016 Guest Skeptic: Dr. Neal Little is an Emergency Physician who works at Chelsea Hospital in Chelsea, Michigan. Case: Johnny is a […] The post SGEM#199: Therapeutic Hypothermia – What is it Good For? He is known to have poorly controlled epilepsy.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

PulmCCM

JANUARY 22, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival. Read on for details.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

PulmCCM

JUNE 12, 2023

Induced hypothermia after cardiac arrest is also called “active temperature control” or “targeted temperature management.” Temperature management (or fever avoidance) should begin immediately after cardiac arrest (ideally in the emergency department, for out-of-hospital arrests) and continued for at least 72 hours.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 105

EM SIM Cases

NOVEMBER 3, 2023

CLINICAL VIGNETTE 58 y/o M presents with hyperthermia and confusion, and was found by bystanders to be acting strange. CASE SUMMARY In this case of exertional heatstroke, the team must identify hyperthermia and actively cool the patient while working the patient up for other causes. Link can be found here.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG EMS Hospitals 52

The Skeptics' Guide to EM

JULY 3, 2021

Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. Background: Hypothermia has been a mainstay of post-arrest care after the publication of two trials in 2002 that both suggested a benefit. This gives a NNT of 4.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Outcomes Wellness 52

PulmCCM

JANUARY 24, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival. Read on for details.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

Mind The Bleep

OCTOBER 29, 2024

Exposure Expose the patient in a systematic manner while keeping remaining body areas covered e.g. 1 limb at a time, to reduce the risk of hypothermia. First aid done pre-hospital. Assess pupillary reaction to light. Remove clothing which may be contaminated with chemicals and jewellery which may cause constriction if swelling occurs.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Don't Forget the Bubbles

JUNE 19, 2023

The centile used to define “small” may differ both by scientific study and by hospital. Hypothermia should be prevented both directly after birth (this includes considering the use of polythene bags in very small neonates born >32 weeks) and during admission. We commonly use less than the tenth centile.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

The Skeptics' Guide to EM

OCTOBER 22, 2022

Background: We have covered Out of Hospital Cardiac Arrests (OHCAs) many, many times on the SGEM. Case: You are the Chief of your local Fire and EMS Department, and an individual contacts you saying he saw a piece on TV about a “Heads Up” CPR device, and he wants to donate half the cost and has his checkbook out.

CPR 52

CPR Hyperthermia / Hypothermia Resuscitation EMS 52

Northwestern EM Blog

JUNE 16, 2024

Myocardial Infarction Medication Sinus node dysfunction Infectious Disease Hypothermia Metabolic Abnormalities (hypothyroidism, hyperkalemia, ect.) Hypothermia Moderate to severe hypothermia can cause significant bradycardia leading to hypotension. Hypothermia. Treatment includes permanent pacemaker placement [9].

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Infectious Diseases Stroke Poisoning 52

The Skeptics' Guide to EM

JUNE 24, 2017

Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline
The RINSE Trial (Rapid Infusion of Cold Normal Saline). Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline
The RINSE Trial (Rapid Infusion of Cold Normal Saline).

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia CPR Resuscitation EMS 40

ACEP Now

APRIL 3, 2024

Early work on TTM in 2002 showed benefit to cooling to 33 degrees Celsius, which subsequently influenced international resuscitation guidelines to recommend mild hypothermia at 32 degrees to 34 degrees Celsius in 2005. degrees Celsius. 5,6 In 2021, the TTM2 trial was published. degrees Celsius for 72 hours. Click to enlarge.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

The Skeptics' Guide to EM

FEBRUARY 11, 2023

NEJM 2022 Guest Skeptic: Dr. Sean Moore is an emergency physician working in Kenora Ontario, where he is Chief of Staff at Lake of the Woods District Hospital, Northern Medical Director for the Ornge air medical transport program and associate medical director with CritiCall Ontario. An anesthetist is working with him for the procedures.

Shock 57

Shock CPR Hyperthermia / Hypothermia Hospitals 57

Emergency Medicine Cases

FEBRUARY 9, 2021

How do we mitigate the risk of hypothermia? What can hospitals do to mitigate blood wastage? What should be the lab resuscitation targets? Why is serum calcium important to draw in the ED for the patient who is exsanguinating?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Resuscitation Hospitals EMS 52

The Skeptics' Guide to EM

MAY 8, 2021

CPR is initiated and a hospital rapid response team is called. Background: Cardiac arrests have high morbidity and mortality rates both in-hospital cardiac arrests (IHCAs) and out of hospital cardiac arrests (OHCAs). The resuscitation team arrives and ACLS protocols are continued. I have not seen a validation study published.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

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. Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. BLS for out-of-hospital cardiac arrest (OHCA).

Basic Life Support 52

Basic Life Support Airway Management CPR Resuscitation 52

EM Literature of Note

JANUARY 9, 2022

A Chilling Conclusion to the Hypothermia Debate? link] Effect of Moderate vs Mild Therapeutic Hypothermia on Mortality and Neurologic Outcomes in Comatose Survivors of Out-of-Hospital Cardiac Arrest 31°C was no better than 34°C for improving neurologic outcomes following OHCA. the subsequent hospitalization rate was around 10%.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 40

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

The Skeptics' Guide to EM

AUGUST 14, 2021

Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Date: August 12th, 2021 Reference: Daya et al. Reference: Daya et al.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

The Skeptics' Guide to EM

OCTOBER 24, 2020

Mobile Smartphone Technology Is Associated With Out-of-hospital Cardiac Arrest Survival Improvement: The First Year “Greater Paris Fire Brigade” Experience. Mobile Smartphone Technology Is Associated With Out-of-hospital Cardiac Arrest Survival Improvement: The First Year “Greater Paris Fire Brigade” Experience.

CPR 52

CPR Hyperthermia / Hypothermia Resuscitation EMS 52

Don't Forget the Bubbles

MAY 17, 2023

The Bubble Wrap Plus is a monthly paediatric journal club reading list from Anke Raaijmakers, working with Professor Jaan Toelen and his team at the University Hospitals in Leuven. Disparities in Clinical Ethics Consultation Among Hospitalized Children: A Case-Control Study. Can’t get enough of Bubble Wrap? Kurepa D, et al.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

Don't Forget the Bubbles

JUNE 26, 2023

Staged reconstructions are a topic in itself (click here for a nice summary by Children’s Hospital of Philadelphia), but here we focus on Stage 1. The JET is treated by deepening sedation (to minimise exogenous and endogenous catecholamines), optimizing electrolytes and active mild hypothermia. Int J Cardiol. 2016;219:14-19.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

Broome Docs

OCTOBER 31, 2022

Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. PMID: 36168956 Bottom line: Despite the significant imperfections of this trial, it is important data (as we lack data on hypothermia after inpatient cardiac arrest), and it adds to the growing body of evidence that suggests hypothermia provides no benefit.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 52

EMDocs

JANUARY 8, 2024

We recommend hospitals develop protocols for postarrest temperature control. Patients with spontaneous hypothermia after ROSC unresponsive to verbal commands should not routinely be actively or passively rewarmed faster than 0.5° C during postarrest temperature control. COR 1, LOE B-NR. COR 1, LOE B-NR. COR 2b, LOE C-LD. C per hour.

Seizures 98

Seizures Shock CPR Hyperthermia / Hypothermia 98

The Skeptics' Guide to EM

FEBRUARY 27, 2021

In Australia, Methoxyflurane has been widely used at sub-anesthetic doses for analgesia in the pre-hospital setting since 1975. Recently, there has been increased interest in using methoxyflurane (Penthrox), an inhaled non-opioid analgesic, to provide rapid short-term analgesia (23, 24).

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Administration Research 52

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. had at least 2 potential etiologies for developing acute myocarditis: i ) Profound hypothermia ( core temperature = 90°F = 32.2°C This was sent by a reader. and K was normal. Here was the ECG: There is sinus tachycardia. Our THANKS to Dr.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

EMDocs

FEBRUARY 9, 2024

Authors: Adam Roussas, MD, MBA, MSE // Reviewed by: Jamie Santistevan, MD ( @jamie_rae_EMdoc, EM Physician, Presbyterian Hospital, Albuquerque, NM); Manpreet Singh, MD ( @MPrizzleER ); and Brit Long, MD ( @long_brit ) Case A 40-year-old female presents to the emergency department for palpitations and lightheadedness.

EKG/ECG 97

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 97

Emergency Medicine Ireland

APRIL 4, 2022

Outcomes are often examined in great detail and are more likely than most patient cohorts to be reflected onto the hospital and even individual surgeons. Likely driven by rewarming induced vasodilation and hypothermia induced diuresis they can be hypovolaemic.

Fluid Resuscitation 40

Fluid Resuscitation Hyperthermia / Hypothermia Outcomes Resuscitation 40

RebelEM

DECEMBER 19, 2022

The authors sought to answer whether double defibrillation and/or vector change defibrillation lead to a greater number of RVF patients surviving to hospital discharge when compared to standard defibrillation therapy. Now that same group has published the results of their full randomized control trial.

EMS 52

EMS CPR Shock Resuscitation 52

EM Ottawa

JULY 6, 2023

Global temperatures are increasing and are projected to continue warming. The rates of warming across out planet are not uniform. In Canada, the loss of snow and sea ice reduces the reflectivity of the surface leading to increased absorption of solar radiation and a faster rate of warming compared to more southern regions.

Hyperthermia / Hypothermia 97

Hyperthermia / Hypothermia Stroke Hospitals Resuscitation 97

Don't Forget the Bubbles

JUNE 30, 2023

Still, after a quick Google search, you realise that hypothermia potently affects potassium shift from the extracellular to the intracellular and extravascular spaces. Still, after a quick Google search, you realise that hypothermia potently affects potassium shift from the extracellular to the intracellular and extravascular spaces.

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

Mind The Bleep

DECEMBER 19, 2023

In cases of hypothermia, re-warming can be done passively (with blankets), or active techniques can be implemented in severe cases. Retrieved from The Royal Children’s Hospital Melbourne : [link] ISPAD. BSPED Guideline for the Management of Children and Young people under the age of 18 with DKA. Diabetic Ketoacidosis.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

EMDocs

DECEMBER 18, 2024

This series provides evidence-based updates to previous posts so you can stay current with what you need to know. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold

Seizures 106

Seizures Hyperthermia / Hypothermia Emergency Department EMS 106

EMDocs

NOVEMBER 13, 2024

Mild hypothermia is normal in patients with advanced cirrhosis; consider lowering threshold for fever to 37.8 Marked hypothermia is specific for SBP (> 90%), and it’s a poor prognostic finding. Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis.

Hyperthermia / Hypothermia 106

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 106

PulmCCM

MARCH 10, 2025

This is part of a series of articles on the duration of CPR for in-hospital cardiac arrest. hospitals each year, physicians receive no formal guidance or training on how, when, or why it should be made. But first, a quick recap of what we know about all in-hospital cardiac arrests and shockable cardiac arrests.

CPR 52

CPR Hospitals Hyperthermia / Hypothermia Resuscitation 52

EMDocs

JUNE 1, 2023

This week we cover the POLAR RCT on hypothermia for neuroprotection in those with severe TBI. Take Aways: The data do not suggest that targeted hypothermia improves neurological function, reduces death, or reduces hospital length of stay as compared to normothermia. Welcome back to the “52 in 52” series. Bradycardia: 18.8%

Hyperthermia / Hypothermia 86

Hyperthermia / Hypothermia Outcomes Hospitals Emergency Department 86