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 then has another seizure in the department.

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

JANUARY 29, 2024

automated external cooling system) for all arrest patients (with any presenting rhythm, occurring in- or out-of-hospital) maintained for at least 24 hours; longer periods of fever prevention (which AHA now calls “temperature control”) for persistently comatose patients are also considered reasonable. °C/hour).

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

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 57

Hospitals Outcomes EKG/ECG Resuscitation 57

ACEP Now

APRIL 3, 2024

Targeted temperature management (TTM) for patients following cardiac arrest resuscitation has gone through several dosing iterations in the past two decades. Finally, the guidelines support active temperature management’s (though not necessarily hypothermia) role in improving post-arrest outcomes. degrees Celsius. Click to enlarge.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

RebelEM

JUNE 19, 2023

This balance is upset in trauma by loss of blood and factors, acidosis, hypothermia and the inflammatory cascade. Primary Results Patients enrolled from 15 emergency medical services at 21 hospitals across 3 countries over 7 years. absolute decrease in death in trauma patients with significant bleeding randomized TXA (NNT = 66).

Blood Transfusions 104

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 104

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

Northwestern EM Blog

MAY 9, 2022

For this reason, carbidopa/levodopa should never be discontinued during hospital admission - or ED boarding. [1] The most acute cause of death from NMS is hyperthermia, which is induced both by D2 receptor antagonism leading to rigidity and impaired thermoregulation from the striatum and hypothalamus. References 1. 12 March 2015.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Administration 52

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

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

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

SEPTEMBER 29, 2018

Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. His primary interests are resuscitation, prehospital critical care, airway management, and point-of-care ultrasound.

Basic Life Support 52

Basic Life Support Airway Management CPR Resuscitation 52

Emergency Medicine Cases

FEBRUARY 9, 2021

What should be the lab resuscitation targets? How do we mitigate the risk of hypothermia? What can hospitals do to mitigate blood wastage? Once the dust settles, what do we need to tell the patient and/or their family about the consequences of being massively transfused?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Resuscitation Hospitals EMS 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

ACEP Now

OCTOBER 11, 2024

3 Once the patient arrives in your emergency department, a rapid review of the patient’s status and results of resuscitative efforts should be performed. Fluid resuscitation will likely be warranted, and with crystalloid solution is most appropriate. Pediatric submersion injuries: emergency care and resuscitation. South Med J.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation 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

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. They had a difficult time getting a definitive airway pre-hospital. Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome.

Airway Management 52

Airway Management CPR Hyperthermia / Hypothermia Outcomes 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.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

The Skeptics' Guide to EM

MAY 8, 2021

CPR is initiated and a hospital rapid response team is called. The resuscitation team arrives and ACLS protocols are continued. Background: Cardiac arrests have high morbidity and mortality rates both in-hospital cardiac arrests (IHCAs) and out of hospital cardiac arrests (OHCAs).

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

EMDocs

MAY 28, 2024

Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Consider risk factors for multi-drug resistant microbes: Recent IV antibiotics Hospitalization within 90 days. COVID-19 and ACS COVID increases the risk of hospitalization, pneumonia, pain, and ACS in SCD patients. times maintenance.

Blood Transfusions 88

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 88

Don't Forget the Bubbles

FEBRUARY 5, 2025

This should include early identification of life-threatening injuries, targeted fluid resuscitation using blood products, pain management, then eventual safeguarding and psychological support. Establish IV access for potential fluid resuscitation. You feel the patient needs fluid resuscitation. Administer O2 if necessary.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

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 team start CPR, and this is emergently converted to extra-corporeal cardiopulmonary resuscitation via the open sternotomy wound. Stage 1 is performed in the first days of life.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

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 93

Seizures Shock CPR Hyperthermia / Hypothermia 93

EM Literature of Note

JANUARY 9, 2022

A Chilling Conclusion to the Hypothermia Debate? Saline Solution on Mortality in Critically Ill Patients No patient-oriented difference in outcomes regardless of fluid choice, although resuscitation volumes were not excessive. the subsequent hospitalization rate was around 10%. Stylet, No?

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 40

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. 2018, November ).

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

Mind The Bleep

OCTOBER 17, 2024

Clinically, your enthusiasm for providing maximal quality care needs balanced against rescue practicalities and a hostile environment (very different to your warm, dry resuscitation bay) – the cold makes all veins disappear…and you may be the only clinician responder at the scene. What illnesses or injuries do we see?

Soft Tissue Injuries 52

Soft Tissue Injuries Seizures Ambulance Services Teamwork 52

Don't Forget the Bubbles

OCTOBER 2, 2024

The Bubble Wrap Plus is a monthly Paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). Original clinical studies Prevention of NICU Admission Hypothermia in Moderate- and Late-Preterm Infants. Can’t get enough of Bubble Wrap?

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Urgent Care 52

Mind The Bleep

OCTOBER 29, 2024

Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% 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. Type of chemical and strength.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Mind The Bleep

FEBRUARY 9, 2024

Intensive care units provide the highest-level care for patients within the hospital. At most hospitals, the CCOT service is run by nurses and other advanced healthcare professionals who are very experienced in assessing and looking after unwell patients. Some respiratory wards offer NIV – some renal units offer dialysis.

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

Don't Forget the Bubbles

AUGUST 12, 2024

After a traumatic brain injury, all children and young people should have a C-ABCDE rapid assessment for life-threatening injuries (as per ATLS guidelines) focussed on trauma resuscitation and stabilisation, followed by a secondary assessment. All children and young people with severe TBI require endotracheal intubation for airway control.

Seizures 75

Seizures Pediatrics Emergency Department Ambulance Services 75

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

Rural Doctors Net

AUGUST 30, 2013

James and Casey are used to this kind of stuff (although Casey’s mostly in-hospital and has even got a CT scanner…James is used to working out of a tent wearing just rabbit skins). Allocate someone to activate ambulance, other clinical personnel, notify local hospital and give retrieval services a head’s up. The CAT will hurt.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

Thinking Critical Care

MAY 18, 2023

This meant that we could dispatch two Shock Team members to any hospital in Scotland, to stabilise and if necessary bring shocked patients into WIG, any time of any day or night. I do not recall one experiment getting as far as the resuscitation stage. We Registrars were each On Call for two weeks, with one week off. 311:1137-43.

Shock 40

Shock Research Resuscitation Sepsis 40

EMDocs

JANUARY 16, 2024

He subsequently walks out of the hospital with a normal neurologic exam two weeks after admission. Hypothermic Arrest In general, hypothermic patients in cardiac arrest should be aggressively resuscitated. Patients can have excellent outcomes despite prolonged resuscitation. Classification of hypothermia.

Hyperthermia / Hypothermia 97

Hyperthermia / Hypothermia Resuscitation CPR EMS 97

EMDocs

JUNE 12, 2024

Previous triad of death = hypothermia, acidosis, and coagulopathy. Liver dysfunction, secondary cirrhosis, critical illness, trauma, and hypothermia reduce citrate metabolism. Hypothermia also leads to hypoCa. Calcium and resuscitation Severely injured trauma patients are commonly hypocalcemic.

Hyperthermia / Hypothermia 100

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 100

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

Don't Forget the Bubbles

NOVEMBER 18, 2024

Epidemiology in Australia In Australia, the reported prevalence of neonatal hypotension in preterm infants is like that in the UK, with around 20-30% of very low birth weight infants experiencing significant hypotension during their initial hospital stay. Hypothermia: Newborns, particularly preterm infants, are prone to hypothermia.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59