Don't Forget the Bubbles

JUNE 26, 2023

But, they may present postnatally with cyanosis/hypoxaemia due to insufficient pulmonary blood flow, cardiogenic shock due to insufficient systemic blood flow, or both. Whilst waiting for an operation, they need to be managed medically. Soon after the operation, the baby is noted to have junctional ectopic tachycardia (JET).

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

Taming the SRU

AUGUST 11, 2024

ABEM updates - R4 Capstone - Sepsis Operations update - R3 taming the sru - traveler’s diarrhea abem updates WITH dr. melissa platt, abem board of directors Beginning 2026, ABEM will be requiring a new certifying exam to replace the previous oral boards.

Sepsis 89

Sepsis Burns Shock Operations 89

RebelEM

NOVEMBER 20, 2023

Military practice guidelines recommend REBOA for profound shock (SBP <90mmHg) 1 and ACEP along with the American College of surgeons recommend REBOA for traumatic life-threatening hemorrhage below the diaphragm in patients with hemorrhagic shock who are unresponsive or transiently responsive to resuscitation.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

RebelEM

APRIL 29, 2024

Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure. Intravenous vs.intraosseous vascular access during out-of-hospital cardiac arrest – protocol for a randomized clinical trial. PMID: 33350794 10 Meilandt C. Resusc Plus. 2023 PMID: 37502742 11 Schwalbach KT et al.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

PHEM Cast

APRIL 27, 2023

Further reading Matt has kindly provided a list of references from his Trauma Care talk which this podcast is based on: Peri-operative and critical care management of the brain – current evidence. Anaesthesia: Vol 77, No S1.

Resuscitation 52

Resuscitation Shock Operations Hospitals 52

RebelEM

AUGUST 12, 2024

Hospitals should be cautious in deciding to put their efforts towards them when the data from this trial has actually shown that it works in a diversified patient population such as that which exists in the United States.

Outcomes 81

Outcomes Hospitals Operations Shock 81

AED Leader

APRIL 22, 2024

It is estimated that over 350,000 cases of out-of-hospital cardiac arrests occur annually in the United States alone. The Role of AEDs in Sudden Cardiac Arrest AEDs are portable electronic devices designed to deliver an electric shock to the heart and restore its rhythm during SCA.

CPR 52

CPR Shock Resuscitation Operations 52

RebelEM

JANUARY 25, 2024

Point-of-care ultrasound (PoCUS) is inherently operator-dependent, which may have led to inconsistencies in the quality and findings of the ultrasound exams across different operators. Additionally, the serial US group had higher hospital readmission rates on days 0-7 and 8-30 without improving hospital or 30-day mortality.

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane). Lane & Mcdonough Definition of an immediate whole body CT (iWBCT) scan Shortly after patient arrival.

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

Don't Forget the Bubbles

JULY 26, 2023

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

RebelEM

JUNE 8, 2023

The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. Intensive Care Med. 2018;44(6):857–67. PMID: 29872882 Jones AE, et al. 2006;130(4):941–6. PMID: 17035422 Holler JG, et al.

Administration 97

Administration Emergency Department Outcomes Documentation/Coding 97

Total Medical ComplianceHIPAA

OCTOBER 9, 2024

Mold buildup, sanitary sewer systems operating correctly, surfaces being free of microorganisms, equipment being cleaned/disinfected/sterilized properly, and supplies being free of damage are just a few other issues to look out for. Clean and disinfect surfaces with an EPA registered hospital level disinfectant.

Hazardous Materials 59

Hazardous Materials Infectious Diseases PPE Shock 59

AED Leader

AUGUST 22, 2024

By delivering an electric shock to restore normal heart rhythm in cases of ventricular fibrillation or other arrhythmias, AEDs play a vital role in increasing survival rates following sudden cardiac arrests. AEDs are designed for easy use, so even people without medical training can operate them effectively in critical situations.

CPR 52

CPR Shock Operations Outcomes 52

AED Leader

SEPTEMBER 27, 2024

The defibrillator sends an electric shock to stop this chaos, letting the heart’s natural pacemaker take back control. Giving a shock in time might just save a life. ” This portable lifesaver guided us with voice prompts as we attached it and administered a shock. That’s huge.

Shock 52

Shock Operations CPR Outcomes 52

EMDocs

JANUARY 11, 2025

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. Operative management is necessary for signs of peritonitis, evidence of perforation, extensive bowel involvement >40cm, or after failed medical management.

EMS 75

EMS Sepsis Shock Fluid Resuscitation 75

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Operations 66

Operations Radiology Radiology Fluid Resuscitation 66

ACEP Now

MAY 9, 2024

A search for Brazilian Butt Lift (BBL) on any social media platform will yield thousands of before-and-after images, faja sales, operating room videos, recovery tips, and patients praising their plastic surgeon. This should be suspected in patients with intraoperative cardiac arrest or shock.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

AED Leader

SEPTEMBER 22, 2024

Portable defibrillators have become game-changers in saving lives during sudden cardiac arrest situations outside the hospital. They check the heart’s rhythm and send a shock to help it beat right again. It checks the heart’s rhythm and sends a shock if needed to get it beating right again. The neat part?

CPR 52

CPR Shock Operations Hospitals 52

AED Leader

SEPTEMBER 24, 2024

With over 350,000 cases occurring outside of hospitals each year in the United States alone, having access to an Automated External Defibrillator (AED) can literally mean the difference between life and death. Immediate access to these devices can save lives, especially in places far from hospitals.

Pediatrics 52

Pediatrics Shock Operations Wellness 52

Critical Care Now

JULY 7, 2024

Military practice guidelines, along with ACEP and the American College of Surgeons, recommend REBOA for traumatic life-threatening hemorrhage below the diaphragm in patients with hemorrhagic shock who are unresponsive or transiently responsive to resuscitation.

Resuscitation 52

Resuscitation Military Outcomes Hospitals 52

Resus Review

AUGUST 27, 2015

She had just left the hospital, and had so many scheduled doctor’s appointments over the next several weeks that the last thing she wanted to do was going to the emergency department. She had been home from the hospital for 3 days, when the chest pressure had started. Friends were coming over. At least perceived control.

Operations 52

Operations EKG/ECG Hospitals Emergency Department 52

Don't Forget the Bubbles

OCTOBER 10, 2024

This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. 2023 Mar 30;110(4):432-438.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

Taming the SRU

FEBRUARY 19, 2024

A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. Arterial lines require specialized monitoring and nursing resources which are not available in all hospital settings. PMID: 35338337. Keville, M. Gelmann, D., Raffman, A., Gelmann, D.,

Shock 59

Shock Resuscitation Ultrasounds Research 59

Intensive Blog

FEBRUARY 7, 2023

Everything ECMO 045: The role of ECPella in unloading the Left Ventricle Author: Dr Sneha Varkey Peer reviewer: Dr Vinodh Nanjayya A 44-year-old female patient suffered an out-of-hospital ventricular fibrillation (VF) arrest. Management of left ventricular distension during peripheral extracorporeal membrane oxygenation for cardiogenic shock.

Shock 52

Shock Hospitals Operations Outcomes 52

EMDocs

DECEMBER 6, 2024

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. 6 Severe toxicity and shock are typically seen with serum iron concentrations above 500 g/dL and serum iron concentrations above 1000 g/dL are associated with significant mortality. 2 L/hr in adults. Erdman, A.

Poisoning 75

Poisoning Fluid Resuscitation Seizures Resuscitation 75

RebelEM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. 4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. J Crit Care. Prior studies have used annual census or shift level crowding.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

AED Leader

DECEMBER 2, 2024

Defibrillation: Once a dangerous rhythm is detected, the AED delivers a controlled electric shock to help restore normal heart rhythm. By ensuring quick access to AEDs in public settings, we can significantly increase survival rates for cardiac arrest victims, leading to improved outcomes and better survival to hospital discharge.

CPR 52

CPR Basic Life Support Resuscitation Hospitals 52

Greater Sydney Area HEMS

APRIL 26, 2023

– Eventual hospital assessment demonstrated no traumatic injuries. In contrast, shock (leading to syncope and rarely cardiac arrest) from ST can occur well before mechanisms of crush injury come into play, with low-flow states described as early as within 6 minutes (2). . . – Prior to extraction, he was GCS 15 and talking.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

ETM Course

MAY 3, 2017

Simple windlass-style tourniquets are relatively inexpensive, easy to apply and easy to operate. If there will be a delay of more than an hour to definitive surgical care (for example, delayed retrieval or prolonged transport time), all efforts should be made to obtain vascular haemorrhage control by a surgeon in the referring hospital.

Military 52

Military Shock Hospitals Operations 52

PHEM Cast

APRIL 18, 2016

All things Pre Hospital Ketamine – Minh Le Cong Key point: patients remember if you manage their pain well. Hauwald, 2002 A co-operative patient does not require immobilization unless their conscious level deteriorates. We have also recorded a three interviews already which will feature in future podcasts.

Fractures 40

Fractures Administration Operations Shock 40

ACEP Now

SEPTEMBER 13, 2023

Years before, he’d started his EM career as medical director of the ER at Memphis’ public hospital and Memphis Fire EMS. Kellermann was a member of the original committee and played a behind-the-scenes role in encouraging its formation. Accidental Death and Disability: The Neglected Disease of Modern Society. National Academics.

EMS 45

EMS Research Academics Military 45

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Review of the Wellcome Library movies on YouTube (1945) [ links below in references ] is instructive as to resuscitative methods of the 1930s and 1940s: Manual methods; gas bag or bellows operated by hand or machine; an anesthesia gas machine; or iron lung. Evaluation: Manually Operated Resuscitators (1971) Emergency Care Research Institute.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

RebelEM

NOVEMBER 3, 2022

The environment, operator-related factors, and equipment are different in a pre-hospital vs. ED setting. 2/3rds of the population were trauma patients, and more patients in the ketamine arm had shock, hypoxemia, extremes of size, and anatomic challenges, potentially biasing the results to favor etomidate.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

Pediatric Emergency Playbook

FEBRUARY 1, 2016

REBOA If you have access to resuscitative endovascular balloon occlusion of the aorta or REBOA, this may be an option to temporize the child to get him to the relative control of the operating room. They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. Brenner et al. Four patients lived, two died.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

An elderly lady in cardiogenic shock (BP 60/40) with no veins , I was lucky to get a 24-gauge PIV into the back of her wrist. Once, while taking a patient to the hospital, Dispatch radioed us to call ASAP (radio rules didn't allow explanation). Intraosseous Infusion. Not as often resorted to promptly, as it should be.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 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

PEMBlog

JUNE 5, 2024

You should also consider the possibility of quote unquote spinal shock. than it is spinal shock. And hypotension, bradycardia, or temperature instability can result from hemorrhagic and or spinal shock. Any patient with a cervical spine injury or a neurologic deficit They’re getting admitted to the hospital.

Fractures 52

Fractures Pediatrics Radiology Radiology 52