The Skeptics' Guide to EM

NOVEMBER 16, 2019

Case: A 59-year-old […] The post SGEM#275: 10th Avenue Freeze Out – Therapeutic Hypothermia after Non-Shockable Cardiac Arrest first appeared on The Skeptics Guide to Emergency Medicine. Background: We have covered therapeutic hypothermia many times on the SGEM. Date: November 6th, 2019 Reference: Lascarrou et al.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia EMS Research Documentation/Coding 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.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

Taming the SRU

DECEMBER 8, 2023

It is possible she was just severely hypothermic.

Hyperthermia / Hypothermia 88

Hyperthermia / Hypothermia Head Injuries Resuscitation Documentation/Coding 88

The Skeptics' Guide to EM

MAY 20, 2023

She is part of the Don’t Forget the Bubbles team and faculty at Queen Mary […] The post SGEM #404: Sitting on the Dock of the Bay-esian Interpretation of Therapeutic Hypothermia for Pediatric Cardiac Arrest first appeared on The Skeptics Guide to Emergency Medicine. Therapeutic hypothermia after out-of-hospital cardiac arrest in children.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics CPR Hospitals 52

EMDocs

JUNE 12, 2024

Previous triad of death = hypothermia, acidosis, and coagulopathy. HypoCa is common in trauma patients and is associated with poor outcomes. Liver dysfunction, secondary cirrhosis, critical illness, trauma, and hypothermia reduce citrate metabolism. Hypothermia also leads to hypoCa. Whole blood does contain less citrate.

Hyperthermia / Hypothermia 89

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 89

The Skeptics' Guide to EM

DECEMBER 16, 2017

Hypothermia for Neuroprotection in Convulsive Status Epilepticus. Case: Johnny is a […] The post SGEM#199: Therapeutic Hypothermia – What is it Good For? Hypothermia for Neuroprotection in Convulsive Status Epilepticus. Background: We have covered hypothermia a number of times on the SGEM. Reference: Legriel et al.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Seizures Hospitals Stroke 40

PulmCCM

JUNE 12, 2023

Induced hypothermia after cardiac arrest is also called “active temperature control” or “targeted temperature management.” TTM2 found no improvement in survival or neurologic outcome among patients randomized to cooling to a target of 33 °C, as compared to controls receiving fever prevention (e.g.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Academics Documentation/Coding Outcomes 105

Dr. Smith's ECG Blog

OCTOBER 8, 2023

ECG#1 ECG#2 ECG#3 ECG#4 ECG#5 See outcomes of all 5 below, with the Queen of Hearts AI Bot interpretation. Severe hypothermia not uncommonly has accompanying T waves inversions. Another frequent feature of hypothermia is atrial fibrillation (not seen in this case) Core temperature of this patient was 29,5 Celsius. There is SR.

Hyperthermia / Hypothermia 118

Hyperthermia / Hypothermia EKG/ECG Wellness Shock 118

RebelEM

JUNE 19, 2023

This balance is upset in trauma by loss of blood and factors, acidosis, hypothermia and the inflammatory cascade. PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy?

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

Pediatric EM Morsels

AUGUST 9, 2024

We have previously discussed hypothermia presentations , GBS infections , and HSV infections. If not treated early, then increased risk of poor outcomes and death. Fortunately, we have addressed many neonatal issues in the PedEMMorsels. Obviously, one of the most concerning considerations in neonates is the potential for infection.

Hyperthermia / Hypothermia 152

Hyperthermia / Hypothermia Emergency Department Seizures Pediatrics 152

Sensible Medicine

JUNE 5, 2023

Did the new treatment reduce the bad outcome so much so that the difference meets a statistical threshold? Two examples explain the challenge of using statistics to judge science In large studies, a tiny difference in outcomes—one that is not “clinically” significant can easily reach statististical significance.

Stroke 91

Stroke Outcomes Hyperthermia / Hypothermia Shock 91

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.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 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

Don't Forget the Bubbles

JUNE 19, 2023

It is useful to know that there are two kinds of weight curves: Descriptive , in which nearly all mothers and their children are included with few exclusion criteria, and Prescriptive , in which groups of women with pathologies that affect neonatal morbidity and mortality outcomes have been excluded. Eur J Pediatr 2016;175:1047-57.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

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.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

PulmCCM

JANUARY 29, 2024

Patients presenting with hypothermia should not be warmed too quickly (allowing their temperature to increase by <0.5°C/hour). There should be an active approach to fever prevention (e.g., °C/hour). “Prompt” electroencephalogram (EEG) was advised strongly for all cardiac arrest survivors not following commands.

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

EMDocs

DECEMBER 18, 2024

Alcohol withdrawal syndrome: improving outcomes through early identification and aggressive treatment strategies. 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 61

Seizures Emergency Department Hyperthermia / Hypothermia EMS 61

Don't Forget the Bubbles

JANUARY 24, 2024

Mortality is high, between 16-43.5% , and neurological outcomes are generally poor amongst survivors. These poor outcomes are related to both the SRSE itself and as a result of the prolonged PICU stay. One study suggests remission in 6 out of 7 patients where it was used, but long-term clinical outcomes remained poor.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

ACEP Now

OCTOBER 3, 2023

These guidelines present the best available evidence to support clinical decision making in the prehospital setting when TBI care may have the most significant impact on outcomes; they also establish a research agenda for future investigations. This document is an update of guidelines first published in 2000, and then updated in 2007.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Taming the SRU

APRIL 13, 2023

Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

EMDocs

NOVEMBER 13, 2024

Older age, recurrent episodes of SBP, hepatorenal syndrome, hepatic encephalopathy, acute kidney injury (AKI), concurrent GI bleeding, and higher MELD scores are predictors of worse outcomes. Mild hypothermia is normal in patients with advanced cirrhosis; consider lowering threshold for fever to 37.8 coli (50-90% of cases).

Hyperthermia / Hypothermia 79

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 79

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 81

Hospitals Outcomes EKG/ECG Resuscitation 81

Don't Forget the Bubbles

AUGUST 4, 2024

Morris and colleagues investigated the efficacy of refrigerated gel packs for therapeutic hypothermia in neonatal retrieval. They used servo-controlled therapeutic hypothermia (versus passive hypothermia) and found no major difference in outcome. More studies on this topic will surely follow. Gallo Ruelas M, et al.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics Burns Sepsis 52

EM Literature of Note

JANUARY 9, 2022

The Annals of Emergency Medicine Podcast continues apace, with free monthly updates from the original research published in the journal: iTunes Link SoundCloud Link Likewise, the Annals of Emergency Medicine Journal Club has published several monthly installments: Predicting Outcomes in Pediatric Pneumonia: Are We Omnipotent or Incompetent?

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 40

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. Clinical Question #1: Are superglottic airway devices non-inferior to endotracheal intubation in OHCA with regards to neurologic outcome?

Airway Management 52

Airway Management CPR Hyperthermia / Hypothermia Outcomes 52

The Skeptics' Guide to EM

FEBRUARY 11, 2023

This has included things like therapeutic hypothermia ( SGEM#54 , SGEM#82 , SGEM#183 and SGEM#275 ), supraglottic devices ( SGEM#247 ), crowd sourcing CPR ( SGEM#143 and SGEM#306 ), epinephrine ( SGEM#238 ) and IO vs IV (SGEM#231 and SGEM#340). .

Shock 55

Shock CPR Hyperthermia / Hypothermia Hospitals 55

ACEP Now

OCTOBER 11, 2024

1,2 Clinical outcomes in submersion injuries are largely dependent on the degree of hypoxic injury experienced by the victim, making prehospital care of paramount importance. Pediatric hypothermic submersion injury and protective factors associated with optimal outcome: a case report and literature review. pediatric hospitals.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation 52

The Skeptics' Guide to EM

MAY 8, 2021

Improving outcomes for patients with cardiac arrests has been an ongoing challenge in pre-hospital and in hospital medicine. SGEM#50 looked at a RCT published in JAMA 2013 looking to see if a vasopressin, steroids, and epinephrine (VSE) protocol for IHCAs could improve survival with favorable neurologic outcome compared to epinephrine alone.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

However, no randomized trial has compared intravenous access to intraosseous access with a primary outcome of good neurologic function. Clinical Question: Is intraosseous vascular access in the pre-hospital setting for OHCA associated with better neurologic outcomes compared to intravenous vascular access?

Basic Life Support 52

Basic Life Support Airway Management CPR Resuscitation 52

Don't Forget the Bubbles

JANUARY 10, 2024

Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. Outcomes Primary outcome Mortality at 28 days after randomisation. The authors chose a patient-centred, primary outcome in keeping with their pragmatic design. What were the research questions? The study asked TWO questions: 1.

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

The Skeptics' Guide to EM

AUGUST 14, 2021

This has included the classic paper from Legend of EM Dr. Ian Stiell on BLS vs. ACLS ( SGEM#64 ), the use of mechanical CPR ( SGEM#136 ), and pre-hospital hypothermia ( SGEM#183 ). The key result was that significantly fewer patients had a favorable neurologic outcome in the IO group compared to the IV group.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

The Skeptics' Guide to EM

FEBRUARY 27, 2021

Delays in providing adequate analgesia leads to poorer patient outcomes, prolonged ED length of stay and reduced patient satisfaction (17, 18). Multiple factors have been thought to contribute to oligoanalgesia (overcrowding, language barriers, age, gender, ethnicity, insurance status) (13-16).

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Administration Emergency Department Research 52

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. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes. His heart rate is creeping up, now 140.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EMDocs

JANUARY 8, 2024

Magnesium does not improve ROSC, survival, or neurologic outcomes, no matter the presenting rhythm (Level 3: no benefit). Patients with spontaneous hypothermia after ROSC unresponsive to verbal commands should not routinely be actively or passively rewarmed faster than 0.5° COR 2b, LOE C-LD. C per hour. COR 2b, LOE C-EO.

Seizures 83

Seizures Shock CPR Hyperthermia / Hypothermia 83

PulmCCM

JUNE 19, 2023

No drug or combination improved the primary outcome (a composite outcome of hypoxemia, visit to the emergency department, hospitalization, or death). Sepsis was a main trigger, and hypothermia and shock were as common (>50%) as coma. That was in NEJM Aug 18 2022. Very high TSH levels (17-100 mIU/L) and very low FT3 (0-2.2)

Infectious Diseases 52

Infectious Diseases Outcomes Hyperthermia / Hypothermia Sepsis 52

The Skeptics' Guide to EM

JANUARY 9, 2021

This has included things like therapeutic hypothermia ( SGEM#54 , SGEM#82 , SGEM#183 and SGEM#275 ), supraglottic devices ( SGEM#247 ), crowd sourcing CPR ( SGEM#143 and SGEM#306 ), and epinephrine ( SGEM#238 ). The crew is asking if they should transport the patient with resuscitation ongoing?

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

Don't Forget the Bubbles

MAY 17, 2023

Early Antibiotic Use and Neonatal Outcomes Among Preterm Infants Without Infections. To feed or not to feed during therapeutic hypothermia in asphyxiated neonates: a systematic review and meta-analysis. Eur J Pediatr. 2023 Apr 13. Patterns of parental online health information-seeking behaviour. Yudianto B, et al. 2023 Apr 13.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72