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

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

The Skeptics' Guide to EM

MAY 8, 2021

He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR […] The post SGEM#329: Will Corticosteroids Help if…I Will Survive a Cardiac Arrest? He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR Safety Team. The resuscitation team arrives and ACLS protocols are continued.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

Don't Forget the Bubbles

JUNE 26, 2023

Too much pulmonary blood flow and we will see well-oxygenated blood ( SpO2 >85% ) but insufficient systemic blood flow (pallor/mottling, cool peripheries, delayed capillary refill time, weak pulses, hypotension, narrow pulse pressure) and hypoxia (lactic acidosis). This is the most nuanced aspect.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

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

RebelEM

DECEMBER 19, 2022

With everything just mentioned considered, DED, in addition to other resuscitative therapies, should still be used for patients in RVF. The early termination is also a concern and may have overestimated the benefits of this intervention. N Engl J Med. 2022 Nov 6 PMID: 36342151 Cheskes S, et al.

EMS 52

EMS CPR Shock Resuscitation 52

Don't Forget the Bubbles

NOVEMBER 11, 2024

Targeted temperature management (TTM) is the induction of varying degrees of patient temperature targeting within Paediatric Intensive Care Unit (PICU): Therapeutic hypothermia- induction of varying degrees of hypothermia. What are the potential complications of therapeutic hypothermia? It can also increase blood pressure.

Hyperthermia / Hypothermia 117

Hyperthermia / Hypothermia Pediatrics Outcomes Resuscitation 117

Mind The Bleep

JULY 8, 2023

Therefore, I’m sharing the things that worked well and were time-effective, and those that didn’t. Other resources Flashcards worked very well for me, but aren’t everyone’s cup of tea. It’s really nicely laid out, and goes through condition by condition, as well as where conditions overlap multiple specialties.

EKG/ECG 52

EKG/ECG Wellness Hyperthermia / Hypothermia Poisoning 52

Don't Forget the Bubbles

JUNE 30, 2023

Elsa was found face down in the family pool 20 minutes after last visual contact and was picked up without resuscitation. She was intubated at the scene and transported to your ED, with cardiopulmonary resuscitation (CPR) performed en route. d) Hypothermia As you ponder these options, the matron hands you the repeat gas.

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

Dr. Smith's ECG Blog

OCTOBER 26, 2020

12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC. The patient received therapeutic hypothermia at 33 degrees C for 24 hours. He has been asymptomatic and doing well since. ICD interrogations have been unremarkable.

EKG/ECG 40

EKG/ECG Hyperthermia / Hypothermia Wellness CPR 40

ACEP Now

OCTOBER 3, 2023

Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented. The GCS must be obtained through interaction with the patient (i.e., The GCS must be obtained through interaction with the patient (i.e.,

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation Pediatrics 98

EMDocs

JUNE 25, 2024

Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. Fluid resuscitation target and fluid Fluid resuscitation is one of the most important parts of management; goal is to increase intravascular volume and ensure end organ perfusion.

Burns 97

Burns Fluid Resuscitation Resuscitation Poisoning 97

Taming the SRU

NOVEMBER 4, 2023

D Thompson and Goel C-spine Imaging: NEXUS is a large, well-done study validating criteria for low-risk of cervical injury that are easy to remember and use at the bedside, and is used in our clinical decision guidelines on AgileMD. Differences with Canadian criteria from NEXUS include elderly, ROM and mechanism.

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation Burns Emergency Department 84

Northwestern EM Blog

MAY 9, 2022

There is no gold standard with respect to its definition, and it requires a medication history (which we typically don't do very well in the emergency department). Any life-threatening hyperthermia should be treated immediately with an ice bath.[2] Therefore, fluid resuscitation and maintenance are important.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Emergency Department 52

RebelEM

JUNE 19, 2023

This balance is upset in trauma by loss of blood and factors, acidosis, hypothermia and the inflammatory cascade. Demographics were well balanced in the two groups. This should continue to make TXA part of standard trauma resuscitation while additional studies are performed.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

Pediatric Emergency Playbook

MARCH 1, 2016

The Trauma Death Spiral Lethal triad of hypothermia, acidosis, and coagulopathy. Resuscitative Pearls Our goal here is damage control. Otherwise, resuscitate, identify the bleeding source, and slow or stop the bleeding with blood products or surgery. Puffer fish or blob: a hyperfibrinolytic tracing.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

The patient was put on Extracorporeal Life Support in the ED 3 hours after initial resuscitation, the core temp was 30° C and the patient was defibrillated with a single attempt. Rituparna et al — as well as Chauhan and Brahma ( Int. Chest compressions and ventilation were begun. In all leads, there is a 2nd wave after the initial QRS.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia CPR EKG/ECG Resuscitation 40

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The trauma call goes out.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. There is a subset of patients who, despite aggressive conventional resuscitation, have an inadequate hemodynamic response and develop refractory shock. Critical Care Medicine.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

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. Each year a team usually reports CPR being delivered.

Soft Tissue Injuries 52

Soft Tissue Injuries Seizures Ambulance Services Teamwork 52

Mind The Bleep

FEBRUARY 9, 2024

She is moderately frail with a few well-managed comorbidities, and states that she would not want to live if she was not able to do her gardening or hold her grandchildren. Because she would not be for intubation, they discuss resuscitation status because, naturally, care during- and post-arrest would involve airway support.

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

Rural Doctors Net

AUGUST 30, 2013

I’d raise here the concept of his ‘anticipated clinical course’ – he’s going to OT and has airway injury that will likely progress – so you might as well intubate on these grounds alone. Sure he’s got a traumatic amputation – your tourniquet has arrested the bleeding, but there may well be more blood loss.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

Dr. Smith's ECG Blog

MAY 23, 2022

The STEMI paradigm cant differentiate between these, and leads to false positives (case 1) as well as false negatives (case 4), both of which could be identified by expert interpretation. The CHALLENGE: In 2008 Hassaguerre found an increased prevalence of ER in patients with idiopathic VFib ( N Engl J Med 358:2016-2023, 2008 ).

EKG/ECG 52

EKG/ECG Documentation/Coding Hyperthermia / Hypothermia Research 52

Don't Forget the Bubbles

NOVEMBER 18, 2024

However, if the infant is well-perfused, cardiovascularly stable, and showing no signs of organ dysfunction, active treatment may not be necessary. Hypothermia: Newborns, particularly preterm infants, are prone to hypothermia. This can manifest as hypotension. This can lead to peripheral vasoconstriction and hypotension.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. His immunizations are current and has received all pneumococcal vaccinations. C or 100.4

Pediatrics 98

Pediatrics Dehydration EMS Hospitals 98

Dr. Smith's ECG Blog

JANUARY 21, 2023

In the resuscitation room, the patient had another seizure that stopped after IV Lorazepam. Acute and reversible J waves are called "Osborn waves" and are often associated with hypothermia which can also induce ventricular arrhythmias (3), where their size correlates with colder temperatures and resolves with warming (5).

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

Don't Forget the Bubbles

OCTOBER 2, 2024

This referral procedure is only possible with a well-structured system and may not be feasible in all settings. Original clinical studies Prevention of NICU Admission Hypothermia in Moderate- and Late-Preterm Infants. Trends in HIE and Use of Hypothermia in California: Opportunities for Improvement. Pecenka C, et al. Pediatrics.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Urgent Care 52

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Don't Forget the Bubbles

JANUARY 6, 2025

Yasuda M, Amagasa S, Kashiura M, et alDuration of prehospital and in-hospital cardiopulmonary resuscitation and neurological outcome in paediatric out-of-hospital cardiac arrestEmergency Medicine Journal 2024;41:742-748. However, there is limited evidence to guide decisions on when to stop resuscitation efforts in this population.

Dislocations 59

Dislocations CPR Ultrasounds Resuscitation 59

Taming the SRU

AUGUST 25, 2023

bicarb <18mEq/L) ketosis (preferably serum beta-hydroxybutyrate >3mmol/L) Risk factors SGLT2 inhibitor use fasting state ketogenic diet intra-abdominal pathology (AGE, pancreatitis, etc.) to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

EMDocs

JANUARY 6, 2025

She receives IV calcium gluconate and bicarbonate as well as oral potassium binders for hyperkalemia. Signs of malnutrition – which places patients at higher risk for infection – can include cachexia, muscular wasting, sunken eyes, redundant skin folds, edema, brittle skin and hair, bradycardia, hypotension, and hypothermia.

Infectious Diseases 75

Infectious Diseases CDC PPE Rapid Diagnostic Testing 75