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.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG EMS Hospitals 52

Pediatric Emergency Playbook

AUGUST 1, 2020

Hyperthermia. Heat illness and heat stroke. Environmental issues for team physicians. Am J Sports Med. 2008 Nov;36(11):2226-37. Ishimine P. In: Pediatric Emergency Medicine, Baren JM, Rothrock SG, Brennan JA, Brown L (Eds), Saunders Elsevier, Philadelphia 2008. Jardine DS. Pediatr Rev 2007; 28:249.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Stroke Burns Pediatrics 52

RebelEM

JUNE 19, 2023

This balance is upset in trauma by loss of blood and factors, acidosis, hypothermia and the inflammatory cascade. SBP < 75 mm Hg: 39% SBP 76-89 mm Hg: 33% Critical Findings: No statistically significant difference in safety outcomes (DVT, PE, MI, Stroke) TXA Placebo RR (95% CI) Primary Outcome Good Functional Outcome (6 months) 53.7%

Blood Transfusions 104

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 104

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

EM Literature of Note

JANUARY 9, 2022

A Chilling Conclusion to the Hypothermia Debate? link] Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients With Acute Ischemic Stroke Stopped early due poor outcomes in patients receiving alteplase prior to endovascular therapy. Stylet, No?

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Stroke Emergency Department Outcomes 40

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

Dr. Smith's ECG Blog

OCTOBER 12, 2024

CTA head and neck were obtained and showed no evidence of intracranial hemorrhage, large vessel occlusion stroke (what a helpful and apt name for an acute arterial occlusion paradigm, by the way.), Vital signs were within normal limits on arrival to the Emergency Department. Blood glucose was not low at 162 mg/dL. or basilar ischemia.

EKG/ECG 118

EKG/ECG Documentation/Coding Emergency Department COPD 118

ACEP Now

OCTOBER 3, 2023

This guideline revision is particularly timely as EMS systems have shown their abilities to dramatically improve survival and neurologic outcome after cardiac arrest, STEMI, acute stroke, and other time-sensitive conditions.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

EMDocs

MAY 28, 2024

Hypothermia, hypotension, and vasoconstriction may affect pulse oximetry reading, which is based on light absorption from fingertip blood flow. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS). Underestimates alveolar hypoxemia.

Blood Transfusions 85

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 85

Don't Forget the Bubbles

FEBRUARY 5, 2025

In the bleeding trauma patient, fluid resuscitation aims to avoid the diamond of death (acidosis, coagulopathy, hypothermia and hypocalcaemia). It can cause significant internal injuries, including carotid artery dissection, stroke, and acquired brain injury, but in 50% of patients, there are no external signs of injury.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

Taming the SRU

MAY 1, 2023

Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures. Poisoned patients will have a Digoxin level, but it is not at all quantitative like it is when dealing with an actual Digoxin overdose.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Pediatric Education

SEPTEMBER 3, 2023

Other states which could also affect sickling would be dehydration, acidosis, hypoxia and hyperthermia. There is no positive association for deep venous thrombosis, cardiomyopathy, heart failure, stroke and no abnormalities of growth parameters in the pediatric population.

Dehydration 40

Dehydration Hyperthermia / Hypothermia Pediatrics Military 40

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

Emergency Medicine Cases

JANUARY 18, 2022

In this months EM Quick Hits podcast: Ken Milne expertly walks us through the 10 biggest EM papers of 2021, Brit Long on a careful structured approach to Febrile Neutropenia to improve outcomes, Catherine Varner on how not to miss Peripartum Cardiomyopathy, Joe Nemeth on Anaphylaxis update and Anand Swaminathan gives us his approach to the Crashing (..)

Anaphylaxis 52

Anaphylaxis EMS Outcomes Hyperthermia / Hypothermia 52

Taming the SRU

APRIL 26, 2023

First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis. Misdiagnosis of exertional heat stroke and improper medical treatment. Cooling Methods in Heat Stroke. April 26, 2023) Acute Hyperthermia in the Emergency Department. Resuscitation 2020. Mil Med 2011.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

Don't Forget the Bubbles

NOVEMBER 18, 2024

Neonatal hypotension can result from inadequate cardiac output, low systemic vascular resistance, or a combination of both, which are influenced by: Cardiac Output: Neonates, particularly preterm ones, may have compromised cardiac output due to myocardial immaturity, leading to reduced stroke volume and heart rate.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

EMDocs

DECEMBER 16, 2023

Both can result in heat exhaustion and heat stroke and have many overlapping symptoms. Patients with heat stroke have hot, dry skin and altered mental status (e.g., C, and heat stroke occurs at a core temperature > 40°C. As you attempt to examine the patient, he has a generalized, tonic-clonic seizure.

Hyperthermia / Hypothermia 76

Hyperthermia / Hypothermia EMS Stroke Seizures 76

Taming the SRU

JUNE 6, 2023

mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

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

EB Medicine

AUGUST 1, 2018

First up is the link between cannabis use and stroke or TIA. times higher risk of stroke or TIA. Nachi: Among metabolic abnormalities, patients can present with hyperthermia, hypoglycemia, hypokalemia, hyponatremia, and metabolic acidosis. times higher risk of stroke or TIA. Effects can be seen within 3 minutes.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

JANUARY 6, 2025

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. 8,88 Careful inquiry and a head-to-toe evaluation are necessary to exclude traumatic injuries.

Infectious Diseases 65

Infectious Diseases CDC PPE Rapid Diagnostic Testing 65