Canadian EM

MAY 18, 2023

In this issue, we collaborated with CJEM team to present “Emergency department crowding negatively influences outcomes for adults presenting with chronic obstructive pulmonary disease”​1​ in a visual abstract format. Over in the resuscitation bay, a CTAS. In the ED, patients with respiratory pathology present on a shiftly basis.

COPD 75

COPD Emergency Department Outcomes Resuscitation 75

RebelEM

JUNE 1, 2023

Post-ROSC management is nuanced and challenging but helps to ensure good outcomes. In theory, rapid identification of the underlying cause should improve outcomes by allowing clinicians to tailor management. Diagnostic yield, safety, and outcomes of Head-to-pelvis sudden death CT imaging in post arrest care: The CT FIRST cohort study.

Outcomes 145

Outcomes Resuscitation Hospitals CPR 145

Don't Forget the Bubbles

DECEMBER 18, 2023

I think we should stop resuscitation. How long should you try to resuscitate? There are no hard and fast rules as to how long a resuscitation attempt should be carried out. We might continue resuscitation attempts longer than usual to allow family members to arrive and hold the child’s hand or be at the bedside when we stop.

Resuscitation 131

Resuscitation Outcomes CPR Hospitals 131

RebelEM

NOVEMBER 30, 2023

This systematic review and meta-analysis attempts to elucidate whether a more conservative fluid resuscitation approach is warranted in volume sensitive sepsis patients, such as those with congestive heart failure (CHF). Outcomes: Primary Outcome: In-hospital mortality. Am J Emerg Med. 2023;73:34-39. 2.89, p = 0.01.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

Don't Forget the Bubbles

NOVEMBER 11, 2024

One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. The aim of TTM is to control the body and brain’s temperature, thus reducing secondary brain injury and improving the neurological outcome. What do the guidelines recommend?

Hyperthermia / Hypothermia 116

Hyperthermia / Hypothermia Outcomes Pediatrics Resuscitation 116

Dr. Smith's ECG Blog

JUNE 27, 2024

A reliable study would keep track of all patients with shockable arrest and analyze the ones who were not enrolled to see their outcomes. Resuscitation Plus [Internet] 2020;4:100032. A patient like this one would not be enrolled because no clinician (ER doc or cardiologist) would enroll such a patient. This study failed to do so.

Resuscitation 99

Resuscitation EKG/ECG Outcomes Hospitals 99

Emergency Medicine Cases

APRIL 23, 2024

The post EM Quick Hits 56 – Nitroglycerin in SCAPE, REBOA, Diverticulitis Imaging, CRAO, Penicillin Allergy, Physician Personality appeared first on Emergency Medicine Cases.

EMS 109

EMS Resuscitation Outcomes Allergic Reactions 109

Emergency Medicine Journal

OCTOBER 26, 2023

Inclusion criteria were non-traumatic cardiac arrests treated with at least one external electric shock with an automated external defibrillator from the basic life support team and resuscitated by a physician-staffed ALS team. Primary outcome was survival at hospital discharge with a good neurological outcome.

Resuscitation 75

Resuscitation Basic Life Support Hospitals CPR 75

Emergency Medicine Journal

NOVEMBER 21, 2024

Background Because of their young age and lack of known comorbidities, paediatric patients with out-of-hospital cardiac arrest (OHCA) often undergo prolonged cardiopulmonary resuscitation (CPR). We aimed to determine the association between prehospital and in-hospital CPR duration and neurological outcomes.

Hospitals 52

Hospitals Outcomes Resuscitation CPR 52

RebelEM

MAY 29, 2023

Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. At the most severe end, this includes endothelial dysfunction leading to increased vascular permeability, abnormal nitric oxide metabolism, and vasodilation (i.e. 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

The Skeptics' Guide to EM

NOVEMBER 30, 2024

After starting cardiopulmonary resuscitation (CPR), you note pulseless electrical activity (PEA) on the monitor. With a survival rate to discharge often below 10% globally, rapid, effective interventions are needed to improve patient outcomes. The paramedic is trying to get intravenous (IV) access to give epinephrine per the protocol.

Administration 86

Administration CPR Airway Management Outcomes 86

The Trauma Pro

SEPTEMBER 21, 2023

Whole blood is the new darling of trauma resuscitation. Assembling a unit of whole blood from the components it was broken down into produces an inferior product from the standpoint of resuscitation. Reference: Whole blood on the scene of injury improves clinical outcome of the bleeding trauma patient.

Resuscitation 113

Resuscitation Outcomes 113

RebelEM

SEPTEMBER 14, 2023

to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% Control: 53.4% D ECLS: 18.2% Control 8.7% Control 38.0% Control: 49.0% RR 0.98; 95% CI 0.80 to 1.19; p = 0.81

Shock 136

Shock Outcomes Resuscitation Stroke 136

First 10 EM

JANUARY 29, 2024

REBOA (resuscitative endovascular balloon occlusion of the aorta) has been discussed in the emergency medicine world for quite some time now, but always with very limited data. Norii 2015, […] The post The UK-REBOA trial appeared first on First10EM.

Resuscitation 94

Resuscitation Outcomes EMS 94

Emergency Medicine Journal

JULY 24, 2023

We aimed to determine the association between the 2020 COVID-19 pandemic and OHCA outcomes and bystander resuscitation efforts among the working-age population. We compared characteristics and outcome differences of the arrests between three prepandemic years (2017–2019) and the pandemic year 2020. to 1.44)).

Resuscitation 52

Resuscitation Outcomes CPR Hospitals 52

Pediatric EM Morsels

SEPTEMBER 22, 2023

While we may allow permissive hypotension in damage control resuscitation of hemorrhagic shock, in neurogenic shock you should maintain an age-appropriate blood pressure. Orenstein JB, Klein BL, Gotschall CS, Ochsenschlager DW, Klatzko MD, Eichelberger MR. Age and outcome in pediatric cervical spine injury: 11-year experience.

Shock 300

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 300

Ultrasound Gel

JUNE 24, 2019

Here is a nice study that looks to see if ultrasound is associated with increased resuscitation efforts or better survival outcomes. Here is a nice study that looks to see if ultrasound is associated with increased resuscitation efforts or better survival outcomes.

Outcomes 52

Outcomes Ultrasounds Resuscitation Research 52

RebelEM

FEBRUARY 8, 2024

were they in the resuscitative phase? were they in the resuscitative phase? were they in the resuscitative phase? to 1.12; p = 0.03 for every change in 5ug/min Lower MAP Value: aOR 0.98; 95% CI 0.98 to 0.99; p <0.01 for every change in 1mmHg Higher BMI: aOR 1.04; 95% CI 1.01 to 1.09; p = 0.01 to 1.37; p <0.01

Resuscitation 126

Resuscitation Outcomes EMS Sepsis 126

The Bottom Line

JUNE 19, 2023

In patients resuscitated from out-of-hospital cardiac arrest (OOHCA) does targeted mild hypercapnia compared to targeted normocapnia improve 6-month neurological outcomes?

Resuscitation 98

Resuscitation Outcomes Hospitals 98

RebelEM

APRIL 29, 2024

Critically ill patients requiring resuscitation often present with many challenges including the ability to secure safe, sterile, fast, and reliable intravenous (IV) access. This can often lead to significant delays in proper resuscitation. Studies reviewed landmark-based CVC compared to IO; using IJ, subclavian, and femoral CVC sites.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Taming the SRU

MARCH 27, 2024

Effect of prehospital high-dose glucocorticoid on hemodynamics in patients resuscitated from out-of-hospital cardiac arrest: a sub-study of the STEROHCA trial. In this study, the authors aim to assess the hemodynamic effects of prehospital high-dose glucocorticoid treatment in resuscitated comatose OHCA patients. Hill, J.

Resuscitation 98

Resuscitation Outcomes CPR Hospitals 98

Don't Forget the Bubbles

JUNE 17, 2024

The Importance of Civility in Critical Care Resuscitation A 3-year-old patient with diabetic ketoacidosis arrives at your ED. While you are leading the resuscitation, one of your senior colleagues belittles a junior staff member for struggling to site an IV line. Conclusion Critical care resuscitation is stressful.

Leadership 105

Leadership Resuscitation Teamwork Patient Safety 105

RebelEM

AUGUST 21, 2023

In response to this critical issue, the TAME Cardiac Arrest Trial has been launched as a definitive phase III multi-center randomized controlled trial for resuscitated cardiac arrest patients. Figure 2 : Extended Glasgow Outcome Scale (GOS-E) (credit: Doc_HG ) Secondary Modified Rankin Score Secondary outcomes included death within 6 months.

Hospitals 98

Hospitals Resuscitation Outcomes CPR 98

St. Emlyn

JUNE 23, 2024

Out-of-hospital cardiac arrest (OHCA) is a leading cause of morbidity and mortality globally, with a survival rate of less than 10% despite […] The post JC: The impact of double sequential external defibrillation timing on outcomes during refractory out-of-hospital cardiac arrest appeared first on St.Emlyn's.

Outcomes 76

Outcomes Hospitals Resuscitation 76

ACEP Now

JULY 7, 2023

2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity. Resuscitation. Resuscitation. Resuscitation. Resuscitation. 2022;175:105-112. Sakai T, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

EMDocs

FEBRUARY 20, 2024

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. Question:In adults with acute pancreatitis, does moderate fluid resuscitation compared to aggressive resuscitation reduce the development of moderately severe or severe pancreatitis? N Engl J Med. 2022 Sep 15;387(11):989-1000. to 9.8L) Moderate: 5.5L (Range 4.0

Fluid Resuscitation 83

Fluid Resuscitation Resuscitation Outcomes Hospitals 83

RebelEM

SEPTEMBER 19, 2022

Background: There are only two interventions that have been proven in the medical literature to improved outcomes in cardiac arrest: high-quality CPR and early defibrillation. Over the years, we as a scientific community have worked extensively to find other interventions that improve outcomes. Resuscitation 2022; 179: 9-17.

CPR 52

CPR Outcomes Resuscitation EMS 52

EMDocs

OCTOBER 12, 2024

Spoon Feed For sickle cell patients (particularly Hgb SS) with a vaso-occlusive episode (VOE), large volume resuscitation (>2L) with lactated ringers (LR) has been shown to have improved outcome measures compared to normal saline (NS). Resuscitation. . #1: LR or NS for Sickle Cell Pain Crisis? 2024 Sep;202:110360.

Resuscitation 81

Resuscitation Outcomes Hospitals 81

RebelEM

JUNE 19, 2023

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? 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7% Prehospital Tranexamic Acid for Severe Trauma.

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. Background Early recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

EM Ottawa

NOVEMBER 27, 2023

Question and Methods: Multi-center pragmatic Bayesian RCT comparing 90d all-cause mortality and 10 secondary outcomes in trauma patients with hemorrhage receiving REBOA + standard of care vs. standard of care alone Findings: At 90d, 54% of patients in the […] The post Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta (..)

Emergency Department 56

Emergency Department Resuscitation Outcomes 56

Taming the SRU

JULY 17, 2024

Patients were randomized to blood product resuscitation guided by either TEG parameters or conventional coagulation tests (INR, platelet count, and fibrinogen). The primary outcome was reduction in blood product utilization and secondary outcome was early rebleeding (at day 5) or late rebleeding (day 42).

Outcomes 94

Outcomes Resuscitation 94

RebelEM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial [published online ahead of print, 2023 Oct 12].

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

Ken Grauer, MD

SEPTEMBER 21, 2024

He could not be resuscitated. To quote Dr. Stephen Smith: "The worst risk factor for a bad outcome in acute MI is young age." Unfortunately — the cardiologist at that center did not recognize the abnormal ECG findings. The patient was discharged without repeating the ECG. The patient arrested outside the hospital.

EKG/ECG 302

EKG/ECG Resuscitation Outcomes Hospitals 302

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. The secondary outcome of mortality was not statistically different however numerically favored the early use of norepinephrine. This resulted in better shock control by 6hrs (76.1%

Sepsis 105

Sepsis Shock Resuscitation Outcomes 105

The Skeptics' Guide to EM

APRIL 27, 2024

Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Reference: Tanner et al, A retrospective comparison of upper and lower extremity intraosseous access during out-of-hospital cardiac arrest resuscitation. Prehospital Emergency Care.

Resuscitation 74

Resuscitation Airway Management EMS Outcomes 74