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

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 144

Outcomes Resuscitation CPR Hospitals 144

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 114

EMS Resuscitation Outcomes Allergic Reactions 114

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 117

Hyperthermia / Hypothermia Pediatrics Outcomes Resuscitation 117

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 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

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

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

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

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 139

Administration Outcomes Resuscitation Radiology 139

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 304

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 304

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 86

Outcomes Hospitals Resuscitation 86

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 133

Shock Outcomes Resuscitation Stroke 133

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 96

Resuscitation Outcomes Hospitals 96

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

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

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

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 90

Resuscitation Airway Management EMS Outcomes 90

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

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 97

Fluid Resuscitation Resuscitation Outcomes Hospitals 97

St. Emlyn

JANUARY 27, 2025

St.Emlyn's - Emergency Medicine #FOAMed What is the impact of physician-led interprofessional pre-hospital teams on survival and mortality outcomes for critically ill and injured patients. The post JC: Do physician led prehospital teams improve outcomes? appeared first on St.Emlyn's.

Outcomes 58

Outcomes Hospitals Research Resuscitation 58

PulmCCM

FEBRUARY 27, 2025

Balanced crystalloids are considered to be probably superior to normal saline as a resuscitation fluid in critically ill patients. Does the choice of balanced solution make a difference in patient outcomes from critical illness? There were no significant differences in any outcome: Bicarbonate levels: (-1.2 Normosol vs 16.0%

Resuscitation 95

Resuscitation Outcomes Research 95

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 99

Resuscitation CPR Outcomes Hospitals 99

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

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 90

Resuscitation Outcomes EMS 90

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Because the patient had asystole, was resuscitated without difficulty, and had no neurologic function, suspected a cerebral hemorrhage was suspected as the etiology of the arrest, specifically subarachnoid hemorrhage. Data collected included demographics, initial rhythm, EKG, emergency department (ED) CT and outcomes. Sprenkle M.

Resuscitation 52

Resuscitation EKG/ECG Hospitals Emergency Department 52

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 92

Hospitals Resuscitation Outcomes CPR 92

EMDocs

JANUARY 16, 2024

Hypothermic Arrest In general, hypothermic patients in cardiac arrest should be aggressively resuscitated. Patients can have excellent outcomes despite prolonged resuscitation. 2,3 If the patient meets criteria for resuscitation, they generally are not declared dead until their core temperature is above 32℃ (“warm and dead”).

Hyperthermia / Hypothermia 103

Hyperthermia / Hypothermia Resuscitation CPR EMS 103

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

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 84

Sepsis Shock Resuscitation Fluid Resuscitation 84

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 58

Emergency Department Resuscitation Outcomes 58

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.

Blood Transfusions 105

Blood Transfusions Outcomes 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

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

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 117

Resuscitation Outcomes EMS Sepsis 117

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 300

EKG/ECG Resuscitation Outcomes Hospitals 300

EMDocs

NOVEMBER 29, 2023

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 84

Fluid Resuscitation Resuscitation Outcomes Hospitals 84

EMDocs

JUNE 12, 2024

HypoCa is common in trauma patients and is associated with poor outcomes. Calcium and resuscitation Severely injured trauma patients are commonly hypocalcemic. Giancarelli et al found that 97% of patients who underwent massive transfusion protocols during trauma resuscitation were hypocalcemic (iCa < 1.1 Am J Emerg Med.

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation Administration Blood Transfusions 104