Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED?

CPR 91

CPR Burns Airway Management Wellness 91

PEMBlog

OCTOBER 26, 2023

Radiology of Meckel’s Diverticulum. The Meckel’s scan is the preferred diagnostic modality, and prompt surgical consultation may be necessary for symptomatic cases. References Dixon P & Nolan D. The Diagnosis of Meckel’s Diverticulum: A Continuing Challenge. Clin Radiol. 1987;38(6):615-9 Ghahremani G.

Radiology 64

Radiology Radiology Resuscitation Administration 64

ALiEM

APRIL 12, 2023

Ever finally step away from a busy resuscitation and someone stops you for peripheral IV access? You set up everything, have the patient positioned, and then notice there is no sterile ultrasound gel. No problem. The trick is to eliminate anything of poor acoustic impedance between the ultrasound probe and the patient’s skin.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

Taming the SRU

JULY 24, 2023

The following day, Interventional Radiology placed a percutaneous cholecystostomy tube. Patients should be resuscitated as deemed appropriate. General surgery was consulted, and given the patient's significant comorbidities, he was transferred to a tertiary care academic center for further evaluation and management.

Ultrasounds 80

Ultrasounds Sepsis Radiology Radiology 80

EM SIM Cases

MAY 9, 2023

Radiologic, Neurologic and Cardiopulmonary Aspects of Submersion Injury. After one round of CPR, the patient’s heart rate will increase and the consulting team should arrive. Pediatric Drowning Download Hon, K. , Cheung, H. & & Cheung, K. Pediatric Emergency Care,32 (9), 623-626. doi: 10.1097/PEC.0000000000000477. 0000000000000477.

Pediatrics 52

Pediatrics CPR Radiology Radiology 52

ACEP Now

AUGUST 12, 2024

Dermatology Jeopardy Radiology Jeopardy Eye Can See the Problem Head and Neck ECG Games: Seize the Iron Throne ACEP Knowledge Bowl: Flex your medical knowledge and compete against your peers in the BattleDocs Arena. Resuscitation: Hone life-saving clinical measures. 28: 1 p.m.–4

Ultrasounds 52

Ultrasounds Research Radiology Radiology 52

RebelEM

JANUARY 25, 2023

Radiology US 90% 96% 14.1 0.27 – 0.83 Abdominal Distension 62 – 67% 89 – 96% 5.64 – 16.8 0.34 – 0.43 Abdominal X-ray 75% 66% 1.6 CT Scan 87% 81% 3.6 ED US 97%% 90%% 9.5 Post Peer Reviewed By: Salim R.

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

RebelEM

MAY 25, 2023

CRYSTALLOIDS Too much crystalloid resuscitation in traumatic hemorrhagic shock can increase dilutional coagulopathy, as well as increase morbidity and mortality Bickell WH et al. I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. vs SBP target <90mmHg which resulted in a mortality of 33.4%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Mind The Bleep

FEBRUARY 29, 2024

200ml/hr for 2 consecutive hours), there are a few potential explanations; -they may be appropriately excreting any excess fluid they had previously been given (de-resuscitating)- for example, were they given 5 litres of crystalloid in resus the day prior?

Documentation/Coding 52

Documentation/Coding Hospitals Wellness Best Practices 52

EM Ottawa

AUGUST 22, 2024

Assessing patients with pleural effusions in the emergency department (ED) can be challenging and nuanced. This is largely due to the lack of guidelines around pleural effusions in the ED. In part one we focused on imaging, diagnosis, and management of parapneumonic effusions.

Emergency Department 64

Emergency Department Infectious Diseases Radiology Radiology 64

The Trauma Pro

AUGUST 14, 2024

Like go to CT, do some more stuff in the ED because that BP cuff just has to be wrong, or call interventional radiology and wait for 45 minutes. Neither can playing around in the resuscitation room, unless the bleeding is spraying you in the face. Radiation can’t fix that.

Radiology 202

Radiology Radiology Operations Resuscitation 202

Don't Forget the Bubbles

FEBRUARY 5, 2025

This should include early identification of life-threatening injuries, targeted fluid resuscitation using blood products, pain management, then eventual safeguarding and psychological support. E.g. burns, neurosurgery, interventional radiology. Establish IV access for potential fluid resuscitation. Administer O2 if necessary.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

EMDocs

DECEMBER 6, 2024

Aggressive fluid resuscitation as patients may be severely hypovolemic from GI symptoms. Case Follow-up: The patient received a fluid resuscitation with 20 mL/kg bolus of normal saline. Radiology in the management of acute iron poisoning. Basic assessment: airway, breathing, circulation. Antiemetics as needed. 2 L/hr in adults.

Poisoning 97

Poisoning Fluid Resuscitation Seizures Resuscitation 97

EB Medicine

JULY 8, 2019

Jeff: Resuscitation should be aimed at early fluid replacement with IV crystalloids for hypovolemic patients and packed RBC transfusions for patients presumed to be unstable from hemorrhage. Internal hernia after laparoscopic Roux-en-Y gastric bypass: a correlation between radiological and operative findings. J Gastrointest Surg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

MARCH 18, 2025

Resuscitate prior to intubation. Bronchoscopy (Pulmonology/critical care): Used in intubated patients, those too unstable for CT despite resuscitation, or if the source of bleeding is not clear despite other imaging (CT). Consult pulmonology/critical care, interventional radiology, and cardiothoracic surgery, which may mean transfer.

COPD 81

COPD Radiology Radiology PPE 81

RebelEM

JUNE 26, 2023

Clinical Take Home Point: In adult patients with trauma at risk of massive transfusion, receiving standard trauma resuscitation management, the addition of 4F-PCC did not result in a decrease in blood product consumption over 24 hours compared to placebo. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03

Administration 143

Administration Outcomes Resuscitation Radiology 143

The Trauma Pro

JULY 10, 2023

This stream of information continues after the patient leaves the trauma bay for CT, imaging, interventional radiology, operating room, ICU, or floor bed. Once this occurs, the entire record is suspect and will not represent the true flow of the resuscitation. All of these occur during a relatively brief period of time.

Resuscitation 100

Resuscitation Radiology Radiology Operations 100

Don't Forget the Bubbles

JANUARY 27, 2025

Overall, ovarian ischaemia is multi-factorial in cases of torsion and there is no clear predictor of necrosis therefore further emphasising the importance of timely action, rationalised use of imaging available to you, appropriate discussions with radiology and surgical teams and low thresholds to escalate. How unstable is this patient?

Ultrasounds 76

Ultrasounds Emergency Department Pediatrics Dehydration 76

Pediatric Emergency Playbook

FEBRUARY 1, 2016

Resuscitative Thoracotomy in Children In a 40-year review of ED thoracotomy, Moore et al. REBOA If you have access to resuscitative endovascular balloon occlusion of the aorta or REBOA, this may be an option to temporize the child to get him to the relative control of the operating room. Overall all-cause adult survival was 6.1%.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Taming the SRU

OCTOBER 1, 2023

Unsuspected tension pneumothorax as a hidden cause of unsuccessful resuscitation. doi:10.1148/radiology.144.4.7111716 Resuscitation. Treasure Island (FL): StatPearls Publishing; November 28, 2022. Rojas R, Wasserberger J, Balasubramaniam S. Ann Emerg Med. 1983;12(6):411-412. doi:10.1016/s0196-0644(83)80502-2 Sharma A, Jindal P.

Fractures 97

Fractures COPD Hospitals Emergency Department 97

ED ECMO

JANUARY 1, 2021

In this episode Joe Bellezzo talks with Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) expert Dr. Zaf Qasim about NON-TRAUMA applications of aortic compression for control of non-compressible non-trauma torso hemorrhage. We discuss this case which highlights the benefit of REBOA as a bridge to definitive hemorrhage control.

Shock 52

Shock Resuscitation Radiology Radiology 52

Pediatric Emergency Playbook

MARCH 1, 2016

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. How Children are Different in Trauma In adults, we speak of “permissive hypotension” (also called “balanced resuscitation” or “damage control resuscitation”).

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

PHEM Cast

FEBRUARY 23, 2017

Priorities for the bleeding trauma patient must include: Minimum time to control of bleeding (tourniquets / haemostatics / knife / interventional radiology) Normothermia Appropriate choice of destination (knife / IR) ? Prehospital Blood Product Resuscitation for Trauma. We believed in permissive hypotension – we were probably wrong.

Blood Transfusions 52

Blood Transfusions Head Injuries Resuscitation Radiology 52

RebelEM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. Background: Hemmorhage is a major cause of preventable death in trauma patients. J Spec Oper Med.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

PEMBlog

JUNE 5, 2024

Resuscitate with volume and blood. In my experience, doing a neurologic exam is really difficult in the resuscitation area, especially when a patient is supine and has an immobilized c spine. This is due to the loss of sympathetic output and vasodilatation. than it is spinal shock. and orifocal neurologic deficit.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Unstable patients do not belong in a radiology suite - they belong in the ED resus bay to be resuscitated first.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

The latter 1950s and 1960s, quested for nerve gas defense studying expired air resuscitation and modern resuscitology; developing intensive care units. To me, it harkens a new scientific renaissance of resuscitation science, emergency care, and creating systems for care. 1950s & 1960s Resuscitation Research. 10/20/2013.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Taming the SRU

MAY 30, 2023

Legal implications vary from country to country. mg/mL) single-dose 2*-mL ampule or equivalent, 2 Lidocaine injection, 20-mg/mL single-dose 5-mL ampule or equivalent, 2 Nitroglycerin, 0.4-mg

OB/GYN 52

OB/GYN Ultrasounds Pediatrics Resuscitation 52

Downeast Emergency Medicine

MARCH 13, 2022

Key Concepts Quickly rule out life-threatening emergencies that require immediate resuscitation. Radiology , RSNA, 1 Oct. Abdominal pain is the most common chief complaint for adult patients in the ED. [1] Think aortic aneurysm dissection, bowel perforation, STEMI (especially in elderly female patients!), Silverio, Luz. Abdominal Pain.”

Ultrasounds 52

Ultrasounds EKG/ECG Radiology Radiology 52

Pediatric Emergency Playbook

JUNE 1, 2017

Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. Author’s advice : obtain troponin testing if there is an abnormal ECG, more than fleeting suspicion of BCI, and/or the child will be admitted for monitoring. Meningococcemia Presenting as a Myocardial Infarction. 2015; AID 953826.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Pediatric Emergency Playbook

APRIL 1, 2017

34 “The mother, or other trusted adult, places her mouth over the child’s open mouth, forming a firm seal as if about to perform mouth-to-mouth resuscitation. Radiologic Cases in Pediatric Emergency Medicine; University of Hawaii. The procedure can be repeated a number of times if not initially successful.”34 Otolaryngol Clin North Am.

Pediatrics 52

Pediatrics CPR Operations Resuscitation 52

EMDocs

JUNE 3, 2023

5 Initial Evaluation The key to the initial resuscitation of the unstable pelvic trauma patient is to rapidly identify and treat the most life-threatening pathology. 13 Massive transfusion protocols (MTP) are hallmarks of trauma resuscitation, and they are critical to the unstable pelvic fracture patient.

Fractures 63

Fractures Resuscitation Operations EMS 63

EMDocs

MARCH 6, 2024

In other patients who are stable and the bleeding has resolved, CTA is of low yield If they are critically ill and have severe bleeding, resuscitate first and consult IR, radiology, and surgery. Severe bleeding and hemodynamically unstable patients: Not the time for colonoscopy; resuscitate and get the CTA.

Blood Transfusions 105

Blood Transfusions Outcomes Resuscitation Radiology 105

EB Medicine

JANUARY 2, 2019

Jeff: All patients with a positive pregnancy test and vaginal bleeding should receive an ultrasound performed by either an emergency physician or by radiology. Nachi: All unstable patients or those with suspected or proven ectopic or heterotopic pregnancies should be immediately resuscitated and taken for surgical intervention.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

EM Ottawa

MARCH 13, 2025

How did ultrasound become a cornerstone of emergency medicine? What ultrasound skills should an emergency physician in Canada possess? And with the rise of handheld devices and AI-driven diagnostics, where is PoCUS in emergency medicine headed? Here, we are going to explore the evolution of PoCUS, from its origins to its projected future.

EMS 72

EMS Ultrasounds Radiology Radiology 72

The Trauma Pro

FEBRUARY 26, 2025

Like go to CT, do some more stuff in the ED because that BP cuff just has to be wrong, or call interventional radiology and wait for 45 minutes. Neither can playing around in the resuscitation room unless the bleeding is spraying you in the face. Radiation cant fix that.

Radiology 166

Radiology Radiology Operations Resuscitation 166

EMDocs

FEBRUARY 21, 2025

Paramedics are unable to resuscitate her, and she dies 6 1/2 hours after arrival in the ED. The radiology report even advised If this study fails to adequately explain patients symptoms, additional imaging may be indicated. Diagnosis is Nausea with vomiting and Acute non-traumatic pain in the lower back. Her husband calls 911.

Documentation/Coding 88

Documentation/Coding Radiology Radiology Patient Safety 88