Ken Grauer, MD

APRIL 26, 2024

Unfortunately the patient arrested before catheterization could be completed — and could not be resuscitated. ECG Blog #193 — Reviews the basics for predicting the " culprit " artery ( as well as reviewing why the term "STEMI" — should be replaced by "OMI" = O cclusion-based MI ). Did YOU notice the abnormal ST-T wave in the PVC?

EKG/ECG 392

EKG/ECG Resuscitation EMS Wellness 392

EMDocs

JANUARY 25, 2025

Well keep it short, while you keep that EM brain sharp. A previously healthy 23-year-old male with no medical or surgical history presents to the ED with generalized malaise and no energy, progressively getting worse over the last six weeks. 10^9/L) Moderate (0.50.9 10^9/L) Severe (< 0.5 10^9/L) Generalized leukopenia (i.e.

EMS 94

EMS Infectious Diseases Allergic Reactions Fluid Resuscitation 94

EM Ottawa

APRIL 18, 2024

In this Prehospital Journal Club Recap, let us take a deep dive into the use of blood products, as well as the adjunct use of automated controlled elevation in CPR.

CPR 115

CPR Resuscitation Shock Wellness 115

PulmCCM

OCTOBER 14, 2024

Albumin has thus been a physiologically attractive therapy as a resuscitation fluid for hypotensive critically ill patients. How well does it work?

Resuscitation 52

Resuscitation Shock Wellness 52

EM Ottawa

APRIL 18, 2024

Join us in our latest Pre-Hospital and Transport Medicine Journal Club, where we take a look at the most recent and relevant literature pertaining to the use of IOs in out-of-hospital cardiac arrest, as well as the impact that pre-hospital intubation has with regards to ROSC success post resuscitative thoracotomy in individuals afflicted by out-of-hospital (..)

Resuscitation 55

Resuscitation Hospitals Wellness 55

ACEP Now

OCTOBER 29, 2024

Caring for critically ill patients with limited information requires snap assessments and judgements for timely resuscitation and efficient emergency department throughput. In this study, clinical gestalt is not only fast, but accurate for the benefit of timely resuscitation and intervention. Sound familiar? Ann Emerg Med.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

Pediatric EM Morsels

SEPTEMBER 22, 2023

” Children compensate for blood and volume loss very well… until they don’t. While we may allow permissive hypotension in damage control resuscitation of hemorrhagic shock, in neurogenic shock you should maintain an age-appropriate blood pressure. Physical exam findings of occult shock in children can be subtle.

Shock 304

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 304

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 Trauma Pro

JUNE 18, 2024

Early resuscitation, particularly with blood products in patients with hemorrhage, is literally a lifesaver. To facilitate this, massive transfusion protocols (MTP) have been designed to rapidly deliver sizable quantities of blood products to the trauma resuscitation bay. As each minute ticks by, survival slowly diminishes.

Pediatrics 113

Pediatrics Blood Transfusions Resuscitation Shock 113

ACEP Now

DECEMBER 6, 2024

Before nitroglycerin (NTG) could be administered, the patient became unresponsive and was transferred to the resuscitation bay, where the monitor revealed a ventricular fibrillation arrest. Cardiac arrest secondary to myocardial ischemia from coronary vasospasm is well documented. N Engl J Med. 1992;326(22):1451-1455. Circulation.

Resuscitation 98

Resuscitation EKG/ECG Documentation/Coding COPD 98

Taming the SRU

JULY 24, 2024

Ann Emerg Med 2024 Background Sepsis remains an increasingly common emergency department condition that is tied to higher morbidity and mortality across the United States as well as the rest of the world. They then tested the LASSO model using the remaining 20% of data to see how well it could detect sepsis at the same time points.

Sepsis 89

Sepsis Resuscitation Emergency Department Wellness 89

Emergency Medicine Cases

JANUARY 15, 2019

These topics are ones that either are not taught very well in training and/or that physicians tend to be not completely comfortable with. They include toxicology, trauma, ophthalmology, orthopaedics, resuscitation, human factors, addiction and pediatric emergencies.

Resuscitation 52

Resuscitation Pediatrics EMS Wellness 52

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Resuscitation. Resuscitation. Resuscitation. Resuscitation. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

The ST elevation in V2-V6 as well as in I and aVL becomes easily recognizable. Resuscitation efforts were undertaken. ECG#3 Resuscitation efforts were ongoing. The patient ultimately did well. The patient was shocked — and then began a long intensive process of resuscitation. The patient went in and out of ROSC.

EKG/ECG 132

EKG/ECG Resuscitation Academics EMS 132

Ken Grauer, MD

FEBRUARY 18, 2023

For more on "Shark Fin" ST elevation — See the Audio Pearl in the ADDENDUM below — as well as ECG Blog #265 for an example of a case with even more dramatic "shark fin" ST elevation ). Cardiopulmonary resuscitation was promptly started — but was unsuccessful.

EKG/ECG 195

EKG/ECG Resuscitation Wellness 195

EM Literature of Note

JANUARY 27, 2024

A brief post collating a few bits of my various work published across the interwebs … The Annals of Emergency Medicine Podcast continues to summarise the meatiest articles from each month, featuring a cycle of new co-hosts, as well: Apple Podcasts Google Podcasts Soundcloud Naturally, there are continuing Journal Club features, covering the (..)

Resuscitation 96

Resuscitation Emergency Department Shock Wellness 96

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

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

On arrival, you find a 35-year-old male, pulseless and apneic with cardio-pulmonary resuscitation (CPR) in progress by a bystander. Your partner asks if you want to administer naloxone as well. Naloxone is a well-established medication used primarily for reversing opioid overdoses.

Hospitals 104

Hospitals CPR EMS Outcomes 104

Don't Forget the Bubbles

NOVEMBER 27, 2023

Four-year-old Ed is being resuscitated for presumed Invasive Group A Streptococcal Sepsis from tonsilitis. Obviously, one also needs to address the cause of the shock, or any efforts in resuscitation will only bring a temporary improvement. This works well for a while, but eventually, the heart beats too fast to fill adequately.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. A 73-year-old female is brought in by EMS for abdominal pain, vomiting, and weakness for two days.

EMS 97

EMS Sepsis Shock Fluid Resuscitation 97

ACEP Now

JULY 7, 2024

If you are single coverage right off the bat, you need to be familiar with your facility’s OB, peds, and difficult airway resuscitation equipment and resources. You do not want to be fumbling through the pads or OB equipment during a critical resuscitation. You are well prepared for this. Lead your room well.

Resuscitation 98

Resuscitation Risk Management Hospitals Critical Access 98

RebelEM

JUNE 7, 2023

Moderate Patients The vast majority of patients will present with a concerning history but clinically may look relatively well. General resuscitation with broad spectrum antibiotics and volume resuscitation if the patient appears to be septic. References Hoffman RS, Burns MM, Gosselin S. Ingestion of Caustic Substances.

Poisoning 98

Poisoning Burns Resuscitation Pediatrics 98

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

EMDocs

SEPTEMBER 14, 2024

The AI performed well in both accuracy and in improving sensitivity. Resuscitation. . #2: Human, Take this Patient to the Cath Lab – AI and STEMI Detection Spoon Feed These researchers developed and trained a deep ensemble artificial intelligence (AI) model to classify ECGs as STEMI versus non-STEMI. 2024;201:110286. 2024.110286.

Emergency Department 95

Emergency Department Resuscitation Pediatrics EKG/ECG 95

RebelEM

FEBRUARY 24, 2025

Well, the established cutoff for the distensibility index is 18%. lactate-targeted fluid resuscitation on regional, microcirculatory and hypoxia-related perfusion parameters in septic shock: a randomized controlled trial. Why does it matter? Arterial Pulse Pressure Variation with Mechanical Ventilation. Am J Respir Crit Care Med.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

EM SIM Cases

NOVEMBER 12, 2022

Stephen Jensen, Brandon Bowdoin, and Kristen Whitworth as well as Spring Lutzen. This case as written by Drs. Stephen Jensen is a third-year emergency medicine resident at Spectrum Health Lakeland. He is completing a longitudinal track in Medical Education during his residency with a focus in simulation and curriculum development.

Resuscitation 40

Resuscitation Stroke EKG/ECG Fractures 40

Dr. Smith's ECG Blog

JUNE 9, 2024

Over the next 10 minutes we resuscitated with high doses of Calcium, Epinephrine, and Bicarbonate. There are no P-waves (this can also happen in hyperkalemia due to sino-ventricular rhythm), but here is it slow and even wider than 9 minutes later: The patient eventually did well and fully recovered.

EKG/ECG 101

EKG/ECG Resuscitation Shock Wellness 101

The Trauma Pro

JUNE 30, 2023

Vital signs during resuscitation may be nothing like those of the rest of the hospital stay. In my next two posts, I’ll write about why the eTFS doesn’t work well during the trauma resuscitation phase of care. It is like nothing else in the hospital stay in terms of pace, intensity, and activity level.

Hospitals 100

Hospitals Administration Resuscitation Best Practices 100

The Trauma Pro

APRIL 30, 2024

In the next post, I’ll look at a brand new paper that includes a cost analysis as well. The resuscitation equipment is not on par with the OR, and one never knows exactly how long the procedure will last. Today, I’ll look at an earlier review article summarizing some smaller studies comparing it to angioembolization.

Radiology 113

Radiology Radiology Research Fractures 113

The Trauma Pro

SEPTEMBER 14, 2023

Part of the resuscitation process for major trauma involves obtaining a chest X-ray. Bottom line: Although this is a relatively small series, the differences between the groups quickly achieved significance. which is excellent. So this approximation appears to be a very good one. Does every patient need a chest CT?

Resuscitation 124

Resuscitation Hospitals Wellness 124

Greater Sydney Area HEMS

APRIL 15, 2023

At one of our recent education days we heard Dr Mark Russell and Dr Mark Newcombe deliver excellent presentations of cases which they had been involved in, involving resuscitative hysterotomy and neonatal resuscitation respectively. Resuscitate in air first, and use higher inflation pressures than you would with adults.

Hospitals 85

Hospitals Resuscitation Hyperthermia / Hypothermia Teamwork 85

Taming the SRU

JANUARY 24, 2024

The case highlights how we as providers can grieve the loss of our patients, as well as the profound relationships with can make with their family members. Leadership curriculum: recruiting & building a team r4 Case follow-up - r3 small groups Leadership curriculum: recruiting & building a team WITH Drs.

Fractures 89

Fractures Leadership Dislocations Resuscitation 89

ALiEM

APRIL 12, 2023

Ever finally step away from a busy resuscitation and someone stops you for peripheral IV access? The thin alcohol layer serves to eliminate any air bubbles under the adhesive cover as well as minimizes residual adhesive material sticking to the probe when removing the cover. No problem. Trick of the Trade 1.

Ultrasounds 103

Ultrasounds Emergency Department Resuscitation Wellness 103

Taming the SRU

SEPTEMBER 15, 2023

Limited availability of radiology-performed US services in certain hospitals, especially overnight Can avoid unnecessary anticoagulation in patients Reduce time in ED to disposition In terms of workflow, when there is suspicion for a DVT, you need to first calculate a Wells’ Score for a DVT If low/moderate risk, can start with a D-dimer prior to committing (..)

CPR 90

CPR Burns Airway Management Wellness 90

Ken Grauer, MD

AUGUST 4, 2023

Exceptions may occur (ie, during cardiopulmonary resuscitation ) — but even then, there will usually be a recognizable pattern of ventricular regularity. A DDENDUM ( 8/5/2023 ) : I received a comment today on this tracing from D avid R ichley , who is well known to most ECG enthusiasts who frequent any of the many ECG internet forums.

EKG/ECG 370

EKG/ECG Academics Resuscitation Wellness 370

EM Ottawa

OCTOBER 5, 2023

Do you remember when every newborn under 30 days with a fever needed an LP/admission/blood cultures? times are a little different but its nuanced. The goal of this update is to provide a practical update in pediatric emergency medicine to the average Canadian adult or community emergency clinician.

Pediatrics 130

Pediatrics Wellness Seizures Resuscitation 130