American Medical Compliance

APRIL 17, 2024

Additionally, A central line-associated bloodstream infection (CLABSI) is a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 hours of central line placement.

Evidence-Based Practice 52

Evidence-Based Practice Outcomes Hospitals 52

The Trauma Pro

JUNE 2, 2023

Central cord syndrome is a special case of spinal cord injury. Many neurosurgeons choose a “wait and see” attitude with central cord syndrome patients. Bottom line: Spine decompression timing remains very controversial, with every neurosurgeon having their own opinion. 2022;157(11):1024-1032. doi:10.1001/jamasurg.2022.4454

Hospitals 246

Hospitals 246

Taming the SRU

FEBRUARY 19, 2024

This post will not cover how to insert arterial lines ( see this prior Taming the SRU post by Dr Baez ) , instead we will cover the utility, mechanics, and pitfalls of IABP. This has been the central question of many research projects with variable outcomes. But are they good enough? Disagreement did not correlate with SOFA score (5).

Shock 59

Shock Resuscitation Ultrasounds Research 59

PulmCCM

APRIL 19, 2024

Midline catheters are long (8 to 20 cm) peripherally inserted lines that terminate in or just distal to the axillary vein. They’re shorter than peripherally inserted central catheters (PICCs), which usually terminate in the superior vena cava. Retrospectiv… Read more

52

52

Taming the SRU

FEBRUARY 22, 2024

M&M - Arterial Lines - Fat Embolism Syndrome - CPC Morbidity & Mortality WITH Dr. Finney Case 1: MVC AMA, especially in pediatrics, is a high-risk disposition that requires thorough discussion and documentation Approach pediatric blunt abdominal trauma with a thorough physical exam and consider decision making tools when applicable Case 2 & (..)

Pediatrics 73

Pediatrics Documentation/Coding Wellness 73

PulmCCM

OCTOBER 16, 2023

Central venous catheters (CVCs, or central lines) are necessary devices to provide dialysis or deliver certain therapies (vasopressors, hypertonic saline, chemotherapy, IV nutrition, etc). As a direct portal to the bloodstream, central lines pose an inherent infection risk. What Causes Central Line Infections?

CDC 52

CDC Hospitals Ultrasounds Documentation/Coding 52

RebelEM

DECEMBER 27, 2023

Norepinephrine is a great first line vasopressor in Cardiogenic shock. In addition to echo and VTI for cardiac output, use IVC assessment for central venous pressure/volume status. Norepinephrine is a great first line vasopressor in Cardiogenic shock. An elevated lactate is a danger sign and requires explanation. Read more

Shock 84

Shock EMS Resuscitation 84

PulmCCM

FEBRUARY 5, 2024

Blood Cultures for Patients With Central Lines Blood cultures should ideally not be drawn solely through an intravascular catheter, as the rate of misleading false positives is high. Also: nurses should remove or replace the needleless connector on the central line, prior to drawing cultures. °C (100.9°F)

Best Practices 111

Best Practices Ultrasounds Infectious Diseases Sepsis 111

University of Maryland Department of Emergency Med

JULY 17, 2023

Central Venous Catheter (CVC; aka central line) placement is a common procedure in both the ED and ICU, and while overall quite safe, does ca. Click to view the rest

58

58

The Trauma Pro

FEBRUARY 20, 2024

There might be a central cord injury causing the arm weakness. Bottom line: Starting a patient encounter with the wrong type of activation can cause major problems. Could the symptoms that the paramedics are observing be due to the car crash? Absolutely ! His TBI might be the source of his confusion.

Documentation/Coding 278

Documentation/Coding Stroke EMS 278

PulmCCM

APRIL 1, 2024

All patients received arterial lines to measure PaO2 precisely. Read in JAMA One in 33 central-line placements results in major complications? ” But less than half of the included studies used ultrasound guidance during central line placements.

Ultrasounds 40

Ultrasounds Operations Outcomes Research 40

Don't Forget the Bubbles

NOVEMBER 27, 2023

The central venous pressure is close to the preload for the right and often good enough to identify a low preload state, where fluid is good, or a high preload state, where fluid is bad. The Surviving Sepsis Campaign International Guidelines recommend either adrenaline or noradrenaline as the first-line inotrope.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

Ultrasound Gel

DECEMBER 19, 2022

We're talking ultrasound-guided subclavian central lines, and a lot of people have opinions. We're talking ultrasound-guided subclavian central lines, and a lot of people have opinions. Are they better than landmark? What should we teach learners? The GEL team discusses through the lens of this fascinating RCT.

Ultrasounds 52

Ultrasounds 52

Emergency Medicine Cases

JULY 13, 2021

The post EM Quick Hits 30 Scaphoid Fracture, Therapeutic Hypothermia, HEADS-ED, Pelvic Trauma, Kratom, Femoral Lines appeared first on Emergency Medicine Cases.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fractures EMS Pediatrics 52

Taming the SRU

JULY 19, 2023

Covey For planned conversations, be intentional about time and location Use your body language to show you are paying attention Don’t interrupt with your own thoughts and solutions Encourage the speaker to finish their thought Paraphrase back what you’ve heard to make sure you understand correctly Respond to unspoken messages conveyed through tone (..)

Ultrasounds 73

Ultrasounds Leadership Hyperthermia / Hypothermia Poisoning 73

Ultrasound Gel

MARCH 14, 2022

Ultrasound has been a friend to central venous catheter placement for a long time. It's always there to make sure you are putting that line in the right place without causing problems. While this has been standard for internal jugular lines for years, it is only more recently that this has been proposed for subclavian lines.

Ultrasounds 52

Ultrasounds 52

The Trauma Pro

JANUARY 3, 2024

Bottom line: A lot is going on in this abstract. The central concept is that it is trying to identify a surrogate for TEG-identified fibrinolysis available in the field. It compares ETCO2 with two other semi-objective indicators, blood pressure and shock index (pulse divided by blood pressure).

Shock 147

Shock Operations Administration Hospitals 147

EB Medicine

JANUARY 3, 2023

In this episode, Sam Ashoo, MD, interviews Ara Festekjian, MD, one of the authors of the November 2022 Pediatric Emergency Medicine Practice article on Pediatric Septic Shock in the Emergency Department Introduction: How common is sepsis in kids and what is the mortality rate in the US?

Shock 52

Shock Pediatrics Airway Management Sepsis 52

EMDocs

FEBRUARY 12, 2024

The partial pressure of oxygen in arterial gases cannot be extrapolated from either central or peripheral venous gases. Peripheral obtained from IV line; central obtained from central venous line. While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

PulmCCM

JULY 10, 2023

Read in NEJM Should platelets be transfused in thrombocytopenic patients before central line placement? Central venous catheterization (CVC or central lines), when placed with ultrasound guidance, have a low rate of severe bleeding complications, even in patients with significant thrombocytopenia.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

JournalFeed

OCTOBER 9, 2021

We cover post-intensive care syndrome, timing of advanced airway in OHCA, opioids and ICU delirium, ultrasound guidance and central line infection risk, and an easier way to find the cricothyroid membrane. It’s the JournalFeed Podcast for the week of October 4-8, 2021.

Ultrasounds 52

Ultrasounds 52

Emergency Medicine Journal

OCTOBER 26, 2023

Terrible triad injury Monteggia fracture-dislocation Isolated radiocapitellar dislocation Occult supracondylar fracture Answer C (Isolated radiocapitellar dislocation) Discussion Plain radiographs showed radiocapitellar line (RCL) malalignment in both the lateral and anteroposterior views ( figure 2 ), suggesting anterior radial head dislocation.

Dislocations 40

Dislocations Fractures Emergency Department 40

ALiEM

AUGUST 9, 2023

A 6-zone lung ultrasound protocol is used for a complete lung examination (Figure 2): Anterior lungs bilaterally are scanned in the mid-clavicular line from the apex to the base of the lungs and diaphragm. Lateral lungs bilaterally are scanned in the mid-axillary line from the apex to the base of the lungs and diaphragm.

Ultrasounds 98

Ultrasounds Pediatrics Emergency Department Operations 98

Taming the SRU

JULY 8, 2023

Scope of practice fights includes many common procedures we do today (intubations, chest tubes, central lines), use of POCUS, and even expansion into AirCare. Primary Board certification was not official until 1989!

EMS 77

EMS Emergency Department Hospitals 77

EMDocs

JANUARY 17, 2024

3, 4, 5) Structure of Benzonatate: Image Courtesy of Wikimedia Commons Chemically known as 4-(butylamino) benzoic acid, benzonatate works peripherally anesthetizing the vagal stretch receptors that initiate the cough reflex in the respiratory passages, and centrally in the medulla’s cough center. (6) 11) A bolus dose at 1.5 J Med Toxicol.

Poisoning 66

Poisoning Seizures Pediatrics Administration 66

JournalFeed

FEBRUARY 15, 2020

This week on JournalFeed , we covered midlines as a central line alternative, a fulminant myocarditis review from the AHA, rounding by acuity not room order, Wellen's syndrome, and more.

52

52

EMDocs

SEPTEMBER 6, 2023

Central line placed to continue vasopressors. Arterial line started. Considerations when patients continue to decompensate despite resuscitation and vasopressors: acidosis, endocrine issues like adrenal insufficiency or hypothyroidism, hypocalcemia, anaphylaxis, hemorrhage, multiple causes of shock, ingestion.

Anaphylaxis 69

Anaphylaxis Shock Sepsis Stroke 69

Critical Care North Hampton

JULY 17, 2020

As a clinical fellow on ITU, you would expect me to be in the thick of it – intubating, inserting central lines, learning how covid patients respond to the various ventilator settings. Since the arrival of COVID, the way we approach things as medical professionals has had to change, almost beyond recognition. But that is.

52

52

RebelEM

FEBRUARY 22, 2023

1 st line med: Timolol (beta blocker) Topical meds can be given simultaneously except for pilocarpine, which is given after IOP is < 40 mmHg. 790-819 EM docs: Central Retinal Artery Occlusion CanadiEM: Medical Concepts – Acute Angle Closure Glaucoma Post Created By: Anand Swaminathan MD, MPH Post Peer Reviewed By: Salim R.

Emergency Department 52

Emergency Department EMS Wellness 52

American Medical Compliance

MAY 16, 2024

Dentists are often on the front lines of pain management. The opioid crisis strains emergency services, hospitals, and healthcare providers who are often on the front lines of treating overdose patients. Opioids depress the central nervous system, which can lead to slowed or stopped breathing, known as respiratory depression.

CDC 52

CDC Evidence-Based Practice Best Practices Administration 52

Mind The Bleep

APRIL 20, 2024

Cyanosis can be peripheral, central or both and it can be seen in cases of shock and cyanotic congenital heart disease. Fig 1 : A baby with central cyanosis (dusky/purple lips and tongue) Pallor is when the skin and mucous membranes appear pale, most commonly it suggests an underlying anaemia.

Shock 52

Shock Wellness 52

Taming the SRU

AUGUST 6, 2023

Kletsel Pustular psoriasis Psoriasis is characterized by discrete plaques of erythema, scales, and fissures of the extremities It is associated with significant morbidity & treatment consists of topical steroids, along with referral to establish with dermatology Use caution with systemic steroids as they can potentially worsen flares While rare, (..)

Infectious Diseases 74

Infectious Diseases Pediatrics Fractures Wellness 74

Mount Sinai EM

NOVEMBER 14, 2022

As Emergency medicine doctors, we rely on ultrasound for so many procedures (central venous access, pericardiocentesis, paracentesis, etc.), Mark this space which should be perpendicular to the midline line you drew previously. After multiple attempts, I made the walk of shame back to my team telling them I couldn’t obtain a sample.

Ultrasounds 130

Ultrasounds Wellness 130

EMDocs

JANUARY 16, 2024

A right femoral arterial line and triple lumen catheter are placed. This is a good time to utilize an arterial line or use the ultrasound to find a central pulse. Avoid supradiaphragmatic central lines in these patients as any guidewire contact with the sensitive hypothermic myocardium can cause them to go back into VF.

Hyperthermia / Hypothermia 83

Hyperthermia / Hypothermia Resuscitation CPR EMS 83

Don't Forget the Bubbles

APRIL 29, 2024

There is a massive shunt of blood to your central circulation that your heart has to pump into your lungs, and that causes you to take a deep breath. Medical treatment with Adenosine Adenosine is our first-line medical treatment for SVT. The atrial tachycardia needs a second-line agent or another therapy (e.g.

Wellness 59

Wellness EKG/ECG 59

ACEP Now

MARCH 14, 2024

Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm. A left thoracostomy, foley, nasogastric tube, and central venous catheter were placed prior to computed tomography (CT) imaging. Syncope can also occur due to disruption of central nervous tissue.

Burns 52

Burns Fluid Resuscitation EKG/ECG Operations 52

EMDocs

JUNE 22, 2023

Put the central line and IO kits nearby. Just prior to the patient’s arrival, we contacted Medcom, which is Mississippi’s centralized medical communication system, to let them know the critical nature of our situation. Call Medcom back, we’re putting in an arterial line for them to hook up when they get here.”

Resuscitation 95

Resuscitation Ultrasounds Critical Access Documentation/Coding 95