Taming the SRU

DECEMBER 8, 2023

It is possible she was just severely hypothermic.

Hyperthermia / Hypothermia 78

Hyperthermia / Hypothermia Resuscitation Head Injuries Documentation/Coding 78

The Skeptics' Guide to EM

JANUARY 13, 2024

Resuscitation 2023. Resuscitation 2023. Your EMS agency has equipped you with small-volume adult bag-valve masks (BVMs), the first responders have been utilizing a standard adult BVM thus far during the resuscitation. Your partner asks you which of the two BVMs you should use to continue the resuscitation.

Hospitals 104

Hospitals CPR Resuscitation Airway Management 104

PulmCCM

JANUARY 22, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival. Read on for details.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

EM SIM Cases

NOVEMBER 3, 2023

CLINICAL VIGNETTE 58 y/o M presents with hyperthermia and confusion, and was found by bystanders to be acting strange. CASE SUMMARY In this case of exertional heatstroke, the team must identify hyperthermia and actively cool the patient while working the patient up for other causes.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG EMS Hospitals 52

PulmCCM

JANUARY 24, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival. Read on for details.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

Emergency Medicine Cases

DECEMBER 6, 2016

The post Best Case Ever 52 – Pediatric Hypothermia Cardiac Arrest appeared first on Emergency Medicine Cases. DeCaen tells his Best Case Ever showing us the value of orchestrated team work and a great example of the saying, "they're not dead until they're warm and dead".

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Pediatrics EMS CPR 52

The Skeptics' Guide to EM

OCTOBER 22, 2022

Head and thorax elevation during cardiopulmonary resuscitation using circulatory adjuncts is associated with improved survival. Resuscitation 2022 Guest Skeptic: Clay Odell is a Paramedic, Firefighter, and registered nurse (RN). Resuscitation 2022 Guest Skeptic: Clay Odell is a Paramedic, Firefighter, and registered nurse (RN).

CPR 52

CPR Hyperthermia / Hypothermia Resuscitation EMS 52

Taming the SRU

MARCH 30, 2024

Predictions scores such as the HOPE score can be used to guide treatment.

Hyperthermia / Hypothermia 83

Hyperthermia / Hypothermia Leadership Emergency Department Seizures 83

Northwestern EM Blog

MAY 9, 2022

The most acute cause of death from NMS is hyperthermia, which is induced both by D2 receptor antagonism leading to rigidity and impaired thermoregulation from the striatum and hypothalamus. Any life-threatening hyperthermia should be treated immediately with an ice bath.[2] Therefore, fluid resuscitation and maintenance are important.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Administration 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

In the resuscitation room, the patient had another seizure that stopped after IV Lorazepam. Acute and reversible J waves are called "Osborn waves" and are often associated with hypothermia which can also induce ventricular arrhythmias (3), where their size correlates with colder temperatures and resolves with warming (5).

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

Pediatric EM Morsels

SEPTEMBER 22, 2023

Shunting of blood to the extremities results in thermal dysregulation and subsequent hypothermia. While we may allow permissive hypotension in damage control resuscitation of hemorrhagic shock, in neurogenic shock you should maintain an age-appropriate blood pressure. Unopposed vagal tone leads to bradycardia.

Shock 273

Shock Pediatrics Hyperthermia / Hypothermia Dislocations 273

EMDocs

NOVEMBER 6, 2023

Use of 20% intravenous lipid emulsion can be efficacious in the resuscitation of life-threatening local anesthetic toxicity, especially from bupivacaine. Life-Threatening Cocaine Toxicity We recommend rapid external cooling for life-threatening hyperthermia from cocaine poisoning. Try calcium; consider pacing! COR 1, LOE C-LD.

Poisoning 93

Poisoning Hyperthermia / Hypothermia Seizures Administration 93

Taming the SRU

APRIL 11, 2024

Management Antibiotics with staph coverage Most spontaneously drain and do not require I&D Hypothermia in neonates Varying definitions with consensus < 36-36.5 Correct pronunciation and understanding of personal narratives is important. There is history behind a person’s name which often has deep and personal meaning.

Ultrasounds 83

Ultrasounds Pediatrics Hyperthermia / Hypothermia Burns 83

Taming the SRU

NOVEMBER 4, 2023

Yates Foot Infection NSTIs are rare but deadly pathology that need to be considered with any soft tissue infection NSTI is a clinical diagnosis, but there are many imaging and laboratory assessments to help increase clinical suspicion Expedited disposition to the OR for NSTIs under 12 hours from ED presentation significantly decreases mortality Emesis (..)

Hyperthermia / Hypothermia 74

Hyperthermia / Hypothermia Resuscitation Burns Emergency Department 74

Taming the SRU

APRIL 13, 2023

Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

EMDocs

DECEMBER 16, 2023

Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. As you attempt to examine the patient, he has a generalized, tonic-clonic seizure. What is your diagnosis, and what are your next steps in evaluation and management?

Hyperthermia / Hypothermia 67

Hyperthermia / Hypothermia EMS Stroke Seizures 67

The Skeptics' Guide to EM

JUNE 24, 2017

Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline
The RINSE Trial (Rapid Infusion of Cold Normal Saline). Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline
The RINSE Trial (Rapid Infusion of Cold Normal Saline).

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia CPR Resuscitation Research 40

Emergency Medicine Cases

FEBRUARY 9, 2021

What should be the lab resuscitation targets? How do we mitigate the risk of hypothermia? Once the dust settles, what do we need to tell the patient and/or their family about the consequences of being massively transfused? Why is serum calcium important to draw in the ED for the patient who is exsanguinating?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Resuscitation Hospitals EMS 52

PulmCCM

JANUARY 29, 2024

Patients presenting with hypothermia should not be warmed too quickly (allowing their temperature to increase by <0.5°C/hour). There should be an active approach to fever prevention (e.g., °C/hour). ECMO used as CPR is referred to as ECPR.)

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

ACEP Now

OCTOBER 3, 2023

The GCS should be measured after airway, breathing, and circulation are assessed, after a clear airway is established, and after necessary ventilatory or circulatory resuscitation has been performed. The GCS must be obtained through interaction with the patient (i.e.,

Documentation/Coding 98

Documentation/Coding Fluid Resuscitation Resuscitation Pediatrics 98

RebelEM

JUNE 19, 2023

This balance is upset in trauma by loss of blood and factors, acidosis, hypothermia and the inflammatory cascade. We should expect TXA to help in immediate stabilization and allow trauma teams the time to intervene (whether that be continued resuscitation, interventional or operative procedures).

Outcomes 99

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 99

EMergucate

JUNE 14, 2017

A 49 year old man with confusion, hypothermia and shock requiring urgent resuscitation has blood results which show The patient … Continue reading →

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Shock Resuscitation EMS 40

EMergucate

JUNE 7, 2017

A 49 year old man with confusion, hypothermia and shock requiring urgent resuscitation has blood results which showSevere HAGMA uncompensated, … Continue reading →

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Shock Resuscitation EMS 40

EMergucate

JUNE 11, 2017

A 49 year old man with confusion, hypothermia and shock requiring urgent resuscitation has blood results which show The same … Continue reading →

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Shock Resuscitation EMS 40

Broome Docs

OCTOBER 31, 2022

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. PMID: 36168956 Bottom line: Despite the significant imperfections of this trial, it is important data (as we lack data on hypothermia after inpatient cardiac arrest), and it adds to the growing body of evidence that suggests hypothermia provides no benefit.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 52

Pediatric Emergency Playbook

MARCH 1, 2016

The Trauma Death Spiral Lethal triad of hypothermia, acidosis, and coagulopathy. 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. Puffer fish or blob: a hyperfibrinolytic tracing.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

The Skeptics' Guide to EM

AUGUST 14, 2021

This has included the classic paper from Legend of EM Dr. Ian Stiell on BLS vs. ACLS ( SGEM#64 ), the use of mechanical CPR ( SGEM#136 ), and pre-hospital hypothermia ( SGEM#183 ). Excluded: Patients who had already received open-label intravenous lidocaine or amiodarone during resuscitation or had known hypersensitivity to these drugs

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

The Skeptics' Guide to EM

OCTOBER 24, 2020

You abandon your coffee order and quickly head next-door, where you are able to start cardiopulmonary resuscitation (CPR) and direct a bystander to find the store’s automated external defibrillator (AED) while waiting for emergency medical services (EMS) to arrive.

CPR 52

CPR Hyperthermia / Hypothermia Resuscitation EMS 52

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

His primary interests are resuscitation, prehospital critical […] The post SGEM#231: You’re So Vein – IO vs. IV Access for OHCA first appeared on The Skeptics Guide to Emergency Medicine. His primary interests are resuscitation, prehospital critical care, airway management, and point-of-care ultrasound.

Basic Life Support 52

Basic Life Support Airway Management CPR Resuscitation 52

The Skeptics' Guide to EM

MAY 8, 2021

The resuscitation team arrives and ACLS protocols are continued. Crit Care Med Feb 2021 Case: A 58-year-old male has a witnessed cardiac arrest while admitted to the observation unit for a chest pain evaluation. CPR is initiated and a hospital rapid response team is called.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

Mind The Bleep

DECEMBER 19, 2023

Therefore, they require fluid resuscitation to restore blood pressure, correct the ketonemia and electrolyte abnormalities, and oliguria. Throughout therapy it is important to monitor fluid input and urine output so that fluid resuscitation measures can be adjusted. It is also vital to do a fluid balance assessment.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

The Skeptics' Guide to EM

MARCH 2, 2019

There is no evidence for a patient-oriented benefit with epinephrine ( SGEM#238 ), other ACLS drugs ( SGEM#64 ), pre-hospital therapeutic hypothermia ( SGEM#54 , SGEM#183 ), or mechanical CPR ( SGEM#136 ). Exclusions: Prisoners, resuscitation deemed inappropriate, advanced airway already in place, and patient’s mouth opened less than 2cm.

Airway Management 52

Airway Management CPR Outcomes Hyperthermia / Hypothermia 52

EMDocs

JANUARY 8, 2024

Patients with spontaneous hypothermia after ROSC unresponsive to verbal commands should not routinely be actively or passively rewarmed faster than 0.5° It may be reasonable to actively prevent fever in patients unresponsive to verbal commands after initial temperature control. COR 2b, LOE C-LD. C per hour. COR 2b, LOE C-EO. Circulation.

Seizures 81

Seizures Shock CPR Hyperthermia / Hypothermia 81

ACEP Now

APRIL 3, 2024

Targeted temperature management (TTM) for patients following cardiac arrest resuscitation has gone through several dosing iterations in the past two decades. Finally, the guidelines support active temperature management’s (though not necessarily hypothermia) role in improving post-arrest outcomes. degrees Celsius. Click to enlarge.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

Mind The Bleep

FEBRUARY 9, 2024

Because she would not be for intubation, they discuss resuscitation status because, naturally, care during- and post-arrest would involve airway support. The ICU team are aware that this patient may require therapeutic hypothermia, continuous cardiac monitoring and may deteriorate to the point of arrest.

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

Emergency Medicine Ireland

APRIL 4, 2022

Likely driven by rewarming induced vasodilation and hypothermia induced diuresis they can be hypovolaemic. It doesn’t take them long to transition to the more conventional ICU patient where fluid does nothing but increase the oedema but in the first 6-12 hours fluid resuscitation often has a role.

Fluid Resuscitation 40

Fluid Resuscitation Hyperthermia / Hypothermia Outcomes Resuscitation 40

EMergucate

NOVEMBER 22, 2013

The End of Therapeutic Hypothermia? GAME CHANGER! HOT OF THE PRESS: this new article in NEJM, the Targeted Temperature Management … Continue reading →

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 40