The Skeptics' Guide to EM

DECEMBER 7, 2018

Date: December 6th , 2018 Reference: Perkins et al. Date: December 6th , 2018 Reference: Perkins et al. This was a before and after study to see if advanced cardiac life support (ACLS) techniques, including IV epinephrine, would improve survival to discharge. JAMA 2009, Hagihara et al.

Epinephrine 130

Epinephrine Life Support Advanced Life Support Defibrillator 130

The Skeptics' Guide to EM

MARCH 11, 2023

Date: March 8, 2023 Reference: Smida et al. Date: March 8, 2023 Reference: Smida et al. The fire-based crew has basic life support (BLS) airway supplies including the King Laryngeal Tube, the paramedic crew carries iGel supraglottic airways (SGAs) in addition to their intubation equipment. Reference: Smida et al.

CPR 130

CPR Defibrillator BLS Paramedic 130

EMT Training Station

FEBRUARY 11, 2024

This could range from basic life support, typically managed by EMTs, to more advanced life support provided by paramedics and other medical specialists. EMTs, for example, are trained in basic life support, while paramedics receive more advanced training, including in pharmacology, cardiology, and trauma care.

EMT 98

EMT EMT Emergency Medical Technician Emergency Medical Services 98

The Skeptics' Guide to EM

SEPTEMBER 23, 2017

[display_podcast] Date: September 19th, 2017 Reference: Cournoyer et al. Prehospital advanced cardiac life support for out-of-hospital cardiac arrest: a cohort study. display_podcast] Date: September 19th, 2017 Reference: Cournoyer et al. JAMA 2009 * Jacobs et al. Resuscitation 2011 * Hagihara et al.

Life Support 130

Life Support Advanced Life Support CPR Defibrillator 130

Don't Forget the Bubbles

AUGUST 7, 2023

Heart rate (HR) and respiratory rate (RR) are THE major vital signs used in Advanced Paediatric Life Support ( APLS) guidance , sepsis guidelines , and Paediatric Early Warning Scores (e.g., The controversy around what is ‘normal’ in infants’ and children’s vitals was demonstrated in a 2011 systematic review by Fleming et al.

Life Support 98

Life Support Advanced Life Support ALS Emergency Department 98

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Date: September 8th, 2021 Reference: Desch et al. The paramedics achieve return of spontaneous circulation (ROSC) after CPR, advanced cardiac life support (ALCS), and Intubation. The TOMAHAWK Investigators. first appeared on The Skeptics Guide to Emergency Medicine.

EMR 130

EMR Coronary Defibrillator Life Support 130

EMDocs

OCTOBER 9, 2023

Adrenal crisis is a rare but life-threatening manifestation of adrenal insufficiency that is precipitated by abrupt steroid cessation after chronic use. References 1) Liu D, Ahmet A, Ward L, et al. 6) Wyckoff MH, Greif R, Morley PT, et al. 6) Wyckoff MH, Greif R, Morley PT, et al. Allergy Asthma Clin Immunol. Circulation.

ED 81

ED Life Support Advanced Life Support CPR 81

REBEL EM

SEPTEMBER 14, 2023

Revascularization of the culprit lesion remains one of the few established treatments though there are numerous other unproven modalities including extracorporeal life support (ECLS). Zeymer HT et al. Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. References: Zeymer HT et al.

Life Support 124

Life Support Coronary CPR OR 124

ACEP Now

OCTOBER 9, 2023

Throughout the Advanced Trauma Life Support manual, a mere three sentences relate to the murky ethics of trauma consent: “Consent is sought before treatment, if possible. In life-threatening emergencies, it is often not possible to obtain such consent. Advanced Trauma Life Support: Student Course Manual.

Heart Attack 126

Heart Attack Life Support Emergency Department Ambulance 126

REBEL EM

APRIL 22, 2024

Paper: Nielsen FM et al. Lower vs higher oxygenation target and days alive without life support in COVID-19. This data supports current practice of targeting a lower O2 sat. Advanced interventions include proning (both on NIV and IMV) and extracorporeal mechanical oxygenation (ECMO).

Life Support 67

Life Support ICU EMS OR 67

The Skeptics' Guide to EM

OCTOBER 24, 2020

Reference: Derkenne et al. Reference: Derkenne et al. Date: October 21st, 2020 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician, creator of the excellent #FOAMed project called First10EM.com and a member of the #SGEMHOP team. AEM Oct 2020. AEM Oct 2020.

Defibrillator 130

Defibrillator Emergency Medical Services CPR Advanced Life Support 130

EMDocs

NOVEMBER 6, 2023

Treatment of cardiac arrest and life-threatening toxicity due to poisoning often requires specialized treatments that most clinicians do not use frequently such as antidotes and venoarterial extracorporeal membrane oxygenation, in addition to effective basic and advanced life support. COR 2a, LOE C-LD. COR 2a, LOE C-LD.

Naloxone 94

Naloxone OR Overdose BLS 94

The Skeptics' Guide to EM

NOVEMBER 13, 2021

Date: November 10th, 2021 Reference: Andersen, et al: Effect of Vasopressin and Methylprednisolone vs Placebo on Return of Spontaneous Circulation in Patients With In-Hospital Cardiac Arrest. JAMA Sept 2021. Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrests first appeared on The Skeptics Guide to Emergency Medicine.

Epinephrine 100

Epinephrine Critical Care Emergency Department Life Support 100

Critical Care Scenarios

MARCH 29, 2020

Resources References * How to monitor anticoagulation during ECMO: Saifee NH, Brogan TV, McMullan DM, et al. Monitoring Hemostasis During Extracorporeal Life Support. Consider leaving the Impella if there are any lingering concerns. 2020;66(2):230–237.

Critical Care 100

Critical Care Life Support ALS OR 100

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Date: January 28th, 2019 Reference: Chu DK et al. Date: January 28th, 2019 Reference: Chu DK et al. Reference: Chu DK et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. The Lancet 2018. The Lancet 2018. The Lancet 2018.

Life Support 130

Life Support ALS STEMI Emergency Department 130

Don't Forget the Bubbles

JUNE 30, 2023

Mazur P, Kosinski S, Podsiadlo P, et al.: Extracorporeal life support rewarming rate is associated with survival with good neurological outcome in accidental hypothermia. Meert et al. American Thoracic Society, 2020 Mazur P, Kosinski S, Podsiadlo P, et al.: Meert et al. The “sweet spot” is between 0.5-2⁰C

CPR 145

CPR Life Support Critical Care ALS 145

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

[display_podcast] Date: September 21st, 2018 Reference: Kawano et al. display_podcast] Date: September 21st, 2018 Reference: Kawano et al. EMS arrives on scene and initiates high quality basic life support (BLS). Case: A 46-year-old man has a cardiac arrest at home, witnessed by family.

BLS 130

BLS Defibrillator Critical Care CPR 130

NCOAE

AUGUST 12, 2022

Here, we present them in alphabetical order: ABC – Airway, Breathing and Circulation – “This is the Golden Rule of emergency medical professionals” AED – Automated External Defibrillator – The device that delivers electric shock to the heart of patients experiencing sudden cardiac arrest A-EMT – Advanced EMT ALS – Advanced Life Support Anaphylaxis— (..)

EMS 52

EMS EMT EMT Emergency Medical Services 52

EMDocs

JANUARY 16, 2024

Carsten L, et al. Extracorporeal Life Support in Accidental Hypothermia with Cardiac Arrest—A Narrative Review. Hypothermia outcome prediction after extracorporeal life support for hypothermic cardiac arrest patients: The HOPE score. Monika BM, Martin D, Balthasar E, et al. 2009;338:b2085. Resuscitation.

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

EMDocs

JUNE 22, 2024

Treatment is supportive with respiratory therapy, critical care, inotropic therapy, and cardiac life support. If AFE occurs during labor, immediate delivery is recommended. ” Obstet Gynecol 123(2 Pt 1): 337-348. link] Society for Maternal-Fetal Medicine. Electronic address, p. ” Am J Obstet Gynecol 215(2): B16-24.

EMS 96

EMS Ambulance FFP ICU 96

Critical Care Scenarios

NOVEMBER 15, 2020

Yes, temporize with supportive care while you go through the process, but do the work—find a legitimate representative or documentation of the patient’s wishes to determine what they’d want before you commit them to lengthy, aggressive life support. References Patel KK, Young L, Howell EH, et al. 2016.1509

ICU 100

ICU Life Support Emergency Department ED 100

FOAMfrat

OCTOBER 28, 2023

Extracorporeal Life Support Organization; Ann Arbor (MI): 2017. Extracorporeal life support: the ELSO red Book; p. Extracorporeal life support: the ELSO red book). You can reach me at bcress@perfusiondynamics.org Brian Cress, CCP, LP, FP-C, NRP References: Brogan T.V., MacLaren G., In: 5th edition.

Life Support 52

Life Support Paramedic CPR OR 52

ACEP Now

DECEMBER 10, 2023

Patients after SA who require intubation, continuous life support, or are permanently obtunded, pose a different challenge for physicians. References Nowland R, Steeg S, Quinlivan L, et al. Wilson MP, Moutier C, Wolf L, et al. Brody, BD, Meltzer EC, Feldman D, et al. 2019;9(3):e023978. Canada, SCC 5.

Naloxone 52

Naloxone Life Support Paramedic ALS 52

EMDocs

AUGUST 22, 2023

PMID: 26447854 Godwin SA, Burton JH, Gerardo CJ, et al. PMID: 28395927 Panchal AR, Berg KM, Hirsch KG, et al. PMID: 28395927 Panchal AR, Berg KM, Hirsch KG, et al. PMID: 26821648 Hemnes AR, Newman AL, Rosenbaum B, et al. Ann Emerg Med. 2017;70(5):758. Circulation. 2019;140(24):e881-e894. BMC Emerg Med.

Emergency Department 68

Emergency Department ALS Life Support OR 68

FOAMfrat

JULY 3, 2024

If they are not already there, get ALS-level care to the patient as soon as possible. According to the CDC (Centers for Disease Control, 2023) some respiratory exposures can result in the long-term development of “reactive airway dysfunction syndrome (RADS)” This is a type of chemical induced asthma and is a life-long condition.

Life Support 105

Life Support ALS Emergency Response OR 105

Irish College of Paramedics

SEPTEMBER 26, 2018

Crewing Models: There are varying models of pre-hospital care ranging from paramedic provision of care through the mix of First Aid (Tanigawa and Tanaka 2006) Basic Life Support (BLS), immediate care, Advanced Life Support (ALS) and the many associated specialist paramedicine grades. 2000, Stiell et al.

Emergency Medical Technician 52

Emergency Medical Technician Paramedicine Paramedicine Advanced Life Support 52

NAEMSP

JANUARY 5, 2023

al answered this question with a prospective observational study which showed a significantly shorter time interval to obtain tibial IO access (4.6 al confirmed that injection of a radionuclide tracer injected intraosseously reaches central circulation within a time comparable to that of intravenous injection. [7] minutes versus 5.4

E-9-1-1 52

E-9-1-1 Advanced Life Support Epinephrine Life Support 52

Don't Forget the Bubbles

NOVEMBER 27, 2023

Although historically used quite frequently, dopamine is no longer recommended by advanced life support guidelines for septic shock unless adrenaline/noradrenaline are unavailable. link] Owen VS, Rosgen BK, Cherak SJ, et al. Available at [link] Walker SB, Conlon TW, Zhang B, et al. Published Online First: 02 August 2023.

Advanced Life Support 143

Advanced Life Support ED ALS OR 143

EMDocs

APRIL 10, 2024

Supportive care includes: protecting the airway if necessary, supplemental oxygen if needed, and vasopressor support if the patient is hypotensive. For patients who in cardiac arrest standard Advanced Cardiac Life Support (ACLS) should be initiated. doi:10.1136/bcr-2019-233119 Neal JM, Barrington MJ, Fettiplace MR, et al.

E-9-1-1 93

E-9-1-1 Plasma Epinephrine Life Support 93

ACEP Now

MARCH 14, 2024

Thus, unstable patients should be stabilized based on a physician’s trauma expertise; whether through Advanced Trauma Life Support, Trauma Combat Casualty Care, or one’s own trauma assessment. Tintinalli JE, Stapczynski J, Ma O, et al. Arnoldo BD, Purdue GF, Kowalske K, et al. 2023 Jul 17. In: StatPearls [Internet].

Operating Room 52

Operating Room ACS Critical Care Coronary 52

AAEM RSA

AUGUST 27, 2020

Nielsen N, Wetterslev J, Cronberg T et al. By the time of the study by Nielsen et al. For both groups, mean time to basic life support was determined to be one-minute, advanced life support started at 10 minutes, and time to ROSC at 25 minutes. Kirkegaard H, Soreide E, de Haas, I et al.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

EMDocs

JULY 3, 2023

Avest E, Taylor S, Wilson M, et al. Emergency Neurological Life Support: Intracranial Hypertension and Herniation. Dubosh NM, Bellolio MF, Rabinstein AA, et al.  Rabinstein AA, Carhuapoma JR, Der-deyn CP, Dion J, Higashida RT, et al. Bakr A, Silva D, Cramb R, et al. Joseph B, Friese RS, Sadoun M, et al.

ED 85

ED E-9-1-1 ALS OR 85

EMDocs

JANUARY 17, 2024

She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). Kim I, Goulding M, Tian F, Karami S, Pham T, Cheng C, et al. When emergency medical services (EMS) arrived, she was in asystole with an empty, recently full, bottle of benzonatate 100 mg capsules. Vet Hum Toxicol.

E-9-1-1 67

E-9-1-1 Overdose Emergency Medical Services Life Support 67

EMDocs

APRIL 22, 2024

Advanced cardiac life support (ACLS) had been initiated and on arrival at the ED, the patient was found to have Pulseless Electrical Activity (PEA). Alerhand et al described ten individual echocardiographic findings of RV strain that suggest PE. Available from: [link] Meneveau, Nicolas, et al. 10,11 Vid 1. Chest , vol.

ED 81

ED NARCAN ALS OR 81

EMT Training Station

MARCH 24, 2023

ALS Standby: The Advanced Life Support (ALS) standby model involves having a dedicated EMS unit with paramedics or EMTs trained in advanced life support positioned nearby during tactical operations.

EMT 52

EMT EMT Emergency Medical Technician Emergency Medical Services 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He was started on Extracorporeal Life Support ("VA ECMO") Here is the ECG on ECMO: Very low voltage On Day 3, the EF recovered (that seems quick!) 3–8 Shi et al. Sandoval Y, Smith SW, Sexter A, et al. Shi S, Qin M, Shen B, et al. Guo T, Fan Y, Chen M, et al. Lala A, Johnson KW, Russak AJ, et al.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

ACEP Now

JULY 7, 2023

More recent literature and guidelines support the use of lidocaine as an alternative agent, and currently both are included in standard advanced cardiovascular life support. References Tsao CW, et al. Benjamin EJ, et al. Kimblad H, et al. Sakai T, et al. Kudenchuk PJ, et al. Lee YH, et al.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98