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.

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Epinephrine Life Support Advanced Life Support Defibrillator 130

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. bleeding, stroke, limb ischemia, and hemolysis).

Life Support 133

Life Support Coronary CPR OR 133

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

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

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. 5 ED physicians often reach for dexamethasone or prednisone, but what are their properties? and cardiovascular disease (OR 1.2-2.56).

ED 82

ED Life Support Advanced Life Support CPR 82

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 CPR Advanced Life Support Defibrillator 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

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. As therapies are escalated, it’s critical for clinicians to have high-quality data on target oxygen levels. Unclear how this bias affects outcomes.

Life Support 67

Life Support ICU EMS OR 67

ACEP Now

OCTOBER 9, 2023

Consent to a trauma evaluation is presumed when a patient presents as a trauma activation; implied consent applies to all life-threatening emergencies and is not unique to trauma activations. Advanced Trauma Life Support: Student Course Manual. Kaufman EJ, Richmond TS, Wiebe DJ, et al. Trauma is unique. 2017;152(9):843.

Heart Attack 126

Heart Attack Life Support Emergency Department Ambulance 126

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 CPR Emergency Medical Services Advanced Life Support 130

EMDocs

JUNE 22, 2024

A) Amniotic fluid embolism B) Eclampsia C) Placental abruption D) Pulmonary embolism Answer: A Amniotic fluid embolism (AFE) is a rare but potentially fatal complication of pregnancy. AFE should be considered in a patient who experiences cardiorespiratory collapse during labor or shortly thereafter.

EMS 96

EMS Ambulance FFP ICU 96

Critical Care Scenarios

MARCH 29, 2020

A PA catheter is more useful for weaning ECMO than during the period of full support. 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.

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

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). One defibrillation for ventricular fibrillation (VF) is provided but the patient remains in VF.

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BLS Defibrillator Critical Care CPR 130

EMDocs

JANUARY 16, 2024

Cardiac surgery is immediately paged for consideration of veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) for active rewarming. His LMA is exchanged for an endotracheal tube without induction or paralytic agents. A right femoral arterial line and triple lumen catheter are placed. His point-of-care labs return with a potassium of 3.4

Defibrillator 84

Defibrillator CPR Epinephrine Life Support 84

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. This study provided weak evidence in support of using corticosteroids for IHCA as part of a VSE protocol. JAMA Sept 2021. JAMA Sept 2021.

Epinephrine 100

Epinephrine Critical Care Emergency Department Life Support 100

FOAMfrat

OCTOBER 28, 2023

My primary interest in these blog posts is to write about the unique transport considerations of Mechanical Circulatory Support Devices (MCS) and to help educate the readers on the physiological concepts of MCS devices and how they work. What is Sweep? My contact information is at the bottom of the blog! Okay, easy enough.

Life Support 52

Life Support Paramedic CPR OR 52

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

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.

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Life Support ALS Emergency Response OR 105

NCOAE

AUGUST 12, 2022

That’s because one of our areas of focus here at The National Center for Outdoor & Adventure Education (NCOAE) is emergency medicine training and education. The post Most EMS Terminology Comes Down to Initials, Abbreviations and Acronyms appeared first on National Center for Outdoor & Adventure Education.

EMS 52

EMS EMT EMT Emergency Medical Services 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. Pearls: Capnography is an overall assessment of the path of CO2 through the entire body.

Emergency Department 68

Emergency Department ALS Life Support OR 68

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.

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Naloxone Life Support ALS Paramedic 52

Don't Forget the Bubbles

NOVEMBER 27, 2023

This recommendation is based upon the availability of PICU support, with lower fluid volumes and earlier vasoactive use being recommended, particularly if there are signs of fluid overload. Shock is defined as a type of circulatory failure where lack of oxygen leads to dysfunction of vital organs. This is beyond the scope of this blog post.

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Advanced Life Support ED ALS OR 143

NAEMSP

JANUARY 5, 2023

Background Despite conflicting literature to support some pharmacological therapies in out of hospital cardiac arrest, the American Heart Association (AHA) currently recommends obtaining vascular access intravenously or intraosseously in cardiac arrest. [1] 1] Table from Hamam et al. Below, we will examine the current literature.

E-9-1-1 52

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

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

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. 2] This linking group can be either an amide (e.g., mL/kg/min. [2]

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. Thick, dry, and calloused skin of a construction worker can have as much as 100 times more resistance than the previous example.

Operating Room 52

Operating Room ACS Critical Care Coronary 52

EMDocs

JULY 3, 2023

Presentation Traumatic SAH occurs following a direct or indirect traumatic mechanism leading to TBI that allows for bleeding into the subarachnoid space. 3 Common associated injuries may include skull fractures, intracerebral contusion, cervical spine injuries, and vascular injuries of the head and neck.

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). Interventions are supportive including benzodiazepines for seizures, sodium bicarbonate for prolonged QRS and arrhythmias, and intravenous lipid emulsion for cardiac arrest. Vet Hum Toxicol. 1986;28(6):543-4. Pediatrics.

E-9-1-1 67

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

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. amiodarone or lidocaine). Circulation. 2022;145(8):e153-e639.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

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

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. The Accu-Chek was 214, and there was no response to empiric Narcan administration.

ED 82

ED NARCAN ALS OR 82

EMT Training Station

MARCH 24, 2023

TEMS personnel were integrated with SWAT teams in various capacities, such as being embedded within the team or providing support from a safe distance. This may include managing trauma injuries, gunshot wounds, and other life-threatening conditions. Rapid blood loss can lead to hemorrhagic shock and, ultimately, death.

EMT 52

EMT EMT Emergency Medical Technician Emergency Medical Services 52

EMDocs

JANUARY 11, 2024

Brain Oxygenation, Perfusion, Edema, and ICP Statements Takeaway: Avoid 100% oxygen saturation. Instead, target 92-98%. Keep hemoglobin > 7 g/dL. Consider lowering ICP if elevated (head of bed elevation, hyperosmolar therapy, etc.). Valproic acid and levetiracetam are reasonable first-line therapies for EEG or clinical seizure activity.

Critical Care 75

Critical Care E-9-1-1 OR ICU 75

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. 3–8 Shi et al. But we diagnose myocarditis at our peril. And so it is wise to look at the coronary arteries. Angiogram was negative.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Pediatric EM Morsels

JULY 21, 2023

We use the GCS score in both trauma and medical patients, but where did this score come from? When is it useful and what does it tell us? Is it actually validated in children, like the Ottawa Ankle Rules or are we using a tool for something other than that for which it was designed and validated, like using Kocher criteria for knee and ankle joints?

Critical Care 246

Critical Care ALS OR Life Support 246

REBEL EM

MARCH 13, 2023

Article : Vianen NJ et al. The search contained terms for (1) prehospital cardiac arrest or prehospital advanced life support, and (2) injuries and trauma. Prehospital traumatic cardiac arrest: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2022 Aug;48(4):3357-3372. Epub 2022 Mar 25. 2022 May 5.

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