The Skeptics' Guide to EM

NOVEMBER 16, 2019

She had a witnessed arrest, and CPR was initiated by bystanders. Unfortunately, that study failed to demonstrate a benefit of therapeutic hypothermia for adult patients admitted to the ICU with convulsive status epilepticus. Case: A 59-year-old woman comes is brought into your emergency department (ED) by EMS in cardiac arrest.

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CPR ALS ICU EMS 100

REBEL EM

AUGUST 21, 2023

This trial aimed to assess whether targeted therapeutic mild hypercapnia (TTMH) applied during the initial 24 hours of mechanical ventilation in the ICU can enhance neurological outcomes at the 6-month mark, as compared to standard care, which involves targeted normocapnia (TN). Paper: Eastwood G, et al.

E-9-1-1 98

E-9-1-1 Critical Care CPR ALS 98

ACEP Now

JANUARY 4, 2025

ED attendings Dr. Gerald Whelan and Dr. Shumary Chow supervising a full arrest in C booththe main trauma roomwith an ED tech administering CPR. I am not one to sit down and look at an ECG or sodium potassium in the ICU, Dr. Clarke said. They learned by doing, he said, by falling down and getting back up. Click to enlarge.)

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ED Emergency Department Ambulance CPR 52

Dr. Smith's ECG Blog

JUNE 23, 2024

His daughter immediately started CPR and another family member called EMS. Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing critical care. When EMS arrived the patient was in ventricular fibrillation. They shocked him twice before return of spontaneous circulation.

Coronary 118

Coronary CAD CPR Critical Care 118

REBEL EM

SEPTEMBER 14, 2023

Did they get bystander CPR? Control: 53.4% D ECLS: 18.2% Control 8.7% Control 38.0% Majority of patients had PCI performed (96.6%) Impella CP was most common mechanical circulatory support in patients without ECLS (85.7%) Death From Any Cause at 30d ECLS: 47.8% Control: 49.0% RR 0.98; 95% CI 0.80 to 1.19; p = 0.81 Control: 9.6% Control 3.8%

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Life Support Coronary CPR ICU 136

EMDocs

JANUARY 16, 2024

He requires low-dose epinephrine to maintain his mean arterial pressure (MAP) in the 60s mmHg and is transported to the cardiothoracic (CT) ICU. 2,11 There are cases of patients recovering after hours of time without a pulse with good CPR. 2,11 There are cases of patients recovering after hours of time without a pulse with good CPR.

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Defibrillator CPR Epinephrine Life Support 109

AmboFOAM

MARCH 14, 2017

Published today is another paper from The Alfred ICU on TH post Out Of Hospital Cardiac Arrest (OHCA), designed primarily to confuse me (and many others I suspect). This is before and after study, looking at outcomes from post VF arrest patients admitted to The Alfred ICU during the 33°C cooling period, and post changing to 36°C cooling.

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ICU CPR Paramedic 52

AAEM RSA

AUGUST 27, 2020

1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. Interventions during the acute phase of treatment post return of spontaneous circulation (ROSC) are therefore critical.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

Don't Forget the Bubbles

JUNE 17, 2024

The team sits down for a hot debrief once the patient is stabilised and transferred to the ICU. A third RCT demonstrated that even brief low-level incivility could increase the risk of major error during CPR by up to 66%. The junior staff member remains silent throughout the debrief and does not attend their shift the following day.

E-9-1-1 105

E-9-1-1 Critical Care CPR ICU 105

Don't Forget the Bubbles

MAY 3, 2023

Reviewed by: Roberto Segura and Mel Ranaweera Article 3: Does hand position affect CPR quality in young children? The effect of hand position on chest compression quality during CPR in young children: Findings from the Videography in Pediatric Resuscitation (VIPER) collaborative. O’Connell KJ, Sandler A, Dutta A, et al.

CPR 52

CPR Emergency Department ALS ICU 52

REBEL EM

SEPTEMBER 5, 2022

The assumption was a mortality of 28% (This was assumed based on department 6month mortality of 33%) The authors did achieve a separation between groups regarding the PaO2 values, but this separation did not start until 2 hours after ICU admission. Liberal O2 (PaO2 13 to 14kPa (98 to 105mmHg) Initial FiO2 set at 0.6 Liberal O2: 33.9%

ICU 52

ICU ALS OR CPR 52

EMDocs

JANUARY 11, 2024

Data that do not establish neurological risk stratification in the first 6 hours after CA include the patient’s age, duration of CPR, seizure activity, serum lactate level or pH, Glasgow motor subscore in patients who received NMB or sedation, pupillary function in patients who received atropine, and optic nerve sheath diameter (95.3%, 20/21).

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Critical Care E-9-1-1 OR ICU 97

NAEMSP

FEBRUARY 15, 2023

These can include feeling compelled to attempt resuscitation despite the team feeling it is futile or not consistent with the patient’s wishes, families demanding CPR despite the presence of a DNR, incompletely filled out DNR forms, and more. had performed CPR on a hospice patient, and 17.9% One study found that 60.8%

Emergency Medical Services 52

Emergency Medical Services EMS CPR Paramedic 52

REBEL EM

MARCH 30, 2023

Comparator: Delayed CAG: Patients were admitted to the ICU, and CAG was performed after 48-96 hours. There are differences within the demographic: More women in the delayed group Delayed group had higher witnessed arrest and bystander CPR Delayed group had more non-shockable rhythms Protocol violations were common.

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Coronary CPR OR ICU 66

REBEL EM

JULY 14, 2022

An example using a real case I had while on call in the ICU: A 61-year-old female had a post-induction arrest on the wards/hospital telemetry floor after being intubated for airway protection. In a PCAC 1 or 2, we may prioritize a cath and tolerate a couple hours without ICU Neuroresuscitation. Great question!

ICU 52

ICU ALS OR CPR 52

ACEP Now

APRIL 3, 2024

7 TTM2 is generally interpreted as favoring normothermia for post-arrest care, but the question is whether this trial is broadly applicable to many countries with less developed community CPR involvement. Changing target temperature from 33 °C to 36 °C in the ICU management of out-of-hospital cardiac arrest: A before and after study.

Advanced Life Support 40

Advanced Life Support ALS Life Support CPR 40

Core EM

JANUARY 16, 2025

It is true, someone finally did an RTC on ICU level patients and found that first pass success IS better with VL than DL (Prekker 2023), but the fact remains that sometimes VL fails. Even if CPR is ongoing – reassess that you did not tube the esophagus. Yellow on inspiration and expiration: your colorimeter is broken.

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E-9-1-1 EMS ALS OR 130