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. Clarke took from 19781980 provide a glimpse into working in an emergency department in the years the specialty was being established. Click to enlarge.) We learned a lot by ourselves, Dr. Clarke said.

ED 52

ED Emergency Department Ambulance CPR 52

REBEL EM

SEPTEMBER 14, 2023

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 vs 13.9% (RR 0.58; 95% CI 0.33 vs 22.6% (RR 1.03; 95% CI 0.88

Life Support 136

Life Support Coronary CPR ICU 136

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.

CPR 100

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. N Engl J Med. Epub 2023 Jun 15.

E-9-1-1 98

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

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. His LMA is exchanged for an endotracheal tube without induction or paralytic agents.

Defibrillator 109

Defibrillator CPR Epinephrine Life Support 109

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 ICU 118

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

EMDocs

JANUARY 11, 2024

In ICUs where advanced cerebral monitoring is not in routine use, target an MAP >80 mm Hg unless there are clinical concerns or evidence of adverse consequences (82.6%, 19/23). In ICUs where noninvasive monitoring of cerebral autoregulation is in routine use, maintain MAP at or near the predicted MAPOPT (88.2%, 15/17).

Critical Care 97

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

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. Which way should we go? O’Connell et al.

CPR 52

CPR Emergency Department ALS ICU 52

REBEL EM

SEPTEMBER 5, 2022

Liberal O2 (PaO2 13 to 14kPa (98 to 105mmHg) Initial FiO2 set at 0.6 Liberal O2: 33.9% HR 0.95; 95% CI 0.75 to 1.21; p = 0.69 Results were consistent in all prespecified subgroups Death at 90d Restrictive O2: 28.7% Liberal O2: 31.1% HR 0.93; 95% CI 0.72 Higher MAP: 34.0% HR 1.08; 95% CI 0.84 to 1.37; p = 0.56 Liberal O2: 33.9% HR 0.95; 95% CI 0.75

ICU 52

ICU ALS OR CPR 52

REBEL EM

MARCH 30, 2023

Comparator: Delayed CAG: Patients were admitted to the ICU, and CAG was performed after 48-96 hours. PMID: 35675081 What They Did: National, multicenter, randomized control, open-label parallel trial performed at 22 centers in FrancePatients enrolled from January 19, 2017 – November 23, 2020. CPC 4: Coma or vegetative state. 1.15; P= 0.32

Coronary 66

Coronary CPR OR ICU 66

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

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. Assigning a patient a single PCAC score upfront may implicitly bias clinicians familiar with the score in how they care for patients.

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. degrees Celsius. degrees Celsius for 72 hours. degrees Celsius “is a reasonable and evidence-based approach.” Circulation. JAMA Netw Open.

Advanced Life Support 40

Advanced Life Support ALS Life Support CPR 40

Core EM

JANUARY 16, 2025

Success at intubation likely takes more time and practice than other procedures, as shown in recent research on ED residents and their success rate at intubating, measured as a function of their total number of intubations (See Figure 1). Practice may not achieve perfection, but it will make you better. fiber optic through the nose).

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E-9-1-1 EMS ALS OR 130