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Resuscitation

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Renoresuscitation: Sepsis resuscitation designed to avoid long-term complications

0 Introduction 0 Over the last few years, I've gone through an almost 180-degree change in my conceptualization of septic shock.  In a perfect world, this  
pulmcrit.org
over 4 years ago
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54

Dr. Smith's ECG Blog: Ventricular Fibrillation, Resuscitation, and Hyperacute T-waves: What does the Angiogram show?

Instructive ECGs in Clinical Context ----Archives, Popular Posts, and an Index of all ECGs are down the right-hand side.  
hqmeded-ecg.blogspot.com
over 4 years ago
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Dr. Smith's ECG Blog: ResQCPR System Approved by FDA. First and only CPR adjunct ever approved.

Instructive ECGs in Clinical Context ----Archives, Popular Posts, and an Index of all ECGs are down the right-hand side.  
hqmeded-ecg.blogspot.com
over 4 years ago
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47

Guess or Gestalt in Major Trauma at St.Emlyn's - St.Emlyn's

I was recently fortunate enough to speak at the the Emergency Medicine Educators Conference in Coventry on a subject that continues to interest me, that of gestalt, judgement and clinical decision making. As I get older I increasingly realise that simply acquiring more knowledge and skills is not enough. What’s really important is how we use that information, how we make decisions, how we make mistakes and how we get it right. I’m also deep in my preparations for a talk at #SMACCUS on ‘Guess, Gestalt or Genius’ and so I’m always on the look out for studies in this area (as there are surprising few). In my talk in Coventry I used the question of when to activate the Major Haemorrhage Protocol (1:1:1 resuscitation as per PROPPR) in trauma patients. Clearly not all patients need it and there are potential harms if we use it on the wrong patients.  
stemlynsblog.org
over 4 years ago
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Resuscitation Dogmalysis - The RAGE Podcast

Cliff Reid (again!) speaking at smaccGOLD, this time engaging in some healthy 'Resuscitation Dogmalysis'.  
ragepodcast.com
over 4 years ago
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COUGH CPR

There are a few magic lo-tech treatments about. There’s the precordial thump, but there’s also the self administered cough CPR. Documented in several case series from the cath labs of the 70s and 80s, coughing every 1-3 seconds was shown to keep patients alive and conscious despite VF cardiac arrest, for up to 39 seconds.  
scancrit.com
over 4 years ago
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SGEM#59: Can I Get A Witness (Family Members Present During CPR)

Case Scenario: You are working in a busy ED when a young new paramedic crew brings in a post cardiac arrest that they are resuscitating. They tell you that the patient collapsed at home during a family event and that a family member immediately started CPR while the rest of the family bore witnesses.  The family is now en route to the ED and the paramedics are concerned that they did the wrong thing by allowing the family to watch.  
thesgem.com
over 4 years ago
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CPR in Pectus Excavatum |

Some pectus excavatum patients have a metal ‘Nuss bar’ inserted below the sternum which can make chest compressions more difficult. In those without one, standard compression depths compress the left ventricle more than in non-pectus subjects, and might lead to myocardial injury.  
resus.me
over 4 years ago
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Open cardiac massage in asthmatic arrests? |

This idea was provoked by a colleague some years ago who could not achieve a palpable pulse during CPR of an arrested asthmatic child. He wondered whether the severe hyperinflation was rendering external cardiac compressions ineffective and whether he should have done a (prehospital) thoracotomy.  
resus.me
over 4 years ago
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The Case of the Balanced Solution - EM Nerd

Saline-based resuscitation strategies were first proposed as far back as 1831 during the Cholera Epidemic. In an article published in the Lancet in 1831, Dr. O’Shaughnessy suggests the use of injected salts into the venous system as a means of combating the dramatic dehydration seen in patients afflicted with this bacterial infection(1). Saline’s potential harms were first observed in post-surgical patients who after receiving large volumes of saline based resuscitation fluids during surgery were found to have a hyperchloremic acidosis (2). Though these changes appear transient and clinically trivial, it is theorized that when applied to the critically ill, the deleterious effects on renal blood flow may increase the rate of permanent renal impairment and even death. Unfortunately, no large prospective trials have demonstrated this hypothesis to be anything more than physiological reasoning. Small prospective trials have exhibited trivial trends in decreased renal blood flow, kidney function, and increased acidosis, though these perturbations were fleeting and of questionable clinical relevance (3, 4, 5, 6, 7). A larger retrospective study, bringing all the biases such trials are known to carry, demonstrated small improvements in mortality of ICU patients treated with a balanced fluid strategy, though it failed to demonstrate improvements in renal function (the theoretical model used to support balanced fluid administration) (8). In 2012 Yonus et al were the first to attempt to prospectively answer this question in an ICU population. Published in JAMA, on first glance the results seemed to vindicate those in support of the use of balanced fluids (9). Yet despite its superficial success, a closer look reveals this trial does little to demonstrate the deleterious effects of chloride-rich resuscitative strategies. In a recent publication in Intensive Care Medicine, Yonus et al re-examine this question in the hopes of once again demonstrating the benefits of balanced fluid strategies for the resuscitation of the critically ill (10).  
emnerd.com
over 4 years ago
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15

Guess or Gestalt in Major Trauma at St.Emlyn's - St.Emlyn's

I was recently fortunate enough to speak at the the Emergency Medicine Educators Conference in Coventry on a subject that continues to interest me, that of gestalt, judgement and clinical decision making. As I get older I increasingly realise that simply acquiring more knowledge and skills is not enough. What’s really important is how we use that information, how we make decisions, how we make mistakes and how we get it right. I’m also deep in my preparations for a talk at #SMACCUS on ‘Guess, Gestalt or Genius’ and so I’m always on the look out for studies in this area (as there are surprising few). In my talk in Coventry I used the question of when to activate the Major Haemorrhage Protocol (1:1:1 resuscitation as per PROPPR) in trauma patients. Clearly not all patients need it and there are potential harms if we use it on the wrong patients.  
feedproxy.google.com
over 4 years ago
Sinaiem dark
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3800

You are catching up on some charts in the resuscitation area of your ED when your triage nurse pushes in a 37 yo M with no PMHX, who presented to your ED complaining of sudden onset lightheadedness and L sided chest pain about 10 minutes PTA while at rest. No prior episodes. No CAD risk factors. No illicit drug use. No family risk factors. The patient appears uncomfortable, diaphoretic and is clutching his chest.  
sinaiem.org
over 4 years ago
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Critical Care

The Surviving Sepsis Campaign [1] advocates maintaining a mean arterial pressure (MAP) of at least 65 mm Hg in sepsis patients undergoing resuscitation. Leone and colleagues [2], in an article published in this journal, suggest considering higher MAP targets in the resuscitation of patients with a history of arterial hypertension so they do not progress to acute kidney injury. Asfar and colleagues [3], in a multicenter, open-label trial, showed no significant difference in mortality outcomes in septic shock patients undergoing resuscitation with an MAP target of either 80 to 85 mm Hg (high-target group) or 65 to 70 mm Hg (low-target group). However, the study did show that chronic hypertensive patients in the higher-target group had lower incidences of acute kidney injury and renal replacement therapy. This likely stems from the need for higher MAPs in chronic hypertensive patients in order to maintain organ blood flow because of a shift of the organ’s autoregulatory range to the right. Thus, targeting a higher MAP for chronic hypertensive patients may help avoid the development of acute kidney injury and the need for renal replacement therapy. Renal replacement therapy carries with it inherent morbidity as well as additional cost. These costs include the need for dialysate fluid and extra personnel and the use of anticoagulation and the extracorporeal circuit [2]. However, chronic hypertensive patients in the high-target group had a greater incidence of new-onset atrial fibrillation (5.2% in the low-target group versus 9% in the high-target group). Patients with new-onset atrial fibrillation during sepsis have been shown to have increased incidences of in-hospital stroke and in-hospital mortality [4] as well as subsequent recurrence of atrial fibrillation and increased long-term risks for heart failure, ischemic stroke, and death [5]. This may offset any benefit of a higher MAP. The ideal target MAP may have to be individualized for specific patient populations. More studies are needed to determine whether baseline blood pressure plays a role in the ultimate determination of the ideal MAP target for patients with sepsis.  
ccforum.com
over 4 years ago
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Sepsis in children

Given the time critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to start investigations and treatment for sepsis, including fluid resuscitation, and to continue with these until sepsis has been excluded  
feeds.bmj.com
over 4 years ago
Www.bmj
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CPR before medical services arrive more than doubles survival after cardiac arrest

Giving cardiopulmonary resuscitation before emergency medical services arrive more than doubles the 30 day survival rate in people who have a cardiac arrest out of hospital, shows a Swedish study reported in the New England Journal of Medicine.1  
feeds.bmj.com
over 4 years ago
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11

Sepsis in children

Given the time critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to start investigations and treatment for sepsis, including fluid resuscitation, and to continue with these until sepsis has been excluded  
feeds.bmj.com
over 4 years ago
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10

Sepsis in children

Given the time critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to start investigations and treatment for sepsis, including fluid resuscitation, and to continue with these until sepsis has been excluded  
feeds.bmj.com
over 4 years ago
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1

Sepsis in children

Given the time critical nature of severe sepsis and septic shock, when sepsis is suspected on clinical grounds it is usually best to start investigations and treatment for sepsis, including fluid resuscitation, and to continue with these until sepsis has been excluded  
feeds.bmj.com
over 4 years ago
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Ever had to sedate during CPR?

Ever had to sedate a patient during CPR? What would be your agent of choice? The Kiwis use ketamine #IPHEC2015 pic.twitter.com/OCv9dpEXtO— erica ley (@ericaley66) May 20, 2015  
prehospitalmed.com
over 4 years ago