The Biggies TTM Trial TTM Trial Hemodynamics Polderman Editorial on TTM HACA Trial (NEJM 2002;346(8):549) Bernard RCT (NEJM 2002;346(8):557) Meta-Analysis ILCOR Hypothermia Statement ILCOR Post-Arrest Care Statement Lancet Review by Kees Polderman Nuts & Bolts Review by Kees Polderman (Crit Care Med 2009;37(3):1101-1120) Mechanisms of Hypothermia by Kees Polderman Study by Oddi ( )-Included Asystole […]
Search Results for: cardiac arrest
EMCrit Wee – Abandon Epinephrine?
Should we stop using Epi in the field for cardiac arrest
EM Nerd-The Case of the Tell-Tale Heart
We can all agree that the use of bedside ultrasound (US) has changed the practice of Emergency Medicine for the better. But with the addition of such a tool, we are now faced with the question of how best to apply this novel modality into our practice. The emergency management of cardiac arrest seems like […]
PulmCrit- Hypothermia for non-shockable arrest: let’s not get hot-headed about this
background Fever is harmful in post-arrest patients. This creates confusion in studies of hypothermia in post-arrest patients: is the benefit of hypothermia due to fever avoidance, due to a benefit from hypothermia itself, or perhaps due to both? Seminal studies in the early 2000s found mortality benefit from application of hypothermia to 33C after cardiac […]
Old Chapter from Crashingpatient.com
2010 ACLS Guidelines web site with tons of resources Do not place sheets between patients and cooling blankets history of hypothermia and review (Chest 2008;133;1267-1274) Hypothermia review article Bernard SA, Buist M, Induced hypothermia in critical care medicine: a review. Crit Care Med 2003;31:2041-51. Major clinical trials have been […]
“The Adventure of the Empty House”
Well before Han Solo was frozen in carbonite, before Sigourney Weaver crossed galaxies in cryostasis, or Walt Disney was cryopreserved, we have been fascinated by the stasis-like powers of hypothermia. Given this enthusiasm, we most likely would have reacted with just as much vigor even if the initial trials of hypothermia for out of hospital […]
Dual External Defibrillation: Close, but Not Touching by Mark Ramzy
The scoop on dual defibrillation
EM Nerd-The Case of the Costly Compound
Epinephrine has been a fundamental therapeutic agent in the management of cardiac arrest since the inception of advanced life support. Despite its ubiquitous use, this practice has never been supported by high quality evidence. With the publication of the PARAMEDIC-2 trial by Perkins et al1, we are now far closer to understanding the true value […]
Error in capnography infographic
Question: What is the error in this infographic? According to the infographic, cardiac arrest causes a sudden complete loss of waveform. This isn’t correct. Cardiac arrest will cause a prompt downtrending etCO2 tracing (the pattern shown in the bottom right box). This is clinically important because if a patient in cardiac arrest is intubated, there […]
EM Nerd-The Case of the Bridge to Nowhere Continues
So often we apply qualitative dichotomies to quantitative differences even when questionable clinical distinction exists. Such is the case with the general interpretation of a recent article published in Resuscitation. Huis in ’t Veld et al examined video recordings of real life Emergency Department resuscitations of patients in cardiac arrest (1). Over a one year […]
The Case of the Perfect Imperfection
The Enemy of Good is Perfect The interpretation of literature is not dissimilar from the interpretation of the Rorschach tests. To one person the data appears to be a freshly hatched butterfly full of hope and promise. While to another it is a discomforting stain resulting from the splatter of improperly handled bodily excrement. What you […]
2015 ACLS Guidelines: What happened to VSE?
. Introduction . In 2008 and 2013, two prospective RCTs from Greece reported benefits from the combination of vasopressin, steroids, and epinephrine (VSE) for in-hospital cardiac arrest. However, other studies investigating the addition of vasopressin alone to epinephrine have been negative. Consequently, vasopressin has been removed from the AHA/ACC algorithms, with a specific recommendation […]
EMCrit Wee – The Targeted Temperature Trial Changes Everything
Cold, but not all that cold may be the way
The Case of the Indiscriminate Waveform
From the very start of our Residency training, Emergency Medicine Physicians are tasked with committing to memory the correctable causes of PEA arrest. It is expected any intern worth their salt should be able to recite the H’s & T’s proselytized by the AHA as far back as 1995 (1). And yet, it quickly becomes […]
SMACC ILCOR Session
Advanced Airway Management During Adult Cardiac Arrest Read the ILCOR Guideline and COMMENT Read and Comment on the Airway CoSTR Additional Resources The Three Papers that made the Guideline Jabre Benger Wang Vasopressors in Adult Cardiac Arrest Read the ILCOR Guideline and COMMENT Read and Comment on the Vasopressor CoSTR Additional Resources PARAMEDIC2 Please, […]
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