All tagged Resuscitation

Episode 110: EMS WEEK with Dr. Zaffer Qasim

Summary

In this episode, Dr. Zaf Qasim discusses advances in medical resuscitation and the future of cardiac arrest care. The conversation covers topics such as compression-only CPR, the controversy surrounding head-up CPR, the use of band and piston-driven devices, and the potential of extracorporeal cardiopulmonary resuscitation (eCPR). The importance of good dispatch and patient selection is emphasized as key factors in improving outcomes. The episode concludes with a discussion on the need for a paradigm shift in how we approach cardiac arrest care. Then, Dr. Zaf Qasim discusses updates in trauma resuscitation. The focus is on the use of whole blood in trauma resuscitation, the importance of meaningful intervention in the pre-hospital setting, the role of ultrasound in trauma resuscitation, and the use of ketamine and fentanyl in RSI and trauma scenarios. Dr. Qasim emphasizes the need for resuscitation before intubation and the importance of controlling bleeding and restoring volume. He also highlights the potential of technology, such as ultrasound and sending real-time information to the trauma team. The conversation ends with a call for hope in the future of pre-hospital medicine.

Takeaways

Advances in medical resuscitation have focused on basic life support (BLS) interventions, such as compression-only CPR and early defibrillation.
The effectiveness of head-up CPR in improving outcomes is still under debate, and more research is needed to determine its role in human resuscitation.
While band and piston-driven devices have shown variable results in improving outcomes, they can be useful logistically in certain situations.
Extracorporeal cardiopulmonary resuscitation (eCPR) shows promise for refractory ventricular fibrillation patients, but its implementation requires system-wide changes and good patient selection.
Good dispatch and patient selection are crucial in improving cardiac arrest care and should be prioritized in system design and protocols.
A paradigm shift is needed to move from a one-size-fits-all approach to cardiac arrest care to a more individualized approach based on patient outcomes and preferences.

The use of whole blood in trauma resuscitation is gaining traction and has shown to improve outcomes.
Meaningful intervention in the pre-hospital setting, such as giving blood and controlling bleeding, is crucial for improving trauma outcomes.
Ultrasound can provide valuable information in trauma resuscitation, including assessing the heart and identifying pericardial effusion.
Ketamine is still a great drug for RSI in trauma, but dosage and patient physiology should be considered.
Technology, such as ultrasound and real-time information sharing, has the potential to enhance trauma resuscitation.
There is hope for the future of pre-hospital medicine, with a focus on improving pre-hospital interventions and outcomes.

Episode 109: Dr. Ken Milne, Small BVMs, and Nitroglycerine

In this episode, Dr. Ken Milne discusses two studies related to emergency medicine. The first study examines the use of small adult ventilation bags in out-of-hospital cardiac arrest. The study found that small bags were associated with a lower rate of return of spontaneous circulation (ROSC) compared to standard bags. However, this was an observational study and more research is needed to draw definitive conclusions. The second study explores the use of nitroglycerin in right ventricular myocardial infarctions (MIs). Traditionally, nitroglycerin has been contraindicated in these cases, but the study found no significant difference in adverse events when nitroglycerin was used. Again, more research is needed to confirm these findings. Overall, these studies highlight the importance of evidence-based practice and the need for further research in emergency medicine. 

Episode 97: 2023 Resuscitation Update

The gang gets back together and discusses new resuscitation data from 2022.

Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest

Question and Methods: double-blind RCT out of Denmark whether high or low arterial blood-pressure targets would be superior in preventing death or severe anoxic brain injury in comatose survivors of OHCA. Enrolled 789 patients

RePHILL Study

Question and Methods: Multicenter RCT out of the UK that investigated prehospital resuscitation using PRBCs and plasma versus normal saline to improve tissue perfusion or mortality in adult trauma patients with hemorrhagic shock.

Mike's favorite study about Refractory VFib

Question and Methods: Shock-refractory VFib remains a common occurrence during OHCA → does dual sequential defib and vector-changing defib improve outcomes in patients with refractory VF? Primary outcome measure was survival to hospital discharge; secondary outcomes termination of VF, ROSC, good neurologic outcome at hospital discharge

Head and thorax elevation during cardiopulmonary resuscitation using circulatory adjuncts is associated with improved survival

Question and Methods: Does the use of a head up device as part of a CPR bundle improve survival from OHCA?

Episode 51: Our Holiday Wish Lists!

Dan and Ed talk about what they hope they get for the holidays and 2020....we also bring our medical director, Dr. Mark Merlin to talk about his wishes for the coming year in prehospital medicine!

We talk about a lot of different topics: whole blood, trauma, developing our younger colleagues, and Ed's current disappointment with his sports teams.

For more info and a free online course on whole blood resuscitation:

www.rdcr.org

Check out MD1 physician response at:

www.md1program.org

Episode 41: Fluids and Pressors

Ed, Mike and Dan get nerdy again talking about IV fluids and vasopressors! What works, why, and what do you need to know about the stuff we put into patients…and why it may be hurting more than helping!

2008 JAMA article on fluid resuscitation:

Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults

R Bellomo, C Hegarty, D Story, L Ho, M Bailey – Jama, 2012 – jamanetwork.com… “Normal” 0.9 per cent salt solution is neither “normal” nor physiological. JAMA … The
biochemical effects of restricting chloride-rich fluids in intensive care. Crit Care Med … Crit
Care Resusc. 2008;10(3):225-23018798721PubMedGoogle

Cochrane Review on colloids or crystalloids:

Colloids or crystalloids for fluid replacement in critically people …

https://www.cochrane.org/…/INJ_colloids-or-crystalloids-fluid-replacement-critically-…

Costs involved in using colloids:

Albumin Use Guidelines and Outcome in a Surgical … – JAMA Network

https://jamanetwork.com/journals/jamasurgery/fullarticle/401980

ATLS 10th edition changes:

ATLS 10th edition offers new insights into managing trauma patients