Tag: resuscitation
Unintended Consequences: Fluid Resuscitation Worsens Shock in an Ovine Model of Endotoxemia
Fluid resuscitation resulted in a paradoxical increase in vasopressor requirement. Additionally, it did not result in improvements in any of the measured microcirculatory- or organ-specific markers measured. The increase... read more
Metabolic Sepsis Resuscitation
There are roughly two strategies for adjusting the intensity of treatment: Titrated strategy: Treatment intensity is adjusted to match the severity of the disease. Escalation-deescalation strategy: Treatment intensity is... read more
Host Genetic Variants in Sepsis Risk
Published data revealed that host genetic variants have a substantial influence on sepsis susceptibility. However, the results have been inconsistent. We aimed to systematically review the published studies and quantitatively... read more
Shock: Roadside to Resus
If you're involved in the care of critically unwell patients then you will frequently encounter patients who are shocked. The European Society of Intensive Care Medicine defines shock as; "Life-threatening, generalized... read more
The Shocked Intubation: Definitive Airway Sans Hypotension
Not many aspects of Emergency Medicine define our specialty better than resuscitation, and few concepts exemplify resuscitation better than shock and intubation. Yet few words together strike greater fear in the minds of... read more
Patient-tailored Triage Decisions by Anesthesiologist-staffed Prehospital Critical Care Teams
The primary objective was to estimate the incidence of patients in the Central Denmark Region triaged to bypass the local emergency department without being part of a predefined fast-track protocol. The secondary objective... read more
Principles of Fluid Management and Stewardship in Septic Shock
There are only four major indications for fluid administration in the critically ill: resuscitation, maintenance, replacement and nutrition (enteral or parenteral). In this review, a conceptual framework is presented looking... read more
Fluid Responsiveness in a Hemodynamically Unstable Patient
Only half of patients who are hemodynamically unstable will respond to a fluid bolus. There are no historical or physical examination findings that can help us decide whether a patient is a fluid responder, but we must treat... read more
Crystalloids vs. Colloids for Fluid Resuscitation in the ICU
This systematic review and meta-analysis, which included only high-level evidence from randomized, controlled trials (RCTs) conducted in intensive care settings, revealed that crystalloids were less effective than colloids... read more
Optimum Chest Compression Point for CPR in Children Revisited Using a 3D Coordinate System Imposed on CT
The optimum chest compression site (P_optimum) in children is debated: European Resuscitation Council recommends one finger breadth above the xiphisternal joint, whereas American Heart Association proposes the lower sternal... read more
The Patients Were Saved. That’s Why the Families Are Suing
What happened to Beatrice Weisman before dawn on Aug. 29, 2013, was not supposed to happen: The medical staff at Maryland General Hospital found her in cardiac arrest, resuscitated her and kept her alive. The matriarch of... read more
Is a Golden Age of Resuscitation on the Horizon?
Is emergency medicine on the verge of "the dawn of a new golden age of resuscitation?" That's the bold prediction from CPR innovator Keith Lurie, MD, a professor of internal and emergency medicine at the University of Minnesota,... read more
Effect of Bag-Mask Ventilation vs Endotracheal Intubation During CPR on Neurological Outcome After OHCA
Among patients with out-of-hospital cardiorespiratory arrest (OHCA), the use of BMV compared with ETI failed to demonstrate noninferiority or inferiority for survival with favorable 28-day neurological function, an inconclusive... read more
Chasing Mortality Endpoints is a Fool’s Errand
"There is no mortality benefit for that." How many times have you heard that? The implication is usually the same: that intervention is a waste of time. A smart, evidence-based clinician wouldn't bother with it. But, what... read more
Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients
Sepsis is associated with generalised endothelial injury and capillary leak and has traditionally been treated with large volume fluid resuscitation. Some patients with sepsis will accumulate bodily fluids. The aim of this... read more
Navigating Medical Emergencies – An interactive guide to patient management
This free eBook presents emergent clinical situations and the core tasks required of healthcare professionals needing to recognize, navigate and safely manage them. It's really about how to perform the ABCs while protecting... read more
How Do Resuscitation Teams at Top-Performing Hospitals for In-Hospital Cardiac Arrest Succeed?
Resuscitation teams at hospitals with high IHCA survival differ from non–top-performing hospitals. Our findings suggest core elements of successful resuscitation teams that are associated with better outcomes and form the... read more
pH-guided Fluid Resuscitation and BICAR-ICU
The use of bicarbonate is a source of eternal disagreement. Bicarbonate has a shameful history of being abused in situations where it's unhelpful (e.g. cardiac arrest). This has impugned its reputation, giving it an aura... read more
Silent Space
Exhausted at the end of a busy week on service in the intensive care unit (ICU), the fellow and I are on our way to the conference room to debrief the week. The overhead code alarm disrupts the temporary lull in activity... read more
Withdrawing vs. Not Offering Cardiopulmonary Resuscitation: Is There a Difference?
In light of the SCC's Cuthbertson v. Rasouli decision, the distinction between withdrawing and not offering a medical treatment is increasingly relevant. Because CPR is a "default" treatment for cardiac arrest, it requires... read more
Preventing Harmful Delays with POCUS During Cardiac Arrest
With the integration of bedside echocardiography into cardiac arrest, we now have a real-time tool to help us glean some of this critical missing information, as well as offer procedural guidance and prognostic data. However,... read more
Haemoglobin concentration and volume of intravenous fluids in septic shock in the ARISE trial
Haemoglobin concentration decreases during resuscitation from septic shock, and has a significant but weak association with the volume of intravenous fluids administered. Median (IQR) haemoglobin concentration at baseline... read more
