David Sweet , Julian Marsden , Kendall Ho , Christina Krause , James A Russell
Many emergency departments have implemented sepsis protocols since the 2001 publication of results from the early goal-directed therapy trial, which showed early targeted resuscitation lowers mortality. As part of an attempt to improve clinical and operational outcomes for emergency departments across British Columbia, we reviewed sepsis management literature and considered sepsis protocol implementation in the province’s emergency departments. During the literature review we found that many observational studies confirmed an association between implementation of emergency sepsis protocols and decreased mortality...
May 2012: British Columbia Medical Journal
Christina Creel-Bulos, Brian Hassani, Michael J Stentz, Gaurav Budhrani, Mani A Daneshmand, Craig S Jabaley, Robert F Groff
Amniotic fluid embolism is a rare obstetric emergency that can be accompanied by profound hypoxemia, coagulopathy, hemorrhage, and cardiogenic shock. Extracorporeal membrane oxygenation may provide a rescue strategy in amniotic fluid embolism with cardiopulmonary collapse. Approaches to anticoagulation must be balanced against the risk of hemorrhage with concomitant coagulopathy. Although extracorporeal membrane oxygenation has been described for cardiopulmonary collapse in the setting of amniotic fluid embolism, its initiation as a bridge to hemostasis and cardiopulmonary recovery in amniotic fluid embolism-induced hemorrhagic and cardiogenic shock remains a novel resuscitation strategy...
July 2020: Critical care explorations
Azzam A Paroya, Kinner M Patel, Sahar Ahmad
Preventing the dispersion of virulent particles during aerosol generating procedures has never been more relevant than during the current coronavirus pandemic. The American Heart Association released interim guidelines to assist in limiting exposure during advanced cardiovascular life support. These include maintaining a closed circuit on the ventilator for intubated patients and to use a high-efficiency particulate air filter during airway management of nonintubated patients. We developed additional modifications to the suggested guidelines such that providers are even further protected from unnecessary aerosolization, and illustrate a sample protocol for provider safety during advanced cardiovascular life support in the coronavirus pandemic...
July 2020: Critical care explorations
Sydney E Dishman, Kathryn E Driggers, Laura S Johnson, Cara H Olsen, Andrea B Ryan, Melissa M McLawhorn, Kevin K Chung
Although do-not-resuscitate orders only prohibit cardiopulmonary resuscitation in the case of cardiac arrest, the common initiation of this code status in the context of end-of-life care may lead providers to draw premature conclusions about other goals of care. The aim of this study is to identify concerns regarding care quality in the setting of do-not-resuscitate orders within the Department of Defense and compare differences in perceptions between members of the critical care team. Design: A cross sectional observational study was conducted...
July 2020: Critical care explorations
Heather A Wolfe, Jesse Wenger, Robert Sutton, Roopa Seshadri, Dana E Niles, Vinay Nadkarni, Jordan Duval-Arnould, Anita I Sen, Adam Cheng
Introduction: Clinical event debriefing functions to identify optimal and suboptimal performance to improve future performance. "Cold" debriefing (CD), or debriefing performed more than 1 day after an event, was reported to improve patient survival in a single institution. We sought to describe the frequency and content of CD across multiple pediatric centers. Methods: Mixed-methods, a retrospective review of prospectively collected in-hospital cardiac arrest (IHCA) data, and a supplemental survey of 18 international institutions in the Pediatric Resuscitation Quality (pediRES-Q) collaborative...
July 2020: Pediatric Quality & Safety
Halden F Scott, Allison Kempe, Sara J Deakyne Davies, Paige Krack, Jan Leonard, Elise Rolison, Joan Mackenzie, Beth Wathen, Lalit Bajaj
Severe sepsis requires timely, resource-intensive resuscitation, a challenge when a sepsis diagnosis is not confirmed. The overall goals were to create a pediatric sepsis program that provided high-quality critical care in severe sepsis (Sepsis Stat), and, in possible sepsis, flexible evaluation and treatment that promoted stewardship (Sepsis Yellow). The primary aims were to decrease time to antibiotics and the intensive care unit requirement. Methods: A 2-tiered clinical pathway was implemented at 6 pediatric emergency departments and urgent care centers, incorporating order sets, education, paging...
January 2020: Pediatric Quality & Safety
Alyssa Kahl, Shruti Khurana, Scott Larson
Percutaneous transhepatic cholangiodrainage is an intervention for obstructive jaundice that, although effective in decreasing bilirubin levels, often leads to depletion of regular bile acids that subsequently cause malabsorption, diarrhea, and acute kidney injury. Bile reinfusion (BR) is a method of enteral refeeding of biliary secretions to replenish innate bile acids to the patient. In addition, BR is a low-cost alternative to exogenous bile acid replacement and abates the need for inpatient fluid resuscitation...
July 2020: ACG Case Reports Journal
Emma Vecchioli, Anne-Gaël Cordier, Anne Chantry, Alexandra Benachi, Isabelle Monier
BACKGROUND: The safety of methods of labor induction in women with previous cesarean deliveries is still debated. We investigated perinatal outcomes associated with labor induction among women with a trial of labor after one cesarean delivery. METHODS: This retrospective study included 339 women with a trial of labor after one prior cesarean and a singleton term fetus in cephalic presentation in 2013-2016 in a French maternity unit. Labor induction was performed with oxytocin, artificial rupture of membranes and/or prostaglandin E2, according to the Bishop score...
2020: PloS One
Maria Carmen G Diaz, Kimberly Dawson
The Coronavirus Disease 2019 (COVID-19) pandemic has created many challenges for healthcare providers. At the forefront is the need to balance optimal patient care with the safety of those providing that care. This is especially true during resuscitations where life-saving procedures cause widespread aerosolization of the virus. Efforts to mitigate this exposure to front-line providers are therefore paramount. We share how we used simulation to prepare our Pediatric Emergency Department for COVID-19 resuscitations...
August 4, 2020: American Journal of Infection Control
Fahad Faqihi, Abdulrahman Alharthy, Mohammed Alodat, Demetrios J Kutsogiannis, Peter G Brindley, Dimitrios Karakitsos
PURPOSE: We investigated the effect of therapeutic plasma exchange (TPE) on life-threatening COVID-19; presenting as acute respiratory distress syndrome (ARDS) plus multi-system organ failure and cytokine release syndrome (CRS). MATERIALS AND METHODS: We prospectively enrolled ten consecutive adult intensive care unit (ICU) subjects [7 males; median age: 51 interquartile range (IQR): 45.1-55.9 years old] with life-threatening COVID-19 infection. All had ARDS [PaO2/FiO2 ratio: 110 (IQR): 95...
July 31, 2020: Journal of Critical Care
Felipe Teran, Michael I Prats, Bret P Nelson, Ross Kessler, Michael Blaivas, Mary Ann Peberdy, Sasha K Shillcutt, Robert T Arntfield, David Bahner
Focused transthoracic echocardiography (TTE) during cardiac arrest resuscitation can enable the characterization of myocardial activity, identify potentially treatable pathologies, assist with rhythm interpretation, and provide prognostic information. However, an important limitation of TTE is the difficulty obtaining interpretable images due to external and patient-related limiting factors. Over the last decade, focused transesophageal echocardiography (TEE) has been proposed as a tool that is ideally suited to image patients in extremis-those in cardiac arrest and periarrest states...
August 11, 2020: Journal of the American College of Cardiology
Matija Bakos, Daniel Dilber, Drazen Belina, Filip Rubic, Toni Matic
A 2-week-old male newborn with a double inlet left ventricle developed a cardiac arrest following modified Blalock-Taussig anastomosis in pediatric intensive care unit. Probable causes of the arrest were hemodynamic instability and thrombosed shunt, which was later recanalized on extracorporeal membrane oxygenation therapy, which was successfully used with a pump flow lower than recommended in these patients-without the shunt clip, but without any complications.
August 6, 2020: Perfusion
Susanna Myrnerts Höök, Nicolas J Pejovic, Francesco Cavallin, Clare Lubulwa, Josaphat Byamugisha, Jolly Nankunda, Thorkild Tylleskär, Tobias Alfven
Background: Heart rate (HR) assessment is crucial in neonatal resuscitation, but pulse oximetry (PO) and electrocardiography (ECG) are rarely accessible in low-resource to middle-resource settings. This study evaluated a free-of-charge smartphone application, NeoTap, which records HR with a screen-tapping method bypassing mental arithmetic calculations. Methods: This observational study was carried out during three time periods between May 2015 and January 2019 in Uganda in three phases...
2020: BMJ Paediatrics Open
Takeshi Murakoshi
The risks and technical difficulties at the cesarean delivery for extremely premature infant under 1,000g are as follows: (1) a premature infant is very weak for pressure of uterine wall or human hands, (2) skin of infant is really premature and weak, (3) uterine wall is thick and difficult to incise at lower segment of uterus, (4) classical vertical incision or reverse T-shape incision are at risk for future uterine rupture, and (5) at the timing of rupture of membrane, uterine wall may contract drastically and the infant is trapped the uterine wall, so called "hug-me-tight-uterus"...
July 2020: Surgery Journal
Juliana Ying Liang Mai, Andrew Holmes, Gert Frahm-Jensen
Advanced Trauma Life Support principles prioritise the management of 'breathing' over 'circulation' in an acute trauma primary survey. In a tamponaded thoracic aortic rupture, however, this may lead to fatal haemorrhagic shock. In this case, we discuss the resuscitation and management of a patient with a massive left sided haemothorax secondary to a grade four blunt traumatic aortic injury. A 26-year-old male was involved in a high-speed motor vehicle crash and was hypoxic and hypotensive at the scene. His oxygenation and haemodynamics improved with supplemental oxygen and fluid resuscitation...
October 2020: Trauma Case Reports
Martin Heinrich, Matthias Lany, Lydia Anastasopoulou, Christoph Biehl, Gabor Szalay, Florian Brenck, Christian Heiss
Introductio: Although management of severely injured patients in the Trauma Resuscitation Unit (TRU) follows evidence-based guidelines, algorithms for treatment of the slightly injured are limited. METHODS: All trauma patients in a period of eight months in a Level I trauma center were followed. Retrospective analysis was performed only in patients ≥18 years with primary TRU admission, Abbreviated Injury Scale (AIS) ≤ 1, Maximum Abbreviated Injury Scale (MAIS) ≤ 1 and Injury Severity Score (ISS) ≤3 after treatment completion and ≥24 h monitoring in the units...
August 4, 2020: Journal of Clinical Medicine
Minehiko Inomata, Takahiro Hirai, Naoki Takata, Nozomu Murayama, Kana Hayashi, Zenta Seto, Kotaro Tokui, Seisuke Okazawa, Kenta Kambara, Shingo Imanishi, Toshiro Miwa, Shoko Matsui, Ryuji Hayashi, Kazuyuki Tobe
Objective The aim of the present study was to analyze the relationship between the patient characteristics and the timing of provision of an explanation about "Do Not Attempt Resuscitation (DNAR)" by attending physicians to advanced lung cancer patients. Methods We conducted a retrospective analysis of patients with advanced or postoperative recurrent lung cancer in whom systemic therapy was initiated between 2015 and 2016. Results The data of a total of 74 patients with lung cancer, including 59 patients with non-small cell lung cancer and 15 with small cell lung cancer were analyzed...
August 4, 2020: Internal Medicine
Louise de Charentenay, Guillaume Schnell, Nicolas Pichon, Maleka Schenck, Pierrick Cronier, Sebastien Perbet, Jean-Baptiste Lascarrou, Thomas Rossignol, Olivier Lesieur, Laurent Argaud, Gwenhael Colin, Bernard Cholley, Jean-Pierre Quenot, Hamid Merdji, Stein Silva, Michael Piagnerelli, Jonathan Chelly, Marie Salvetti, Segolene Couraud, Nicolas Deye, Marc Danguy des Déserts, Marine Paul, Guillaume Thiery, Marc Simon, Charlotte Martin, François Vincent, Vincent Das, Gwenaelle Jacq, Frederic Jacobs, Alexis Soummer, Julien Mayaux, Pascal Beuret, Abdelkader Ouchenir, Caroline Durant, Mickael Darmon, Elie Azoulay, Bertrand Sauneuf, Cedric Daubin, Nicolas Mongardon, Lucie Biard, Alain Cariou, Thomas Geeraerts, Stephane Legriel
BACKGROUND: Near-hanging is a life-threatening event about which few data are available. RESEARCH QUESTION: What are the outcomes and early predictors of hospital mortality in critically ill patients with near-hanging. STUDY DESIGN: and Methods. Adults patients with successful resuscitation of suicidal near-hanging injury admitted to 31 university or university-affiliated ICUs in France and Belgium between 1992 and 2014 were studied retrospectively...
August 3, 2020: Chest
Peter Natalzia, William Murk, Jeffrey J Thompson, Maia Dorsett, Jeremy T Cushman, Philip Reed, Brian M Clemency
BACKGROUND & PURPOSE: Pandemics such as COVID-19 can lead to severe shortages in healthcare resources, requiring the development of evidence-based Crisis Standard of Care (CSC) protocols. A protocol that limits the resuscitation of out-of-hospital cardiac arrests (OHCA) to events that are more likely to result in a positive outcome can lower hospital burdens and reduce emergency medical services resources and infection risk, although it would come at the cost of lives lost that could otherwise be saved...
August 3, 2020: Resuscitation
Yohei Okada, Takeyuki Kiguchi, Taro Irisawa, Kazuhisa Yoshiya, Tomoki Yamada, Koichi Hayakawa, Kazuo Noguchi, Tetsuro Nishimura, Takuya Ishibe, Yoshiki Yagi, Masafumi Kishimoto, Hiroshi Shintani, Yasuyuki Hayashi, Taku Sogabe, Takaya Morooka, Haruko Sakamoto, Keitaro Suzuki, Fumiko Nakamura, Norihiro Nishioka, Tasuku Matsuyama, Satoshi Matsui, Takeshi Shimazu, Kaoru Koike, Takashi Kawamura, Tetsuhisa Kitamura, Taku Iwami
BACKGROUND: There is limited information on the predictive accuracy of commonly used predictors, such as lactate, pH or serum potassium for the survival among out-of-hospital cardiac arrest (OHCA) patients with hypothermia. This study aimed to identify the predictive accuracy of these biomarkers for survival among OHCA patients with hypothermia. METHODS: In this retrospective analysis, we analyzed the data from a multicenter, prospective nationwide registry among OHCA patients transported to emergency departments in Japan (the JAAM-OHCA Registry)...
August 5, 2020: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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