Article of the Week

Big Questions in EM: Recapping the Evidence on Cardiac Arrest, Massive GI Bleeding, and Sepsis

Presented by Dr Thomas Lynch.

This is an awesome lecture given at one of our weekly conference which recaps some of the evidence in big emergency medicine topics:

Cardiac ArrestMassive GI Bleeding, & Sepsis.

Big, interesting, questions with the evidence in the PDF-lecture can be found here

CARDIAC ARREST:

Does prehopital induction of hypothermia affect survival to discharge and neurological outcome?

Is 33 C better than 36 C for all cause mortality, neurological outcome and death at 180 days?

Does Epinephrine, vasopressin and steroids improve outcomes in hospital cardiac arrest?

Is cardiac standstill on ECHO predictive of outcome?

MASSIVE GI BLEED

Restrictive vs liberal transfusion strategy: which one is better?

PPIs, Octreotide, Prophylactic Abx: To give or not to give?

Resuscitation ratios: (pRBCs, FFP, Platelets, Fluids) what should we be doing?

What are the affects of early short course of TXA on vascular occlusive events, and all cause mortality?

SEPSIS

What’s up with PROCESS and ARISE Trials?

Of all the things, it looks like its all about hypotension and time to antibiotics.

Can we use ED US to estimate CVP?

Take home points below…

Cardiac Arrest

  • Consider different drug combo for in vs out of hospital arrest
  • Prehospital cooling not important for short transport times
  • bedside US for decision making:
    • cardiac standstill on presentation = 0% survival
  • Target temperature management. (NOT hypothermia)

Massive Bleeding

  • 7 is the magic number
  • PPI, Octreotide…pick your battles
  • Abx for cirrhotic
  • Damage control resuscitaiton principles
  • TXA for massive bleeds

Sepsis

  • Early IVF
  • Early Abx
  • Catheters and blood not necessary
  • IVC US for fluid status
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s