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


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?


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?


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


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

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