September 11, 2019

Clay Smith

Critical Care, EMS, Pediatrics, Resuscitation

Are PALS Ventilation Rates Too Slow?

September 11, 2019

Clay Smith

Critical Care, EMS, Pediatrics, Resuscitation

For pediatric in-hospital arrest, ventilation exceeding guideline recommendations was common and was associated with improved survival to discharge.

July 23, 2019

Clay Smith

Critical Care, EMS, Cardiology, Resuscitation

Dual Sequential Defibrillation - Earlier Is Better?

July 23, 2019

Clay Smith

Critical Care, EMS, Cardiology, Resuscitation

Dual sequential defibrillation (DSD) was ineffective overall in refractory ventricular fibrillation (v-fib) in terminating v-fib to return of spontaneous circulation (ROSC). The subgroup in which DSD was performed earlier (shocks 4-8) had improved ROSC.

July 22, 2019

Clay Smith

EMS, Pediatrics, Pharmacy/Pharmacology, Resuscitation

Have We Fixed Dosing Errors in Pediatric EMS?

July 22, 2019

Clay Smith

EMS, Pediatrics, Pharmacy/Pharmacology, Resuscitation

Prehospital personnel made frequent pediatric drug dosing errors in several critical scenarios. A drug reference that reduced calculations helped, but the error rate was still dangerously high.

June 21, 2019

Clay Smith

Cardiology, Critical Care, EMS, Resuscitation

How Not to Fry Defibrillators With Dual-Sequential Shocks

June 21, 2019

Clay Smith

Cardiology, Critical Care, EMS, Resuscitation

Learn how to avoid frying one defibrillator with the other if you use dual-sequential defibrillation as well as the most effective pad placement and inter-shock timing.

May 17, 2019

Sam Parnell

Resuscitation, Critical Care, Cardiology, EMS

Hands-On Defibrillation - A Safer Way?

May 17, 2019

Sam Parnell

Resuscitation, Critical Care, Cardiology, EMS

Polyethylene drapes used as a physical barrier to cover patients during defibrillation reduced electrical current to acceptable levels for medical personnel to continue compressions throughout defibrillation during cardiac arrest.

April 17, 2019

Clay Smith

Cardiology, Resuscitation

COACT RCT - Post-Arrest Angiography Without STEMI

April 17, 2019

Clay Smith

Cardiology, Resuscitation

There was no difference in 90-day survival or other outcomes with immediate vs delayed cardiac catheterization in patients who were post-cardiac arrest and had no STEMI criteria on ECG.

April 11, 2019

Clay Smith

Trauma, EMS, Critical Care, Resuscitation, Pediatrics, Retail/Urgent Care

What Defines Pediatric Hypotension?

April 11, 2019

Clay Smith

Trauma, EMS, Critical Care, Resuscitation, Pediatrics, Retail/Urgent Care

The Pediatric Advanced Life Support (PALS)/Advanced Trauma Life Support (ATLS) formula to define hypotension in children (i.e. 5th percentile SBP) seems to be a good compromise between German and U.S. population norms for children. The formula is: Low SBP = <70 + 2(age in years).

April 9, 2019

Clay Smith

Airway, Critical Care, EMS, Pediatrics, Resuscitation

Advanced Airway for Pediatric Cardiac Arrest - Should We Just Bag?

April 9, 2019

Clay Smith

Airway, Critical Care, EMS, Pediatrics, Resuscitation

There may be a slight advantage for pediatric cardiac arrest patients in survival with good neurological outcome by using simple bag-valve mask ventilation over advanced airway management.

April 8, 2019

Clay Smith

Resuscitation, Airway, EMS

Advanced Airway For Non-Shockable OHCA?

April 8, 2019

Clay Smith

Resuscitation, Airway, EMS

Advanced airway management (AAM) was associated with increased overall survival in out-of-hospital cardiac arrest (OHCA) (though not survival with favorable neurological outcome) in patients with non-shockable initial rhythm. There was no difference in survival with use of AAM in patients with initial shockable rhythm.

April 3, 2019

Clay Smith

Critical Care, EMS, Resuscitation

SWAP Score - Shockable, Witness, Age, pH for OHCA

April 3, 2019

Clay Smith

Critical Care, EMS, Resuscitation

Patients presenting to the ED with out-of-hospital cardiac arrest with a non-shockable rhythm, unwitnessed arrest, age >60, and pH≤7 have a 0% chance of good neurological outcome, specificity 100%.

April 2, 2019

Clay Smith

EMS, Resuscitation

Did Removal of Atropine From ACLS Impact Survival?

April 2, 2019

Clay Smith

EMS, Resuscitation

Removal of atropine from the ACLS algorithm did not result in a decrease in survival in patients with non-shockable rhythms.

March 15, 2019

Clay Smith

Resuscitation, Practice of EM

In-Flight Medical Emergencies

March 15, 2019

Clay Smith

Resuscitation, Practice of EM

In-flight medical emergencies are common, most often presenting with syncope. As emergency physicians, we are trained to handle most scenarios.

March 13, 2019

Clay Smith

Critical Care, Resuscitation, Pharmacy/Pharmacology

ANDROMEDA-SHOCK - Capillary Refill vs. Lactate

March 13, 2019

Clay Smith

Critical Care, Resuscitation, Pharmacy/Pharmacology

Peripheral perfusion guided resuscitation was better than lactate clearance in patients with septic shock in regard to improving organ dysfunction at 72 hours (SOFA score) and barely missed statistical significance in reducing 28-day mortality.

February 21, 2019

Clay Smith

Critical Care, EMS, Pain/Sedation/Procedure, Pediatrics, Resuscitation, Trauma

Pediatric Needle Decompression - What Size Needle?

February 21, 2019

Clay Smith

Critical Care, EMS, Pain/Sedation/Procedure, Pediatrics, Resuscitation, Trauma

A standard 5cm 14-16 gauge needle for chest decompression was more than twice as long as needed for children < 13 years old based on CT chest wall thickness (CWT).

January 28, 2019

Sam Parnell

Critical Care, EMS, Cardiology, Resuscitation

Shockingly Ineffective - Double Sequential Defibrillation for Refractory Vfib and Vtach

January 28, 2019

Sam Parnell

Critical Care, EMS, Cardiology, Resuscitation

$Shockingly Ineffective - Double Sequential Defibrillation for Refractory Vfib and Vtach$

Prehospital double sequential defibrillation was not associated with improved survival for out-of-hospital cardiac arrest patients with refractory ventricular fibrillation or pulseless ventricular tachycardia.

January 23, 2019

Clay Smith

Critical Care, Pediatrics, Resuscitation

Does EtCO2 Matter In Pediatric Arrest?

January 23, 2019

Clay Smith

Critical Care, Pediatrics, Resuscitation

There was no difference in survival to discharge in children with an EtCO2 >20mm Hg during CPR. Focus on high quality CPR and not this number.

January 22, 2019

Clay Smith

Critical Care, EMS, Pharmacy/Pharmacology, Pediatrics, Resuscitation

Antiarrhythmics In Arrest - New ILCOR Update

January 22, 2019

Clay Smith

Critical Care, EMS, Pharmacy/Pharmacology, Pediatrics, Resuscitation

The European Resuscitation Council International Liaison Committee on Resuscitation 2018 guideline has made one minor change regarding antiarrhythmic drugs in arrest: lidocaine, in place of amiodarone, is now a viable, equally effective option in patients with VF/pVT refractory to defibrillation.

January 21, 2019

Clay Smith

Airway, EMS, Resuscitation

ETT vs. SGA for OHCA - Metaanalysis Includes AIRWAYS-2 and PART

January 21, 2019

Clay Smith

Airway, EMS, Resuscitation

There was no difference in an endotracheal tube vs supraglottic airway for patients with out-of-hospital cardiac arrest in the outcomes of return of spontaneous circulation, survival to admission, survival to discharge, or survival with good neurological outcome in studies with low risk of bias in this large metaanalysis.

January 18, 2019

Clay Smith

Critical Care, Pain/Sedation/Procedure, Resuscitation

Extracorporeal Life Support in the Emergency Department

January 18, 2019

Clay Smith

Critical Care, Pain/Sedation/Procedure, Resuscitation

This is a review of ECLS, aka ECMO, in the ED. It covers when, why, how, and what might go wrong. If you’re thinking of starting or improving your ED ECLS program, this review will help.

December 22, 2018

Clay Smith

Education, Resuscitation

RCTs Made Simple as Infographics

December 22, 2018

Clay Smith

Education, Resuscitation

We want to feature great free medical education #FOAMed resources from around the web. One I learned of this week is called Visualmed. It is run by a third year IM resident at UConn, Usama Nasir. It takes key RCTs and turns them into infographics.