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Tactical Medicine News

Heads Up! There is No Association with Improved Outcomes for Head Up CPR: Why We Must Read Past the Abstract

by Marco Torres
Sep 19, 2022
Background: There are only two interventions that have been proven in the medical literature to improved outcomes in cardiac arrest: high-quality C...
Tactical Medicine News

The BOX Trial: BP & O2 Targets in Comatose Survivors of Cardiac Arrest

Background: Hypoxemia and hypoperfusion are important factors in outcomes after ROSC.  While hypoxemia (SpO2 <90%) is clearly deleterious, it is...
Tactical Medicine News

External Validation of Pittsburgh Cardiac Arrest Category (PCAC) Illness Severity Score

Background Information: Multiple illness severity scores have been developed for use after out-of-hospital cardiac arrest (OHCA) and in-hospital ca...
Tactical Medicine News

Effect of Intra-Arrest Transport and eCPR on Neurologic Outcomes in Refractory OHCA

Background Information: Refractory out of hospital cardiac arrest (OHCA) is defined as prolonged cardiac arrest and cardiac arrest without return o...
Tactical Medicine News

REBEL Cast Ep106: The COCA Trial – Calcium in Cardiac Arrest

Background: The utility of pharmacological interventions for patients with OHCA are rather limited with no robust evidence that they improve outcom...
Tactical Medicine News

REBEL Cast Ep104: VAM-IHCA – Vasopressin and Methylprednisolone for In-Hospital Cardiac Arrest

Background: Two prior trials compared the addition of vasopressin 20 IU (for each dose of epinephrine) and methylprednisolone 40mg to placebo for i...
Tactical Medicine News

Are You Pausing Too Long During CPR?

Background: Outside of early defibrillation and high-quality CPR, little has been shown to improve outcomes in out-of-hospital cardiac arrest (OHCA...
Tactical Medicine News

EM Quick Hits 33 Polytrauma Tips & Tricks, Toxic Megacolon, ECG in PE, Patch Calls, CT Before LP, Nebulized Ketamine

In this month's EM Quick Hits podcast, Anand Swaminathan on tips and tricks in polytrauma, Rohit Mohindra on diagnosis and management of toxic mega...
Tactical Medicine News

TTM2: Hypothermia vs Normothermia for Out-of-Hospital Cardiac Arrest

Background Information: Hypothermia was first introduced in 2002 by two studies, Bernard et al and The Hypothermia After Cardiac Arrest (HACA) tria...
Tactical Medicine News

In the Pipeline: Head Up CPR in OHCA?

Background: Head up (HUP) CPR is an emerging concept.  The theory behind HUP is it allows for venous blood to drain from the brain to the heart the...
Tactical Medicine News

MIRACLE2 Risk Score for Early Prediction of Neurologic Outcome in Out-of-Hospital Cardiac Arrest

Background Information: Out-of-hospital cardiac arrest (OHCA) remains a diagnostic challenge to providers and a significant burden on healthcare sy...
Tactical Medicine News

Effectiveness of Sodium Bicarbonate Administration on Mortality in Cardiac Arrest Patients: A Systematic Review and Meta-Analysis

Background/Introduction: The use of Sodium Bicarbonate (SB) in cardiac arrest has had a complicated history with strong and varied opinions on its ...
Tactical Medicine News

Ep142 Neonatal Resuscitation – Airway, Temperature Control, Central Access, Hemodynamics, Glucose Control and Tranport

Dr. Hilary Whyte, Dr. Jabeen Fayyaz, Dr. Emily MacNeill discuss a neonatal resuscitation algorithm, airway management, fluid resuscitation, central...
Tactical Medicine News

IV or IO Epi in OHCA?

Background: Epinephrine remains a staple in cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA).  However, the optimal dos...
Tactical Medicine News

Rebellion in EM 2019: All PEA is Not the Same via Tarlan Hedayati, MD

A 57-year-old man is watching his son’s baseball game when he suddenly collapses. Witnesses did not appreciate a pulse, so they started CPR. Unfor...
Tactical Medicine News

REBEL Core Cast 28.0 – Conference Pearls

Take Home Points  No palpable pulse does not equal no perfusion. We aren’t great at feeling pulses Patients with moderate to severe signs and symp...
Tactical Medicine News

EMU 365 A New Frontier in Cardiac Arrest Management with Salim Rezaie

This EMU365 Video features Dr. Salim Rezaie of REBEL EM presenting his approach to airway management and epinephrine dosing in cardiac arrest based...
Tactical Medicine News

EM Quick Hits 11 Blunt Cerebrovascular Injury, Physostigmine, TEE in Cardiac Arrest, Understanding Nystagmus, Subtle Inferior MI, Choicebo

In this EM Quick Hits podcast we have Emily Austin on physostigmine for anticholinergic toxidrome, Walter Himmel on understanding nystagmus to diff...
Tactical Medicine News

HYPERION: Targeted Temperature Management in Cardiac Arrest Patients with Non-Shockable Rhythms

Background Information: Therapeutic hypothermia is the use of targeted temperature management to reduce neurologic sequelae resulting from the seve...
Tactical Medicine News

Dosing and Timing of Epinephrine in OHCA

Background: Epinephrine (adrenaline) remains a central part of management of OHCA in ACLS guidelines. Recent studies (i.e. PARAMEDIC-2) have raised...
Tactical Medicine News

Pulse Checks in Cardiac Arrest Should be Dead

Background: In an older study published in Resuscitation 1998 [1], ED physicians, ICU physicians, and nurses tried to identify a carotid pulse in ...
Tactical Medicine News

CritCases 12 Accidental Hypothermia and Cardiac Arrest

In this CritCases blog Michael Misch takes us through a case of accidental hypothermia and cardiac arrest, reviewing the controversies in managemen...
Tactical Medicine News

JJ 14 Epinephrine in Cardiac Arrest

Does epinephrine improve the chances of return of spontaneous circulation at the expense of the brain? In other words, while we know that epinephri...
Tactical Medicine News

How Do You FEEL About Echo in Cardiac Arrest?

Background: Focused use of ultrasound in resuscitation of patients with shock and cardiac arrest has become increasingly embraced in both the emerg...
Tactical Medicine News

Sodium Bicarbonate in Cardiac Arrest Management

Background: As with all medications in cardiac arrest (i.e. epinephrine, amiodarone) the benefits of sodium bicarbonate administration have been di...
Tactical Medicine News

RSI, Predictors of Cardiac Arrest Post-Intubation, and Critically Ill Adults

Background:Intubation is a commonly performed procedure in the ED and ICU. We have discussed the physiologically difficult intubation before on REB...
Tactical Medicine News

Effect of POCUS in Cardiac Arrest on Compression Pauses

Background: The provision of high-quality compressions with minimal interruptions is central to the management of cardiac arrest. Along with defibr...
Tactical Medicine News

Can We Agree on Cardiac Standstill?

Background: Point of Care Ultrasound (POCUS) has gained wider use in resuscitation of patients presenting with cardiac arrest. POCUS can play an im...
Tactical Medicine News

Impact of POCUS During Cardiac Arrest Resuscitation on Compression Pauses

The provision of high-quality compressions with minimal interruptions is central to the management of cardiac arrest. Along with defibrillation, hi...
Tactical Medicine News

Is Amiodarone Dead?

Background: Amiodarone is a class III antidysrhythmic first released for human use in 1962. As with other drugs in this class, amiodarone acts by b...
Tactical Medicine News

Episode 96 Beyond ACLS Cardiac Arrest – Live from EMU Conference 2017

This is the first ever video podcast on EM Cases with Jordan Chenkin from EMU Conference 2017 discussing how to optimize three aspects of cardiac a...
Tactical Medicine News

In-Hospital Cardiac Arrest: The First 15 Minutes

Background: Over the past few years there has been a shift in cardiac arrest from the mantra of ABC (Airway, Breathing, Circulation) to CAB (Circul...
Tactical Medicine News

Episode 93 – PALS Guidelines

I remember when I started practicing emergency medicine a decade and a half ago it seemed that any kid who came to our ED in cardiac arrest died. I...
Tactical Medicine News

Cardiac Arrest, Return of Spontaneous Circulation (ROSC) With No ST-Segment Elevation on ECG. Now What?

Background: The American Heart Association/American College of Cardiology (AHA/ACC) give a Class I recommendation for activation of the cardiac cat...
Tactical Medicine News

Journal Jam 7 – Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial

Journal Jam 7 - Amiodarone vs Lidocaine vs Placebo in Cardiac Arrest: The ALPS Trial. In our most popular EM Cases episode to date - ACLS Guideline...
Tactical Medicine News

Best Case Ever 46 – Chris Nickson on Hickam’s Dictum

EM Cases Best Case Ever - Chris Nickson on Hickam's Dictum. Usually we use the heuristic of Occam's razor to help us arrive at one diagnosis that m...
Tactical Medicine News

Best Case Ever 45 – Mike Winters on Cardiac Arrest

I had the great pleasure of meeting Dr. Mike Winters on his first ever visit to Canada at North York General's Emergency Medicine Update Conference...
Tactical Medicine News

Beyond ACLS: Pre-Charging the Defibrillator

Post Written By: Sam Ghali (Twitter: @EM_RESUS) In cardiac arrest care there has been a lot of focus over the years on limiting interruptions in ch...
Tactical Medicine News

Classic Journal Review: The OPALS Study

  The Ontario Prehospital Advanced Life Support (OPALS) Study Background: Sudden cardiac arrest is common and, obviously, very bad. In the US, ther...
Tactical Medicine News

The Role of TEE in Cardiac Arrest

Background: Sudden cardiac arrest has very poor outcomes; less than 11% of patients in cardiac arrest in the Emergency Department survive to discha...
Tactical Medicine News

Episode 71 ACLS Guidelines 2015 – Cardiac Arrest Controversies Part 1

A lot has changed over the years when it comes to managing the adult in cardiac arrest. As a result, survival rates after cardiac arrest have risen...
Tactical Medicine News

Beyond ACLS: From CPR to Cath – The New ACC/AHA Cardiac Arrest Algorithm

So you are minding your own business when a 60 year old patient comes in after witnessed Out-Of-Hospital Cardiac Arrest (OHCA).  She had a witnesse...
Tactical Medicine News

Three Predictors of Success in Cardiac Arrest

The goal of resuscitation in cardiac arrest is to respond in a timely, effective manner that leads to good patient outcomes.  Resuscitation is not ...
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