Highlights from the 2015 American Heart Association CPR and ECC guidelines

The newest round of the 2015 American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) contains 315 recommendations.¹ It is easy to be overwhelmed by this massive (275 pages) document so this post will distill what you need to know in the emergency department. This update marks the end of a 5-year revision cycle for the AHA and the shift to a continuously updated model. Current and future guidelines can now be found at ECCGuidelines.heart.org. This round lacks any of the major foundational changes seen in 2010; however, we do say goodbye to some recommendations (bye bye vasopressin).

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By Sean Kivlehan, MD MPH|2019-09-05T20:30:15-07:00Nov 9, 2015|Cardiovascular, CME, Critical Care/ Resus, Guideline Review|

Trick of the Trade: Dermal Avulsion Injuries 2.0

This year I published a Novel, Simple Method for Achieving Hemostasis of Fingertip Dermal Avulsion Injuries in the Journal of Emergency Medicine ¹ — a technique I’ve used in my local ED for several years. In brief, this involves achieving hemostasis over a fingertip skin avulsion by using a tourniquet followed by tissue adhesive glue. After bringing the technique to press and sharing this video, I’ve received great tips from peers and subsequently refined it with some additional ideas. Thus I present for the first time on ALiEM: Dermal Avulsion Injuries 2.0.

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By Brian Lin, MD|2016-11-11T19:39:55-08:00Nov 5, 2015|Expert Peer Reviewed (Clinical), Trauma, Tricks of the Trade|

ALiEMU CAPSULES Module 4: Pharmacology of Emergency Airway Management – Part 2

The next CAPSULES module is in! Part 2 of our 2-part airway series is now published on the Academic Life in EM University (ALiEMU) website. Pharmacology of Airway Management – Part 1 provided some outstanding information on topics such as preoxygenation and apneic oxygenation, awake intubation, delayed sequence intubation, and the pediatric airway. We are excited to announce the next installment of the popular CAPSULES series: Pharmacology of Emergency Airway Management – Part 2.

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By Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP|2017-10-01T20:25:47-07:00Nov 3, 2015|Capsules, Tox & Medications|

AIR Series: Environmental Module

Unlike the previous cardiology modules, the environmental module was comparatively under-represented in the top 50 sites of the Social Media Index. Below we have listed our selection of the 3 highest quality blog posts within the past 12 months (as of September 2015) related to environmental emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 0 AIRs and 3 Honorable Mentions.

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By Andrew Grock, MD|2017-03-05T14:14:16-08:00Oct 29, 2015|Approved Instructional Resources (AIR series), Environmental|

Evaluation and Management of Heat Stroke

Heat-related illnesses comprise a continuum of disorders ranging from the minor heat edema, heat rash, heat cramps, and heat exhaustion to the more life-threatening condition known as heat stroke. As a general rule, it is involves a process whereby heat gain overwhelms the body’s mechanisms of heat loss. Often it is caused by an impairment of the body’s cooling and adaptive mechanism to effectively transfer heat to the environment, thus leading to a rise in core temperature. ¹

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By Katherine Li|2016-11-11T19:39:56-08:00Oct 28, 2015|Environmental, Expert Peer Reviewed (Clinical)|

PV Card: Initial Pain Medication Options in the Emergency Department

The emergency department (ED) manages acute pain on a daily basis, ranging from non-traumatic back pain to traumatic fractures. Some providers jump immediately to opioids without considering other non-opioid alternatives or start at incorrect doses. In the age of the opioid epidemic (ALiEM-Annals of EM journal club; bookclub discussing Dreamland) and medication errors, choosing the initial right agent(s) and dose(s) are important. Dr. Nick Koch and Dr. Sergey Motov (@PainFreeED) from Maimonides Medical Center present a thoughtful, evidence-based PV reference card on selecting and dosing initial pain medications for ED patients. Also congratulations to Dr. Motov and his team for their recent 2015 Annals of EM publication¹ on subdissociative dose ketamine for analgesia.

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By Michelle Lin, MD|2021-10-04T09:52:20-07:00Oct 23, 2015|ALiEM Cards, Tox & Medications|

PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

For many years, end tidal CO2 monitoring initially was helpful in differentiating tracheal versus esophageal intubations. Now with continuous end tidal capnography, providers have access to so much more information during a cardiac arrest resuscitation, as summarized by the recently released 2015 American Heart Association (AHA) recommendations.¹ Thanks to Dr. Abdullah Bakhsh from Emory University for a great PV card to help remind us of these key cardiac resuscitation pearls.

PV Card: Continuous End Tidal CO2 Monitoring in Cardiac Arrest

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Adapted from [1-4]

References

Link M, Berkow L, Kudenchuk P, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S444-64. [PubMed]
Ahrens T, Schallom L, Bettorf K, et al. End-tidal carbon dioxide measurements as a prognostic indicator of outcome in cardiac arrest. Am J Crit Care. 2001;10(6):391-398. [PubMed]
Silvestri S, Ralls G, Krauss B, et al. The effectiveness of out-of-hospital use of continuous end-tidal carbon dioxide monitoring on the rate of unrecognized misplaced intubation within a regional emergency medical services system. Ann Emerg Med. 2005;45(5):497-503. [PubMed]
Kleinman M, Brennan E, Goldberger Z, et al. Part 5: Adult Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S414-35. [PubMed]

By Michelle Lin, MD|2021-10-19T19:25:31-07:00Oct 20, 2015|ALiEM Cards, Cardiovascular, Critical Care/ Resus|

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