Emergency Preservation and Resuscitation
|
|
|
- Prudence Simmons
- 5 years ago
- Views:
Transcription
1 Emergency Preservation and Resuscitation Samuel A. Tisherman, MD, FACS, FCCM Director, Center for Critical Care and Trauma Education Director, SICU RA Cowley Shock Trauma Center
2 Disclosures Co-author of patent Emergency Preservation and Resuscitation Method Grant funding from Department of Defense Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma Off label use Saline Cardiopulmonary bypass pumps and cannulas
3 Outline CPR Post-arrest hypothermia Cardiac arrest and trauma Hypothermia and trauma EPR
4 Peter Safar and Mouth-to-mouth
5 ABCs of CPR
6 Hypothermia after Cardiac Arrest
7 2005 AHA Guidelines for CPR and Emergency Cardiovascular Care Unconscious adult patients with ROSC after out-of-hospital cardiac arrest should be cooled to 32 C to 34 C (89.6 F to 93.2 F) for 12 to 24 hours Postresuscitation Support. Circulation, 2005.
8 Prehospital Cooling
9 Trauma case at Shock Trauma 23 yo male Stab wound to the heart Arrest in Trauma Resuscitation Unit
10 CPR doesn t work in trauma
11 Clinical problem: Cardiac arrest from trauma Abdomen Chest Blunt Penetrating Overall Rhee, JACS, 2000 Survival (%)
12 Time to Death in Combat Casualties Dr. Peter Safar Col. Ron Bellamy
13 Influences Circ arrest Drowning Hth after CA
14 Emergency Preservation and Resuscitation Protection and preservation of the organism during circulatory arrest of 2 h or longer for transportation and control of bleeding during pulselessness followed by delayed resuscitation. Could allow survival from otherwise lethal insults
15
16 O 2 consumption Free radicals Inflammation Excitatory neurotransmitters Coagulopathy Stress Shivering
17
18 Predisposition in Trauma Patients Exposure (field and trauma bay) Opening of body cavities Blood loss Infusion of cold fluids Limited heat production Shock Sedation, anesthesia, EtOH and drugs
19 Triad of Death
20 Retrospective studies Increased injury severity Decreased temperature Increased mortality
21 PA Trauma Outcome Study Statewide trauma registry 38,520 trauma patients ( ) 1,921 (5%) hypothermic on admission (<35 o C) Adjusted for everything possible Age Injury severity Mechanism of injury Route of temp measurement Odds ratio for death 3.03 ( ) Crit Care Med, 2005.
22 Hypothermia will add 10 years to your life
23
24 Safar Center for Resuscitation Research
25 SCRR Animal ICU Dogs and pigs Anesthesia - light N 2 O-halothane Physiologic monitoring: ECG, MAP, PAP, PCW, CVP, ETCO2 ABG, Hct, lytes, glucose Temps: tympanic, PA, esoph, rectal 24 h/day ICU care
26
27 Temperature ( o C) Exsanguination Cardiac Arrest Model Exsanguination Cardiac Arrest min Time VF Bleed Flush CPB MAP Tty
28 Hypothermia Dose Response min 34 o C 30 min 28 o C 60 min 15 o C 90 min 10 o C
29 Exsanguination Cardiac Arrest (Tty 10 o C) Final OPC 90 min 120 min 5 Brain Death 4 Coma 3 Severe Disability 2 Moderate Disability Volume >500 ml/kg Whole body 1 Normal Behringer, CCM, 2003.
30 Mechanisms
31 Drug list Adenosine Thiopental Thio/Phenytoin MK801 YM872 Nimodipine Diltiazem Lidocaine Insulin/glucose W7 Cyclohexamide Tempol Cyclosporine A
32 Drug list Adenosine Thiopental Thio/Phenytoin MK801 YM872 Nimodipine Diltiazem Lidocaine Insulin/glucose W7 Cyclohexamide Tempol Cyclosporine A
33
34 Prolonged HS->arrest, PHCA Bloodgas CPR EPR ph 6.79± ±0.12 Potassium 7.9 ± ±1.4 Lactate 15.2± ±2.4 BE -16.9± ±1.5 Splenectomy MAP Spleen transection HS time CPR:124±11 min SA: 128±17 min CPR group EPR group Continuous bleeding Cardiac arrest CPB Wu et al. Circulation, 2006.
35 Prolonged HS->arrest, PHCA Overall Performance Category CPR EPR-I (hypo-12h) EPR-II (hypo-36) 5 Dead 4 Coma 3 Severe disability 2 Moderate disability 1 Normal *Seizures Wu et al. Circulation, *
36 We re not the only ones
37 HypoThermosol USUHS Model
38 Rhee and Alam Rewarming Cooling
39 5 min exsanguination 1 min CA 20 min EPR (including aortic flush) 60 min CPB MAP (mmhg) 100 (Temp N-EPR) (Temp H-EPR) Temp (ºC) Time
40 Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma Political: Centers Medical: Protocols EPR-CAT Trial Training Ethical: Consent Financial: Funding
41
42 Specific aims Rapidly identify potential candidates for EPR within 5 min of pulselessness. Rapidly induce EPR by infusing ice-cold saline to attain a tympanic membrane temperature (Tty) of 10 o C. Following hemostasis, delayed resuscitation will be via cardiopulmonary bypass (CPB). Survival without significant neurologic deficits.
43 Subject Inclusion Criteria yo Signs of life (pulse, respirations, reactive pupils, or spontaneous movement) present within 5 min of ED arrival or in the ED Remains pulseless after OCCPR and no response to clamping aorta
44 Subject Exclusion Criteria No signs of life for > 5 min Traumatic brain injury Electrical asystole Obvious non-survivable injury Massive tissue trauma involving multiple sites Pregnancy Prisoner
45 Mean Arterial Pressure (MAP, mmhg) Final gasp Lose pulse Open chest Emergency Preservation Transport to OR Hemostasis <60 min MAP Tty Tympanic Temperature (Tty, o C) 0 Time 0 Trauma Aortic flush Delayed resuscitation
46 Technique: Flush Cannulate descending aorta Drain right atrial appendage Pump large volume of ice-cold fluid Temperature goal Tty (brain) 10 o C
47 Team
48 Training
49 Outcome Survival to D/C without major neuro sequelae Direct complications of the technique Cannulae and vessels Coagulopathy Organ system failures
50 Outcome Survival (28 d) Neurologic function (12 months) Glasgow Outcome Scale (Extended) 1. Dead 2. Vegetative state 3. Lower severe disability 4. Upper severe disability 5. Lower moderate disability 6. Upper moderate disability 7. Lower good recovery 8. Upper good recovery Quality of life SF-36
51 Control groups Concurrent patients Meet criteria, but team not available Might have bias Historical controls
52 Regulatory hoops FDA DSMB IRB CC/PD
53 Community consultation Public disclosure
54 Emergency Preservation and Resuscitation / nyti.ms/ 1pX2UEl Technology Quarterly: Q Monitor The big sleep HEALTH NYT NOW Killing a Patient to Save His Life By KATE MURPHY JUNE 9, 2014 PITTSBURGH Trauma patients arriving at an emergen sustaining a gunshot or knife wound may find themselve Doctors have begun human trials of suspended animation to buy more time for critically injured patients medical experiment. Sep 6th 2014 From the print edition Surgeons will drain their blood and replace it with fr Without heartbeat and brain activity, the patients will be THE picture that And then the surgeons will try to save their lives. is immediately Researchers at the University of Pittsburgh Medical brought to mind clinical trial that pushes the boundaries of conventional s by talk of
55 Funding Telemedicine and Advanced Technology Research Center
56 FDA DSMB IRB CC/PD Training Moving forward
57 Thanks
Mild. Moderate. Severe. 32 to to and below
Mohamud Daya MD, MS Mild 32 to 34 Moderate 28 to 32 Severe 28 and below Jon Rittenberger Shervin Ayati Protocol Development Committee Hypothermia Working Group Lynn Wittwer Jon Jui John Stouffer Scott
INDUCED HYPOTHERMIA. F. Ben Housel, M.D.
INDUCED HYPOTHERMIA F. Ben Housel, M.D. Historical Use of Induced Hypothermia 1950 s - Moderate hypothermia (30-32º C) in open heart surgery to protect brain against global ischemia 1960-1980 s - Use of
The Evidence Base. Stephan A. Mayer, MD. Columbia University New York, NY
Hypothermic for Cardiac Arrest The Evidence Base Stephan A. Mayer, MD Director, Neuro-ICU Columbia University New York, NY Disclosures Columbia University Clinical Trials Pilot Award Radiant Medical, Inc.
In-hospital Care of the Post-Cardiac Arrest Patient. David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine
In-hospital Care of the Post-Cardiac Arrest Patient David A. Pearson, MD, FACEP, FAAEM Associate Program Director Department of Emergency Medicine Disclosures I have no financial interest, arrangement,
CPR What Works, What Doesn t
Resuscitation 2017 ECMO and ECLS April 1, 2017 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN Circulation 2013;128:417-35
Advanced Resuscitation - Adult
C02A Resuscitation 2017-03-23 17 years & older Office of the Medical Director Advanced Resuscitation - Adult Intermediate Advanced Critical From PRIMARY ASSESSMENT Known or suspected hypothermia Algorithm
Patient Case. Post cardiac arrest pathophysiology 10/19/2017. Disclosure. Objectives. Patient Case-TM
Disclosure TARGETED TEMPERATURE MANAGEMENT POST CARDIAC ARREST I have nothing to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect
Update on Sudden Cardiac Death and Resuscitation
Update on Sudden Cardiac Death and Resuscitation Ashish R. Panchal, MD, PhD Medical Director Center for Emergency Medical Services Assistant Professor Clinical Department of Emergency Medicine The Ohio
Post-Cardiac Arrest Syndrome. MICU Lecture Series
Post-Cardiac Arrest Syndrome MICU Lecture Series Case 58 y/o female collapses at home, family attempts CPR, EMS arrives and notes VF, defibrillation x 3 with return of spontaneous circulation, brought
Advanced Resuscitation - Adolescent
C02B Resuscitation 2017-03-23 10 up to 17 years Office of the Medical Director Advanced Resuscitation - Adolescent Intermediate Advanced Critical From PRIMARY ASSESSMENT Known or suspected hypothermia
Advanced Resuscitation - Child
C02C Resuscitation 2017-03-23 1 up to 10 years Office of the Medical Director Advanced Resuscitation - Child Intermediate Advanced Critical From PRIMARY ASSESSMENT Known or suspected hypothermia Algorithm
CHILL OUT! Induced Hypothermia: Challenges & Successes in the
CHILL OUT! Induced Hypothermia: Challenges & Successes in the ICU Colleen Bell RN, BS, CCRN, Donna Brault RN, BSN, CCRN, Cathy Patnode RN, BSN, CCRN Champlain Valley Physician Hospital November 2012 Objectives
Update on Sudden Cardiac Death and Resuscitation
Update on Sudden Cardiac Death and Resuscitation Ashish R. Panchal, MD, PhD Medical Director Center for Emergency Medical Services Assistant Professor Clinical Department of Emergency Medicine The Ohio
New Therapeutic Hypothermia Techniques
New Therapeutic Hypothermia Techniques Joseph P. Ornato, MD, FACP, FACC, FACEP Professor & Chairman, Emergency Medicine Virginia Commonwealth University Health System Richmond, VA Medical Director Richmond
5 Key EMS Articles for 2012
5 Key EMS Articles for 2012 Corey M. Slovis, M.D. Vanderbilt University Medical Center Metro Nashville Fire Department Nashville International Airport Nashville, TN 5 Key Topics Cardiac Arrest Trauma
CrackCast Episode 8 Brain Resuscitation
CrackCast Episode 8 Brain Resuscitation Episode Overview: 1) Describe 6 therapeutic interventions for the post-arrest brain 2) List 5 techniques for initiating therapeutic hypothermia 3) List 4 mechanisms
TOO COOL OR NOT TOO COOL- THERAPEUTIC HYPOTHERMIA IN THE ICU SCCM TX 2017 TED WU MD PEDIATRIC CRITICAL CARE UNIVERSITY OF TEXAS HEALTH SAN ANTONIO
TOO COOL OR NOT TOO COOL- THERAPEUTIC HYPOTHERMIA IN THE ICU SCCM TX 2017 TED WU MD PEDIATRIC CRITICAL CARE UNIVERSITY OF TEXAS HEALTH SAN ANTONIO DISCLOSURE I have no relationships with commercial companies
HYPOTHERMIA IN TRAUMA. Kevin Palmer EMT-P, DiMM
HYPOTHERMIA IN TRAUMA Kevin Palmer EMT-P, DiMM DISCLOSURE No Financial conflicts of interest Member of the Wilderness Medical Society Diploma in Mountain Medicine Fellowship in the Academy of Wilderness
UTSW/BioTel EMS TRAINING BULLETIN January EMS TB Accidental Hypothermia
UTSW/BioTel EMS TRAINING BULLETIN January 2015 EMS TB 15-001 Accidental Hypothermia Purpose: 1. To provide patient assessment and management guidance to UTSW/BioTel EMS Providers about Accidental Hypothermia
Curricullum Vitae. Dr. Isman Firdaus, SpJP (K), FIHA
Curricullum Vitae Dr. Isman Firdaus, SpJP (K), FIHA Email: ismanf@yahoo.com Qualification : o GP 2001 (FKUI) o Cardiologist 2007 (FKUI) o Cardiovascular Intensivist 2010 - present o Cardiovascular Intervensionist
Therapeutic Hypothermia
Objectives Overview Therapeutic Hypothermia Nerissa U. Ko, MD, MAS UCSF Department of Neurology Critical Care Medicine and Trauma June 4, 2011 Hypothermia as a neuroprotectant Proven indications: Adult
Hypothermia: The Science and Recommendations (In-hospital and Out)
Hypothermia: The Science and Recommendations (In-hospital and Out) L. Kristin Newby, MD, MHS Professor of Medicine Duke University Medical Center Chair, Council on Clinical Cardiology, AHA President, Society
INDUCED HYPOTHERMIA A Hot Topic. R. Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences
INDUCED HYPOTHERMIA A Hot Topic R. Darrell Nelson, MD, FACEP Emergency Medicine Wake Forest University Health Sciences Conflicts of Interest Sadly, we have no financial or industrial conflicts of interest
Prehospital Post Arrest Care AHA Strive to Revive 2017 November 3, 2017
Prehospital Post Arrest Care AHA Strive to Revive 2017 November 3, 2017 Jon Rittenberger, MD, MS Department of University of Pittsburgh Employers: Disclosures - Rittenberger University of Pittsburgh UPMC
RACE CARS: Hospital Response. David A. Pearson, MD Department of Emergency Medicine Carolinas Medical Center February 23, 2012
L MODULE 9 RACE CARS: Hospital Response David A. Pearson, MD Department of Emergency Medicine Carolinas Medical Center February 23, 2012 2 Objectives: Post-cardiac arrest syndrome Therapeutic hypothermia
Toxins and Environmental: HEAT- and COLD-RELATED EMERGENCIES. Accidental Hypothermia/Cold Exposure
Toxins and Environmental: HEAT- and COLD-RELATED EMERGENCIES Accidental Hypothermia/Cold Exposure Goal: To aid EMS Providers in: the recognition and treatment of systemic effects of accidental hypothermia
ED Thoracotomy Left chest opened and extended across sternum with 1000mL blood drained Pericardium opened with 100mL blood drained 1cm laceration in t
Case Report 39yM stabbed in the left upper chest by wife with kitchen knife. Intubated in the field. Loss of vitals on arrival to hospital while in ambulance. In ED, (-) palpable pulse and (+) organized
Therapeutic Hypothermia ANZCA 2013
Therapeutic Hypothermia ANZCA 2013 Stephen Bernard MD Therapeutic Hypothermia-Indications Anoxic brain injury (cardiac arrest) Severe traumatic brain injury Spinal cord injury Why not Therapeutic Hypothermia?
Manual Defibrillation. CPR AGE: 18 years LOA: Altered HR: N/A RR: N/A SBP: N/A Other: N/A
ROC AMIODARONE, LIDOCAINE OR PLACEBO FOR OUT OF HOSPITAL CARDIAC ARREST DUE TO VENTRICULAR FIBRILLATION OR TACHYCARDIA (ALPS) STUDY: MEDICAL CARDIAC ARREST MEDICAL DIRECTIVE An Advanced Care Paramedic
Cardiac Arrest due to Trauma
Cardiac Arrest due to Trauma Colonel Michael Reade MBBS MPH DPhil DMedSc DIMCRCSEd AFRACMA FANZCA FCICM ADF Professor of Military Medicine & Surgery University of Queensland & ADF Joint Health Command
ECG Changes in Patients Treated with Mild Hypothermia after Cardio-pulmonary Resuscitation for Out-of-hospital Cardiac Arrest
ECG Changes in Patients Treated with Mild Hypothermia after Cardio-pulmonary Resuscitation for Out-of-hospital Cardiac Arrest R. Schneider, S. Zimmermann, W.G. Daniel, S. Achenbach Department of Internal
Case Presentation. Cooling. Case Presentation. New Developments in Cardiopulmonary Arrest: Therapeutic Hypothermia in Resuscitation
New Developments in Cardiopulmonary Arrest: Therapeutic Hypothermia in Resuscitation Michael Sayre, MD Emergency Medicine and LeRoy Essig, MD Pulmonary/Critical Care Medicine Case Presentation 3:40 (+
Post-Arrest Care: Beyond Hypothermia
Post-Arrest Care: Beyond Hypothermia Damon Scales MD PhD Department of Critical Care Medicine Sunnybrook Health Sciences Centre University of Toronto Disclosures CIHR Physicians Services Incorporated Main
Overview and Latest Research on Out of Hospital Cardiac Arrest
L MODULE 1 Overview and Latest Research on Out of Hospital Cardiac Arrest Jamie Jollis, MD Co PI RACE CARS 2 Out of Hospital Cardiac Arrest in U.S. 236 000 to 325 000 people in the United States each year
The ABC of CAB- Circulation, Airway, Breathing: PALS/Resuscitation Update
The ABC of CAB- Circulation, Airway, Breathing: PALS/Resuscitation Update Jennifer K. Lee, MD Johns Hopkins University Dept. of Anesthesia, Division of Pediatric Anesthesia Disclosures I have research
Objectives. Design: Setting &Patients: Patients. Measurements and Main Results: Common. Adverse events VS Mortality
ADVERSE EVENTS AND THEIR RELATION TO MORTALITY IN OUT-OF-HOSPITAL CARDIAC ARREST PATIENTS TREATED WITH THERAPEUTIC HYPOTHERMIA Reporter R1 吳志華 Supervisor VS 王瑞芳 100.04.02 Niklas Nielsen, MD, PhD; Kjetil
Samphant Ponvilawan Bumrungrad International
Samphant Ponvilawan Bumrungrad International Definitions Artificial circulation using VA ECMO as an alternative to ventilation and external cardiac massage Indications Out-of-Hospital Cardiac Arrest (OHCA)
CPR Cardio Pulmonary Resuscitation
CPR Cardio Pulmonary Resuscitation CPR = sequence of immediate actions to sustain flow of oxygenated blood unconsciousness and not breathing normally > start CPR! vital functions: Consciousness Breathing
Temperature Profile Of the Brain During Suspended Animation
BEE 453 Temperature Profile Of the Brain During Suspended Animation Cora Ku Yuichi Sakai Amy Wong Ophelia Yeung May 5, 2003 1. Executive Summary In most cases of serious truncal injuries, cardiac arrest
Financial Disclosure. Objectives 9/24/2018
Hemorrhage and Transfusion Adjuncts in the Setting of Damage Control Joseph Cuschieri, MD FACS Professor of Surgery, University of Washington Adjunct Professor of Orthopedics and Neurosurgery, University
Regionalization of Post-Cardiac Arrest Care
Regionalization of Post-Cardiac Arrest Care David A. Pearson, MD, FACEP, FAAEM Department of Emergency Medicine Disclosures I have no financial interest, arrangement, or affiliations and no commercial
SUMMARY OF MAJOR CHANGES 2010 AHA GUIDELINES FOR CPR & ECC
SUMMARY OF MAJOR CHANGES 2010 AHA GUIDELINES FOR CPR & ECC The following is a summary of the key issues and changes in the AHA 2010 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac
POST-CARDIAC ARREST CARE: WHAT HAPPENS AFTER ROSC MATTERS! Emergency Nurses Association
POST-CARDIAC ARREST CARE: WHAT HAPPENS AFTER ROSC MATTERS! Emergency Nurses Association - 2016 Nicole Kupchik MN, RN, CCNS, CCRN, PCCN, CMC Objectives Discuss the 2015 AHA Guideline Updates for Post- Arrest
Z19.2 Cross Reference to Patient Care Maps & Clinical Care Procedures
2017-04-07 Old version G1 Code of Ethics G2 Scope and Function G3 Scene Assessment G4 Triage G5 Primary Survey G6 Shock G7 Load and Go G8 Secondary Survey G9 Unconscious Patient G10A Obstructed Airway
PUZZLE. EARLY IMPACT ALS Jamie Syrett, MD Director of Prehospital Care Rochester General Health System PUZZLE THINKING OUTSIDE THE BOX! EARLY IMPACT?
PUZZLE EARLY IMPACT ALS Jamie Syrett, MD Director of Prehospital Care Rochester General Health System PUZZLE THINKING OUTSIDE THE BOX! EARLY IMPACT? IV ACCESS? What things do we do that make a difference?
After this review our system decided to implement guidelines which allowed EMS personnel to
How far is too far? A review of the evidence for Prehospital Termination of Resuscitation after Cardiac Arrest Shalu S. Patel, MD Christine Van Dillen MD University of Florida-Gainesville Out-of-hospital
Stayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines
Stayin Alive: Pediatric Advanced Life Support (PALS) Updated Guidelines Margaret Oates, PharmD, BCPPS Pediatric Critical Care Specialist GSHP Summer Meeting July 16, 2016 Disclosures I have nothing to
Hypothermia After Cardiac Arrest: Where Are We Now?
Hypothermia After Cardiac Arrest: Where Are We Now? David A. Pearson, MD, MS Associate Professor Director of Cardiac Arrest Resuscitation Carolinas HealthCare System Disclosures I have no financial interest,
Outcomes of Therapeutic Hypothermia in Cardiac Arrest. Saad Mohammed Shariff, MBBS Aravind Herle, MD, FACC
Outcomes of Therapeutic Hypothermia in Cardiac Arrest Saad Mohammed Shariff, MBBS Aravind Herle, MD, FACC https://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@scon/documents/downloadable/ucm_427331.pdf
Big Chill in the Big Apple: Why FDNY is Not Getting the Cold Shoulder
Big Chill in the Big Apple: Why FDNY is Not Getting the Cold Shoulder John Freese, MD Medical Director of Training Director of Prehospital Research OLMC Medical Director New York City Fire Department Complexities
Beth Cetanyan, RN AHA RF Aka The GURU
* Beth Cetanyan, RN AHA RF Aka The GURU *Discuss common causes of Pediatric CA *Review current PALS Guidelines *Through case presentations and discussion, become more comfortable and confident in providing
Surgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 13 Resuscitation and Preparation for Anesthesia & Surgery Key Points 2 13.1 Management of Emergencies and Cardiopulmonary Resuscitation The emergency measures that
Pediatric Advanced Life Support
Pediatric Advanced Life Support Pediatric Chain of Survival Berg M D et al. Circulation 2010;122:S862-S875 Prevention Early cardiopulmonary resuscitation (CPR) Prompt access to the emergency response system
Nassau Regional Emergency Medical Services. Advanced Life Support Pediatric Protocol Manual
Nassau Regional Emergency Medical Services Advanced Life Support Pediatric Protocol Manual 2014 PEDIATRIC ADVANCED LIFE SUPPORT PROTOCOLS TABLE OF CONTENTS Approved Effective Newborn Resuscitation P 1
Shock and Resuscitation: Part II. Patrick M Reilly MD FACS Professor of Surgery
Shock and Resuscitation: Part II Patrick M Reilly MD FACS Professor of Surgery Trauma Patient 1823 / 18 Police Dropoff Torso GSW Lower Midline / Right Buttock Shock This Monday Trauma Patient 1823 / 18
Damage Control in Abdominal and Pelvic Injuries
Damage Control in Abdominal and Pelvic Injuries Raul Coimbra, MD, PhD, FACS The Monroe E. Trout Professor of Surgery Surgeon-in Chief UCSD Medical Center Hillcrest Campus Executive Vice-Chairman Department
the bleeding won t stop? Liane Manz RN, BScN, CNCC(c) Royal Alexandra Hospital
What do you do when the bleeding won t stop? Teddie Tanguay RN, MN, NP, CNCC(c) Teddie Tanguay RN, MN, NP, CNCC(c) Liane Manz RN, BScN, CNCC(c) Royal Alexandra Hospital Outline Case study Normal coagulation
Disclosures. Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 ECG. Case. Case. Case Summary 4/22/2016
Extra-Corporeal Membrane Oxygenation During Cardio- Pulmonary Resuscitation ECPR April 22, 2016 Nothing to disclose. Disclosures Ivan J Chavez MD Case ECG History 60 y/o male No prior history of CAD In
Post Cardiac Arrest Care 2015 American Heart Association Guideline Update for CPR and Emergency Cardiovascular Care
Post Cardiac Arrest Care 2015 American Heart Association Guideline Update for CPR and Emergency Cardiovascular Care รศ.ดร.พญ.ต นหยง พ พานเมฆาภรณ ภาคว ชาว ส ญญ ว ทยา คณะแพทยศาสตร มหาว ทยาล ยเช ยงใหม System
Post-Resuscitation Care. Prof. Wilhelm Behringer Center of Emergency Medicine University of Jena
Post-Resuscitation Care Prof. Wilhelm Behringer Center of Emergency Medicine University of Jena Conflict of interest Emcools Shareholder and founder, honoraria Zoll: honoraria Bard: honoraria, nephew works
Understanding the Cardiopulmonary Bypass Machine and Its Tubing
Understanding the Cardiopulmonary Bypass Machine and Its Tubing Robert S. Leckie, MD Division of Cardiac Anesthesia, Beth Israel Deaconess Medical Center ABL 1/09 Reservoir Bucket This is a cartoon of
Cardiac Arrest Registry Database Office of the Medical Director
Cardiac Arrest Registry Database 2010 Office of the Medical Director 1 Monthly Statistical Summary Cardiac Arrest, September 2010 Western Western Description Division Division % Totals Eastern Division
After resuscitation from cardiac arrest, brain injury is a
Pilot Randomized Clinical Trial of Prehospital Induction of Mild Hypothermia in Out-of-Hospital Cardiac Arrest Patients With a Rapid Infusion of 4 C Normal Saline Francis Kim, MD; Michele Olsufka, RN;
Lecture. ALS Algorithm
Lecture ALS Algorithm 1 Learning outcomes The ALS algorithm Treatment of shockable and non-shockable rhythms Potentially reversible causes of cardiac arrest 2 Adult ALS Algorithm 3 To confirm cardiac arrest
EAST MULTICENTER STUDY DATA DICTIONARY. Temporary Intravascular Shunt Study Data Dictionary
EAST MULTICENTER STUDY DATA DICTIONARY Temporary Intravascular Shunt Study Data Dictionary Data Entry Points and appropriate definitions / clarifications: Entry space Definition / Instructions 1. Specific
Shock. William Schecter, MD
Shock William Schecter, MD The Cell as a furnace O 2 1 mole Glucose Cell C0 2 ATP 38 moles H 2 0 Shock = Inadequate Delivery of 02 and Glucose to the Cell 0 2 Cell ATP 2 moles Lactic Acid Treatment of
Therapeutic hypothermia following cardiac arrest
TITLE: Therapeutic hypothermia following cardiac arrest AUTHOR: Jeffrey A. Tice, MD Assistant Professor of Medicine Division of General Internal Medicine Department of Medicine University of California
Management of Cardiac Arrest Based on : 2010 American Heart Association Guidelines
Management of Cardiac Arrest Based on : 2010 American Heart Association Guidelines www.circ.ahajournals.org Elham Pishbin. M.D Assistant Professor of Emergency Medicine MUMS C H E S Advanced Life Support
Neurotrauma: The Place for Cooling
Neurotrauma: The Place for Cooling Cooling: to achieve hypothermia History, evidence, open questions Cooling: to achieve normothermia Evidence, open questions Cooling: Practical Aspects Hypothermia: History
Therapeutic hypothermia
INDUCED HYPOTHERMIA Dr. Attilla Kiss M.D. Acting Medical Director Emergency Services EMS Medical Director St. John Medical Center OBJECTIVES Define and explain Induced Hypothermia Discuss both pre-hospital
E-CPR National Trends & Local Plans
E-CPR National Trends & Local Plans Objectives What is E-CPR? Jon Marinaro MD FCCM Chief, Surgical Critical Care UNM Associate Director UNM Adult ECMO Program Why would one do it? Evidence behind E-CPR?
E-CPR National Trends & Local Plans
E-CPR National Trends & Local Plans Jon Marinaro MD FCCM Chief, Surgical Critical Care UNM Associate Director UNM Adult ECMO Program Objectives What is E-CPR? Why would one do it? Evidence behind E-CPR?
Preparing for your upcoming PALS course
IU Health PALS Study Guide Preparing for your upcoming PALS course UPDATED November 2016 Course Curriculum: 2015 American Heart Association (AHA) Guidelines for Pediatric Advanced Life Support (PALS) AHA
Hypothermia Post Cardiac Arrest: An Update
Hypothermia Post Cardiac Arrest: An Update Justin Lundbye, M.D., FACC Hospital of Central Connecticut Justin.Lundbye@HHCHealth.org Outline Background Whom to Cool How to Cool Post Cardiac Arrest Care Other
Cold Water Shock, Hypothermia and Cardiac Arrest
Cold Water Shock, Hypothermia and Cardiac Arrest In spring the warm air temperatures lure hibernating humans out of the house. and the waters beckon. While the air temperature may be 60-80 F, the water
High Risk + Challenging Trauma Cases. Hawaii. Topics 1/27/2014. David Thompson, MD, MPH. Head injury in the anticoagulated patient.
High Risk + Challenging Trauma Cases David Thompson, MD, MPH Hawaii Topics Head injury in the anticoagulated patient Shock recognition Case 1: Head injury HPI: 57 yo male w/ PMH atrial fibrillation, on
Induced Hypothermia for Cardiac Arrest. Heather Hand RN,CCRN,CNRN,ATCN,LNC
Induced Hypothermia for Cardiac Arrest Heather Hand RN,CCRN,CNRN,ATCN,LNC Cardiac Arrest Epidemiology 400,000 arrests / year in U.S.A 3 / 4 Out-of-hospital 1 / 4 In-hospital survival to hospital 1-5% discharge
Pediatric advanced life support. Management of decreased conscious level in children. Virgi ija Žili skaitė 2017
Pediatric advanced life support. Management of decreased conscious level in children Virgi ija Žili skaitė 2017 Life threatening conditions: primary assessment, differential diagnostics and emergency care.
Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS
Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia
WORKSHEET for Evidence-Based Review of Science for Veterinary CPCR
RECOVER 2011 1 of 12 WORKSHEET for Evidence-Based Review of Science for Veterinary CPCR 1. Basic Demographics Worksheet author(s) Jane Quandt Mailing address: 501 DW Brooks Drive Small Animal Medicine
Do chest compressions have a role in the early treatment of haemorrhage - induced traumatic cardiac arrest
15 th National Resuscitation Congress 4 th April 2018 Do chest compressions have a role in the early treatment of haemorrhage - induced traumatic cardiac arrest Dr Sarah Watts 1, Surg Capt Jason Smith
Lesson learnt from big trials. Sung Phil Chung, MD Gangnam Severance Hospital, Yonsei Univ.
Lesson learnt from big trials Sung Phil Chung, MD Gangnam Severance Hospital, Yonsei Univ. Trend of cardiac arrest research 1400 1200 1000 800 600 400 200 0 2008 2009 2010 2011 2012 2013 2014 2015 2016
Resuscitation Science : Advancing Care for the Sickest Patients
Resuscitation Science : Advancing Care for the Sickest Patients William Hallinan University of Rochester What is resuscitation science? Simply the science of resuscitation : Pre arrest Arrest care Medical
Objectives. Trends in Resuscitation POST-CARDIAC ARREST CARE: WHAT S THE EVIDENCE?
POST-CARDIAC ARREST CARE: WHAT S THE EVIDENCE? Nicole Kupchik RN, MN, CCNS, CCRN, PCCN, CMC Objectives Discuss the 2015 AHA Guideline Updates for Post- Arrest Care Discuss oxygenation & hemodynamic taregts
Neuroprognostication after cardiac arrest
Neuroprognostication after cardiac arrest Sam Orde 1st May 2018 Set the scene 55 yo man, found collapsed in park, looks like he d been jogging, no pulse, bystander CPR, ambulance arrives 5 mins later,
Johnson County Emergency Medical Services Page 23
Non-resuscitation Situations: Resuscitation should not be initiated in the following situations: Prolonged arrest as evidenced by lividity in dependent parts, rigor mortis, tissue decomposition, or generalized
Emergency Department Thoracotomy
Emergency Department Thoracotomy November 3, 2017 North Oaks Shock Trauma Symposium Jeremy R. Timmer, M.D., FACS Objectives Background of RT Indications for RT Contraindications for RT Survival Benefits
JUNCTIONAL STAB WOUND SAVING THE UN-SAVABLE
JUNCTIONAL STAB WOUND SAVING THE UN-SAVABLE MARVIN WAYNE, MD, FACEP, FAAEM, FAHA ASSOCIATE CLINICAL PROF. DEPT. OF EM, UNIVERISTY OF WASHINGTON EMS MEDICAL DIRECTOR WHATCOM COUNTY WA EMERGENCY DEPT. PEACEHEALTH
Delayed or Intermittent CPR in Primary severe Hypothermia
Delayed or Intermittent CPR in Primary severe Hypothermia Dr John Ellerton, MR England and Wales and ICAR Medcom on behalf of the authors Current hypothermia guidelines recommend that CPR is started as
Tina Yoo, PharmD Clinical Pharmacist Alameda Health System Highland Hospital
Tina Yoo, PharmD Clinical Pharmacist Alameda Health System Highland Hospital 1 Review changes in the 2015 AHA ACLS guidelines with emphasis on changes in therapeutic hypothermia Provide overview of ACLS
But unfortunately, the first sign of cardiovascular disease is often the last. Chest-Compression-Only Resuscitation Gordon A.
THE UNIVERSITY OF ARIZONA Sarver Heart Center 1 THE UNIVERSITY OF ARIZONA Sarver Heart Center 2 But unfortunately, the first sign of cardiovascular disease is often the last 3 4 1 5 6 7 8 2 Risk of Cardiac
Case scenario V AV ECMO. Dr Pranay Oza
Case scenario V AV ECMO Dr Pranay Oza Case Summary 53 y/m, k/c/o MVP with myxomatous mitral valve with severe Mitral regurgitation underwent Mitral valve replacement with mini thoracotomy Pump time nearly
Accidental Hypothermia
Accidental Hypothermia Doug Brown, MD, FRCPC Emergency Physician Royal Columbian & Eagle Ridge Hospital October, 2013 Objectives 45min lecture, 15min discussion & questions: Inspirational case & overview
Michigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS
Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia
Student Guide Module 4: Pediatric Trauma
Student Guide Module 4: Pediatric Trauma Problem based learning exercise objectives Understand how to manage traumatic injuries in mass casualty events. Discuss the features and the approach to pediatric
Update of CPR AHA Guidelines
Update of CPR AHA Guidelines Donald Hal Shaffner Course objective is to have an updated understanding of the American Heart Association s treatment algorithms for the management of cardiac decompensation
Therapeutic Hypothermia. Jonas Cooper, MD MPH
Therapeutic Hypothermia Jonas Cooper, MD MPH Hypothermia in Cardiology Early cardiac surgery included cooling to 15 C and stopping all blood flow for one hour while surgery proceeded Belsey RH et al. Profound
Chapter 9. Learning Objectives. Learning Objectives 9/11/2012. Cardiac Arrhythmias. Define electrical therapy
Chapter 9 Cardiac Arrhythmias Learning Objectives Define electrical therapy Explain why electrical therapy is preferred initial therapy over drug administration for cardiac arrest and some arrhythmias
Ipotermia terapeutica controversie e TTM 2 Trial Iole Brunetti
Ipotermia terapeutica controversie e TTM 2 Trial Iole Brunetti U.O.C Anestesia e Terapia Intensiva Policlinico San Martino - GENOVA Natural Course of Neurological Recovery Following Cardiac Arrest Cardiac
INSTITUTE FOR MEDICAL SIMULATION & EDUCATION ACLS PRACTICAL SCENARIOS
Practical Teaching for Respiratory Arrest with a Pulse (Case 1) You are a medical officer doing a pre-operative round when 60-year old patient started coughing violently and becomes unconscious. Fortunately