Resident Journal Review: Available Evidence Regarding Targeted Temperature Management (TTM)

Authors: Rithvik Balakrishnan MD; Taylor M. Douglas, MD; Taylor Conrad, MD, MS; Theodore Segarra, MD; Christianna Sim, MD, MPH
Editors: Kelly Maurelus MD FAAEM, Kami Hu MD FAAEM
Originally published: Common Sense
July/August 2020

Introduction
The ability to obtain good neurological outcomes after cardiac arrest is often limited. Interventions during the acute phase of treatment post return of spontaneous circulation (ROSC) are therefore critical.¹ The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. While the utility of therapeutic hypothermia for preservation of neurologic function post-cardiac arrest had been suggested in the early 1950s and 1960s, ^2-4 the studies were inconclusive, with high complication rates. It was not until the 1990s that studies showed possible benefits to mild hypothermia in animal models. ^5-10 The results of the 2002 trial by the Hypothermia after Cardiac Arrest Study Group were the basis for the inclusion of therapeutic hypothermia in the American Heart Association’s post-cardiac arrest care guidelines.¹¹ Subsequent trials have assessed the difference between therapeutic hypothermia to 33 degrees Celsius (ºC) and “targeted temperature management” (TTM) aiming for 36ºC, the duration of TTM, the method used to achieve and maintain it, and whether TTM confers a similar neurological benefit for cardiac arrests secondary to non-shockable rhythms; some of these trials will be discussed below and will help us answer the question at hand.

New Florida Law Requiring Written Consent for Pelvic Exams: Stumbling Towards Trauma-Informed Care

Image credit: Flickr

Authors:Emily Lara S. Dawra, BS, MSII

University of Miami Miller School of Medicine MD Program
AAEM/RSA Member

Kasha Bornstein, MSc Pharm, EMT-P, MSIV
University of Miami Miller School of Medicine MD/MPH Program
AAEM/RSA Modern Resident Blog Copy Editor

Introduction
On June 18, 2020, Florida Governor Rick DeSantis approved Florida Senate Bill 698, which strictly prohibited and criminalized the non-emergent use of pelvic examinations without written consent of either the patient or legal guardian.¹ The new measure has particular implications for the flow of operations in emergency departments across Florida, as the requirements are a potential source of confusion, additional legal jeopardy, and increased bureaucratic workload. Effective as of July 1, 2020, this legislation has already garnered strong reactions from medical professionals, including the American College of Obstetrics and Gynecology, who believe this serves a “gross intrusion in the patient-physician relationship,” and whose statement is further endorsed by the Florida Medical Association.^2,3 This article describes and expands on the spoken concerns surrounding this bill as they may apply to the emergency clinician. 

Lightning Strike Emergencies Part 2: Trauma Approach

Image Credit: Piqsels

Author:

Vivek Abraham, MD
PGY-1, Orthopedic Surgery

Additional Authors:

Ivan Yue, MD

PGY-1, Emergency Medicine
Naval Medical Center San Diego
AAEM/RSA Publications and Social Media Committee

Alexander Li, MD
PGY-1, Orthopedic Surgery

Naval Medical Center Portsmouth

Introduction
Lightning strike triage and cardiac resuscitation was previously covered in part 1. Abnormal cardiac rhythms are the most common fatal complications of lightning strikes, but other complications of lightning strikes can cause high morbidity and mortality if left untreated. This article will go over injury patterns that may be seen and diagnosed in the emergency room.

Lightning Strike Emergencies Part 1: Triage and Cardiac Emergency

Image Credit: Piqsels

This post was peer reviewed.
Click to learn more.

Author:

Vivek Abraham, MD
PGY-1, Orthopedic Surgery

Additional Authors:

Alexander Li, MD
PGY-1, Orthopedic Surgery

Naval Medical Center Portsmouth

Ivan Yue, MD

PGY-1, Emergency Medicine
Naval Medical Center San Diego
AAEM/RSA Publications and Social Media Committee

 

Introduction
Lightning strikes occur commonly, with an estimated global incidence of 240,000 worldwide per year with deaths numbering 24,000.[1] As more people embark on expeditions and explore the outdoors, they are putting themselves at risk of these strikes. Due to the prevalence and mortality of lightning strikes, emergency medicine physicians and other healthcare providers should be adept in treating these life-threatening injuries. This article reviews the guidelines for triage and management of cardiac emergencies due to lightning.