2000 Outcomes Shock 
Pediatric EM Morsels
JULY 21, 2023
Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. Fun fact for animal lovers!-
RebelEM
MAY 18, 2023
Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. The goal of the trial was to see if early vasopressors improved shock control by 6 hours. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Liberal: 14.9%
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RebelEM
DECEMBER 17, 2024
A large observational study of > 2000 patients found an association with fever at presentation and ICU survival for patients with severe sepsis or septic shock ( Sunden-Culberg 2017 ). Importantly, all of the patients in this study had septic shock requiring vasopressors and mechanical ventilation.
Sensible Medicine
JUNE 5, 2023
Did the new treatment reduce the bad outcome so much so that the difference meets a statistical threshold? Two examples explain the challenge of using statistics to judge science In large studies, a tiny difference in outcomes—one that is not “clinically” significant can easily reach statististical significance.
Don't Forget the Bubbles
OCTOBER 7, 2024
Was the patient thrown from the source (suggestive of DC shock and may result in further blunt force trauma)? Children, especially toddlers, may insert objects into outlets, leading to shocks or burns. Electrical devices used near water sources can cause severe shocks. Was the voltage high or low (as below)?
PulmCCM
MAY 22, 2023
Early mobilizers got significantly more exercise, but had no improvement in any clinical outcome (days alive outside the hospital, ventilator-free days, ICU-free days, or cognitive or psychological function). At least one expert questioned whether the study was adequately powered. In an NHLBI-sponsored trial enrolling 1563 patients at 60 U.S.
Don't Forget the Bubbles
NOVEMBER 15, 2023
One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. She had septic shock on presentation and was resuscitated with 60ml/kg of balanced crystalloid solution and escalating vasoactive medications. Ann Intensive Care.
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