The Skeptics' Guide to EM

FEBRUARY 3, 2023

The patient is in ventricular fibrillation, and you achieve return of spontaneous circulation (ROSC) on the second shock. Since 2002, we have seen several larger trials that have raised questions about the value of hypothermia. The patient is still unconscious. A post-arrest ECG doesn’t show any signs of STEMI.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Documentation/Coding Outcomes 52

EMDocs

JANUARY 11, 2025

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. ISSN 2002-4436. Cureus, 15(12), e50511.

EMS 72

EMS Sepsis Shock Fluid Resuscitation 72

Emergency Medicine Ireland

JUNE 10, 2024

Patients are going to be pretty sick often from multiple pathologies but COHb on its own is enough to produce severe neurological injury, shock and even cardiac injury is also quite prevalent. The Lindell Weaver NEJM RCT in 2002 did suggest a neuro benefit but only 8% of the patients in this trial were intubated.

Poisoning 52

Poisoning EMS Burns Shock 52

Greater Sydney Area HEMS

APRIL 26, 2023

In contrast, shock (leading to syncope and rarely cardiac arrest) from ST can occur well before mechanisms of crush injury come into play, with low-flow states described as early as within 6 minutes (2). UK Health and Safety Executive, London; 2002. Nope they’re different. That sounds like an IIMS waiting to happen…why the controversy?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

ACEP Now

MAY 9, 2024

The procedure has soared in popularity as beauty standards have shifted and cosmetic surgery has become increasingly transparent on social media platforms, with reported cases in the United States increasing from 614 in 2002 to 61,387 by 2021, a nearly 10,000 percent increase. Cosmetic Surgery National Data Bank: 2002 Statistics.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Don't Forget the Bubbles

JULY 26, 2023

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

ACEP Now

MARCH 14, 2024

Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. 30(11):p S424-S430, November 2002. Neurologic and neuropsychological symptoms during the first year after an electric shock: results of a prospective multicenter study. Click to enlarge.)

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

PR depression — has been shown to be a relatively common ECG sign associated with clinically silent PE ( Kudo et al — JACC 39(12): 2000-2004, 2002 ). As often emphasized by Dr. Smith — sinus tachycardia is not a common finding with acute OMI unless something else is going on (ie, cardiogenic shock ).

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EKG/ECG EMS Shock Ultrasounds 77

PHEM Cast

APRIL 18, 2016

Hauwald, 2002 A co-operative patient does not require immobilization unless their conscious level deteriorates. The periscope video of the SKEPTIC trial presentation is accessible here: [link] The Royal Flying Doctors Service (RFDS) use infusion of ketamine to manage agitated mental health patient without need for intubation.

Fractures 40

Fractures Administration Operations Shock 40

Pediatric Emergency Playbook

JANUARY 1, 2016

Be aware that later stages of malrotation may present as shock – they present in hypovolemic shock due to third-spacing from necrotic bowel and/or septic shock from translocation or perforation. 2002; 141(6):793-7. Babies may also present unwell, with bloating and abdominal tenderness to palpation. J Emerg Med.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

The combination of abnormalities determines the category of pathophysiology: respiratory distress, respiratory failure, CNS or metabolic problem, shock, or cardiopulmonary failure. Does this child look volume depleted? Endocrine Emergencies - Could this be congenital adrenal hyperplasia with low sodium, high potassium, and shock?

Seizures 40

Seizures Sepsis Pediatrics Shock 40

Dr. Smith's ECG Blog

JULY 3, 2020

The patient was in shock on arrival in the ED — and multiple blood transfusions were needed. The mechanism for these ECG changes of hyperkalemia is interesting ( Webster et al: Emerg Med J 19:74-77, 2002 ). She sustained chest wall trauma, including rib fractures with serious bleeding. WHAT is the rhythm in this tracing?

Blood Transfusions 52

Blood Transfusions EKG/ECG Shock Fractures 52

Pediatric Emergency Playbook

JUNE 1, 2017

The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’. 2002; 12:411-413. 2002; 78:27-30. 2002; 17:169-172. That may very well be true, but any virus can be invasive with myocardial involvement.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

ACEP Now

APRIL 3, 2024

Early work on TTM in 2002 showed benefit to cooling to 33 degrees Celsius, which subsequently influenced international resuscitation guidelines to recommend mild hypothermia at 32 degrees to 34 degrees Celsius in 2005. degrees Celsius. 5,6 In 2021, the TTM2 trial was published.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

Pediatric Emergency Playbook

JANUARY 1, 2017

Neonatal pain pathways are particularly plastic; prompt assessment of and increased alertness to neonatal pain may help to mitigate long-lived pain sensitivity and hyperalgesia ( Taddio 2002 ). For many medications, these children will have a greater weight-normalized clearance than adults ( Berde 2002 ). 2002 Oct 3;347(14):1094-103.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Pediatric Emergency Playbook

OCTOBER 1, 2015

He is in compensated shock. Pediatr Surg Int (2002) 18: 50-53 DiBaise JK, Scolapio JS. The Huber needle is not a resuscitative line. Obtain proper access to give fluids -- do not rely on the port-a-cath. Vascular devices are notoriously troublesome. In the European Respiratory Journal, Munck et al.

Pediatrics 40

Pediatrics Fractures Resuscitation Burns 40

Taming the SRU

AUGUST 30, 2023

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. 2002 Jan 2;287(1):92-101. Intensive Care Med. 2021 Nov;47(11):1181-1247. doi: 10.1007/s00134-021-06506-y. Epub 2021 Oct 2. PMID: 34599691; PMCID: PMC8486643. Arthritis Rheum. 1996 Feb;39(2):304-7. doi: 10.1002/art.1780390220. 1780390220.

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

EMDocs

DECEMBER 16, 2023

Heat stroke can lead to end-organ dysfunction such as rhabdomyolysis, disseminated intravascular coagulation, cardiogenic shock, liver failure, and cerebral edema. Broad-spectrum antibiotics (A) for septic shock are not inappropriate given the hyperthermia, tachycardia, and hypotension. Journal of athletic training , 42 (3), 333–342.

Hyperthermia / Hypothermia 68

Hyperthermia / Hypothermia EMS Stroke Seizures 68

Intensive Blog

FEBRUARY 9, 2023

2002, Mar). Vasopressors such as noradrenaline are often required (systemic vasodilation is common in hepatic failure). Disability- treat hypoglycaemia if present. Supportive care and monitoring Prioritise short-acting agents, avoid medications that accumulate in hepatic failure Usually ICU measures (e.g. Mycotoxins revisited: Part I.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

EMDocs

NOVEMBER 13, 2023

However, IgE-mediated or not, anaphylactic shock is possible in either case. Ann Surg 2002, 236 (3), 386-393; discussion 393-385. IgE-mediated reactions to contrast do exist, but they are very rare. Williams, J. Felker, R. Timmons, S. DOI: 10.1097/01.Sla.0000027174.01008.A0 0000027174.01008.A0 A0 From NLM. (31) 31) Ciapetti, M.;

Stroke 87

Stroke Radiology Radiology Emergency Department 87

EMDocs

JANUARY 20, 2025

Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. 13 While there is good data that early antibiotics for patients in septic shock reduce mortality 18-19 the role of early and aggressive volume resuscitation and its impacts on patient-centered outcomes remain unclear. Inwald et al.

Dehydration 50

Dehydration Fluid Resuscitation Sepsis Resuscitation 50