2009, Resuscitation and Shock - Emergency Care Today

Don’t Forget About the IO in the Critically Ill Patient

RebelEM

APRIL 29, 2024

Critically ill patients requiring resuscitation often present with many challenges including the ability to secure safe, sterile, fast, and reliable intravenous (IV) access. This can often lead to significant delays in proper resuscitation. Studies reviewed landmark-based CVC compared to IO; using IJ, subclavian, and femoral CVC sites.

Resuscitation

Resuscitation Administration Emergency Department Ultrasounds

emDOCs Podcast – Episode 103: Thermal Burn Injury

EMDocs

JUNE 25, 2024

Fluid resuscitation target and fluid Fluid resuscitation is one of the most important parts of management; goal is to increase intravascular volume and ensure end organ perfusion. Calculating fluid resuscitation: Parkland formula: 4 mL X % TBSA X weight in kilograms. IOs and central lines are also options. link] (2019).

Burns

Burns Fluid Resuscitation Resuscitation Poisoning

Hypothermic Cardiac Arrest: Pearls and Pitfalls

EMDocs

JANUARY 16, 2024

Hypothermic Arrest In general, hypothermic patients in cardiac arrest should be aggressively resuscitated. Patients can have excellent outcomes despite prolonged resuscitation. 2,3 If the patient meets criteria for resuscitation, they generally are not declared dead until their core temperature is above 32℃ (“warm and dead”).

Hyperthermia / Hypothermia

Hyperthermia / Hypothermia Resuscitation CPR EMS

The CLOVERS Trial

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis

Sepsis Shock Administration Resuscitation

Diagnostics and Therapeutics: Arterial Lines and Invasive Blood Pressure Monitoring

Taming the SRU

FEBRUARY 19, 2024

One such study of 263 patients without hypertensive emergencies treated in a resuscitation unit found that 40% of patients had a MAP difference ≥ 10 mmHg between IABP and NIBP measurements. A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock.

Shock

Shock Resuscitation Ultrasounds Research

How terrible can it be to fail to recognize OMI? To whom is OMI Obvious or Not Obvious?

Dr. Smith's ECG Blog

OCTOBER 8, 2024

A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. She could not be resuscitated. 2009;Available from: [link] 4. She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD. Later the next day, she went into cardiac arrest again.

EKG/ECG

EKG/ECG Documentation/Coding Resuscitation Shock

Chemical Burns

Mind The Bleep

OCTOBER 29, 2024

Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. This includes adequate pain control, fluid resuscitation, and stabilization of any systemic complications. Cardiovasc Intervent Radiol 32 , 155–158 (2009). 2020.0056.

Burns

Burns Fluid Resuscitation PPE Resuscitation

SGEM#238: The Epi Don’t Work for OHCA

The Skeptics' Guide to EM

DECEMBER 7, 2018

You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). He is unsuccessfully shocked. JAMA 2009, Hagihara et al. published in Resuscitation 2011. A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation.

Advances Cardiac Life Support (ACLS)

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals

Unstable Pelvic Trauma Patient: ED Presentations, Evaluation, and Management

EMDocs

JUNE 3, 2023

4 Patients with pelvic fractures are considered unstable when systolic blood pressure < 90mmHg and heart rate >120bpm, or in those with dyspnea, altered mental status, or skin findings of shock. 13 Massive transfusion protocols (MTP) are hallmarks of trauma resuscitation, and they are critical to the unstable pelvic fracture patient.

Fractures

Fractures Resuscitation Operations EMS

Impact of Emergency Department Crowding on Lung Protective Ventilation

RebelEM

MARCH 27, 2023

What They Did: Retrospective, observational cohort study in a single high-volume academic hospital The ED had a 5 bed area used for ongoing management and resuscitation of patients who clinically deteriorate while boarding or while actively undergo a workup in other sections of the ED. J Crit Care. Crit Care Explor. Crit Care Med.

Emergency Department

Emergency Department Operations Academics Documentation/Coding

Emergencies of the Third Trimester

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

Journal of Emergencies, Trauma and Shock, 3(1), 39. Reid, C (2011) Prehospital resuscitative hysterotomy op.cit. Geoff Jara-Almonte, MD and Hilary Fairbrother, MD // Editor: Alex Koyfman, MD Resuscitation of the Pregnant Trauma Patient – Pearls and Pitfalls www.emdocs.net 2/6/2015 Desjardins, G. Stafford, I. Leibowitz, A.

OB/GYN

OB/GYN Ultrasounds Emergency Department Resuscitation

Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. Fundamentally, cardiogenic shock is an issue of decreased cardiac output. NEJM 362(9):779; March 4, 2009.

EKG/ECG

EKG/ECG Shock Fluid Resuscitation Documentation/Coding

Milestones of Modern Progress in Emergency Care

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

The latter 1950s and 1960s, quested for nerve gas defense studying expired air resuscitation and modern resuscitology; developing intensive care units. To me, it harkens a new scientific renaissance of resuscitation science, emergency care, and creating systems for care. 1950s & 1960s Resuscitation Research.

Emergency Nursing

Emergency Nursing EMS Resuscitation Military

The Pediatric Surgical Abdomen

Pediatric Emergency Playbook

AUGUST 1, 2017

2009; 197:211-215. 2009 Jun;123(6):1548-55 Chinn WM, Zavala DC, Ambre J. Evid Based Rev Surg. 2013;216(3):501-505. Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012; 10:115-119. Mazeh H et al. Tip appendicitis: clinical implications and management. Amer J Surg. Puig S et al. Semin Roentgenol. 2008; 22-28. Pediatrics.

Pediatrics

Pediatrics Ultrasounds Resuscitation Sepsis

Big Labs, Little People

Pediatric Emergency Playbook

APRIL 1, 2016

There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We should use lactate to detect occult shock. Children compensate so well for shock, that subtle tissue hypoxia may not be detected until later. 2014;30: 493-495.

Pediatrics

Pediatrics Sepsis Shock Outcomes

Sepsis Updates Relevant to the Emergency Physician

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. What are the most up-to-date guidelines for managing this patient?

Sepsis

Sepsis Fluid Resuscitation Resuscitation Shock

Grand Rounds Recap 11.13.24

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1 mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric

Psychiatric Seizures Emergency Department Pediatrics

MI in Children

Pediatric Emergency Playbook

JUNE 1, 2017

Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. 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’. 2009; 8:67-69. 2009; 24:156-8.

Pediatrics

Pediatrics EKG/ECG Wellness Seizures

Pediatric Pain

Pediatric Emergency Playbook

JANUARY 1, 2017

Further, children participate in and absorb their family’s culture and specific personality from a very young age ( Finley 2009 ). Some children are ultra-rapid-metabolizers of codeine to morphine, causing a rapid “bolus” of the available drug, with respiratory depression and death in some cases ( Ciszkowski 2009 , Racoosin 2013 ).

Pediatrics

Pediatrics Soft Tissue Injuries Burns Emergency Department

EM@3AM: Takotsubo Cardiomyopathy

EMDocs

JANUARY 20, 2024

Symptoms of heart failure and cardiogenic shock may develop in more severe cases. Answer: Takotsubo Cardiomyopathy 1-18 Background: Also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, stress cardiomyopathy, Gebrochenes-Herz syndrome, and broken-heart syndrome.

EMS

EMS Fluid Resuscitation Shock EKG/ECG

EM@3AM: Hyperthermia

EMDocs

DECEMBER 16, 2023

Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. Ice water immersion and iced peritoneal lavage are additional methods used to lower temperature but are more invasive or can prevent additional resuscitative efforts.

Hyperthermia / Hypothermia

Hyperthermia / Hypothermia EMS Stroke Seizures