Taming the SRU

FEBRUARY 19, 2024

A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. In general, radial artery readings in patients with shock likely underestimate central pressure which can lead to increasing vasopressor dosing. PMID: 35338337. Keville, M.

Shock 59

Shock Resuscitation Ultrasounds Research 59

The Skeptics' Guide to EM

JANUARY 15, 2022

Case: You respond to a rapid response on the floor for a 58-year-old woman in septic shock who is requiring emergent rapid sequence intubation (RSI). A 2009 randomized control trial conducted in French ICUs supported the use of ketamine in this patient population [5].

Sepsis 43

Sepsis Shock Emergency Department Outcomes 43

The Skeptics' Guide to EM

DECEMBER 7, 2018

He is unsuccessfully shocked. JAMA 2009, Hagihara et al. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation. JAMA 2012 and Cournoyer et al.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

PulmCCM

JANUARY 2, 2025

Paraphrasing: A highly-cited 2009 paper by FDA-affiliated authors argued that a loss of efficacy over placebo by up to 50% and an absolute increase in mortality of 7% are acceptable to conclude a new treatment is “noninferior” when testing antibiotics for nosocomial pneumonia.

Sepsis 98

Sepsis Outcomes Stroke Shock 98

EMDocs

JUNE 25, 2024

National Burn Repository 2019 Update, Report of data from 2009–2018. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. References American Burn Association. link] (2019). Cartotto R, Johnson LS, Savetamal A, Greenhalgh D, Kubasiak JC, Pham TN, Rizzo JA, Sen S, Main E. J Burn Care Res.

Burns 72

Burns Fluid Resuscitation Resuscitation Poisoning 72

Dr. Smith's ECG Blog

JULY 18, 2014

Case Continued 2 days later the patient became increasingly tachycardic, hypotensive, ashen, clammy (in cardiogenic shock) and had a new murmur. Rupture can be either free wall rupture (causing tamonade) or septal rupture, causing ventricular septal defect with left to right flow and resulting pulmonary edema and shock. Apr 28, 2009.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

Greater Sydney Area HEMS

APRIL 26, 2023

A literature search on ST as recently as 2009 yielded only 5 articles, as compared to thousands of non-medical commentaries. 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). .

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. This patient’s severe aortic stenosis (AS) and associated severe cardiogenic shock likely created the ECG pattern, resulting in a very difficult challenge for our inpatient team. Fundamentally, cardiogenic shock is an issue of decreased cardiac output.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

Journal of Emergencies, Trauma and Shock, 3(1), 39. 2009) Trauma in the Obstetrical Patient. Holbrook MD September 01, 2013 Umbilical Cord Prolapse and Other Cord Emergencies Marybeth Lore, MD Complications of Labor and Delivery by Jeanie Ward Pulmonary Embolism: Evaluation in the pregnant patient. Stafford, I. Leibowitz, A.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

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 52

Pediatrics Sepsis Shock Outcomes 52

PHEM Cast

JULY 14, 2016

Journal of Emergencies, Trauma, and Shock. 2009 May;10(2):74–8. A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients afternormal cervical spine CT. 2014 Feb 11;7(4):251–5. Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. J Neurotrauma. 2014 Mar 15;31(6):531–40.

Fractures 52

Fractures Hospitals Shock Research 52

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

Dr. Smith's ECG Blog

JULY 7, 2013

Rupture can be either free wall rupture (causing tamonade) or septal rupture, causing ventricular septal defect with left to right flow and resulting pulmonary edema and shock. Apr 28, 2009. If detected early by ultrasound, the patient can be saved. 3) Oliva et al. (3) J Am Coll Cardiol 53(17):1503-9.

Ultrasounds 52

Ultrasounds EKG/ECG Emergency Department Shock 52

The Skeptics' Guide to EM

FEBRUARY 10, 2018

In 2009, a study by Panickar et al found no positive effect in giving steroids to pre-school children with wheeze (2). It is really common during the winter months and often due to a viral infection (1). There has always been some uncertainty about the benefit of prednisolone for viral wheeze in pre-school children.

Emergency Department 40

Emergency Department Pediatrics Sepsis Hospitals 40

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. Cardiovasc Intervent Radiol 32 , 155–158 (2009). Blood tests: FBC, U&Es, coagulation screen, electrolytes including calcium depending on the chemical involved (see below under ‘Decontamination’). Check temperature and blood glucose levels. Sagoschen, I.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

PHEM Cast

APRIL 18, 2016

Blackham & Benger, 2009. 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. Muscle spasm is superior to any artificial method.

Fractures 40

Fractures Operations Administration Shock 40

ACEP Now

FEBRUARY 6, 2024

2009; 47:236–238. Yes, there are real issues with urine analysis, however in our case it was shocking how fluorescent the patient’s urine was when exposed to ultraviolet (UV) light. 2007;176(8):1097-1099. doi 10.1503/cmaj.061288. Verelst S, Vermeersch P, Desmet K. Clin Toxicol. doi: 10.1080/15563650802432954.

Poisoning 52

Poisoning Pediatrics Shock Research 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’. 2009; 8:67-69. 2009; 24:156-8. 2009; 27:942-947. That may very well be true, but any virus can be invasive with myocardial involvement. 2004; 90:e17.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

RebelEM

NOVEMBER 3, 2022

Albert 2011, Jabre 2009) However, the existing literature comparing etomidate and ketamine is conflicting. 2/3rds of the population were trauma patients, and more patients in the ketamine arm had shock, hypoxemia, extremes of size, and anatomic challenges, potentially biasing the results to favor etomidate. in the etomidate cohort.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. Patients at risk for ARDS were stratified by the Lung Injury Prevention Score (LIPS) which predicts the probability of developing ARDS and subsequent mortality. Crit Care Explor. 2022 Feb 8; PMID: 35156050 Higgins TL et al.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

PulmCCM

OCTOBER 16, 2023

per 1,000 central-line days between 2001 and 2009. For example, a patient who presented with shock and mitral regurgitation, received a central line for vasopressors on day 0, and was found to have bacteremia from blood cultures drawn on day 3 due to endocarditis would have a CLABSI, but not a CRBSI. also decreased from 3.64

CDC 52

CDC Hospitals Ultrasounds Documentation/Coding 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

AslangerE A 65-year-old gentleman presented to the emergency department after experiencing two recent ICD shocks in the preceding hours. The subsequent ECG, taken 5-10 minutes post-shock, depicted a soothing of ST deviation. This was contributed by Co-editor Emre Aslanger, an interventional cardiologist in Turkey.

EKG/ECG 111

EKG/ECG Shock Administration Emergency Department 111

PEMBlog

OCTOBER 18, 2023

Neonatal Toxic Shock Syndrome C. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease E. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease The patient was diagnosed with Neonatal Toxic Shock Syndrome-Like Exanthematous Disease (NTED). Neonatal toxic shock syndrome-like exanthematous disease (NTED).

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

Taming the SRU

NOVEMBER 13, 2024

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

Psychiatric 88

Psychiatric Seizures Emergency Department Pediatrics 88

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 64

Sepsis Fluid Resuscitation Resuscitation Shock 64

EMDocs

NOVEMBER 13, 2024

Management: Patients can rapidly progress to septic shock and multiorgan failure. C (100° F), or if the ascitic fluid ANC is > 250 cells/mm 3 Mortality increases by 8-10% for every hour delay in antibiotics for patients with cirrhosis and septic shock. 2009 Mar 7;15(9):1042-9. For antibiotics, utilize local antibiogram.

Hyperthermia / Hypothermia 86

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 86

EMDocs

JANUARY 16, 2024

However, consideration of infection, endocrine shock (adrenal, thyroid disease), electrolyte abnormalities, hypoglycemia or central nervous system (CNS) disasters is important. Published 2009 Jun 10. 17 It is crucial to figure out why the patient is hypothermic and reverse the underlying cause if possible. 2009;338:b2085.

Hyperthermia / Hypothermia 83

Hyperthermia / Hypothermia Resuscitation CPR EMS 83

EMDocs

JANUARY 20, 2024

Symptoms of heart failure and cardiogenic shock may develop in more severe cases. Patients with features of shock may require vasopressors, and the decision on the specific drug hinges on the presence or absence of left ventricular outflow tract (LVOT) obstruction.

EMS 73

EMS Fluid Resuscitation Shock EKG/ECG 73

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 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

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 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Perhaps, not insignificantly, they were accustomed to receiving systematized government-supplied medical and trauma care, with "shock rooms" receiving an influx of victims, as contrasted to those later who opposed "socialized medicine." Committee on Shock. Mouth-to-Airway (adjunct). Advanced Emergency Nursing Blog.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Pediatric Emergency Playbook

MAY 1, 2017

He will be dehydrated – possibly in shock. 2009; 124(4):1193-6. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home. Critical Care Although rare, the critically ill neonate with hyperbilirubinemia requires immediate intervention. He will be irritable. Pediatrics.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

The Skeptics' Guide to EM

APRIL 14, 2018

This trial showed TXA is safe and effective treatment in patients with hemorrhagic shock from trauma in reducing mortality. The latest guidelines from the SOGC on PPH was published in 2009 [5]. PPH is one of the leading causes of maternal mortality around the world [2].

Administration 52

Administration Shock 52

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. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality.

Fractures 54

Fractures Resuscitation Operations EMS 54

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 52

Sepsis Shock Administration Resuscitation 52

RebelEM

MAY 15, 2024

Neutropenic Fever: Fever (one reading of 38.3C Give appropriate fluids, vasopressors, and antibiotics.

Infectious Diseases 87

Infectious Diseases Administration Sepsis Anaphylaxis 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. link] Lacunza, San Román, I., García-Molina, E.,

Hyperthermia / Hypothermia 67

Hyperthermia / Hypothermia EMS Stroke Seizures 67