Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Don't Forget the Bubbles

MAY 6, 2024

This multicentre retrospective cohort study looked at 202 children in California aged 1- 24 months who presented acutely between 2010 and 2021. 807 patients between the ages of 7 days to 17 years, from the ED, ward and PICU, were included across ten hospitals in Switzerland.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Pediatric Emergency Playbook

AUGUST 1, 2017

2010; 26:769-781. 2010; 149(3):386-391. Management of the child after enema-reduced intussusception: hospital or home? 2010; 45:1182-1186. 2010; 28(11):544-548. Acute Intestinal Obstruction in children: Experience in a Tertiary Care Hospital. 2010 Oct;40(4):613-20. . J Emerg Med. 2012; 43(1):49-51.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

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. Arterial lines require specialized monitoring and nursing resources which are not available in all hospital settings. PMID: 35338337. Keville, M. Gelmann, D., Raffman, A., Gelmann, D.,

Shock 59

Shock Resuscitation Ultrasounds Research 59

Mind The Bleep

JULY 15, 2023

Alchi B, 2010) Membranous nephropathy (MN) is characterised by the formation of immune complexes in the space between podocytes and the glomerular basement membrane. If a child presents acutely unwell with nephrotic syndrome they are likely to be in hypovalaemic shock, have an infection, or both. MPGN is usually idiopathic in children.

Allergic Reactions 52

Allergic Reactions Shock Hospitals Wellness 52

RebelEM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. 4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. 2011 Feb 15; Epub 2010 Aug 27. J Crit Care. Am J Respir Crit Care Med.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Dr. Smith's ECG Blog

JULY 12, 2020

They informed me that she had just been hospitalized 10 days ago for "some fluid around the heart" and was discharged after one day without incident. Ultimately, she spent several days in the hospital and no further fluid collected. Why did she go from stable to shock in seconds? She was discharged home in good condition.

EKG/ECG 40

EKG/ECG Hospitals Ultrasounds Wellness 40

Taming the SRU

AUGUST 30, 2023

In a small study involving 79 hospitalized children, PCT was found to be elevated in bacterial infections, with a decrease after appropriate antibiotic therapy, and decreased in viral infections [24]. Critical Care Medicine 38():p S26-S34, February 2010. | . + Procalcitonin (PCT) Etiology: PCT was first discovered in 1984.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

EB Medicine

AUGUST 6, 2019

Nachi: However, in 2010, the FDA approved the first DOAC, a real game-changer. Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Jeff: That is simply shocking! This can help with destination selection when relevant. Let’s also talk lab studies.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Taming the SRU

OCTOBER 1, 2023

May be considered first line in the future however results may be dependent upon provider training and hospital resources [17]. Pigtail catheters (8.5Fr - 14Fr) have similar efficacy to chest tubes and are associated with faster removal, fewer complications, and shorter hospital LOS [27-31]. Can Respir J. 2017;2017:6014967.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

RebelEM

MAY 15, 2024

Follow your hospital’s protocol (if available). High Risk Patients will need hospitalization and IV antibiotics. Neutropenic Fever: Fever (one reading of 38.3C Give appropriate fluids, vasopressors, and antibiotics.

Infectious Diseases 98

Infectious Diseases Administration Sepsis Anaphylaxis 98

ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. Christopher’s Hospital for Children by private equity (PE) firm Paladin Healthcare Capital for 170 million dollars. 14 Dr. Stinson remembers what it was like to work for a PE-owned hospital early in her career. “I

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

RebelEM

JANUARY 29, 2024

CHEST 2010. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). PMID: 19741062 Kucher N et al. Circ 2014.

Stroke 136

Stroke Outcomes Hospitals Administration 136

ACEP Now

AUGUST 8, 2023

4,5 Relying on a chart review of clinical features, potentially obtained after hospital admission, when the final diagnosis is known is unreliable and inappropriate for creation of a CDR. Arch Dis Child Educ Pract Ed 2010; 95: 83-87. Circulation 2010; 121: 1544-1579. Clinical decision rules: how to build them.

Shock 52

Shock Hospitals Wellness 52

RebelEM

SEPTEMBER 26, 2022

There was no statistically significant difference in failure to control bleeding by day 5 or failure to prevent rebleeding after day 5, total hospital length of stay in the first admission, total ICU and hospital length of stay up to 42 days, or 5 and 42-day mortality rates between the two groups. Furthermore, 14.3%

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

PulmCCM

OCTOBER 9, 2023

Called NICE-SUGAR trial ( NEJM 2009 ), conducted at 42 hospitals in Australia and New Zealand, it found that intensive glucose control actually harmed people, by frequently inducing severe hypoglycemia. The most recent listed on the Justia website was in 2010.) and many other countries.

Shock 52

Shock Outcomes Hospitals Wellness 52

EMDocs

APRIL 22, 2024

1-3 VTE is responsible for hospitalizing over 250,000 Americans every year, and there are an estimated 100,000 deaths annually associated with these conditions. However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). Am J Prev Med. 2009.12.017.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

PEMBlog

JUNE 5, 2024

Epub 2010 Oct 29. You should also consider the possibility of quote unquote spinal shock. than it is spinal shock. And hypotension, bradycardia, or temperature instability can result from hemorrhagic and or spinal shock. Factors associated with cervical spine injury in children after blunt trauma. Ann Emerg Med.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Still, except for the public hospital, other hospitals did little emergency work and would have unattended first aid or treatment room in which one could meet one's physician or have an intern provide care in the meanwhile. Rebuilding of EDs in proximity to Radiology, Blood Bank, OR, and ICU, becoming organic to the hospital.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Downeast Emergency Medicine

APRIL 26, 2021

Four level-1 US trauma centers participated in the study where the inclusion criteria were trauma patients who were within 2 hours of their injury and were transported to the trauma center from either the field or another hospital. When looking at the subgroups with severe shock, there was an 18.5% MI or stroke).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

EB Medicine

SEPTEMBER 1, 2018

Nachi: Right, but in Australia, not only are the snakes more venomous but the hospital transport distances are much longer, so, basically they sacrifice the limb to potentially save a life. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Nachi: Let’s move on to diagnostic studies.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Advanced Emergency Nursing from AENJ

MAY 3, 2014

image of Fell-O'Dwyer apparatus.) Wellcome Library Movies of Artificial Respiration (hospital-based) from 1940s showing in six parts several methods in context of anaesthesia training. < Committee on Shock. Fell then collaborated with O'Dwyer to add his foot-powered positive pressure insufflator. ( Inspired much rescue training.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

EB Medicine

AUGUST 1, 2018

Nachi: Sometimes… Jeff: This month’s issue was authored by Mollie Williams, who is the EM residency program director at the Brooklyn Hospital Center. Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 million, and cocaine at 1.9

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

FEBRUARY 12, 2024

Authors: Rachel Kelly, MD ( EM Resident Physician, Stony Brook University Hospital); Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. is more likely to portend death (13, 14). Resuscitation from a pH of 6.5:

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

Pediatric Emergency Playbook

JANUARY 1, 2017

Assessing and managing children’s pain can be challenging, because they may not exhibit typically recognized signs and symptoms ( Srouji 2010 ). The Baker-Wong FACES Pain Rating scale ( Figure 1 ) was developed with feedback from children and has been validated for use in those 3 years of age and older ( Keck 1996 , Tomlinson 2010 ).

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

PEMBlog

JANUARY 17, 2024

Full blown sepsis and toxic shock syndrome. Well, you definitely shouldn’t be sending a blood culture because if you’re worried about bacteremia and sepsis, that kid needs to stay in the hospital. So when do you want to think about admission to the hospital or short stay unit versus discharge? Pediatrics.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Pediatric EM Morsels

MARCH 7, 2025

Tranexamic Acid Use in United States Children’s Hospitals. Crit Care Explor. 2020;2(1):e0075. Published 2020 Jan 29. doi:10.1097/CCE.0000000000000075 0000000000000075 Nishijima DK, Monuteaux MC, Faraoni D, et al. J Emerg Med. 2016;50(6):868-874.e1. doi:10.1016/j.jemermed.2016.02.004

Pediatrics 231

Pediatrics Blood Transfusions Anaphylaxis Military 231

Advanced Emergency Nursing from AENJ

SEPTEMBER 13, 2015

She’s there because your hospital is under-resourced, has injury or illness not thought related to gravidity, is too “sick” to make it to OB Labor/Delivery, or you’re trying to get OR to open. In rural Critical Access Hospitals, or austere conditions, you may be all that is available. Use the NODESAT technique. EMBlog Mayo Clinic.

Airway Management 40

Airway Management Resuscitation Critical Access Emergency Nursing 40

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 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

EMDocs

JANUARY 16, 2025

but PPV ranges from 25.1-39.5% years Internal validation cohort: 43,400 patients with mean age 3.7 years External validation cohort: 45,855 patients with mean age 2.6 years Best performing criteria identified by AUPRC and AUROC 4-organ-system model translated into the Phoenix Sepsis Score had best mortality prediction characteristics AUPRC of 0.23-0.38

Sepsis 94

Sepsis Pediatrics Shock Hospitals 94

Sensible Medicine

AUGUST 14, 2024

In his work, Dr. Goldwater describes a kind of toxic-shock (cytokine) reaction in the body that results from the combination of a cold virus plus being infected with a common bacterium—each pathogen relatively harmless on its own but deadly together. .”)

CDC 93

CDC Sepsis Research Pediatrics 93

Don't Forget the Bubbles

JULY 5, 2023

Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. GPs and local hospitals should provide easy access to medication and vaccinations to ensure good compliance. What medications would you give to control pain in hospital? He is apyrexial.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

FEBRUARY 24, 2025

Two-month-old Isla presents to their local hospital following a prolonged apnoea at home. The condition increases blood viscosity and pulmonary vascular resistance, leading to pulmonary hypertension, haemodynamic collapse, and, ultimately, death due to hypoxaemia and refractory shock. They had a two-day history of reduced feeding.

Pediatrics 59

Pediatrics Outcomes Blood Transfusions Sepsis 59

Don't Forget the Bubbles

NOVEMBER 5, 2023

The Bubble Wrap Plus is a monthly paediatric Journal Club reading list from Professor Jaan Toelen (University Hospitals Leuven) and Dr Anke Raaijmakers (Sydney Children’s Hospital). Hospital Admissions for Abusive Head Trauma Before and During the COVID-19 Pandemic. Can’t get enough of Bubble Wrap? Healy CM, et al. JAMA Pediatr.

Pediatrics 105

Pediatrics Hospitals Infectious Diseases Outcomes 105