Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

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. were more likely to respond.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

RebelEM

JANUARY 29, 2024

CHEST 2010. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 Efficacy and Safety of Low Dose Recombinant Tissue-Type Plasminogen Activator for the Treatment of Acute Pulmonary Thromboemolism: A Randomized, Multicenter Controlled Trial. PMID: 19741062 Kucher N et al. Circ 2014.

Stroke 136

Stroke Outcomes Hospitals Administration 136

PulmCCM

OCTOBER 9, 2023

The most recent listed on the Justia website was in 2010.) Read in NEJM Extracorporeal membrane oxygenation (ECMO) for cardiogenic shock after MI (ECLS-SHOCK trial) When patients with massive myocardial infarctions develop cardiogenic shock, it’s a terrible sign.

Shock 52

Shock Outcomes Hospitals Wellness 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. 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

ACEP Now

AUGUST 8, 2023

Arch Dis Child Educ Pract Ed 2010; 95: 83-87. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. Circulation 2010; 121: 1544-1579. Clinical decision rules: how to build them. Hiratzka LF, Bakris GL, Beckman JA, et al.

Shock 52

Shock Hospitals Wellness 52

The Skeptics' Guide to EM

FEBRUARY 25, 2023

He is found to be in hypoxic respiratory failure and septic shock. Case: A 6-month-old boy presents to the emergency department (ED) with three days of worsening cough, cold symptoms, and fever. Parents note that he has been progressively more tired and difficult to arouse. Intravenous (IV) access is obtained. He is quickly intubated.

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2010; 26:769-781. 2010; 149(3):386-391. 2010; 45:1182-1186. 2010; 28(11):544-548. 2010 Oct;40(4):613-20. . J Emerg Med. 2012; 43(1):49-51. Martin V, Shaw-Smith C. Review of genetic factors in intestinal malrotation. Pediatr Surg Int. Nehra D, Goldstein AM. Am J Emerg Med. 2012; 30:426-431. Whitehouse et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

JUNE 26, 2023

But, they may present postnatally with cyanosis/hypoxaemia due to insufficient pulmonary blood flow, cardiogenic shock due to insufficient systemic blood flow, or both. The seminal trial addressing this in the Norwood population was The Single Ventricle Reconstruction Trial, published in 2010.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

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. Pyuria is defined as greater than 5 white blood cells and positive leucocytes on urinalysis. These children had a negative urinalysis and positive urine culture and were not prescribed antibiotics.

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

ACEP Now

NOVEMBER 7, 2023

Double sequential external defibrillation (DSED) is a technique in which rapid sequential shocks are placed from two defibrillators, with defibrillation pads in two planes, such as anterior-lateral and anterior-posterior. Improvement of out-of-hospital cardiac arrest survival rate after implementation of the 2010 resuscitation guidelines.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

RebelEM

JANUARY 25, 2023

2010, (Ch) 92: p 1216-1227. Am Surg 2010; 76:687-691. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 Louis, Mosby, Inc.,

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

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

EMDocs

APRIL 22, 2024

However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). 2010 Apr;38(4 Suppl):S495-501. A thin wall (diameter <5mm) is suggestive of an acute etiology”. RV pressures > LV pressures. link] Beckman MG, Hooper WC, Critchley SE, Ortel TL.

Ultrasounds 98

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

Taming the SRU

OCTOBER 1, 2023

Observation: A 2010 systematic review of 3 RCTs found no difference in mortality, progression of PTX size, or length of hospital stay between chest tube and observation for stable trauma patients with occult PTX [33]. J Emerg Trauma Shock. Management of spontaneous pneumothorax: British Thoracic Society Pleural Disease Guideline 2010.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

ACEP Now

SEPTEMBER 3, 2024

Private equity investment in health care has increased more than 20-fold since 2000, with 70 percent of this activity since 2010. He was shocked when the hospital CEO took him up on it, but a year later, volumes increased 30 percent with his emphasis on quality rather than cost-cutting.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

RebelEM

SEPTEMBER 26, 2022

As described in the CONSORT statement, the use of p-values in table 1 is inappropriate as the study is not powered to show a difference in baseline characteristics between the treatment and control group in an RCT (Schulz 2010). CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

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

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

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

Journal of Emergencies, Trauma and Shock, 3(1), 39. Emergency department evaluation and management of peripartum cardiomyopathy. The Journal of emergency medicine, 36(2), 141-147. An obstetric emergency called peripartum cardiomyopathy! Capriola, M. Peripartum cardiomyopathy: a review. International journal of women's health, 5, 1.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Downeast Emergency Medicine

APRIL 26, 2021

When looking at the subgroups with severe shock, there was an 18.5% When stratifying TXA administration time after injury and qualifying shock incidence, there appeared to be a lower 30 d mortality if TXA was given within 1 hour of the incident. Lancet 2010; 376:23-32.[ MI or stroke). 2015;527(7578):s193-197.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

RebelEM

MARCH 27, 2023

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. Patients at risk for ARDS were stratified by the Lung Injury Prevention Score (LIPS) which predicts the probability of developing ARDS and subsequent mortality. Am J Respir Crit Care Med.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

PHEM Cast

SEPTEMBER 6, 2017

You can also see when your treatment is working- if you give a patient in septic shock some fluid and improve their CO, you’ll see a rise in ETC02 You can confirm adequacy of respiratory function in the fitting or post-ictal patient when all other methods fail PITFALLS Device failure- lines blocking, batteries running out, pump failure.

CPR 52

CPR Resuscitation Operations Shock 52

Pediatric Emergency Playbook

MARCH 1, 2016

On arrival, he was in compensated shock, with tachycardia. 2010 Nov;19(4):286-91. A 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad. He decompensates and needs blood.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

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’. 2010; 12(3): 3–8. 2010 Oct 1;33(10):821-42. That may very well be true, but any virus can be invasive with myocardial involvement. Cardiovasculr Ultrasound.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

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

MAY 3, 2014

Committee on Shock. **Ruben’s description of essential portability of resuscitation equipment. Note novelty of use without a pressurized cylinder. Photos of early AMBU bag & foot-pump suction in use. The self-inflating resuscitator--evolution of an idea. Anaesthesia and intensive care, 38, 10-15. Inspired much rescue training.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

Taming the SRU

AUGUST 30, 2023

Critical Care Medicine 38():p S26-S34, February 2010. | Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. N Engl J Med. 2023 Feb 2;388(5):439-452. doi: 10.1056/NEJMra2206346. PMID: 36724330; PMCID: PMC9912245. Levi, Marcel MD, PhD; van der Poll, Tom MD, PhD. DOI: 10.1097/CCM.0b013e3181c98d21

Infectious Diseases 89

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

EB Medicine

SEPTEMBER 1, 2018

In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Jeff: And to round out this section – just be aware that rare effects such as osteonecrosis, ischemic stroke, massive PE, and septic shock have all been reported. Those on anticoagulants and anti-platelet agents are at increased risk. Clin Toxicol (Phila).

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Dr. Smith's ECG Blog

JULY 12, 2020

Why did she go from stable to shock in seconds? By far, the most common etiology of acute pericarditis in a young adult is idiopathic ( Khandaker et al: Mayo Clin Proc 85(6): 572-593, 2010 ) although many ( most ) of these idiopathic cases are probably viral. She was discharged home in good condition.

EKG/ECG 40

EKG/ECG Hospitals Ultrasounds Wellness 40

EB Medicine

JULY 8, 2019

Additionally, back in 2010, it was estimated that 6.6% Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. Nachi: It sure is, but maybe even more worrisome is the rising prevalence of obesity. While it was < 15% in 1990, by 2016 it reached 40%. million adults!!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EB Medicine

AUGUST 1, 2018

Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 From 2010 to 2011, the number of ED visits by children aged 12 to 17 years old due to synthetic cannabinoid use also has doubled. Marijuana actually maintains the highest lifetime use of an illicit drug used within the US.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EB Medicine

AUGUST 6, 2019

Nachi: However, in 2010, the FDA approved the first DOAC, a real game-changer. Jeff: That is simply shocking! Jeff: Unfortunately, these agents have a narrow therapeutic window and many drug-drug interactions, and they require frequent monitoring - making them less desirable to many. Let’s also talk lab studies.

Emergency Department 40

Emergency Department Stroke Wellness Resuscitation 40

RebelEM

MAY 15, 2024

Read More: Infectious Disease Society of America 2010 Clinical Practice Guidelines Life in the Fast Lane: Febrile Neutropaenia Uptodate: overview of neutropenic fever syndromes EMRAP: Risk stratification of neutropenic fever MDCalc: MASCC Score MDCalc: CISNE Score References: Ahn S, Rice TW, Yeung SJ, Cooksley T. Sepkowitz, K. Boeckh, M.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

EMDocs

FEBRUARY 12, 2024

First, there can be a poor correlation between venous and arterial gases in states of shock, hemodynamic instability, or extremes of acid-base disturbances, due to poor cardiac output/circulatory failure impairing venous and arterial flow, with associated poor gas exchange as well as hypercapnia and acidemia at the tissue level (8).

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

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] Larach, M. Gronert, G. Brandom, B.

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

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