The Skeptics' Guide to EM

DECEMBER 7, 2018

He is unsuccessfully shocked. There was also no increase in survivors with good neurological outcomes with ACLS. published in Resuscitation 2011. Clinical Question: Does the use of epinephrine in cardiac arrest improve survival rates with a favourable neurological outcome? JAMA 2009, Hagihara et al.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

Mind The Bleep

AUGUST 5, 2023

Complications Short bowel syndrome (following significant resection, and more common following removal of the ileocaecal valve) Intestinal stricture Sepsis / shock DIC Intestinal perforation Mortality (1, 3) References Ginglen JG, Butki N. One-year outcomes following surgery for necrotising enterocolitis: a UK-wide cohort study.

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

The Skeptics' Guide to EM

APRIL 28, 2018

Background: There have been a large number of trials on steroids for a variety of conditions in the last year and we have covered some of them on the SGEM: * The ADRENAL trial on steroids in septic shock demonstrating no all-cause mortality benefit at 90 days ( SGEM#208 ). Comparison: Placebo or no corticosteroids.

Hospitals 40

Hospitals Emergency Department Outcomes Shock 40

RebelEM

NOVEMBER 3, 2022

Albert 2011, Jabre 2009) However, the existing literature comparing etomidate and ketamine is conflicting. Outcomes: Primary Outcome: Incidence of post-induction hypotension Secondary Outcome : First-pass success rate of endotracheal intubation Primary Results: 84 articles were identified for potential inclusion.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. 4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. This is a critical error that leads to poorer outcomes for patients in need of critical care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

PEMBlog

JANUARY 17, 2024

2011 Mar;127(3):e573-80. Epub 2011 Feb 21. Clin Infect Dis 2011; 52:e18. Full blown sepsis and toxic shock syndrome. A representative randomized control trial from Palin from 2013 showed that the addition of TrimSulfa did not improve outcomes in a very large cohort that contained lots of children. Pediatrics.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Pediatric Emergency Playbook

AUGUST 1, 2017

2011; 364(3):255-264. Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. 2011; 29:1136-1140.:205-211. 2011; 523-527. 2011; 24: 552-561. Necrotizing Enterocolitis.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

PHEM Cast

APRIL 10, 2016

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. Arriving by Emergency Medical Services Improves Time to Treatment Endpoints for Patients With Severe Sepsis or Septic Shock. 2011 Aug 30;18(9):934–40.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

PulmCCM

SEPTEMBER 9, 2021

Yet in 2011 a landmark randomized, controlled trial measured the effect that an intravenous bolus had on mortality in children with severe febrile illness in 3 African countries. The primary outcome was 90-day survival. The tertiary outcomes were ICU and hospital mortality and ICU and hospital length of stay. more than 2].

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

Taming the SRU

AUGUST 30, 2023

A 2011 meta-analysis in the journal of Academic Emergency Medicine found ESR, CRP, and PCT were not acutely useful in the diagnosis of septic arthritis due to wildly varying sensitivities and specificities between studies. 2011 Jan;3(1):118-27. 2011 Aug;18(8):781-96. 2011 Sep;18(9):1011. In: StatPearls [Internet].

Infectious Diseases 87

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

Dr. Smith's ECG Blog

JUNE 1, 2020

Classification of the morphologic type of VT may provide clues to etiology, outcome and treatment. Follow-Up to This Case: Although I did not learn specific details of this case — I did find out that this patient failed to respond to antiarrhythmic treatment and multiple shock attempts. WHY CARE about QRS Morphology with VT?

EKG/ECG 52

EKG/ECG Resuscitation Shock Outcomes 52

PHEM Cast

SEPTEMBER 6, 2017

trauma 2004) showed that end-tidal CO2 may be of value in predicting outcome from major trauma (19). Qvigstad et al showed in again in Resuscitation in 2013, confirming inter-individual variation in effectiveness of CPR using ETCO2 as a surrogate for CO Trauma Deakin et al. (J.

CPR 52

CPR Resuscitation Operations Wellness 52

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., 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 87

Psychiatric Emergency Department Seizures Pediatrics 87

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 94

Emergency Department Resuscitation COPD Shock 94

RebelEM

MAY 15, 2024

2011 Jun;153(6):773-9. Epub 2011 Apr 22 Coyne CJ, Le V, Brennan JJ, Castillo EM, Shatsky RA, Ferran K, Brodine S, Vilke GM. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america, Clinical Infectious Diseases, 2011, 52(4):e56-93.

Infectious Diseases 105

Infectious Diseases Administration Sepsis Anaphylaxis 105

EMDocs

JANUARY 4, 2024

Cardiogenic shock and hypotension can occur (systolic heart failure with reduced ejection fraction.) 10,12 Refractory shock or malignant arrhythmias occur in < 5% of patients. Whole bowel irrigation: 3 Not routinely performed and limited evidence to support improved outcome in general. 2011; 109: 418-422.

Seizures 66

Seizures EKG/ECG Poisoning Shock 66

Mind The Bleep

JUNE 17, 2023

A study in 2011 of 258 children admitted to hospital with pneumonia found that 8.5% Kirovski I, 2011) It’s important to think about the possibility of an empyema or bad pneumonia in a child with difficulty in breathing, fever and abdominal pain. of patients present initially with acute abdominal pain. Gadiparthi R, W. 2023, June 14).

Shock 93

Shock Wellness Emergency Department Ultrasounds 93

Mind The Bleep

FEBRUARY 27, 2024

The FEAST study published in 2011 was undertaken across centers in Uganda, Kenya and Tanzania, and randomly allocated children presenting with severe infection and impaired perfusion to groups receiving albumin bolus, saline bolus or no bolus. Boluses were given in 20-40ml/kg aliquots. saline), however more research is needed in this area. [4]

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

Mind The Bleep

JUNE 17, 2023

A study in 2011 of 258 children admitted to hospital with pneumonia found that 8.5% Kirovski I, 2011) It’s important to think about the possibility of an empyema or bad pneumonia in a child with difficulty in breathing, fever and abdominal pain. of patients present initially with acute abdominal pain. Gadiparthi R, W. 2023, June 14).

Shock 52

Shock Wellness Emergency Department Ultrasounds 52

EMDocs

OCTOBER 5, 2024

Pressors where indicated for septic shock (typically Norepinephrine starting at 0.05 12 Complications Inadequate empiric therapy can lead to treatment delays and worse outcomes. Imipenem confers highest risk of seizures ESBL-E are often hospital acquired infections and can prolong hospital stay or lead to worse outcomes.

EMS 74

EMS Infectious Diseases Sepsis Hospitals 74

ALiEM

OCTOBER 30, 2024

We did not use clonidine, despite its known alpha agonist utility in opioid withdrawal, due to the undifferentiated nature of our patients receiving the pathways, not wanting to give an antihypertensive agent to patients who sometimes are experiencing shock and other critical illness. 2011 Dec;6:1-4. 2023 Jan 1;53(1):140-2.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

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. 2005 Oct 5;9(5):R498-501. doi: 10.1186/cc3771.

Hyperthermia / Hypothermia 68

Hyperthermia / Hypothermia EMS Stroke Seizures 68

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

JANUARY 2, 2019

With opportunities to improve outcomes for both the fetus and the mother, I’m confident that this episode will be worth your time. Nachi: For patient who have a threatened miscarriage in the first trimester, there is a 2-fold increased risk of subsequent maternal and fetal adverse outcomes.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40