The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC? CPR is currently in progress with a single shock having been delivered.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

Mind The Bleep

FEBRUARY 27, 2024

1] It is worth mentioning this formula was designed for well, euvolaemic children, which does not represent the popluation of children who require IV fluids. saline vs balanced crystalloid solutions for initial fluid management in the treatment of septic shock which may give us more insight into this topic. [5]

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

Greater Sydney Area HEMS

APRIL 26, 2023

Both the stuff of legend and go by multiple names including harness hang syndrome and orthostatic intolerance, as well as bigfoot and the abominable snowman, respectively. See I told you this sounded a lot like crush injury… Let me put it another way: ST is a state of shock that can be rapidly induced by passive hanging. That’s it?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

Pediatric Emergency Playbook

OCTOBER 1, 2016

Well appearing? Consider allergic proctocolitis if the child is well. It is important to note that 15% of necrotizing enterocolitis occurs in full-term babies; malrotation can present simply in shock, without initial overt bleed. Think -- pink stain, without clot: Infants and Young Children Well appearing?

Pediatrics 52

Pediatrics Wellness Shock Resuscitation 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2011; 364(3):255-264. 2011; 29:1136-1140.:205-211. 2011; 523-527. 2011; 24: 552-561. 2011; 146(6):660-665. Necrotizing Enterocolitis. N Eng J Med. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. 2016; 13:590-600. Walsh MC et al. Am J Emerg Med. Chien M et al. J Emerg Med.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

MAY 6, 2024

The data was collected from a cohort from 2011- 2015 (nearly ten years ago). While the use of oral corticosteroids to treat wheeze in asthma is well-established, evidence for their benefit in viral-induced wheeze is mixed. Criteria for the sepsis scoring systems were not defined explicitly. Why does it matter?

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

PHEM Cast

JULY 14, 2016

Crane T, Cooke MW, Wellings R, Wayte S, Higgins J. 2011 May;70(5):1282–5. Journal of Emergencies, Trauma, and Shock. Elsevier Ltd; 2015 Apr 1;46(4):528–35. Smyth M, Cooke MW. Value of a rigid collar: in need of more research and better devices. Emergency Medicine Journal. 2013 May 13;30(6):516–6. The University of Warwick.

Fractures 52

Fractures Hospitals Shock Research 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). If RV pressure is extreme, it can exceed LV pressure causing paradoxical septal wall motion toward the LV as well. 2011 Mar;123(16):1788-1830. RV pressures > LV pressures.

Ultrasounds 98

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

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Pediatric Emergency Playbook

MAY 1, 2017

Home care The neonate who is safe to go home is well appearing, and not dehydrated. Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

All went well. Journal of Emergencies, Trauma and Shock, 3(1), 39. Reid, C (2011) Prehospital resuscitative hysterotomy op.cit. Not in the textbook, but it worked. Usually, in the ED, the simple and great goal is to get the parturient upstairs to OB-GYN, if you have one, as soon as possible. Nguyen, H. M., & Healy, D.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Pediatric Emergency Playbook

NOVEMBER 1, 2015

Etomidate is perfectly acceptable, but ketamine is actually a superior drug to etomidate in the rapid sequence intubation of children in septic shock. Ketamine is reasonable as well: there is no contraindication to ketamine except for known hydrocephalus. It is safe in head trauma. TBI is not a contraindication. Relax, it’s a myth.

Shock 40

Shock Sepsis Airway Management Pediatrics 40

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 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. Acad Emerg Med.

Infectious Diseases 89

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

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

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

DECEMBER 1, 2015

Victims of electrical injuries present either in extremis or as the seeming well patient with insidious, developing disease. Most patients do well, and the burn heals by secondary intention. It’s a high-flow artery to the face, and if disrupted, the child may have significant bleeding and possibly hemorrhagic shock. J Emerg Med.

Burns 40

Burns Emergency Department EKG/ECG Shock 40

ACEP Now

AUGUST 8, 2023

Circulation 2011; 123: 2213-2218. Many of these “high risks” may be absent from ED medical records or unknown to patients (connective tissue disease, valvular heart disease), are subjective (onset, pain descriptors, and severity) while the interrater reliability of physical examination and subjective historical features is unknown.

Shock 52

Shock Hospitals Wellness 52

Pediatric Emergency Playbook

FEBRUARY 1, 2016

Protocols work well for adults, but trauma in children requires that we exercise our clinical muscles just a bit more. They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Brenner et al.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

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. saline as well as to two different infusion rates of said fluids. As well, the difference between a fluid bolus and a fluid challenge is important.

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

PEMBlog

JUNE 5, 2024

Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. 2011 Aug;58(2):145-55. Infants can get a cervical spine injury during breech delivery or, unfortunately, during non accidental trauma as well. than it is spinal shock. MMWR Recomm Rep. PMID: 22237112.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

Mind The Bleep

FEBRUARY 9, 2024

She is moderately frail with a few well-managed comorbidities, and states that she would not want to live if she was not able to do her gardening or hold her grandchildren. Circulation Is there evidence of shock – think hypoperfusion; confusion, chest pain, rising lactate, low BP.What is the most likely cause of this?

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

Dr. Smith's ECG Blog

JUNE 1, 2020

Pleomorphic VT is less well known than the other morphologic forms of VT. 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. He could not be resuscitated. —

EKG/ECG 52

EKG/ECG Resuscitation Shock Outcomes 52

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. There may have very well been a policy where only RTs can make changes to a ventilator after an order was placed to ensure accurate documentation. 2011 Feb 15; Epub 2010 Aug 27. PMID: 19325480 Gajic O, et al.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Pediatric Emergency Playbook

MARCH 1, 2016

On arrival, he was in compensated shock, with tachycardia. Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. 2011 May;18(5):477-82. A 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. Acad Emerg Med.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Dr. Smith's ECG Blog

APRIL 15, 2019

Here was his initial ED ECG: There is sinus tachycardia at a rate of about 140 There is profound ST Elevation across all precordial leads, as well as I and aVL. In this abstract from 2011, we found that 4%(4 of 99) type 2 MI and 38% of type 1 MI had ST Elevation. He presented very tachycardic with a very high fever.

EKG/ECG 40

EKG/ECG Sepsis Documentation/Coding Shock 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 Jeff: And the etiology of CHS is not well understood. Nachi: There is a well-studied theory here and it relates to the TRPV1 receptor that we talked about earlier. million, and cocaine at 1.9

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

EMDocs

OCTOBER 5, 2024

ESBL are found exclusively in Gram-negative organisms, including: Klebsiella pneumoniae Klebsiella oxytoca Escherichia coli Proteus mirabilis Pseudomonas aeruginosa The first reported beta-lactamase enzyme was reported in 1963, and today there are well over 350 ESBL enzyme variants. Microb Drug Resist 2011; 17:267. In: PostTW, ed.

EMS 98

EMS Infectious Diseases Sepsis Hospitals 98

Pediatric Emergency Playbook

JANUARY 1, 2017

Tachycardia, tachypnea, and a change in behavior can be indicators not only to the presence of pain, but possibly to its etiology as well. For children greater than one year who are preverbal, a well performing scale is the FLACC score: Face, Legs, Activity, Cry, Consolability ( Table 3 ).

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 95

Sepsis Fractures Documentation/Coding Administration 95

Mind The Bleep

JUNE 17, 2023

Examine for capillary refill, peripheral pulses, are they warm and well perfused? 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.

Shock 93

Shock Wellness Emergency Department Ultrasounds 93

EB Medicine

JANUARY 2, 2019

Per a 2010 and 2011 Cochrane review, there is not evidence to recommend one antibiotic over another, so let your local antibiograms guide your treatment. HDS patients who are well-appearing with a pregnancy of undetermined location should be discharged with a 48h beta hcg recheck and ultrasound. Jeff: Let’s move on to disposition.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

PEMBlog

JANUARY 17, 2024

2011 Mar;127(3):e573-80. Epub 2011 Feb 21. Clin Infect Dis 2011; 52:e18. Well when a break in the skin occurs, normal skin, flora, and bacteria can enter the subcutaneous tissue, where they do not belong, and they can also invade the lymphatic system. Full blown sepsis and toxic shock syndrome. Pediatrics.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Mind The Bleep

JUNE 17, 2023

Examine for capillary refill, peripheral pulses, are they warm and well perfused? 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.

Shock 52

Shock Wellness Emergency Department Ultrasounds 52

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 89

Psychiatric Seizures Emergency Department Pediatrics 89

EMDocs

JANUARY 20, 2025

1,2 For hypervolemia in heart failure patients, orthopnea >2 pillows is the most reliable clinical finding, 3,4 though an increase in peripheral edema and increased weight can be useful as well. 6-8 In patients who are on long-term hemodialysis, typical non-invasive signs of volume assessment seem to be unreliable as well.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75