EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 86

Sepsis Shock Resuscitation Fluid Resuscitation 86

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. 109 (20):361-368, 2012 — CLICK HERE ). Referring to Figure-1 — this 53-year old woman who presented in extremis with cardiogenic shock and an initial pH = 6.9, This was sent by a reader. and K was normal.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

Pediatric Emergency Playbook

JUNE 1, 2016

Do we recognize shock early enough? World wide, shock is a leading cause of morbidity and mortality in children, mostly for failure to recognize or to treat adequately. So, what is shock? Simply put, shock is the inadequate delivery of oxygen to your tissues. How do we prioritize our interventions? Pericardial Effusion?

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Shock Sepsis Pediatrics Ultrasounds 40

RebelEM

APRIL 29, 2024

Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure. 2012 PMID: 21893125. Intravenous vs.intraosseous vascular access during out-of-hospital cardiac arrest – protocol for a randomized clinical trial. Resuscitation. 9 Zhang W et al. Medicine (Baltimore).

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Resuscitation Administration Emergency Department Ultrasounds 105

PHEM Cast

APRIL 16, 2018

2012; 73: 102-10. The outcomes from different resuscitative interventions in a haemorrhagic shock model in porcine model: From: Watts et al. Use of CPR in hemorrhagic shock, a dog model. Critical Care; 2012. Ultrasound during TCA: Cureton et al. Doi: 1098/rstb.2010.0232 2010.0232 Wise et al. EMJ; 2005: 22-24.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

PHEM Cast

APRIL 10, 2016

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine; 2012 Jun 27;20(1):1–1. 2012 Jan;30(1):51–6. One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study. 2012 Dec 15;186(12):1264–71.

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Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

AED Leader

SEPTEMBER 26, 2024

This device can shock the heart back into rhythm. Key takeaways Defibrillators are devices that send electrical shocks to the heart to fix dangerous rhythms. AEDs can save lives outside hospitals by giving quick shocks when someone has a sudden cardiac arrest. It sends an electrical shock to the heart.

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Shock CPR Hospitals EMS 52

Don't Forget the Bubbles

JULY 26, 2023

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

The Skeptics' Guide to EM

DECEMBER 7, 2018

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. He is unsuccessfully shocked. Background: The AHA has five steps in the Chain-of-Survival for out-of-hospital cardiac arrest (OHCA). JAMA 2012 and Cournoyer et al.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

PHEM Cast

FEBRUARY 23, 2017

Penn-Barwell JG, Roberts SA, Midwinter MJ, Bishop JR: Improved survival in UK combat casualties from Iraq and Afghanistan: 2003-2012. Weaver AE, Eshelby S, Norton J, Lockey DJ: The introduction of on-scene blood transfusion in a civilian physician-led pre-hospital trauma service. Lots to think about! 2016 Jul;46(1):3–16.

Blood Transfusions 52

Blood Transfusions Head Injuries Resuscitation Radiology 52

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. Pediatr Cardiol.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2012; 43(1):49-51. BMJ 2012; 345:e5521. 2012; 3:247-250. 2012; 92:527-39. Management of the child after enema-reduced intussusception: hospital or home? Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. J Am Coll Surg. 2004; 199(4):628-635. Lee HC et al. J Emerg Med. Martin V, Shaw-Smith C.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

PHEM Cast

JULY 14, 2016

Out-of-hospital spinal immobilization: its effect on neurologic injury. 2012 May;37(11):937–42. Journal of Emergencies, Trauma, and Shock. Connor D, Greaves I, Porter K, Bloch M, consensus group Faculty of Pre-Hospital Care. Pre-hospital spinal immobilisation: an initial consensus statement. Acad Emerg Med.

Fractures 52

Fractures Hospitals Shock Research 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. Shock 40(6):p 527-531, December 2013. | PMID: 35338337.

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Shock Resuscitation Ultrasounds Research 59

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

ETM Course

MAY 3, 2017

Potential dangers of improvised tourniquets include poor fit, inability to control haemorrhage, un-noticed cuff deflation/device failure leading to re-bleeding and difficulty transporting the patient (intra or inter-hospital) with the device in-situ. Ft Detrick, Maryland: Borden Institute; 2012. References: Kragh J, Kirby J, Ficke J.

Military 52

Military Shock Hospitals Operations 52

Pediatric Emergency Playbook

OCTOBER 1, 2016

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. Give blood for compensated shock, prepare for massive transfusion if giving more than 40 mL/kg total blood products. 2012 Nov 9;2(1):46. 2012 Mar 14;307(10):1072-9.

Pediatrics 52

Pediatrics Wellness Shock Resuscitation 52

The Skeptics' Guide to EM

MARCH 10, 2018

Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. AEM March 2018. AEM March 2018.

Blood Transfusions 40

Blood Transfusions Emergency Department Shock Hospitals 40

Don't Forget the Bubbles

OCTOBER 10, 2024

This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. 2012 Aug 15;(8):CD004872.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

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

Thinking Critical Care

MAY 18, 2023

In 1983 I was an Englishman abroad, the London anaesthetist who was appointed to be the English anaesthetist on the Shock Team only because the outstanding candidate from Oxford had preferred to take up a job doing muscle relaxant research with Kitz and Katz in the USA. 4] The research agenda at the time was broad.

Shock 40

Shock Research Sepsis Resuscitation 40

Pediatric Emergency Playbook

MAY 1, 2017

He will be dehydrated – possibly in shock. Hospital Stay for Healthy Term Newborn Infants. 2012; 129(4). 2012 Aug;130(2):e352-7. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home. He will be irritable. References Benitz WE. Pediatrics. Pediatrics.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

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]. Raised inflammatory markers BMJ 2012; 344 :e454 doi:10.1136/bmj.e454 Gabay C, Kushner I. 2012 Jul 23;2(1):32. Oncotarget.

Infectious Diseases 89

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

PEMBlog

JUNE 5, 2024

2012 Jan 13;61(RR-1):1-20. 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. MMWR Recomm Rep. PMID: 22237112. Resuscitate with volume and blood. 2 percent or less.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

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. 2012 Oct;30(8):1371-7. is more likely to portend death (13, 14). Am J Emerg Med.

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Emergency Department Resuscitation COPD Shock 98

EMDocs

OCTOBER 5, 2024

They are found primarily in hospital specimens but are increasing in frequency in samples from the community. 4 The incidence of ESBL-E identified in bacterial cultures in the United States increased by 53% from 2012 to 2017. Pressors where indicated for septic shock (typically Norepinephrine starting at 0.05

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EMS Infectious Diseases Sepsis Hospitals 93

Don't Forget the Bubbles

DECEMBER 11, 2023

This is shocking, but they discovered a staggering dose-response model when they compared these results with medical histories. Children in hospital and healthcare environments naturally experience many big and unfamiliar emotions, so supporting them through those emotions is a must. doi: [link] Evans, G. doi: [link] Krockow, E.,

Wellness 104

Wellness Research Outcomes Shock 104

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

Pediatric Emergency Playbook

JANUARY 1, 2017

For example, a very anxious caregiver can easily transmit his or her anxiety to the child, which may either inhibit or amplify presentation of symptoms ( Bearden 2012 ). Unexplained tachycardia may be the early signs of shock. Committee on Bioethics and Committee on Hospital Care. 2012 Jul;37(6):680-6. Pediatrics.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

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 93

EMS Fluid Resuscitation Shock EKG/ECG 93

Pediatric EM Morsels

MARCH 7, 2025

2012 Feb;147(2):113-9. Tranexamic Acid Use in United States Children’s Hospitals. 2011 Mar26;377(9771):1096-101, 1101.e1-2. PubMed: 21439633] Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military Application of Tranexamic Acid in TraumaEmergency Resuscitation (MATTERs) Study. Crit Care Explor. 2020;2(1):e0075. J Emerg Med.

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Pediatrics Blood Transfusions Anaphylaxis Military 231

Don't Forget the Bubbles

FEBRUARY 24, 2025

Two-month-old Isla presents to their local hospital following a prolonged apnoea at home. We know that vaccination is key for protection, as there were 63 deaths in just one year before the vaccination was recommended in pregnancy in 2012. 2012 May 7;11(1):70 Berger et al. They had a two-day history of reduced feeding.

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Pediatrics Outcomes Blood Transfusions Sepsis 59

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 94

CDC Sepsis Research Pediatrics 94

RebelEM

DECEMBER 17, 2024

What The Evidence Says: Antipyretics are commonly given to patients with fever suspected to be caused by an infection in both at home and in the hospital setting. A small RCT of 200 patients with septic shock using external cooling found that patients who were cooled had lower vasopressor requirements and a lower 14-day mortality rate.

Sepsis 71

Sepsis Shock EMS Emergency Department 71

Taming the SRU

OCTOBER 31, 2024

Development of a New Screening Tool for Pediatric Septic Shock. Ann Emerg Med 2024; Big Picture Current screening tools for pediatric septic shock and sepsis are highly specific but lack sensitivity. Score ranges from 0-4 points Quick Pediatric Septic Shock Screening Score (qPS4).

Sepsis 72

Sepsis Shock Pediatrics Administration 72

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 73

Dehydration Fluid Resuscitation Sepsis Resuscitation 73

Don't Forget the Bubbles

FEBRUARY 17, 2025

He has been started on timely broad-spectrum antibiotics according to hospital protocol. Volume resuscitation has historically been the first-line therapy for patients in septic shock. Approximately 20% of adults with septic shock in the ICU exhibit venous congestion, with significant implications for prognosis and treatment.[3]

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Pediatrics Ultrasounds Shock Resuscitation 78