EMDocs

SEPTEMBER 7, 2024

Clinical features include abdominal or flank pain; ecchymosis to the flank, periumbilical region, proximal thighs, or scrotum; and hemorrhagic shock early in the disease course. 2012 Aug;43(2):e157-61. For blunt injury to zone III, an alternative method for hemorrhage control should be pursued (e.g., angioembolization). J Emerg Med.

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EMS Fluid Resuscitation Resuscitation Radiology 97

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.

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Resuscitation Shock Ultrasounds CPR 52

ETM Course

JUNE 28, 2015

Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Intra-Aortic Balloon Occlusion to Salvage Patients with Life-Threatening Hemorrhagic Shocks from Pelvic Fractures J Trauma 2010; 68(4): 942–8 (full article free text) 3. Shock 2014; 41(2): 130–7 12. Martinelli et al.

Hospitals 52

Hospitals Resuscitation Shock Military 52

RebelEM

APRIL 29, 2024

2012 PMID: 21893125. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation. Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins. Resuscitation. 9 Zhang W et al. Medicine (Baltimore).

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Resuscitation Administration Emergency Department Ultrasounds 105

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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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.

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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. 2012; 30:426-431. 2012; 29:231-236 Blakely ML et al. Intestinal Malrotation – Not Just the Pediatric Surgeon’s Problem. J Am Coll Surg. 2004; 199(4):628-635. Lee HC et al. Intestinal Malrotation and Catastrophic Volvulus in Infancy.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

The Skeptics' Guide to EM

DECEMBER 7, 2018

He is unsuccessfully shocked. JAMA 2012 and Cournoyer et al. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation. JAMA 2009, Hagihara et al.

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Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 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.

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Shock Resuscitation Ultrasounds Research 59

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.

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Pediatrics Wellness Shock Resuscitation 52

RebelEM

JANUARY 25, 2023

J Trauma Acute Care Surg 2012; 73(5): S362-9. 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 PMID: 23758299 Maung AA et al.

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

PHEM Cast

JULY 14, 2016

2012 May;37(11):937–42. Journal of Emergencies, Trauma, and Shock. Prasarn ML, Horodyski M, Dubose D, Small J, Del Rossi G, Zhou H, et al. Total Motion Generated in the Unstable Cervical Spine During Management of the Typical Trauma Patient. Gill DS, Mitra B, Reeves F, Cameron PA, Fitzgerald M, Liew S, et al. 2014 Feb 11;7(4):251–5.

Fractures 52

Fractures Hospitals Shock Research 52

The Skeptics' Guide to EM

MARCH 10, 2018

The American College of Chest Physicians published some evidence-based recommendations in 2012 on anticoagulation therapy [1]. shock, a bleeding visible vessel, renal disease, or lack of consent. For the adult management of epistaxis there is something called the Dundee Protocol. We will put a link in the show notes to the protocol.

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Blood Transfusions Emergency Department Shock Hospitals 40

Pediatric Emergency Playbook

MAY 1, 2017

He will be dehydrated – possibly in shock. 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. Critical Care Although rare, the critically ill neonate with hyperbilirubinemia requires immediate intervention. Pediatrics.

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Dehydration Pediatrics Wellness Seizures 52

Don't Forget the Bubbles

OCTOBER 10, 2024

The others, such as respiratory rate, heart rate, and decompensated shock, were excluded due to the presumed difficulty for non-healthcare professionals to assess them accurately. 2012 Aug 15;(8):CD004872. There is a significant misalignment between parent and professional scoring systems. Cochrane Database Syst Rev. PMID: 22895944.

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Taming the SRU

AUGUST 30, 2023

Raised inflammatory markers BMJ 2012; 344 :e454 doi:10.1136/bmj.e454 Gabay C, Kushner I. 2012 Jul 23;2(1):32. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Inflammatory responses and inflammation-associated diseases in organs. Oncotarget. 2017 Dec 14;9(6):7204-7218.

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Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 90

Dr. Smith's ECG Blog

MARCH 15, 2023

We designed a step-up protocol in which shocks at 50, 100, 200, 300, and 360 J were used for transthoracic cardioversion. IF the Patient is Younger and Athletic: The mechanism of AFib in younger, athletic individuals is often heavily influenced by increased vagal tone ( Rao and Shipon — ACC, 2019 — and — Calvo et al — Br J Sports Med, 2012 ).

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EKG/ECG Dehydration Stroke Shock 52

EMDocs

NOVEMBER 13, 2024

Management: Patients can rapidly progress to septic shock and multiorgan failure. C (100° F), or if the ascitic fluid ANC is > 250 cells/mm 3 Mortality increases by 8-10% for every hour delay in antibiotics for patients with cirrhosis and septic shock. 2012; 55:1551-1561. For antibiotics, utilize local antibiogram.

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Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 105

EMDocs

DECEMBER 6, 2024

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. 6 Severe toxicity and shock are typically seen with serum iron concentrations above 500 g/dL and serum iron concentrations above 1000 g/dL are associated with significant mortality. Published 2012 Jul 1.

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Poisoning Fluid Resuscitation Seizures Resuscitation 97

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. O: There was an association between increased diastolic shock index score and mortality at 90 days and performed similarly to more advanced measures of morbidity and mortality in septic shock including lactate levels and SOFA scores.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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%

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Sensible Medicine

SEPTEMBER 11, 2023

Investigators from Leipzig Germany called the trial ECLS-SHOCK. It studied the use of extracorporeal life support in patients with cardiogenic shock due to acute myocardial infarction. ECLS-SHOCK delivered shocking results. Cardiogenic shock often leads to death. First some background. Think pump failure.

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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. Hold off the shock!”

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Shock CPR Hospitals EMS 52

Dr. Smith's ECG Blog

OCTOBER 8, 2023

The patient died of cardiogenic shock within 24 hours despite mechanical circulatory support. The axis is to the right and QRS complexes in lead I and aVL are predominantly negative suggesting LPFB. This patient at cath had a large CX occlusion with a massive troponin release. Troponin T >42.000ng/L.

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Hyperthermia / Hypothermia EKG/ECG Shock Wellness 121

Pediatric Emergency Playbook

JUNE 1, 2017

The Systemic Lupus International Collaborating Clinics (SLICC) revised the criteria in 2012. 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’. 2012; AID 471759. 2012; 7:19796. 2012; 59(13):1123-1133.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 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. In patients with penetrating trauma permissive hypotension may remain useful for longer or at least until a patient can be differentiated and the bleeding controlled. Lots to think about! 2016 Jul;46(1):3–16.

Blood Transfusions 52

Blood Transfusions Head Injuries Resuscitation Radiology 52

EMDocs

OCTOBER 5, 2024

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 They are found primarily in hospital specimens but are increasing in frequency in samples from the community.

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EMS Infectious Diseases Sepsis Hospitals 97

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. 2012)‘How do Different Aspects of Self-Regulation Predict Successful Adaptation to School?’, Two-thirds of patients had experienced at least one ACE, and one in eight had an ACE score of over four. Riviere, E.

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Wellness Research Outcomes Shock 104

Taming the SRU

APRIL 26, 2023

Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. Intensive Care Med 2012. Am Fam Physician 2019; 99:482. Klein Klouwenberg PM, Ong DS, Bonten MJ, Cremer OL. Pileggi DJ, Cook AM. Neuroleptic Malignant Syndrome. Ann Pharmacother 2016.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

Pediatric Emergency Playbook

JANUARY 1, 2016

Be aware that later stages of malrotation may present as shock – they present in hypovolemic shock due to third-spacing from necrotic bowel and/or septic shock from translocation or perforation. 2012; 43(1): e49–e51. Babies may also present unwell, with bloating and abdominal tenderness to palpation. J Emerg Med.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 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.

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Shock Research Sepsis Resuscitation 40

ETM Course

MAY 3, 2017

Ft Detrick, Maryland: Borden Institute; 2012. References: Kragh J, Kirby J, Ficke J. Extremity Injury. In: Savitsky E, Eastbridge B, editors. Combat Casualty Care: Lessons Learned from OEF and OIF. Practical use of emergency tourniquets to stop bleeding in major limb trauma.

Military 52

Military Shock Hospitals Operations 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.

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EKG/ECG Hospitals Shock Documentation/Coding 98

PulmCCM

SEPTEMBER 23, 2021

Guarracino F, Ferro B, Morelli A, Bertini P, Baldassarri R, Pinsky MR: Ventriculoarterial decoupling in human septic shock. Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S et al : Diastolic dysfunction and mortality in severe sepsis and septic shock. European heart journal 2012, 33(7):895-903.

Stroke 40

Stroke Sepsis Shock Ultrasounds 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.

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Emergency Nursing EMS Resuscitation Military 40

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.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

Dr. Smith's ECG Blog

MAY 8, 2023

Annals of Emergency Medicine 2012; 60(12):766-776. Impella (cardiac output augmentation device) placed for cardiogenic shock Unfortunately, the patient progressed to multiorgan failure with worsening cardiac output despite being maxed on pressors and a balloon pump. He expired 4 days later.

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EKG/ECG Documentation/Coding Outcomes Shock 52