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

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 93

Sepsis Shock Resuscitation Fluid Resuscitation 93

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?

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

Stop and Think

MARCH 31, 2024

As I walk through the hospital these days, having looked at the actual evidence for what we do, my brain struggles to resolve the tension between the popularity of treatments vs the dubious evidence. Our main finding was that industry paid doctors more than $12 billion dollars between 2013-2022. Subscribe now So. B as in billions.

Research 138

Research Shock Hospitals 138

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. First aid done pre-hospital. 2013 May;74(5):1363-6. Blood tests: FBC, U&Es, coagulation screen, electrolytes including calcium depending on the chemical involved (see below under ‘Decontamination’). Check temperature and blood glucose levels.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

PHEM Cast

APRIL 27, 2023

– Wiles – 2017 – Anaesthesia Blood pressure management in trauma: from feast to famine?

Resuscitation 52

Resuscitation Shock Operations Hospitals 52

RebelEM

JANUARY 29, 2024

Am J Cardiol 2013. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). JACC Cardiovasc Interv 2018. PMID: 30025734 Sharifi M et al. PMID: 23102885 Aykan AC et al. Clin Exp Emerg Med 2023.

Stroke 136

Stroke Outcomes Hospitals Administration 136

EMDocs

OCTOBER 9, 2023

6 However, due to the vasoconstrictive effects, hydrocortisone may be useful in refractory shock. Published 2013 Aug 15. Corticosteroids in septic shock: a systematic review and network meta-analysis. Given its mineralocorticoid properties, hydrocortisone is traditionally used for adrenal insufficiency. 2013;9(1):30.

Basic Life Support 108

Basic Life Support CPR Fractures Emergency Department 108

PEMBlog

OCTOBER 18, 2023

Neonatal Toxic Shock Syndrome C. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease E. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease The patient was diagnosed with Neonatal Toxic Shock Syndrome-Like Exanthematous Disease (NTED). This patient was hospitalized for 4 days where he remained well-appearing.

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

RebelEM

AUGUST 12, 2024

Hospitals should be cautious in deciding to put their efforts towards them when the data from this trial has actually shown that it works in a diversified patient population such as that which exists in the United States. Contemp Clin Trials. Epub 2022 Aug 28. PMID: 36038001 Levi TM, et al. Rev Bras Ter Intensiva.

Outcomes 81

Outcomes Hospitals Operations Shock 81

PHEM Cast

JULY 14, 2016

2013 May 13;30(6):516–6. Out-of-hospital spinal immobilization: its effect on neurologic injury. 2013 Jul 19;30(8):679–82. 2013 Dec 22;31(1):86–6. Journal of Emergencies, Trauma, and Shock. Elsevier Ltd; 2013 Jan 1;44(1):122–7. Pre-hospital spinal immobilisation: an initial consensus statement.

Fractures 52

Fractures Hospitals Shock Research 52

RebelEM

JANUARY 25, 2024

Interestingly, though not statistically significant, patients in the serial US group had a longer length of hospital stay compared to the control group (4d vs 3d). Additionally, the serial US group had higher hospital readmission rates on days 0-7 and 8-30 without improving hospital or 30-day mortality. R I Med J (2013).

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

PHEM Cast

APRIL 10, 2016

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. Severe Sepsis in Pre-Hospital Emergency Care. 2013 Jun;44(6):1116–25. 2013 Apr;28(2):104–6. 2013 Apr 12;30(5):397–401. 2009;13(5):R167.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Mind The Bleep

DECEMBER 19, 2023

Majority of DKA patients are in a fluid deficit and present acutely with shock. Signs of shock to be mindful for are tachycardia, hypotension, prolonged CRT, pallor, and a weak thready pulse. Fluid boluses are given according to local guidelines, but generally shocked patients should receive a 10ml/kg 0.9% Diabetic Ketoacidosis.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

PHEM Cast

APRIL 16, 2018

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. 2013; 74: 634-8. Effect of adrenaline on survival in out of hospital cardiac arrest: randomised double-blind placebo controlled trial. 2012; 73: 102-10.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

EMDocs

JANUARY 16, 2024

He subsequently walks out of the hospital with a normal neurologic exam two weeks after admission. 10 The score predicts the probability of survival to hospital discharge using a number of factors including CPR duration, serum potassium, core temperature, age, and suspected mechanism of hypothermia. 2013 Jan 24;368(4):394].

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

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. Staged reconstructions are a topic in itself (click here for a nice summary by Children’s Hospital of Philadelphia), but here we focus on Stage 1. 2018;37(7):879-885.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED? ETT onto a fiberoptic scope.

CPR 90

CPR Burns Airway Management Wellness 90

PHEM Cast

FEBRUARY 23, 2017

Weaver AE, Eshelby S, Norton J, Lockey DJ: The introduction of on-scene blood transfusion in a civilian physician-led pre-hospital trauma service. Scand J Trauma Resusc Emerg Med 21(Suppl1):S27, 2013. Lots to think about! References: RePhill Trial Homepage: [link] Smith IM, James RH, Dretzke J, Midwinter MJ. 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. 23: 353–360.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 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. | Gelmann, D.,

Shock 59

Shock Resuscitation Ultrasounds Research 59

Pediatric Emergency Playbook

AUGUST 1, 2017

2013; 95(6): 474-477. 2013; 48:1789-1793. Management of the child after enema-reduced intussusception: hospital or home? 2013; 44(1):53-57. 2013; 200:969-973. 2013; 50:54-86 Intestinal Obstruction Babl FE et al. Mercer AE, Phillips R. Arch Dis Child. 2012; 92:527-39. Peters B et al. 2014; 8(5):533-541.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

JANUARY 10, 2024

Severe anaemia is a common and life-threatening cause of hospital admission in children in sub-Saharan Africa. 8% die in hospital, with a further 12% dying in the six months following discharge. Population 6171 children from three hospitals in Uganda and one in Malawi were assessed for eligibility. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

PulmCCM

JULY 10, 2023

In the MERCY trial, 607 critically ill patients with sepsis (most with septic shock) at 26 hospitals in Croatia, Italy, Kazakhstan, and Russia were randomized to receive meropenem by either continuous (3 g / 24 hours) or intermittent administration (1 g every 8 hours). However, the practice has not been supported by randomized trials.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 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

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]. 2013 Jun 15;13:272. 2013 May;13(5):426-35. Epub 2013 Feb 1. days (secondary endpoint) [51]. Arch Intern Med.

Infectious Diseases 89

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

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. ST elevation (STE) in lead augmented vector right (aVR), coexistent with multilead ST depression, was endorsed as a sign of acute occlusion of the left main or proximal left anterior descending coronary artery in the 2013 STEMI guidelines.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Pediatric Emergency Playbook

FEBRUARY 1, 2016

They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest. 2013 Sep;184(1):352-7. 2013 Jun;48(6):1377-83. Brenner et al. Pediatrics. 2014 Apr;133(4):e1104-16. J Surg Res.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

ACEP Now

OCTOBER 10, 2023

Hospitals should incorporate this approach into clinical practice as part of active management for this serious condition.” Results A total of 7,036 patients were recruited from 121 hospitals that could be included in the modified intention-to-treat analysis. Goal-directed resuscitation for patients with early septic shock.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

ACEP Now

APRIL 3, 2024

1,2 However, the European TTM1 trial in 2013 showed similar outcomes for those cooled to 33 degrees Celsius compared to 36 degrees Celsius, leading to a 2015 AHA class I recommendation of “cooling between 32 degrees Celsius-36 degrees Celsius.” degrees Celsius. 5,6 In 2021, the TTM2 trial was published. degrees C.” Accessed March 26, 2024.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

Dr. Smith's ECG Blog

AUGUST 9, 2019

Hint: patient is in shock and was put on ECMO ST depression in aVR Here is the angiogram from Rohin's case: Case 5. 7) The 2013 ACC/AHA STEMI guidelines consider this a “STEMI equivalent,” where thrombolytic therapy is not contraindicated (Evidence level B, no specific class of recommendation).(16) Which artery? Knotts et al.

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58). Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. Fundamentally, cardiogenic shock is an issue of decreased cardiac output.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

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

Rural Doctors Net

AUGUST 30, 2013

James and Casey are used to this kind of stuff (although Casey’s mostly in-hospital and has even got a CT scanner…James is used to working out of a tent wearing just rabbit skins). Allocate someone to activate ambulance, other clinical personnel, notify local hospital and give retrieval services a head’s up. The CAT will hurt.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

PEMBlog

JUNE 5, 2024

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. Any patient with a cervical spine injury or a neurologic deficit They’re getting admitted to the hospital.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

Pediatric Emergency Playbook

MAY 1, 2017

He will be dehydrated – possibly in shock. Hospital Stay for Healthy Term Newborn Infants. 2013 Apr-Jun; 2(2): 61–69. 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. 2015; 135(5):948-53.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Dr. Smith's ECG Blog

MAY 5, 2022

A few days later an ECG was repeated which showed normal sinus rhythm with no further hyperkalemia findings: After a 3-week hospitalization for acute renal failure, hyperkalemia, and compartment syndrome, the patient was discharged to acute rehab. Physician also reads it as normal) Severe shock, obtunded, and a diagnostic prehospital ECG.

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52