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STREAM-2: Half-Dose Tenecteplase vs Primary PCI in Older Patients with STEMI?

RebelEM

The STREAM-1 trial found that for [2] patients with STEMI presenting within 3 hours of symptom onset and unable to attain PCI within 1 hour of first medical contact, a pharmaco-invasive strategy resulted in similar rates of death, shock, heart failure, or reinfarction compared to primary PCI. Primary PCI: 95.7% Primary PCI: 95.7%

EKG/ECG 138
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Approach to Shock

Pediatric Emergency Playbook

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
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The Latest in Critical Care, 7/10/23 (Issue #8)

PulmCCM

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
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REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

RebelEM

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 137
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Heat-Related Illness

Pediatric Emergency Playbook

2013 Jul-Aug; 48(4): 546–553. Heat illness and heat stroke. J Athl Train. DeFranco MJ et al. Environmental issues for team physicians. Am J Sports Med. 2008 Nov;36(11):2226-37. Ishimine P. Hyperthermia. In: Pediatric Emergency Medicine, Baren JM, Rothrock SG, Brennan JA, Brown L (Eds), Saunders Elsevier, Philadelphia 2008. Jardine DS.

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Big Labs, Little People

Pediatric Emergency Playbook

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. 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.

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How To Manage Tracheo-Innominate Fistula

ACEP Now

2013:1960-62. Tracheoinnominate fistula: acute bleeding and hemorrhagic shock due to a trachea-innominate artery fistula. Tracheo-innominate artery fistula after stroke. The evolution of tracheal injury due to ventilatory assistance through cuffed tubes: a pathologic study. 169:334-48. Quereshi AZ. Ann Thorac Cardiovasc Surg.