ACEP Now

NOVEMBER 7, 2023

Out-of-hospital cardiac arrest unfortunately occurs relatively commonly and emergency physicians must be equipped to diagnose and treat this rapidly. The primary outcome was survival to hospital discharge. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. N Engl J Med.

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Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

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ACEP Now

JUNE 14, 2024

And the Board approved a new clinical policy, “Critical Issues in the Management of Adult Patients Presenting to the ED with Seizures,” rescinding the 2014 clinical policy with same title. Open applications will be coming soon, but you can find out more and get on the interest list today at acep.org/EDap.

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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.

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Dr. Smith's ECG Blog

DECEMBER 14, 2016

The patient had no hypertension, no tachycardia, a normal hemoglobin, no drug use, no hypotension/shock, no murmur of aortic stenosis. What do you want to do now, considering you will need to awaken the hospital's only catheterization team, which must be alert for the next long day in the cath lab? If it is MI, is it type 1 or type 2?

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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. 2014; 14:83.

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Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Methods STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? Knotts et al.

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Pediatric Emergency Playbook

AUGUST 1, 2017

J Pediatr Surg 2014; 49:1619. 2014; 8(5):533-541. Management of the child after enema-reduced intussusception: hospital or home? 2014; 15(4):859-871. Acute Intestinal Obstruction in children: Experience in a Tertiary Care Hospital. J Pediatr Surg 2005; 40:197. Sulkowski JP, Cooper JN, Congeni A, et al. J Emerg Med.

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Dr. Smith's ECG Blog

OCTOBER 17, 2024

The patient had a protracted hospitalization and did not survive. As often emphasized by Dr. Smith — sinus tachycardia is not a common finding with acute OMI unless something else is going on (ie, cardiogenic shock ). Figure-2: From Grauer K: ECG Pocket Brain-2014 ePub — regarding "My Take" on defining the ST segment baseline.

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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]. Epub 2014 Dec 3. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.

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EMDocs

NOVEMBER 13, 2024

Paracentesis performed within 12 hours was associated with lower in-hospital mortality and shorter length of stay when compared to paracentesis performed within 12-72 hours (13% compared to 27%). Management: Patients can rapidly progress to septic shock and multiorgan failure. 2014 Sep;109(9):1436-42. increase in mortality.

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Pediatric EM Morsels

JULY 21, 2023

doi: 10.1136/archdischild-2014-306851. Epub 2014 Sep 8. 2014 Oct;29(10):1299-304. Epub 2014 Feb 13. Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma. Fun fact for animal lovers!- PMID: 31274797. Baldock AJ, Bennett T. 107.498345.

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EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. What are the most up-to-date guidelines for managing this patient?

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RebelEM

MAY 15, 2024

Follow your hospital’s protocol (if available). High Risk Patients will need hospitalization and IV antibiotics. 2014 Aug 21;124(8):1251-8; quiz 1378. doi: 10.1182/blood-2014-02-482612. Epub 2014 May 28. 2014, November 10). 2014 Jul; 58(7): 3799–3803. Neutropenic Fever: Fever (one reading of 38.3C

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RebelEM

JANUARY 29, 2024

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). CHEST 2010. PMID: 19741062 Kucher N et al. PMID: 24226805 Piazza G et al.

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Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

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EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. For those listening, my hospital probably looks a little bit like yours. Roughly half of in-hospital mortality is associated with septic in some fashion. At our hospital in northern Manhattan they like to breath around 18.

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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. Emerg Med J 31(2):93–95, 2014. Lots to think about! References: RePhill Trial Homepage: [link] Smith IM, James RH, Dretzke J, Midwinter MJ. 2016 Jul;46(1):3–16.

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EMDocs

APRIL 22, 2024

1-3 VTE is responsible for hospitalizing over 250,000 Americans every year, and there are an estimated 100,000 deaths annually associated with these conditions. However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). 2014 May;145(5):950-957.

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RebelEM

MARCH 2, 2023

Essentially there was no difference, meaning we wouldn’t expect to find a difference in outcomes Although not patient oriented, why is there no breakdown of how many patients had cardiogenic shock, congestive heart failure, echocardiographic findings, or even troponin levels. Circulation 2014. Low O2 protocol: 3.1%

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ACEP Now

AUGUST 8, 2023

4,5 Relying on a chart review of clinical features, potentially obtained after hospital admission, when the final diagnosis is known is unreliable and inappropriate for creation of a CDR. Methodologic standards for interpreting clinical decision rules in emergency medicine: 2014 update. Ann Emerg Med 2014; 64: 286-291 Phillips B.

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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.

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Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. However, patients in the 1:1 group had the lowest 24-hour mortality ( 14% vs 18% vs 22% vs 24% ; p = 0.01), and in-hospital mortality ( 32% vs 36% vs 40% vs 44% ; p = 0.01). 2014 Sep;45(9):1287-95.

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Greater Sydney Area HEMS

APRIL 26, 2023

– Eventual hospital assessment demonstrated no traumatic injuries. In contrast, shock (leading to syncope and rarely cardiac arrest) from ST can occur well before mechanisms of crush injury come into play, with low-flow states described as early as within 6 minutes (2). . . – Prior to extraction, he was GCS 15 and talking.

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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?

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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.

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PEMBlog

JUNE 5, 2024

2014 May;133(5):e1179-88. 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. Cervical spine injury patterns in children. Pediatrics. doi: 10.1542/peds.2013-3505.

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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. 2014 Apr;133(4):e1104-16. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock.

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Advanced Emergency Nursing from AENJ

MAY 3, 2014

link] Accessed 04/24/2014 ** An Eighteenth-Nineteenth century bellows kit for artificial ventilation, or for insufflating the rectum with tobacco smoke. Wellcome Library, London Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 Committee on Shock. Popularized extrication and spinal immobilization.

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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. 2014 Feb;19(2):168-175. Epub 2014 Jan 3. 2014 Apr;21(2):81-8.

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EMDocs

JANUARY 6, 2024

You review his chart and note that he had a heart transplant in 2014 but has not followed up with a cardiologist for at least 3 years. 1 There are over 50,000 visits related to heart transplant in the United States each year and over half of these patients are admitted to the hospital from the ED.

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Pediatric Emergency Playbook

JANUARY 1, 2017

A special note on codeine : Tylenol with codeine (“T3”) has never been a very effective pain medication, as up to 10% of patients lack enzymatic activity to metabolize it into morphine, its active form ( Crews 2014 ). neutropenia) ( Babl 2011 , Dokko 2014 ). Unexplained tachycardia may be the early signs of shock. Pediatrics.

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RebelEM

NOVEMBER 11, 2024

compared cefepime to piperacillin-tazobactam in a cohort of 250 patients with septic shock and found a signal toward higher mortality in those receiving cefepime. What They Did: Investigators performed a retrospective cohort study in the Emergency Department at the University of Michigan between July 1, 2014 through December 31, 2018.

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PulmCCM

DECEMBER 3, 2024

Maintaining a mean arterial pressure (MAP) of 65 mm Hg has been advised for patients with sepsis and other forms of vasodilatory shock. More than a dozen randomized controlled trials (RCTs) have sought to identify whether higher or lower MAP targets produce better outcomes in critically ill patients with shock. Epub ahead of print.

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Pediatric EM Morsels

FEBRUARY 2, 2024

Hospitalization for travel-related illness are around 10% for both VFR and tourists (Leuthard 2015) Multiple studies have reported the most common travel infections in various countries. 2014 Dec;31(6):678-87. Travel-associated disease among US residents visiting US GeoSentinel clinics after return from international travel.

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Dr. Smith's ECG Blog

FEBRUARY 10, 2025

They presented to a hospital clinic for routine paracentesis, after which they developed nausea and syncope attributed to a vasovagal episode from the procedure. BRASH syndrome: Bradycardia, Renal Failure, AV blockade, Shock, and Hyperkalemia. Labs showed a non-hemolyzed potassium of 6.2, West J Emerg Med 2017. Farkas et al.

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Mind The Bleep

JUNE 17, 2023

A study in 2011 of 258 children admitted to hospital with pneumonia found that 8.5% They may present in hypovalaemic shock On examination you may feel a sausage shaped mass in the right side of the abdomen which crosses the midline. of patients present initially with acute abdominal pain. Review of Abdominal Migraine in Children.

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