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.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

PHEM Cast

APRIL 10, 2016

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. Arriving by Emergency Medical Services Improves Time to Treatment Endpoints for Patients With Severe Sepsis or Septic Shock. 2014 Oct 28;:1–9. Elsevier B.V;

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. 2014 Sep;45(9):1287-95. His heart rate is creeping up, now 140.

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Resuscitation Operations Sepsis Pediatrics 139

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. In 2014, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine started a task force, and by 2016, updated definitions were out again! I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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%

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 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 could use it to track treatment , and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults. Clinical Chemistry.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Don't Forget the Bubbles

JANUARY 10, 2024

Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. 3,950 children were recruited between September 2014 to May 2017. Outcomes Primary outcome Mortality at 28 days after randomisation. The authors chose a patient-centred, primary outcome in keeping with their pragmatic design.

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

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. 2014; (38): 1275–1281. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 40

ACEP Now

NOVEMBER 7, 2023

Double sequential external defibrillation (DSED) is a technique in which rapid sequential shocks are placed from two defibrillators, with defibrillation pads in two planes, such as anterior-lateral and anterior-posterior. The primary outcome was survival to hospital discharge. Hershey Medical Center and associate editor of ACEP Now.

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Resuscitation Hospitals Shock CPR 52

RebelEM

JANUARY 25, 2023

Emery Med J 2014; 31(3): 248-9. Small bowel obstruction: Outcome and cost implications of admitting service. 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 PMID: 24532357 Oyasiji T et al.

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Operations Sepsis Resuscitation Ultrasounds 52

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.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Pediatric Emergency Playbook

AUGUST 1, 2017

Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. J Pediatr Surg 2014; 49:1619. 2014; 8(5):533-541. 2014; 15(4):859-871. J Med Genet 2008; 45:1. Hirschsprung's disease.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Epub 2014 Dec 3. Epub 2014 Oct 27. Int J Rheum Dis. 2015 Mar;18(3):352-9. doi: 10.1111/1756-185X.12496.

Infectious Diseases 89

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

EB Medicine

JULY 8, 2019

Jeff: A 2014 study even showed an up to 80% reduction in the likelihood of developing DM2 postoperatively at the 7-year mark. overall, these surgeries are relatively safe with one 2014 review publishing a 10-17% overall complication rate and a perioperative 30 day mortality of less than 1%. 2014(8):CD003641. Am J Emerg Med.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

FEBRUARY 12, 2024

First, there can be a poor correlation between venous and arterial gases in states of shock, hemodynamic instability, or extremes of acid-base disturbances, due to poor cardiac output/circulatory failure impairing venous and arterial flow, with associated poor gas exchange as well as hypercapnia and acidemia at the tissue level (8).

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Emergency Department Resuscitation COPD Shock 98

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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Sepsis Fluid Resuscitation Resuscitation Shock 91

RebelEM

MAY 15, 2024

2014 Aug 21;124(8):1251-8; quiz 1378. doi: 10.1182/blood-2014-02-482612. Epub 2014 May 28. Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Time to antibiotics and outcomes in cancer patients with febrile neutropenia. 2014;14:162.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

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. 10 Dysrhythmias (more commonly ventricular), chest pain, dyspnea, acute CHF and shock are all possible. Reported clinical symptoms range from mild heart failure and palpitations to cardiogenic shock.

EMS 89

EMS Infectious Diseases Shock Emergency Department 89

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.

Sepsis 113

Sepsis Outcomes Administration Shock 113

EMDocs

JUNE 27, 2024

2014 Feb;69(2):144-51. Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. Factors associated with adverse outcome among children with sickle cell disease admitted to the pediatric intensive care unit: an observational cohort.

Pediatrics 97

Pediatrics Dehydration EMS Hospitals 97

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. demonstrating that functional outcome at 3 months did not differ between the CTA and MRI groups (38.5% vs. 38.1%) with a good functional outcome.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Mind The Bleep

JUNE 17, 2023

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. Bluman J, 2014) The abdominal pain is colicky / crampy, intermittent and diffuse, the child may struggle to point to a single area of pain. Review of Abdominal Migraine in Children.

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Shock Wellness Emergency Department Ultrasounds 93

Mind The Bleep

JUNE 17, 2023

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. Bluman J, 2014) The abdominal pain is colicky / crampy, intermittent and diffuse, the child may struggle to point to a single area of pain. Review of Abdominal Migraine in Children.

Shock 52

Shock Wellness Emergency Department Ultrasounds 52

PEMBlog

JANUARY 17, 2024

Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:e10. Full blown sepsis and toxic shock syndrome. Clin Infect Dis 2011; 52:e18. Stevens DL, Bisno AL, Chambers HF, et al. Fortunately, those are rare.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

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. PMID: 39556565.

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Shock Sepsis Outcomes Hospitals 75

EMDocs

JANUARY 16, 2025

Trajectory of Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock. 2014 Oct;31(e1):e19-24. Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. but PPV ranges from 25.1-39.5% 0.38 (95% CI 0.20-0.39) 0.39) AUROC of 0.71-0.92 and PPV of 5.3-7.1%

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Sepsis Pediatrics Shock Hospitals 95

Dr. Smith's ECG Blog

FEBRUARY 10, 2025

Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving Global Outcomes conference. BRASH syndrome: Bradycardia, Renal Failure, AV blockade, Shock, and Hyperkalemia. Eur J Emerg Med 2020. Durfey et al. Severe hyperkalemia: can the electrocardiogram risk stratify for short-term adverse events.

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EKG/ECG Shock Operations Emergency Department 118

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.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. 2014; 349–356. coli and Staphylococcus aureus.

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Blood Transfusions Stroke Dehydration Sepsis 126

Dr. Smith's ECG Blog

MARCH 8, 2025

Several 200 J shocks did not terminate the VF, so a second defibrillator was applied for double sequential defibrillation with 400 J. Was her outcome to be expected for ostial RCA OMI? The catheter was out of the body and the arteriotomy had been closed, so there is no pressure waveform. In the midst of this, she went into VF.

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EKG/ECG CPR Resuscitation Wellness 75

Sensible Medicine

JANUARY 19, 2025

Yet it seems that US public health authorities has simply accepted this as the state of affairs, rather than trying to procure what can explain this absurd disparity in health outcomes. By all health outcome measures, US public health is a complete failure and someone who thinks radically different is needed. So on this point, RFK Jr.

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Administration Pediatrics Research Outcomes 145