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.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Pediatric Emergency Playbook

MARCH 1, 2016

On arrival, he was in compensated shock, with tachycardia. Resuscitative Pearls Our goal here is damage control. Otherwise, resuscitate, identify the bleeding source, and slow or stop the bleeding with blood products or surgery. 2014 Apr;63(4):460-2. 2014 Aug;49(8):1295-9. He decompensates and needs blood.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

PHEM Cast

FEBRUARY 23, 2017

Prehospital Blood Product Resuscitation for Trauma. Emerg Med J 31(2):93–95, 2014. 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

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

EMDocs

NOVEMBER 1, 2023

6 Treatment : Airway Definitive airway management should be performed in those with respiratory distress with attention to appropriate resuscitation started beforehand in the setting of potential distributive shock from mediastinitis. 4 Fluid resuscitation and vasopressor use as appropriate. McGraw-Hill Education; 2014.

Operations 86

Operations Radiology Radiology Fluid Resuscitation 86

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! Patient’s need adequate fluid resuscitation.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

EMDocs

APRIL 22, 2024

However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). During this resuscitation two different ultrasound machines were used to capture images due to a malfunction with the first machine after initial images were captured. doi: 10.1378/chest.13-1087.

Ultrasounds 97

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Shock 97

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

The latter 1950s and 1960s, quested for nerve gas defense studying expired air resuscitation and modern resuscitology; developing intensive care units. To me, it harkens a new scientific renaissance of resuscitation science, emergency care, and creating systems for care. 1950s & 1960s Resuscitation Research.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

2014) Emergency Care Institute, New South Wales. 2014) Tiny Tip: PRE -eclampsia. Journal of Emergencies, Trauma and Shock, 3(1), 39. Reid, C (2011) Prehospital resuscitative hysterotomy op.cit. 2014) Medscape.com Sullivan, MG (2007) Time Is Critical for Success in Perimortem C-Section ACEP News. Stafford, I.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Pediatric Emergency Playbook

AUGUST 1, 2017

J Pediatr Surg 2014; 49:1619. 2014; 8(5):533-541. J Pediatr Surg 2005; 40:197. Sulkowski JP, Cooper JN, Congeni A, et al. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. Pyloric Stenosis Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. Fundamentally, cardiogenic shock is an issue of decreased cardiac output. In the cath lab, the patient’s blood pressure remained low.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

RebelEM

JANUARY 25, 2023

Emery Med J 2014; 31(3): 248-9. 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 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 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. 2014; 14:83.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 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

JUNE 1, 2017

Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. 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’. 2014; 14(1): 23-227. 2014; 5(4)L631-634.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

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. Resuscitate with volume and blood. And hypotension, bradycardia, or temperature instability can result from hemorrhagic and or spinal shock. Cervical spine injury patterns in children.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

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).

Emergency Department 98

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?

Sepsis 83

Sepsis Fluid Resuscitation Resuscitation Shock 83

RebelEM

MAY 15, 2024

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 Give appropriate fluids, vasopressors, and antibiotics. Raad, II, et al., Gibson C, Berliner N. Eur J Haematol 2005; 75:1.

Infectious Diseases 90

Infectious Diseases Administration Sepsis Anaphylaxis 90

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. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Resuscitation.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

ACEP Now

OCTOBER 10, 2023

Goal-directed resuscitation for patients with early septic shock. Published November 10, 2014. ARISE Investigators; ANZICS Clinical Trials Group; Peake SL, et al. N Engl J Med. 2014;371(16):1496-506. The adventure of the cardboard box. EMCrit website. link] Published June 30, 2013. Accessed September 17, 2023. Spiegel R.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

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 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Intensive Blog

FEBRUARY 9, 2023

2014, Jan). Vasopressors such as noradrenaline are often required (systemic vasodilation is common in hepatic failure). Disability- treat hypoglycaemia if present. Supportive care and monitoring Prioritise short-acting agents, avoid medications that accumulate in hepatic failure Usually ICU measures (e.g. Silibinin [link] Warrillow, S.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

EMDocs

JUNE 27, 2024

2014 Feb;69(2):144-51. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

Pediatrics 94

Pediatrics Dehydration EMS Hospitals 94

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. Andrews et al.

Dehydration 73

Dehydration Fluid Resuscitation Sepsis Resuscitation 73

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. During the resuscitation, she received amiodarone 450 mg IV, lidocaine 100 mg IV, and magnesium 6 g IV. In the midst of this, she went into VF. The patient developed electrical storm with recurrent VF.

EKG/ECG 77

EKG/ECG CPR Resuscitation Wellness 77

Don't Forget the Bubbles

OCTOBER 9, 2023

It shocked me how big an effect this expert had on the teams, especially given the studied teams usually worked together and had an average of seven years of neonatal experience. I was shocked by the way I had been spoken to, scared about breaking the baby, and felt out of my depth. That was the end of the conversation. and Ramsel D.

Seizures 116

Seizures Incident Reporting Research Emergency Department 116

Advanced Emergency Nursing from AENJ

SEPTEMBER 13, 2015

When: The patient needs airway control for resuscitation of mother or child, emergent surgery for maternal or fetal indications; block cannot be effected or would be unsafe. The concept of post-mortem caesarian delivery is being supplanted by ante -mortem resuscitative uterine extraction to save both mother and child. May 24, 2014.

Airway Management 40

Airway Management Resuscitation Critical Access Emergency Nursing 40

EMDocs

JANUARY 6, 2025

Based on available hospital resources, the patient is treated for septic shock secondary to pneumonia and an infected wound using broad-spectrum antibiotics and IV crystalloid fluids. She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI.

Infectious Diseases 72

Infectious Diseases CDC PPE Rapid Diagnostic Testing 72