Pediatric Emergency Playbook

FEBRUARY 1, 2020

2014; 1492-1496. Glycocalyx shedding is anhanced by age and correlates with increased fluid requirement in patients with major burns. 2017; 50(1):60-65. Sebastian R et al. Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: The best alternative? 2015; e24-227 Sherren PB et al. Lethal triad in severe burns.

Burns 52

Burns Pediatrics Shock 52

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. 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

PHEM Cast

JULY 14, 2016

Journal of Emergencies, Trauma, and Shock. 2014 Feb 11;7(4):251–5. 2014 Mar 15;31(6):531–40. 2014 Jul 3;14(1):1–5. 2014 Mar 15;31(6):531–40. A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients afternormal cervical spine CT. J Neurotrauma. Emerg Med J.

Fractures 52

Fractures Hospitals Shock Research 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. were more likely to respond.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

EMergucate

DECEMBER 9, 2014

I presented this talk at the ACEM Annual Scientific Meeting 2014 – Wednesday 10/12/14 References Evidence FOR fluid resus … Continue reading →

Sepsis 52

Sepsis Shock 52

Downeast Emergency Medicine

APRIL 5, 2021

Findings from 12-lead electrocardiography that predict circulatory shock from pulmonary embolism: systematic review and meta-analysis. Ann Noninvasive Electrocardiol 2014.[ Electrocardiographic abnormalities in patients with acute pulmonary embolism complicated by cardiogenic shock. Am J Emerge Med 2014.[ Pubmed ]

EKG/ECG 40

EKG/ECG Shock Burns Academics 40

RebelEM

JANUARY 25, 2024

2014 Aug;2(8):638-46. Epub 2014 Jul 3. POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Respir Med. PMID: 24998674. Eur J Intern Med. 2022 Dec;106:9-38.

Ultrasounds 128

Ultrasounds Outcomes COPD Hospitals 128

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. McGraw-Hill Education; 2014. 4 Fluid resuscitation and vasopressor use as appropriate.

Operations 92

Operations Radiology Radiology Fluid Resuscitation 92

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.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. This patient’s severe aortic stenosis (AS) and associated severe cardiogenic shock likely created the ECG pattern, resulting in a very difficult challenge for our inpatient team. Fundamentally, cardiogenic shock is an issue of decreased cardiac output.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 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. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation.

Resuscitation 52

Resuscitation Hospitals Shock CPR 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

AUGUST 1, 2017

J Pediatr Surg 2014; 49:1619. 2014; 8(5):533-541. 2014; 15(4):859-871. 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. Semin Pedaitr Surg. Applegate KE.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

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. This is from the 2014 ACC/AHA guidelines. If it is MI, is it type 1 or type 2? Is it STEMI or NonSTEMI? Is it acute persistent occlusion? Earlier versions are more specific. "A

EKG/ECG 52

EKG/ECG Shock Hospitals Wellness 52

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

Dr. Smith's ECG Blog

OCTOBER 17, 2024

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. There is sinus tachycardia at ~100/minute.

EKG/ECG 73

EKG/ECG EMS Shock Ultrasounds 73

Taming the SRU

AUGUST 30, 2023

According to a 2014 review in the Journal of Rheumatology, PCT may be useful to determine the presence of bacterial infection in patients with rheumatologic disease because it is highly specific for bacterial inflammation, although it lacks sensitivity and should not be used to rule-out bacterial infection. Epub 2014 Dec 3.

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

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.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

EMDocs

NOVEMBER 13, 2024

Management: Patients can rapidly progress to septic shock and multiorgan failure. C (100° F), or if the ascitic fluid ANC is > 250 cells/mm 3 Mortality increases by 8-10% for every hour delay in antibiotics for patients with cirrhosis and septic shock. 2014 Sep;109(9):1436-42. For antibiotics, utilize local antibiogram.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 105

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 98

Infectious Diseases Administration Sepsis Anaphylaxis 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 90

Sepsis Fluid Resuscitation Resuscitation Shock 90

Sensible Medicine

APRIL 29, 2024

This came as a shock to me. Then they applied the specification curve analysis to one specific database—the NHANES (National Health and Nutrition Examination Survey) from 2007 to 2014. The cardiac literature overflows with association studies, but each one uses one analytic method.

Stroke 142

Stroke Documentation/Coding Shock Research 142

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

EMDocs

JULY 15, 2023

However, it must be considered in toxic-appearing patients, those with prosthetic heart valves, artificial joints, or immunocompromised states Clinicians must keep a broad differential and consider other conditions such as necrotizing fasciitis, clostridial myonecrosis, compartment syndrome, toxic shock syndrome, etc. pneumoniae , S.

EMS 91

EMS Infectious Diseases Shock Ultrasounds 91

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

Pediatric EM Morsels

MARCH 17, 2023

J Emerg Trauma Shock. In the US, the venomous snakes include rattlesnakes , copperheads, cottonmouths/water moccasins , and coral snakes [ CDC, 2021 ] Rattlesnakes live all across the United State s Copperheads inhabit the eastern U.S. as far west as Texas Cottonmouths/Water Moccasins live in the southeastern U.S. 2008;1(2):97-105.

CDC 130

CDC Poisoning Pediatrics Shock 130

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. ISPAD Clinical Practice Consensus Guidelines 2014. 2014 Sep;15 Suppl 20:154-79.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 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). 2014 May;145(5):950-957. A thin wall (diameter <5mm) is suggestive of an acute etiology”. RV pressures > LV pressures. doi: 10.1378/chest.13-1087. PMID: 24092475. Marino, P.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

PHEM Cast

FEBRUARY 23, 2017

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! 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

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 CHEST 2010. PMID: 19741062 Kucher N et al. Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. PMID: 24226805 Piazza G et al.

Stroke 136

Stroke Outcomes Hospitals Administration 136

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. 2014) Medscape.com Sullivan, MG (2007) Time Is Critical for Success in Perimortem C-Section ACEP News. 2014) Trauma in the Obstetric Patient: A Bedside Tool. Stafford, I.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

ACEP Now

AUGUST 8, 2023

Methodologic standards for interpreting clinical decision rules in emergency medicine: 2014 update. Ann Emerg Med 2014; 64: 286-291 Phillips B. How to avoid missing an aortic dissection. ACEP NOW 2023; 42 (6): 14. Green SM, Schriger DL, Yealy DM. Clinical decision rules: how to build them. Arch Dis Child Educ Pract Ed 2010; 95: 83-87.

Shock 52

Shock Hospitals Wellness 52

Greater Sydney Area HEMS

APRIL 26, 2023

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). . Halliwill JR, Sieck DC, Romero SA, Buck TM, Ely MR (2014) Blood pressure regulation X: what happens when the muscle pump is lost?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Perhaps, not insignificantly, they were accustomed to receiving systematized government-supplied medical and trauma care, with "shock rooms" receiving an influx of victims, as contrasted to those later who opposed "socialized medicine." Erratum in Mouth-to-Airway [adjunct] 4/22/2014. Committee on Shock.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 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. that was barely statistically significant.

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52