Sensible Medicine

OCTOBER 21, 2024

It was a small study at one hospital. CAST shocked the world of cardiology because suppression of rhythm disturbances after MI had been an accepted practice. I was shocked at how many people said that they read Sensible Medicine. The story begins in Nottingham UK in 1980. But its lessons are large. First the background.

Evidence-Based Practice 112

Evidence-Based Practice Shock Fractures Outcomes 112

RebelEM

JANUARY 9, 2024

Except for patients with poor gut absorption or those with critical infectious processes such as septic shock or necrotizing fasciitis, this belief appears to be unfounded. The use of oral temafloxacin compared with a parenteral cephalosporin in hospitalized patients with pneumonia. 2015; 12(5):e1001825. 2001; 111(5):367-74.

Infectious Diseases 99

Infectious Diseases Pediatrics EMS Administration 99

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. First aid done pre-hospital. 2015 Jun;11(2):227-31. Blood tests: FBC, U&Es, coagulation screen, electrolytes including calcium depending on the chemical involved (see below under ‘Decontamination’). Check temperature and blood glucose levels.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

RebelEM

JANUARY 25, 2024

Interestingly, though not statistically significant, patients in the serial US group had a longer length of hospital stay compared to the control group (4d vs 3d). Additionally, the serial US group had higher hospital readmission rates on days 0-7 and 8-30 without improving hospital or 30-day mortality. Lancet Respir Med.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

RebelEM

JANUARY 29, 2024

JACCC Cardiovasc Interv 2015. 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). PMID: 26315743 Tapson VF et al.

Stroke 136

Stroke Outcomes Hospitals Administration 136

PHEM Cast

APRIL 16, 2018

It might be better to consider traumatic cardiac arrest as a completely different disease eg LOST: Low Output State due to Trauma The 2015 European Resuscitation Council and UK Resuscitation Council Algorithms for Traumatic Cardiac Arrest: To read the whole ERC guideline on special circumstances cardiac arrest including trauma, click here.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

ALiEM

OCTOBER 30, 2024

Clinical impact: Rather than arguing with the patient about the likelihood of this phenomenon occurring and whether this is a true allergy, the patient is informed that they do not need to immediately start treatment to receive care in the hospital. 2015 Apr 28;313(16):1636-44. PMID 25919527 Sue KL, Cohen S, Tilley J, Yocheved A.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

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. Severe Sepsis in Pre-Hospital Emergency Care. 2015 Aug 26;:1–31. 2015 Oct 17;:1–16. 2015 Apr 24;:1–10. 2009;13(5):R167. 2014 Oct 28;:1–9.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Don't Forget the Bubbles

JULY 26, 2023

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

PHEM Cast

FEBRUARY 23, 2017

J Trauma Acute Care Surg 78(5):1014–1020, 2015. Prehosp Emerg Care 19(1):1–9, 2015. Weaver AE, Eshelby S, Norton J, Lockey DJ: The introduction of on-scene blood transfusion in a civilian physician-led pre-hospital trauma service. Lots to think about! Prehospital Blood Product Resuscitation for Trauma. 2016 Jul;46(1):3–16.

Blood Transfusions 52

Blood Transfusions Head Injuries Resuscitation Radiology 52

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp! Am J Emerg Med.

Operations 93

Operations Radiology Radiology Fluid Resuscitation 93

The Skeptics' Guide to EM

JUNE 15, 2018

Implementation of a Novel Algorithm to Decrease Unnecessary Hospitalizations in Patients Presenting to a Community Emergency Department With Atrial Fibrillation. AEM June 2018 Guest Skeptic: Dr. Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario.

Emergency Department 52

Emergency Department Fluid Resuscitation Sepsis Hospitals 52

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. She arrives in the emergency department (ED) with decreased level of consciousness and shock. Date: September 8th, 2021 Reference: Desch et al. The TOMAHAWK Investigators.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

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]. . + Procalcitonin (PCT) Etiology: PCT was first discovered in 1984. However, it was not until a 1993 study that its significance was realized.

Infectious Diseases 89

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

PHEM Cast

JULY 14, 2016

Elsevier Ltd; 2015 Apr 1;46(4):528–35. Out-of-hospital spinal immobilization: its effect on neurologic injury. Journal of Emergencies, Trauma, and Shock. Connor D, Greaves I, Porter K, Bloch M, consensus group Faculty of Pre-Hospital Care. Pre-hospital spinal immobilisation: an initial consensus statement.

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.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Don't Forget the Bubbles

NOVEMBER 15, 2023

She had septic shock on presentation and was resuscitated with 60ml/kg of balanced crystalloid solution and escalating vasoactive medications. A 2015 study published in the Lancet demonstrated a reduction in hyponatraemia by adopting an isotonic strategy compared with a hypotonic strategy. Ann Intensive Care. Ann Intensive Care.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

Pediatric Emergency Playbook

OCTOBER 1, 2016

It is important to note that 15% of necrotizing enterocolitis occurs in full-term babies; malrotation can present simply in shock, without initial overt bleed. Give blood for compensated shock, prepare for massive transfusion if giving more than 40 mL/kg total blood products. 2015 Jul;17(7):27. 2015 Nov;13(12):2109-17.

Pediatrics 52

Pediatrics Wellness Shock Resuscitation 52

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. 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). 2015 Jul;115(1):76-83. Epub 2015 May 19. Trauma Surg Acute Care Open. Br J Anaesth. doi: 10.1093/bja/aev134.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Don't Forget the Bubbles

MAY 6, 2024

807 patients between the ages of 7 days to 17 years, from the ED, ward and PICU, were included across ten hospitals in Switzerland. The data was collected from a cohort from 2011- 2015 (nearly ten years ago). Prednisolone was associated with a greater reduction in WSS at 4 hours and reduced length of hospital stay.

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

AED Leader

SEPTEMBER 22, 2024

Portable defibrillators have become game-changers in saving lives during sudden cardiac arrest situations outside the hospital. They check the heart’s rhythm and send a shock to help it beat right again. It checks the heart’s rhythm and sends a shock if needed to get it beating right again. The neat part?

CPR 52

CPR Shock Operations Hospitals 52

RebelEM

OCTOBER 31, 2022

Burke 2015) Subgroup analysis can lead to “false positives due to multiple comparisons, false negatives due to inadequate power, and limited ability to inform individual treatment decisions because patients have multiple characteristics that vary simultaneously.” Chest 2017; 151:1229-38. PMID: 27940189 Fujii T, Salanti G, Belletti A, et al.

Sepsis 52

Sepsis Outcomes Research Shock 52

Taming the SRU

FEBRUARY 19, 2024

A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. Arterial lines require specialized monitoring and nursing resources which are not available in all hospital settings. Shock 40(6):p 527-531, December 2013. | PMID: 35338337.

Shock 59

Shock Resuscitation Ultrasounds Research 59

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?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

PulmCCM

DECEMBER 11, 2024

An excellent review article titled “Sepsis and Septic Shock” was published 4 December 2024 in the New England Journal of Medicine. It’s a wonderful contribution to the literature and well worth reading. But it feels like something important was missed, or misplaced.

Sepsis 45

Sepsis Shock Research Wellness 45

ETM Course

MAY 3, 2017

Potential dangers of improvised tourniquets include poor fit, inability to control haemorrhage, un-noticed cuff deflation/device failure leading to re-bleeding and difficulty transporting the patient (intra or inter-hospital) with the device in-situ. 2015 Aug;79(2):232-7 J Trauma Acute Care Surg.

Military 52

Military Shock Hospitals Operations 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2015; 18 Gilmore AW et al. Management of the child after enema-reduced intussusception: hospital or home? 2015 Jun;50(6):923-7 Herliczek TW et al. Acute Intestinal Obstruction in children: Experience in a Tertiary Care Hospital. 2015; 3(5):53-56. J Ultrasound. Am J Emerg Med. 2011; 29:1136-1140.:205-211.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Pediatric Emergency Playbook

FEBRUARY 1, 2016

They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. 2015 Jan;50(1):177-81. Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest. 2015 Oct 19. Brenner et al. described a case series of 6 patients from two Level I trauma centers.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

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.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

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.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Taming the SRU

MAY 3, 2023

CLINICAL CASE: History of Present Illness: An elderly female initially presented to an outside hospital with a variety of respiratory symptoms and was subsequently diagnosed with COVID-19 pneumonia. For a complete discussion of cardiogenic shock and right ventricular failure, please see this other Air Care Series post on the subject.

Wellness 52

Wellness Hospitals Shock Outcomes 52

ACEP Now

APRIL 3, 2024

1,2 However, the European TTM1 trial in 2013 showed similar outcomes for those cooled to 33 degrees Celsius compared to 36 degrees Celsius, leading to a 2015 AHA class I recommendation of “cooling between 32 degrees Celsius-36 degrees Celsius.” degrees Celsius. 5,6 In 2021, the TTM2 trial was published. degrees C.” Accessed March 26, 2024.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

EB Medicine

NOVEMBER 1, 2018

It was peer reviewed by Dr. O’Keefe and Dr. Silverberg from Florida State University College of Medicine and Kings County Hospital, respectively. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. Thankfully, fatalities are declining, with just 565 in 2015. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

PEMBlog

JUNE 5, 2024

2015 Apr;22(4):441-6. Epub 2015 Mar 16. 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. Leonard JC, Jaffe DM, Olsen CS, Kuppermann N. Acad Emerg Med.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

Pediatric Emergency Playbook

MAY 1, 2017

He will be dehydrated – possibly in shock. Hospital Stay for Healthy Term Newborn Infants. 2015; 135(5):948-53. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home. He will be irritable. References Benitz WE. Pediatrics. Bhutani V et al. Pediatrics.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

EB Medicine

JUNE 6, 2019

Taylor and Shaukat of Emory and Coney Island Hospital respectively for their efforts in peer reviewing this huge topic. Jeff: An interesting question for your abdominal pain patient is to ask about the ride to the hospital. You can also use the shock index, which as a reminder is simply the HR/SBP. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40