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. In general, radial artery readings in patients with shock likely underestimate central pressure which can lead to increasing vasopressor dosing. PMID: 35338337. Keville, M.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Pediatric Emergency Playbook

FEBRUARY 1, 2016

REBOA If you have access to resuscitative endovascular balloon occlusion of the aorta or REBOA, this may be an option to temporize the child to get him to the relative control of the operating room. They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. 2015 Jan;50(1):177-81. 2015 Oct 19.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

ETM Course

MAY 3, 2017

Simple windlass-style tourniquets are relatively inexpensive, easy to apply and easy to operate. 2015 Aug;79(2):232-7 Studies comparing different commercially available tourniquets have produced mixed results so no single device can be recommended over another. 2008 Feb;64(2 Suppl):S38-49 Tourniquet use for civilian extremity trauma.

Military 52

Military Shock Hospitals Operations 52

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. That’s a spine or neurosurgery operation. Acad Emerg Med.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

PHEM Cast

SEPTEMBER 6, 2017

You can also see when your treatment is working- if you give a patient in septic shock some fluid and improve their CO, you’ll see a rise in ETC02 You can confirm adequacy of respiratory function in the fitting or post-ictal patient when all other methods fail PITFALLS Device failure- lines blocking, batteries running out, pump failure.

CPR 52

CPR Resuscitation Operations Wellness 52

Pediatric Emergency Playbook

JUNE 1, 2017

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’. Fontan Operation and the Single Ventricle. 2015; 19(2):e107-e109. 2015; AID 953826. 2015; AID 905097. Congenit Heart Dis. 2007; 2:2-11.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. These procedures require an experienced operator. A joint statement released by the American College of Surgeons/American College of Emergency Physicians recommends that zone 1 REBOA should only be performed if the anticipated time to start the operation is less than 15 minutes. c) Or, do both?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Don't Forget the Bubbles

JULY 5, 2023

Afro-Caribbean patients should be screened for sickle cell before anaesthesia for possible pre-operative transfusion. Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. Anemia ; 2015.DOI:10.1155/2015/791498. DOI:10.1155/2015/791498.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EB Medicine

MARCH 1, 2019

Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. In those with severe injury, you may note refractory hypotension secondary to cardiogenic shock. The latter also recommend ED thoracotomy in those with refractory shock.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Pediatric Emergency Playbook

JANUARY 1, 2017

Neonatal observational scales have been validated in the intensive care and post-operative settings; ED-specific quantitative scales are lacking. CRIES ( Table 1 ) was validated for post-operative patients; to adapt its use for the ED, the most conservative approach is to substitute “preoperative baseline” with normal range for age.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

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." Committee on Shock. Mouth-to-Airway (adjunct). Advanced Emergency Nursing Blog.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Taming the SRU

AUGUST 30, 2023

A 2015 prospective, cross-sectional study of 78 Thai patients published in the International Journal of Rheumatic Disease demonstrated a sensitivity of 59% and specificity of 84% for PCT with a cut-off of 0.5 This finding was not significantly different among operators with different levels of experience, or between adults and children.

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

EMDocs

JUNE 3, 2023

4 Patients with pelvic fractures are considered unstable when systolic blood pressure < 90mmHg and heart rate >120bpm, or in those with dyspnea, altered mental status, or skin findings of shock. 12 Patients with pelvic fractures and concerning straddle mechanisms should be thoroughly evaluated for genitourinary injuries.

Fractures 57

Fractures Resuscitation Operations EMS 57

EB Medicine

JUNE 6, 2019

Nachi: Moving on to blood pressure: frank hypotension should make you immediately think of a ruptured AAA or septic shock 2/2 an intra abd infection. You can also use the shock index, which as a reminder is simply the HR/SBP. The greatest value of a lactate level is to detect occult shock and sepsis. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EB Medicine

JULY 8, 2019

Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. These patients often require emergent operative intervention. First up, the kids.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

ALiEM

OCTOBER 30, 2024

We did not use clonidine, despite its known alpha agonist utility in opioid withdrawal, due to the undifferentiated nature of our patients receiving the pathways, not wanting to give an antihypertensive agent to patients who sometimes are experiencing shock and other critical illness. 2015 Apr 28;313(16):1636-44. 2023;29(6):470-476.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

EB Medicine

JANUARY 2, 2019

Jeff: Perhaps most importantly, no history or physical alone can rule in or out an ectopic pregnancy, for that you’ll need testing and imaging or operative findings. A 2015 randomized trial found similar outcomes for IM methotrexate compared to placebo for tubal ectopics. Jeff: Up first is the urine pregnancy test.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

EB Medicine

AUGUST 1, 2018

Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 Make sure that the patient knows not to operate vehicles or heavy machinery under the influence of drugs. Acute effects of synthetic cannabinoids: update 2015. million, and cocaine at 1.9 2015;313(24):2456-2473.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

NOVEMBER 13, 2023

26 With regards to penetrating neck injuries, particularly those in which the platysma is violated, CTA of the neck has allowed a shift away from mandatory operative exploration of Zone 2 neck wounds (those in the mid-neck). However, IgE-mediated or not, anaphylactic shock is possible in either case. Bmj 2015, 351 , h5762.

Stroke 98

Stroke Radiology Radiology Emergency Department 98

EMDocs

JANUARY 16, 2025

Trajectory of Mortality and Health-Related Quality of Life Morbidity Following Community-Acquired Pediatric Septic Shock. 2015 Sep 16;19(1):325. 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 0.92 (95% CI 0.70-0.92)

Sepsis 81

Sepsis Pediatrics Shock Hospitals 81