RebelEM

APRIL 29, 2024

In these situations, the American Heart Association (AHA) and the European Resuscitation Council (ERC) of 2015 recommend the intraosseous (IO) route after the peripheral route and before the central venous route ( 1). 2015 PMID: 25768683 8 Leidel BA. This can often lead to significant delays in proper resuscitation. Trauma 1996.

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Resuscitation Administration Emergency Department Ultrasounds 105

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. 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’). Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9%

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Pediatric Emergency Playbook

FEBRUARY 1, 2020

2015; 46:870-873. 2015; e24-227 Sherren PB et al. Clinical differences between major burns patients deemed survivable and non-survivable on admisssion. Mathis E et al. Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects. 2017; 4:91. Osuka A et al. 2017; 50(1):60-65. Sebastian R et al. Sebastian R et al.

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Burns Pediatrics Shock 52

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.

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Resuscitation Shock Ultrasounds CPR 52

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. 2015; 12(5):e1001825. This feels intuitive as the IV route seems like it would be stronger, faster, and fix the patient better than the oral route. PLoS medicine.

Infectious Diseases 99

Infectious Diseases Pediatrics EMS Administration 99

ETM Course

JUNE 28, 2015

Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Intra-Aortic Balloon Occlusion to Salvage Patients with Life-Threatening Hemorrhagic Shocks from Pelvic Fractures J Trauma 2010; 68(4): 942–8 (full article free text) 3. J Trauma Acute Care Surg 2015 Apr;78(4):721-8 4.

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Hospitals Resuscitation Shock Military 52

Taming the SRU

JUNE 24, 2024

Follow this algorithm in patients with unstable bradycardia with acute heart failure, change in mental status, or concern for shock, physicians should start with atropine, 1 mg and may be continued every 3 to 5 minutes if effective. MedEdPORTAL Publications; 2015. Circulation , vol. 1103–1104, [link] Cousar J, Bohanske M, Hill J.

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Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

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 2015 Mar;18(3):352-9. They recommended synovial fluid analysis as essential to the diagnosis [30]. Int J Rheum Dis. 2018.09.070.

Infectious Diseases 89

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

PHEM Cast

FEBRUARY 23, 2017

J Trauma Acute Care Surg 78(5):1014–1020, 2015. Prehosp Emerg Care 19(1):1–9, 2015. 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! Prehospital Blood Product Resuscitation for Trauma.

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Blood Transfusions Head Injuries Resuscitation Radiology 52

RebelEM

MARCH 30, 2023

Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. Cerebral unresponsiveness CPC 5: Brain death. Empana, J.-P.,

Hospitals 66

Hospitals Outcomes EKG/ECG Resuscitation 66

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. 2015 Aug 26;:1–31. Elsevier B.V;

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

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.

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Pediatrics Wellness Shock Resuscitation 52

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 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.

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Shock Resuscitation Fluid Resuscitation Sepsis 52

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.

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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 A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. PMID: 26315743 Tapson VF et al.

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Stroke Outcomes Hospitals Administration 136

RebelEM

JANUARY 25, 2024

POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. 2015 Oct;50(4):480-7. Epub 2015 May 22. Lancet Respir Med. 2014 Aug;2(8):638-46. Epub 2014 Jul 3. PMID: 24998674. Kok B, Wolthuis D, Bosch F, van der Hoeven H, Blans M. Eur J Intern Med. 2022 Dec;106:9-38. Epub 2022 Aug 1.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

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; 2015. 4 Fluid resuscitation and vasopressor use as appropriate. 2022;53:29-36.

Operations 93

Operations Radiology Radiology Fluid Resuscitation 93

EM Curious

JULY 1, 2015

ER Cast Part 1 Part 2 SMACC-stalgia SMACC CHICAGO 2015 PEARLS [PODCAST]: Missed SMACC Chicago and want to hear what all the buzz was about? Check out this video at the new CORE EM website regarding the tongue blade test to assist with your decision making. Or maybe just want to reminisce on the great time you had at the conference?

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EMS Ultrasounds EKG/ECG Fractures 52

PHEM Cast

JULY 14, 2016

Elsevier Ltd; 2015 Apr 1;46(4):528–35. Journal of Emergencies, Trauma, and Shock. 2015 May;78(5):943–8. N Engl J Med. 2003 Dec 25;349(26):2510–8. Oteir AO, Smith K, Stoelwinder JU, Middleton J, Jennings PA. Should suspected cervical spinal cord injury be immobilised?: A systematic review. Smyth M, Cooke MW. J Neurotrauma.

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Fractures Hospitals Shock Research 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. A fluid shift, if you will.

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Resuscitation Dehydration Administration Shock 80

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. 2015 Sep;94(39):e1557.

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Shock Resuscitation Ultrasounds Research 59

Downeast Emergency Medicine

APRIL 5, 2021

Findings from 12-lead electrocardiography that predict circulatory shock from pulmonary embolism: systematic review and meta-analysis. Acad Emerge Med 2015. [ Ann Noninvasive Electrocardiol 2015.[ Electrocardiographic abnormalities in patients with acute pulmonary embolism complicated by cardiogenic shock. Pubmed ]

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EKG/ECG Shock Burns Academics 40

The Skeptics' Guide to EM

JUNE 15, 2018

Usually they just shock me and send me home.” comparing diltiazem vs. metoprolol in the management of atrial fibrillation or flutter with rapid ventricular rate in the emergency department ( J Emerg Med 2015 ). I’ve had atrial fibrillation a number of time before. SGEM#133 reviewed a study by Fromm C et al.

Emergency Department 52

Emergency Department Fluid Resuscitation Sepsis Hospitals 52

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

She arrives in the emergency department (ED) with decreased level of consciousness and shock. The paramedics achieve return of spontaneous circulation (ROSC) after CPR, advanced cardiac life support (ALCS), and Intubation. The EKG shows sinus tachycardia with nonspecific changes and no ST segment elevations, Q waves, or hyperacute T waves.

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EKG/ECG Academics EMS CPR 52

AED Leader

SEPTEMBER 22, 2024

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. If it hears a jumbled rhythm that could mean trouble, it’s ready to send a shock. It delivers electric shocks to restore normal heart rhythm.

CPR 52

CPR Shock Operations Hospitals 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. 2015 Jul;115(1):76-83. Epub 2015 May 19. But unfortunately for Ranulf, as Tarquin stood, he slipped on a blob of spilt quince jelly. Lurching awkwardly sideways, Tarquin fell towards his best friend, the knife lunging deep into the left side of his chest. Trauma Surg Acute Care Open.

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Resuscitation Operations Sepsis Pediatrics 139

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.

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EKG/ECG Hospitals Shock Documentation/Coding 98

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.

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Sepsis Shock Research Wellness 45

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

Don't Forget the Bubbles

MAY 6, 2024

The data was collected from a cohort from 2011- 2015 (nearly ten years ago). Criteria for the sepsis scoring systems were not defined explicitly. Data post 30 days was not reviewed, nor was functional health or quality of health outcomes. Is this truly reflective of the current population? Why does it matter?

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Sepsis Pediatrics Outcomes Documentation/Coding 75

Emergency Medicine Ireland

OCTOBER 16, 2023

The incidence of dynamic LVOTO in those with septic shock is remarkably high and is reported to be 20% in one study from ICU echo guru Michel Slama. Even if it’s not that common it’s yet another reason why the super shocked patient should get a timely echo. Critical Care 19 , 1–8 (2015). Chauvet, J.-L.

Sepsis 52

Sepsis Shock Wellness 52

ALiEM

JULY 17, 2023

Match Data The unprecedented numbers of unfilled PGY-1 EM residency training positions in the NRMP Match results shocked the specialty these last two years. In fact, the average number of applicants between 2015-2020 and 2022-2023 were relatively similar, with the latter demonstrating 122 more applicants (2,801 vs 2,923).

EMS 52

EMS Burns Emergency Department Shock 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).

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Sepsis Shock Hospitals Infectious Diseases 52

Emergency Medicine Ireland

MAY 27, 2024

This is a somewhat philosophical approach that reminds us that the PA pressures themselves don’t prognosticate especially well but a failure of flow from right to left will result in cardiogenic shock and death. 65 , 1976–1997 (2015). 31 , 369–385 (2015). Souza, R. & & Humbert, M. Jentzer, J. & Mathier, M.

Poisoning 52

Poisoning Shock Wellness 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. 2015 Oct 19. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. 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

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.

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EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40