Taming the SRU

SEPTEMBER 1, 2023

2015) reported a sensitivity of 98.9% for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al.,

Sepsis 93

Sepsis Administration Documentation/Coding Fractures 93

Don't Forget the Bubbles

DECEMBER 11, 2023

Naturally, it can seem obvious to us now that abuse and trauma in childhood can affect your health and well-being quite significantly, but what was surprising at the time was not just that these events had an impact but how much of an impact these adverse childhood events had. Could there be an element of causation as well as correlation?

Wellness 103

Wellness Research Outcomes Shock 103

EMDocs

NOVEMBER 1, 2023

ECG – May show tachycardia or rate related ST depressions Laboratory evaluation: CBC w/ differential – may reveal leukocytosis with left shift CMP, Lipase – can reveal alternative intra-abdominal diagnoses as well as show findings of end-organ hypoperfusion (elevated serum creatinine, transaminitis, etc.) McGraw-Hill Education; 2015.

Operations 67

Operations Radiology Radiology Fluid Resuscitation 67

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. As well as considering volume, hyponatraemia is a harmful consequence of incorrect administration of fluids. Remember, we can add more if needed, but taking it away is much harder.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

ALiEM

JULY 17, 2023

as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4]. 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.

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).

Sepsis 52

Sepsis Shock Hospitals Outcomes 52

Pediatric Emergency Playbook

OCTOBER 1, 2016

Well appearing? Consider allergic proctocolitis if the child is well. 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. Think -- pink stain, without clot: Infants and Young Children Well appearing?

Pediatrics 52

Pediatrics Wellness Shock Resuscitation 52

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. 2015 May;169(4):492-505. Epub 2015 Mar 30. C or 100.4 mg/kg, max 0.4

Pediatrics 75

Pediatrics EMS Dehydration Hospitals 75

Don't Forget the Bubbles

MAY 6, 2024

The data was collected from a cohort from 2011- 2015 (nearly ten years ago). While the use of oral corticosteroids to treat wheeze in asthma is well-established, evidence for their benefit in viral-induced wheeze is mixed. Criteria for the sepsis scoring systems were not defined explicitly. Why does it matter?

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Taming the SRU

MAY 3, 2023

During the admission, she completed a course of broad-spectrum antibiotics and as the underlying shock state improved, she was also weaned off all vasopressor support. She was noted to have improvement in her underlying respiratory status as well and was extubated approximately three weeks later.

Wellness 52

Wellness Hospitals Shock Outcomes 52

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Mind The Bleep

FEBRUARY 7, 2024

After a red cell transfusion they have some adult Hb which shifts the curve to the right and you then need a high partial pressure of oxygen to saturate well. Well, a baby in a prone position can better equally inflate both lungs, overall compliance of the chest wall is better and the alveoli are better inflated.

Wellness 52

Wellness Sepsis Stroke Shock 52

EM Curious

JULY 1, 2015

More FOAMed HARDWARE MALFUNCTION PACEMAKER AND AICD MANAGEMENT IN THE ED [BLOG]: EM Docs brings us some well needed cardiac hardware meducation on the patient with AICD/pacemaker issues presenting to the ED. Check out this video at the new CORE EM website regarding the tongue blade test to assist with your decision making.

EMS 52

EMS Ultrasounds EKG/ECG Fractures 52

Pediatric EM Morsels

JULY 21, 2023

2015 Feb;100(2):207-8. Systematic review showed 85% of studies with substantial reliability with kappa statistic >0.6 Fun fact for animal lovers!- cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! Nayana Prabha PC, Nalini P, Tiroumourougane Serane V. Indian Pediatr.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

PHEM Cast

JULY 14, 2016

Elsevier Ltd; 2015 Apr 1;46(4):528–35. Crane T, Cooke MW, Wellings R, Wayte S, Higgins J. Journal of Emergencies, Trauma, and Shock. 2015 May;78(5):943–8. Should suspected cervical spinal cord injury be immobilised?: A systematic review. Smyth M, Cooke MW. Emergency Medicine Journal. 2013 May 13;30(6):516–6.

Hospitals 52

Hospitals Fractures Shock Research 52

Dr. Smith's ECG Blog

MAY 8, 2023

There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessively discordant TE in V2-V4. American Heart Journal 170(6):1255-1264; December 2015. Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. He expired 4 days later.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Pediatric Emergency Playbook

FEBRUARY 1, 2016

Protocols work well for adults, but trauma in children requires that we exercise our clinical muscles just a bit more. They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. 2015 Jan;50(1):177-81. 2015 Oct 19. Traumatized children need your full attention. Brenner et al. J Surg Res.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

All went well. Journal of Emergencies, Trauma and Shock, 3(1), 39. Geoff Jara-Almonte, MD and Hilary Fairbrother, MD // Editor: Alex Koyfman, MD Resuscitation of the Pregnant Trauma Patient – Pearls and Pitfalls www.emdocs.net 2/6/2015 Desjardins, G. Not in the textbook, but it worked. Capriola, M.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Pediatric Emergency Playbook

JANUARY 1, 2017

Tachycardia, tachypnea, and a change in behavior can be indicators not only to the presence of pain, but possibly to its etiology as well. For children greater than one year who are preverbal, a well performing scale is the FLACC score: Face, Legs, Activity, Cry, Consolability ( Table 3 ).

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Don't Forget the Bubbles

JANUARY 10, 2024

These were presented as hazard ratios and included fever at presentation, previous transfusion ever, haemoglobinuria, malaria, sickle cell disease on enrolment, HIV, evidence of sepsis, malnutrition, shock, hypothermia, and dehydration. Groups were well matched at baseline. Published 2015 Feb 2. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

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

EB Medicine

MARCH 1, 2019

Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST. Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. Nachi: Definitely.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 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.

Infectious Diseases 86

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 86

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. 1950s & 1960s Resuscitation Research. Trimble, Tom, RN CEN.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

EB Medicine

SEPTEMBER 1, 2018

As some background, from 2006-2015 there were almost 66,000 reported snake exposures and 31 deaths from snake envenomation in the US. You may have heard of the recommendations for incision / excision, use of venom extraction devices, tourniquets, chill methods and even electroshock therapy – well these methods are all OUT.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

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 Wellness Operations 52

Mind The Bleep

JUNE 17, 2023

Examine for capillary refill, peripheral pulses, are they warm and well perfused? The child will be well in between episodes of pain. Brott NR, 2023) The child will look otherwise well and the abdomen will be soft with only mild tenderness to palpation in the lower abdomen with no guarding. Are there crepitations?

Shock 93

Shock Wellness Emergency Department Ultrasounds 93

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. For the sake of completeness, just be aware that there is also the biliopancreatic diversion with or without a duodenal switch, as well as a vertical banded gastroplasty.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. We now have a patient who is in sustained SVT but with no features of shock. Family history. What if this does not work?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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 Jeff: And the etiology of CHS is not well understood. Nachi: There is a well-studied theory here and it relates to the TRPV1 receptor that we talked about earlier. million, and cocaine at 1.9

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EB Medicine

JUNE 6, 2019

For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. Jeff: Well that’s scary - I know I’ve already missed a case, but luckily, he returned thanks to good return precautions, which we’ll get to in a few minutes. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Mind The Bleep

JUNE 17, 2023

Examine for capillary refill, peripheral pulses, are they warm and well perfused? The child will be well in between episodes of pain. Brott NR, 2023) The child will look otherwise well and the abdomen will be soft with only mild tenderness to palpation in the lower abdomen with no guarding. Are there crepitations?

Shock 52

Shock Wellness Emergency Department Ultrasounds 52

EB Medicine

AUGUST 6, 2019

Nachi: Well, I’m sure more of those studies are still coming. Jeff: Edoxaban is up next, approved by the FDA in 2015 for similar indications as the other Factor Xa inhibitors. Nachi: Well that was a ton of information and background on the DOACs. Jeff: That is simply shocking! Jeff: Agree. Let’s also talk lab studies.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EMDocs

JULY 15, 2023

The patient reported feeling better, pain and other symptoms were well controlled 24 hours after starting antibiotics and pain medication. Erysipelas is characteristically nonpurulent , and lymphangitis and regional lymphadenopathy may be present, but these often occur in cellulitis as well. 2015, July 31). pneumoniae , S.

EMS 66

EMS Infectious Diseases Shock Ultrasounds 66

PEMBlog

JUNE 5, 2024

2015 Apr;22(4):441-6. Epub 2015 Mar 16. Infants can get a cervical spine injury during breech delivery or, unfortunately, during non accidental trauma as well. You should also consider the possibility of quote unquote spinal shock. than it is spinal shock. Leonard JC, Jaffe DM, Olsen CS, Kuppermann N.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

EB Medicine

NOVEMBER 1, 2018

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. Pay attention to the entry and exit sites, as the pathway of the shock is predictive of the potential for myocardial injury and arrhythmia. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 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.

EKG/ECG 52

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 52