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

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. Well, take a step back to start with. Indeed diuresing the hypotensive patient may well be the way to go.

Poisoning 52

Poisoning Wellness Shock 52

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

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. 2015 Jun;11(2):227-31. Check temperature and blood glucose levels. J Toxicol Clin Toxicol.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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 94

Sepsis Documentation/Coding Administration Fractures 94

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

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 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

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

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

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

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. The sudden death of an apparently healthy child is a devastating tragedy, and if it’s preventable, the costs of supine sleep may be worthwhile.

CDC 77

CDC Sepsis Research Pediatrics 77

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 Dehydration EMS Hospitals 75

RebelEM

JANUARY 25, 2024

CHF, in particular, lends itself well to diagnosis and treatment with PoCUS, as it readily reveals the presence of B lines. POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. 2015 Oct;50(4):480-7. Epub 2015 May 22. vs. 18.3%). vs. 74%), consolidation (37.3% Lancet Respir Med.

Ultrasounds 130

Ultrasounds Outcomes COPD Hospitals 130

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

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

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

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

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

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

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

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

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

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. 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.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. You will be running the show today, and you want to use your preparation time well. 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. The trauma call goes out. So, what are your key priorities?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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

Pediatric Emergency Playbook

AUGUST 1, 2017

2015; 18 Gilmore AW et al. 2015 Jun;50(6):923-7 Herliczek TW et al. 2015; 3(5):53-56. Intussusception in Children: Imaging Choices. Semin Roentgenol. 2008; 15-21. Bartocci M et al. Intussusception in childhood: role of sonography on diagnosis and treatment. J Ultrasound. Am J Emerg Med. 2011; 29:1136-1140.:205-211. Janitz et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

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

ETM Course

MAY 3, 2017

2015 Aug;79(2):232-7 Tourniquets also cause compression and ischaemia of the tissues directly under the cuff, which can cause neuropraxia (which may be permanent) and prolonged muscle weakness, although these are also rare complications. 2008 Feb;64(2 Suppl):S38-49 Tourniquet use for civilian extremity trauma. J Trauma Acute Care Surg.

Military 52

Military Shock Hospitals Operations 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Pediatric Emergency Playbook

MAY 1, 2017

Home care The neonate who is safe to go home is well appearing, and not dehydrated. Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

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

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

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