Remove 2016 Remove CPR Remove Shock
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Therapeutics: Pacing Through Skin and Vein

Taming the SRU

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. Bektas, Firat, and Secgin Soyuncu. The efficacy of transcutaneous cardiac pacing in ED.”

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SGEM#340: Andale, Andale Get An IO, IO for Adult OHCA?

The Skeptics' Guide to EM

Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. This was the ALPS randomized control trial published in NEJM 2016.

Shock 52
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Electrical injuries

Don't Forget the Bubbles

Was the patient thrown from the source (suggestive of DC shock and may result in further blunt force trauma)? Children, especially toddlers, may insert objects into outlets, leading to shocks or burns. Electrical devices used near water sources can cause severe shocks. Was the voltage high or low (as below)?

Burns 80
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Episode 28: LOST

PHEM Cast

The outcomes from different resuscitative interventions in a haemorrhagic shock model in porcine model: From: Watts et al. 2016; 105: 52-58. Use of CPR in hemorrhagic shock, a dog model. Closed chest compressions reduce survival in a model of haemorrhagic-induced traumatic cardiac arrest. EMJ 2017; 34: 860-900.

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REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

RebelEM

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 Thrombolysis Compared with Heparin for the Initial Treatment of Pulmonary Embolism: A Meta-Analysis of the Randomized Controlled Trials. PMID: 15262836 Sharifi M et al. Pulseless Electrical Activity in Pulmonary Embolism Treated with Thrombolysis (from the “PEAPETT” Study).

Stroke 136
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Cardiac Rhythms/ECG Module

Don't Forget the Bubbles

Stredder et al, Archives of Disease in Childhood 2016 we see that 58% were not asked about triggers, 30% were not asked about duration and, importantly for risk stratification, 59% were not asked for a family history of cardiac disease. For anyone approaching a structured ABC would be a priority to establish whether shock was present or not.

EKG/ECG 98
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What Is the Best Defibrillation Strategy for Refractory Ventricular Fibrillation?

ACEP Now

1 Overall, survival is poor following cardiac arrest, and is affected by factors including age, comorbidities, witnessed arrest, early CPR, early defibrillation, and return of spontaneous circulation (ROSC). 4,5,6 Extracorporeal membrane oxygenation (ECMO) has been studied and found to improve survival after ventricular fibrillation.