EMDocs

DECEMBER 1, 2024

The disease is generally mild, but in untreated cases, it can lead to more severe outcomes, especially in patients with underlying conditions such as glucose-6-phosphate dehydrogenase deficiency. Even though the disease often resolves spontaneously, prompt antibiotic therapy is essential for optimal outcomes. 2016 Oct;29(5):433-9.

EMS 83

EMS Infectious Diseases Shock Resuscitation 83

Taming the SRU

JANUARY 10, 2024

Phenobarbital has been proven to be equivalent to benzodiazepines with regard to clinical, pharmacologic and utilization outcomes. Therefore this should remain high on the differential if a patient with history of SCAD presents with similar symptoms. Phenobarbital should be dosed based on IBW and patient risk factors.

EKG/ECG 92

EKG/ECG Shock Fractures Emergency Department 92

RebelEM

AUGUST 14, 2023

in both groups Mean APACHE II score was 12 in both groups Almost half of the patients had septic shock at enrollment Mean time from sepsis identification to randomization was 1.4 Secondary Outcome Results: ICU mortality: placebo 20.0% The primary outcome was patient oriented. 906 randomized to the Placebo cohort.

Sepsis 98

Sepsis Outcomes Administration EMS 98

RebelEM

JUNE 8, 2023

Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Don't Forget the Bubbles

OCTOBER 7, 2024

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

Burns Fluid Resuscitation Shock Resuscitation 80

The Skeptics' Guide to EM

AUGUST 14, 2021

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.

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Shock CPR Hyperthermia / Hypothermia EMS 52

EMDocs

NOVEMBER 13, 2024

Older age, recurrent episodes of SBP, hepatorenal syndrome, hepatic encephalopathy, acute kidney injury (AKI), concurrent GI bleeding, and higher MELD scores are predictors of worse outcomes. Management: Patients can rapidly progress to septic shock and multiorgan failure. 2016; 63:1299-1309. coli (50-90% of cases). Hepatology.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 80

PHEM Cast

APRIL 16, 2018

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. Survival and neurological outcome after OOH TCA in pediatric & adult populations: a systematic review. 2012; 73: 102-10.

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Resuscitation Shock Ultrasounds CPR 52

RebelEM

APRIL 29, 2024

Given AHA guidelines recommend early epinephrine administration in cardiac arrest, obtaining access is imperative for resuscitative efforts ( 9) When evaluating over 300,000 out-of-hospital cardiac arrests, a meta-analysis found no significant change in primary outcomes when IV and IO access were compared ( 10 ). Resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Don't Forget the Bubbles

JULY 26, 2023

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

EKG/ECG Hospitals Shock Documentation/Coding 98

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. Injury 2016; 47: 797– 804. J Pediatr Surg.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. In 2014, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine started a task force, and by 2016, updated definitions were out again! I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

PHEM Cast

APRIL 10, 2016

March 2016. This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. Arriving by Emergency Medical Services Improves Time to Treatment Endpoints for Patients With Severe Sepsis or Septic Shock. 2009;13(5):R167.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

EMDocs

DECEMBER 6, 2024

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. 6 Severe toxicity and shock are typically seen with serum iron concentrations above 500 g/dL and serum iron concentrations above 1000 g/dL are associated with significant mortality. McGraw Hill; 2016.

Poisoning 77

Poisoning Fluid Resuscitation Seizures Resuscitation 77

Intensive Blog

FEBRUARY 7, 2023

Despite thromboaspiration, she had recurrent VF arrests with worsening cardiogenic shock (CS), so an Impella CP (Abiomed, Danvers, MA) was inserted through the right femoral artery for left ventricular (LV) support. Figure 1: The development of LV Distension syndrome on VA ECMO (adapted from Amarelli et al (2016) 15 Q5. Eur Heart J.

Shock 52

Shock Hospitals Operations Outcomes 52

Don't Forget the Bubbles

JANUARY 10, 2024

Some wonder if giving blood to children with a haemoglobin <6g/dl will improve outcomes. Outcomes Primary outcome Mortality at 28 days after randomisation. The authors chose a patient-centred, primary outcome in keeping with their pragmatic design. What were the research questions? The study asked TWO questions: 1.

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

EMDocs

JUNE 27, 2024

2016 Dec;91(12):1185-1190. Epub 2016 Oct 3. Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. Am J Hematol. PMID: 27543812. Ilonze C, Rai P, Galadanci N, Zahr R, Okhomina VI, Kang G, Padmanabhan D, Lebensburger J, Alishlash AS.

Pediatrics 76

Pediatrics Dehydration EMS Hospitals 76

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. Damping Damping is essentially the shock absorbers in the pressurized system. Keville, M.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Pediatric Emergency Playbook

APRIL 1, 2016

There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We could use it to track treatment , and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults. 2016; 417: 54–56.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

EMDocs

DECEMBER 23, 2024

Do we still shock? Gorgels et al (5) looked at procainamide vs lidocaine and again and primary outcome was VTach termination. After a little bit of etomidate and a quick shock, the patient was back in normal sinus rhythm and cardiology was consulted for evaluation. Epub 2016 Oct 15. Are there any meds you can give?

EKG/ECG 64

EKG/ECG Wellness Shock EMS 64

Emergency Medicine Ireland

OCTOBER 30, 2023

A somewhat underwhelming start Second is the VANISH trial by Gordon et al, JAMA 2016. Primary outcome here was kidney based rather than mortality. Vasopressin versus norepinephrine infusion in patients with septic shock. Jama 316 , 509–518 (2016). This was closer to home in the UK, with 18 ICUs. Gordon, A. Nagendran, M.

Shock 52

Shock Sepsis Wellness Outcomes 52

Don't Forget the Bubbles

MAY 10, 2023

A shocked friend is being ushered out of the way. 2016; 24(135): 1-10.DOI: The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre. A teenager lies on the resus trolley. They’re getting CPR. Your eyes are drawn to their chest. They have been stabbed. Andenæs, E.,

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

Pediatric Emergency Playbook

AUGUST 1, 2017

2016; 13:590-600. Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Eur J Pediatr Surg 2016; 26:192. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. 2016; 5(1):5-12. Necrotizing Enterocolitis. N Eng J Med. Niño DF et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax, 1968-2016. J Emerg Trauma Shock. Eur Respir Rev. Ann Emerg Med.

Fractures 95

Fractures COPD Hospitals Emergency Department 95

RebelEM

SEPTEMBER 26, 2022

What They Did Single-center randomized controlled study design performed by the Department of Hepatology & Liver transplantation in New Delhi Study participants, investigator clinicians, data collectors, and data analysts were blinded Investigators recruited participants from February 27, 2016 – March 3, 2018.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

These indices would have reinforced the clinical decision progress and avoided bad outcomes from unsuccessful estimates. An elderly lady in cardiogenic shock (BP 60/40) with no veins , I was lucky to get a 24-gauge PIV into the back of her wrist. So much more than just a BP cuff and a rhythm monitor. Intraosseous Infusion.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

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. McGraw Hill; 2016. Published 2016 May 18. Management and outcomes of open pelvic fractures: An update. Pelvis Injuries.

Fractures 54

Fractures Resuscitation Operations EMS 54

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. 2016 Dec;115(6):317-21. 2016 Aug 23;134(8):e113. PMID: 29094869. Brigden ML. Am Fam Physician. Circulation.

Infectious Diseases 87

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

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Many of these issues were described in a prior post by Dr. Angie Lobo ( @aloboMD ) (For open-access reviews of this literature, see Saw 2016 , Saw 2017 , or Hayes 2018.) were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock. Lobo et al. examined SCAD presenting as STEMI (unlike Hassan et al.

EKG/ECG 52

EKG/ECG Wellness Shock Ultrasounds 52

EB Medicine

JULY 8, 2019

While it was < 15% in 1990, by 2016 it reached 40%. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. Nachi: Recent estimates from 2015-2016 put the prevalence of obesity of those 2 years old to 19 years old at about 19%. Jeff: Well that’s kind worrisome.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EB Medicine

JUNE 6, 2019

Nachi: For more information on HIV and its management, check out the February 2016 issue of Emergency Medicine Practice , which covered this and more in depth. Nachi: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Don't Forget the Bubbles

MARCH 4, 2024

This study retrospectively identified 1,414 children, presenting to 15 UK EDs (2016 -2017), who had been screened for malaria. This was a secondary outcome embedded in the Travel Fever study – a multi-centre, retrospective diagnostic accuracy study for imported malaria. Schlapbach LJ, Watson RS, Sorce LR, et al. doi:10.1001/jama.2024.0179

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

PulmCCM

DECEMBER 3, 2024

Maintaining a mean arterial pressure (MAP) of 65 mm Hg has been advised for patients with sepsis and other forms of vasodilatory shock. More than a dozen randomized controlled trials (RCTs) have sought to identify whether higher or lower MAP targets produce better outcomes in critically ill patients with shock. PMID: 39556565.

Shock 75

Shock Sepsis Outcomes Hospitals 75

EMDocs

FEBRUARY 12, 2024

First, there can be a poor correlation between venous and arterial gases in states of shock, hemodynamic instability, or extremes of acid-base disturbances, due to poor cardiac output/circulatory failure impairing venous and arterial flow, with associated poor gas exchange as well as hypercapnia and acidemia at the tissue level (8).

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric 87

Psychiatric Seizures Emergency Department Pediatrics 87