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.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

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.

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Resuscitation Administration Emergency Department Ultrasounds 105

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

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

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.

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Shock Operations Hospitals Outcomes 52

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

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.

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Shock Resuscitation Ultrasounds Research 59

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

ACEP Now

NOVEMBER 7, 2023

Double sequential external defibrillation (DSED) is a technique in which rapid sequential shocks are placed from two defibrillators, with defibrillation pads in two planes, such as anterior-lateral and anterior-posterior. The primary outcome was survival to hospital discharge. 2020;396(10265):1807-1816. Pacing Clin Electrophysiol.

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Resuscitation Hospitals Shock CPR 52

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

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

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 89

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

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 Shock Ultrasounds Wellness 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

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 105

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 105

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. Fun fact for animal lovers!-

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. O: There was an association between increased diastolic shock index score and mortality at 90 days and performed similarly to more advanced measures of morbidity and mortality in septic shock including lactate levels and SOFA scores.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

RebelEM

NOVEMBER 30, 2023

Current SSC guidelines recommend fluid resuscitation with at least 30mL/kg IV crystalloid in patients with sepsis induced hypoperfusion or septic shock within the first three hours of resuscitation, regardless of comorbidities. Outcomes: Primary Outcome: In-hospital mortality. 2.89, p = 0.01. times more intubations and 2.15

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Sepsis Fluid Resuscitation Resuscitation Administration 121

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 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. What are the most up-to-date guidelines for managing this patient?

Sepsis 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

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.

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Sepsis Outcomes Administration EMS 98

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 136

Stroke Outcomes Hospitals Administration 136

Don't Forget the Bubbles

APRIL 7, 2025

Early recognition of these signs is crucial, as timely hormone replacement can significantly improve outcomes. Early identification and treatment can significantly improve long-term outcomes, preventing complications such as severe short stature, metabolic disturbances, and delayed puberty. Why are we worried about hypopituitarism?

Dehydration 72

Dehydration Pediatrics Administration Seizures 72

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

RebelEM

MAY 15, 2024

Epub 2016 Dec 29. Changing aetiology, clinical features, antimicrobial resistance, and outcomes of bloodstream infection in neutropenic cancer patients. Time to antibiotics and outcomes in cancer patients with febrile neutropenia. Give appropriate fluids, vasopressors, and antibiotics. Ann Emerg Med. 2017 Jun;69(6):755-764.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

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

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)?

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Burns Fluid Resuscitation Shock Resuscitation 80

EMDocs

JANUARY 4, 2024

Cardiogenic shock and hypotension can occur (systolic heart failure with reduced ejection fraction.) 10,12 Refractory shock or malignant arrhythmias occur in < 5% of patients. Whole bowel irrigation: 3 Not routinely performed and limited evidence to support improved outcome in general. 2016 May;181(5):482-7.

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

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 96

Fractures COPD Hospitals Emergency Department 96

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

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.

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Resuscitation Operations Sepsis Pediatrics 139

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

EMDocs

DECEMBER 16, 2023

Heat stroke can lead to end-organ dysfunction such as rhabdomyolysis, disseminated intravascular coagulation, cardiogenic shock, liver failure, and cerebral edema. Broad-spectrum antibiotics (A) for septic shock are not inappropriate given the hyperthermia, tachycardia, and hypotension. Resuscitation. , 148 , 173–190. link] Swee, duS.,

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

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

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.

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Blood Transfusions Research Outcomes Hospitals 78

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