EB Medicine

FEBRUARY 13, 2017

For the first episode, we are going to focus on one of the most popular articles from last year, the October 2016 issue, entitled “Optimizing Survival Outcomes For Adult Patients With Nontraumatic Cardiac Arrest.” Welcome to the inaugural episode of EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice journal.

Outcomes 40

Outcomes Resuscitation Shock 40

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. Improvement of out-of-hospital cardiac arrest survival rate after implementation of the 2010 resuscitation guidelines.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

Taming the SRU

FEBRUARY 19, 2024

One such study of 263 patients without hypertensive emergencies treated in a resuscitation unit found that 40% of patients had a MAP difference ≥ 10 mmHg between IABP and NIBP measurements. A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock.

Shock 59

Shock Resuscitation Ultrasounds Research 59

RebelEM

JUNE 8, 2023

Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. 2016; PMID: 27720568 Guest Post By: Courney Knieriem, MD PGY-1, Emergency Medicine Resident RWJBH Community Medical Center, Toms River, NJ Courtneyknieriem.md@rutgers.edu Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Pediatric Emergency Playbook

AUGUST 1, 2017

2016; 13:590-600. Eur J Pediatr Surg 2016; 26:192. Necrotizing Enterocolitis. N Eng J Med. 2011; 364(3):255-264. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Walsh MC et al. Necrotizing Enterocolitis: A Practitioner’s Perspective. Pediatr Rev. 1988; 9(7):219-226. Hirschsprung's disease.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 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 should use lactate to detect occult shock. Children compensate so well for shock, that subtle tissue hypoxia may not be detected until later. 2016; 417: 54–56.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 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

RebelEM

NOVEMBER 30, 2023

This systematic review and meta-analysis attempts to elucidate whether a more conservative fluid resuscitation approach is warranted in volume sensitive sepsis patients, such as those with congestive heart failure (CHF). Am J Emerg Med. 2023;73:34-39. What They Did: Researchers performed a systematic review and meta-analysis.

Sepsis 121

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

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

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

EMDocs

SEPTEMBER 6, 2023

Resuscitate and administer antibiotics. Differential Diagnosis for patient: Infectious endocarditis, CNS infection or abscess, necrotizing soft tissue infection, toxic shock, obstructive pyelonephritis, toxic ingestion, TTP, anaphylaxis with primarily hemodynamic effects, thromembolic phenomenon. 2016 Apr;34(4):694-6.

Anaphylaxis 96

Anaphylaxis Shock Sepsis Stroke 96

EMDocs

JUNE 25, 2024

Fluid resuscitation target and fluid Fluid resuscitation is one of the most important parts of management; goal is to increase intravascular volume and ensure end organ perfusion. Calculating fluid resuscitation: Parkland formula: 4 mL X % TBSA X weight in kilograms. 2016 Aug;42(5):953-1021. Total amount over 24 hours.

Burns 97

Burns Fluid Resuscitation Resuscitation Poisoning 97

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

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

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

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

JUNE 30, 2023

Ranulf went white with the shock. In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. This was a randomised controlled multisite study comparing resuscitation of trauma patients requiring massive transfusion using either 1:1::1 or 1:1:2 ratios of platelets to plasma to red blood cells.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Don't Forget the Bubbles

MAY 10, 2023

A shocked friend is being ushered out of the way. Resuscitation is a team sport. Role stickers or role aprons with names on them are simple measures to highlight resuscitation roles. A study in Denmark in 2021 explored barriers to effective resuscitation in over 900 in-hospital resuscitations across six hospitals in Denmark.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

PHEM Cast

FEBRUARY 23, 2017

In systems in which a potentially less harmful resuscitation strategy can be delivered sooner – PH systems with packed red cells / fresh frozen plasma / whole blood or freeze dried plasma, then it seems pragmatic to aim for normotension (predicted normal blood pressure) sooner in the patient’s care timeline than we have been e.g. at one hour.

Blood Transfusions 52

Blood Transfusions Head Injuries Resuscitation Radiology 52

RebelEM

MAY 15, 2024

Epub 2016 Dec 29. Give appropriate fluids, vasopressors, and antibiotics. Default to using whichever score your oncologist is more comfortable with. Application of the MASCC and CISNE Risk-Stratification Scores to Identify Low-Risk Febrile Neutropenic Patients in the Emergency Department. Ann Emerg Med. 2017 Jun;69(6):755-764. 2016.11.007.

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

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. Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamotrigine.

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

EMDocs

DECEMBER 16, 2023

Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. Ice water immersion and iced peritoneal lavage are additional methods used to lower temperature but are more invasive or can prevent additional resuscitative efforts.

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

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! Patient’s need adequate fluid resuscitation.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Taming the SRU

OCTOBER 1, 2023

Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax, 1968-2016. Unsuspected tension pneumothorax as a hidden cause of unsuccessful resuscitation. J Emerg Trauma Shock. Resuscitation. Eur Respir Rev. 2010;19(117):217-219. 2018;320(14):1471-1480. doi:10.1001/jama.2018.14299 Ann Emerg Med.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Taming the SRU

APRIL 26, 2023

Resuscitation 2020. J Emerg Med 2016. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. Ann Pharmacother 2016. First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

The latter 1950s and 1960s, quested for nerve gas defense studying expired air resuscitation and modern resuscitology; developing intensive care units. To me, it harkens a new scientific renaissance of resuscitation science, emergency care, and creating systems for care. 1950s & 1960s Resuscitation Research.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Advanced Emergency Nursing from AENJ

JANUARY 31, 2016

Compare the possibilities of cardiac arrest resuscitation survival while in the Cardiac Cath Lab, the witnessed versus unwitnessed cardiac arrest in the ED, or the witnessed versus unwitnessed out-of-hospital cardiac arrest. No priming allowed: the shock converted to unresuscitable asystole and the patient died.

Ambulance Services 40

Ambulance Services Emergency Nursing Shock Resuscitation 40

ACEP Now

MARCH 14, 2024

Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. McGraw Hill; 2016. Click to enlarge.)

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Pediatric Emergency Playbook

JUNE 1, 2017

Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’. 2016; 203:138-140. 2016; 10(6):14-15.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. 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.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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 98

Emergency Department Resuscitation COPD Shock 98

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. 13 Massive transfusion protocols (MTP) are hallmarks of trauma resuscitation, and they are critical to the unstable pelvic fracture patient.

Fractures 64

Fractures Resuscitation Operations EMS 64

Pediatric Emergency Playbook

JANUARY 1, 2017

NON-PHARMACOLOGIC TREATMENT The first line of treatment in all pain management is non-pharmacopeia ( Horeczko 2016 ). mg/kg IV, up to 10 mg) may be substituted for ibuprofen ( Paniyot 2016 ). Unexplained tachycardia may be the early signs of shock. 2016 Feb;29 Suppl 1:S48-55. Ketoralac (0.5 Pediatrics.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Don't Forget the Bubbles

FEBRUARY 17, 2025

He has had some additional episodes of hypotension post-intubation, which is treated with further volume resuscitation. Volume resuscitation has historically been the first-line therapy for patients in septic shock. congenital heart disease, septic cardiomyopathy), aggressive volume resuscitation (e.g.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

EB Medicine

JANUARY 2, 2019

Jeff: It’s worth noting, however, that a 2016 systematic review found no reliable evidence supporting routine screening for asymptomatic bacteriuria, so send a urinalysis and culture only if there is suspicion for a UTI. Even if the urinalysis is negative, the culture may still have growth.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

Pediatric EM Morsels

MARCH 7, 2025

mg/kg [Nishijima 2016] Poorly studied in renally impaired patients. Military Application of Tranexamic Acid in TraumaEmergency Resuscitation (MATTERs) Study. But what is the drug really approved for, how does it actually work, and what are some of the off-label (for now) uses of TXA that add value to this medication?

Pediatrics 231

Pediatrics Blood Transfusions Anaphylaxis Military 231