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

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

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

Taming the SRU

JUNE 24, 2024

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.” Circulation , vol.

Advances Cardiac Life Support (ACLS) 89

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 89

Taming the SRU

FEBRUARY 19, 2024

A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. In general, radial artery readings in patients with shock likely underestimate central pressure which can lead to increasing vasopressor dosing. PMID: 35338337. Keville, M.

Shock 59

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. Vasopressin versus norepinephrine infusion in patients with septic shock. Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. Jama 316 , 509–518 (2016).

Shock 52

Shock Sepsis Wellness Outcomes 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. Current Opinion in Critical Care 22 , 260–266 (2016).

Sepsis 52

Sepsis Shock Wellness 52

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

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

RebelEM

APRIL 29, 2024

2016 PMID:27075364 13 Astasio-Picado Á et al. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation. Impact of intraosseous versus intravenous resuscitation during in-hospital cardiac arrest: A retrospective study. Resuscitation. 2021 PMID: 34273470 12 Petitpas F et al.

Resuscitation 104

Resuscitation Administration Emergency Department Hospitals 104

EMDocs

JUNE 25, 2024

American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. 2016 Aug;42(5):953-1021. Cartotto R, Johnson LS, Savetamal A, Greenhalgh D, Kubasiak JC, Pham TN, Rizzo JA, Sen S, Main E. J Burn Care Res. 2024 May 6;45(3):565-589. ISBI Practice Guidelines Committee; Steering Subcommittee; Advisory Subcommittee.

Burns 74

Burns Fluid Resuscitation Resuscitation Poisoning 74

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. Closed chest compressions reduce survival in a model of haemorrhagic-induced traumatic cardiac arrest. EMJ 2017; 34: 860-900. Resuscitation.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

Sensible Medicine

AUGUST 14, 2024

In his work, Dr. Goldwater describes a kind of toxic-shock (cytokine) reaction in the body that results from the combination of a cold virus plus being infected with a common bacterium—each pathogen relatively harmless on its own but deadly together.

CDC 69

CDC Sepsis Research Pediatrics 69

PHEM Cast

FEBRUARY 23, 2017

2016 Jul;46(1):3–16. 2016 Sep;81(3):458-62. Prehospital Blood Product Resuscitation for Trauma. Shorter times to packed red blood cell transfusion are associated with decreased risk of death in traumatically injured patients. Powell EK, Hinckley WR, Gottula A, Hart KW, Lindsell CJ, McMullan JT. J Trauma Acute Care Surg.

Blood Transfusions 52

Blood Transfusions Head Injuries Resuscitation Radiology 52

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. McGraw Hill; 2016. Neurologic and neuropsychological symptoms during the first year after an electric shock: results of a prospective multicenter study. Click to enlarge.) Accessed October 21, 2023.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Don't Forget the Bubbles

JULY 3, 2024

Respiratory Syncytial Virus-Associated Hospitalizations in Children <5 Years: 2016-2022. Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis. Current practice in the care of children with functional constipation: What is the hold up? van der Zande JMJ, et al. 2024 Jun 25.

Pediatrics 105

Pediatrics Fluid Resuscitation Research Hospitals 105

EB Medicine

JANUARY 10, 2020

MACE= Major Adverse Cardiovascular Event: including re-infarction, stroke, dysrhythmia, heart failure, cardiogenic shock, and death. MACE= Major Adverse Cardiovascular Event: including re-infarction, stroke, dysrhythmia, heart failure, cardiogenic shock, and death. Part 2 : Why do we care? Patterns to know… Troponin.

Emergency Department 40

Emergency Department EKG/ECG Shock Sepsis 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. Accessed 2/29/2016. Accessed 2/29/2016.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

ACEP Now

JUNE 8, 2023

2 Interestingly, the 2019 IDSA guidelines recommended that adults with CAP, including those with severe pneumonia, not routinely receive corticosteroids in the absence of refractory septic shock. 1 What do we do with conflicting recommendations? Many clinicians, including myself, opted to wait for additional data–which we now have.

Infectious Diseases 59

Infectious Diseases Administration Hospitals Shock 59

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

JUNE 27, 2024

2016 Dec;91(12):1185-1190. Epub 2016 Oct 3. May substitute levofloxacin if allergic to cephalosporin Anti-viral medications if indicated Oseltamivir for influenza Patients >14 days old Remdesivir for COVID Patients >28 days old and at least 7lbs (3.2 Am J Hematol. PMID: 27543812.

Pediatrics 76

Pediatrics Dehydration EMS Hospitals 76

RebelEM

NOVEMBER 6, 2023

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. Hydroxocobalamin Versus Methylene Blue for the Treatment of Vasoplegic Shock Associated With Cardiopulmonary Bypass. 2023 Jul 19.

Shock 69

Shock Administration Academics Hospitals 69

Pediatric EM Morsels

NOVEMBER 3, 2023

2016 Apr; 32(4): 227–231. Worldwide, children <5 years old account for 76% of deaths related to malaria, but these are predominantly in Sub-Saharan Africa (WHO 2022) P. vivax , P. malariae , and the less common P. knowlesi and P. simium (Forgie 2022) P. vivax and P. falciparum parasitemia , and no other defined cause of AMS (WHO 2023).

Seizures 277

Seizures Pediatrics CDC Infectious Diseases 277

EB Medicine

MARCH 4, 2020

No 1996 AAP guidelines, 2016 ACG guidelines, and 2017 IDSA guidelines all note diarrhea illness but may be vomiting predominant. Specifically, Salmonella, shigella, Campylobacter, and Yersinia 2016 ACG guidelines recommend them for patients with watery diarrhea and moderate to severe illness with fever for at least 72 hours.

Emergency Department 40

Emergency Department Dehydration Poisoning Allergic Reactions 40

Pediatric EM Morsels

JULY 21, 2023

2016 Aug;23(8):878-84. Epub 2016 Aug 1. Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma. Fun fact for animal lovers!- cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! 107.498345.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

EMDocs

NOVEMBER 4, 2023

December 27, 2016. J Emerg Trauma Shock. Tracy CR, Steers WD, Costabile R. Diagnosis and management of epididymitis. Urol Clin North Am. 2008;35(1):101-vii. doi:10.1016/j.ucl.2007.09.013 2007.09.013 Adhikari, L. Testicular. Radiology Key. Accessed May 2, 2023. link] Wampler SM, Llanes M. Common scrotal and testicular problems.

EMS 68

EMS Ultrasounds Emergency Department Infectious Diseases 68

Advanced Emergency Nursing from AENJ

JANUARY 31, 2016

It took years to encounter "primary VF" (due to lack of 911 systems and late discovery/responses) but the switch to immediate shock had taken place: it was a clear very fine low voltage VF ("I've got a bad a feeling about this …"). No priming allowed: the shock converted to unresuscitable asystole and the patient died.

Emergency Nursing 40

Emergency Nursing Ambulance Services Shock Resuscitation 40

AED Leader

OCTOBER 11, 2023

Thanksgiving Mains According to the National Grocers Association, for Thanksgiving 2016, Americans were stuffing their shopping carts with over 311 million pounds of turkey and over 213 million pounds of potatoes ! For a festive finishing touch to your board, sprinkle with toasted nuts and pomegranate seeds.

CPR 52

CPR Burns Hospitals Wellness 52

AED Leader

OCTOBER 11, 2023

Thanksgiving Mains According to the National Grocers Association, for Thanksgiving 2016, Americans were stuffing their shopping carts with over 311 million pounds of turkey and over 213 million pounds of potatoes ! For a festive finishing touch to your board, sprinkle with toasted nuts and pomegranate seeds.

CPR 52

CPR Burns Hospitals Wellness 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: A teenager lies on the resus trolley. They’re getting CPR. Your eyes are drawn to their chest. They have been stabbed. Blood is everywhere – on the patient, the bed, the floor. Your heart rate cranks up another notch. You feel it pounding in your chest.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

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. Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock.

Sepsis 119

Sepsis Fluid Resuscitation Resuscitation Administration 119

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. 2016 Jan 7;4(1). Were the study groups similar at the start of the trial? N Engl J Med.

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenic shock). As per Dr. Frick — sinus tachycardia is usually not seen with acute OMI unless the patient is in cardiogenic shock. Additionally, there is borderline right axis deviation. Both were wrong.

EKG/ECG 104

EKG/ECG Ultrasounds Shock EMS 104

Pediatric Emergency Playbook

DECEMBER 1, 2015

It’s a high-flow artery to the face, and if disrupted, the child may have significant bleeding and possibly hemorrhagic shock. Electrical Injuries: Shocking or Subtle?” The labial artery is just deep to the burn, and as the eschar sloughs off, it can be exposed. J Emerg Med. 2000;18(2):181-187. doi:10.1016/S0736-4679(99)00190-0.

Burns 40

Burns Emergency Department EKG/ECG Shock 40

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

JANUARY 10, 2024

Therefore this should remain high on the differential if a patient with history of SCAD presents with similar symptoms. della porta & Hajdu Alcohol withdrawal syndrome is a highly prevalent and morbid condition.

EKG/ECG 93

EKG/ECG Shock Fractures Emergency Department 93

Taming the SRU

OCTOBER 1, 2023

Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax, 1968-2016. J Emerg Trauma Shock. Eur Respir Rev. 2010;19(117):217-219. doi:10.1183/09059180.00005310 Hallifax RJ, Goldacre R, Landray MJ, Rahman NM, Goldacre MJ. 2018;320(14):1471-1480. doi:10.1001/jama.2018.14299 2018.14299 Isaka M, Asai K, Urabe N.

Fractures 96

Fractures COPD Hospitals Emergency Department 96