EMDocs

SEPTEMBER 6, 2023

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. Shock types: distributive, cardiogenic, obstructive, metabolic, hypovolemic, adrenal.

Anaphylaxis 97

Anaphylaxis Shock Sepsis Stroke 97

PulmCCM

OCTOBER 7, 2024

Midodrine A 75-year-old woman seems to have recovered from septic shock, but each time her norepinephrine infusion is reduced from 0.05 It was reported to improve blood pressure in children with septic shock in 1979, and in the treatment of orthostatic hypotension in 1981. mcg/kg/min, her mean arterial pressure falls below 65 mm Hg.

Shock 98

Shock Outcomes 98

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

MARCH 4, 2025

Bacterial Meningitis Mimics: Other flu-like illnesses: COVID, influenza, toxic shock syndrome, myocarditis, endocarditis, spinal epidural abscess, pneumonia. 2016 Jun;72 (6):768-769]. A 2020 Cochrane review found the pooled sensitivity was 65%. Do not rely on this to rule out bacterial meningitis. 2016;72(4):405-438.

Infectious Diseases 85

Infectious Diseases Seizures Poisoning Sepsis 85

EMDocs

JANUARY 23, 2024

Episode 93: BRASH syndrome Background: Brash syndrome has 5 components: bradycardia, renal failure, AV nodal blocker, shock, hyperkalemia. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. BRASH syndrome: Bradycardia, Renal failure, Av blocker, Shock, and Hyperkalemia. Published February 15, 2016.

Shock 115

Shock Dehydration Sepsis EKG/ECG 115

EMDocs

NOVEMBER 19, 2024

Low-dose lipid emulsion for pediatric vasoplegic shock due to quetiapine and fluvoxamine overdose: a case report. 2016 Dec;54(10):899-923. Intravenous lipid emulsion as an adjuvant therapy of acute clozapine poisoning. Hum Exp Toxicol. 2021;40(7):1053-1063. Hubbard AM, House LM, Lee JM. Clin Toxicol (Phila). Stroup TS, Gray N.

Poisoning 111

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

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 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

EMDocs

DECEMBER 23, 2024

Do we still shock? 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. If the patient has a BP of 60/palp, its easy, right? Synchronized cardiovert and move on with your day. But what if he has a normal blood pressure?

EKG/ECG 75

EKG/ECG Shock Wellness EMS 75

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 128

EKG/ECG Ultrasounds Shock EMS 128

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

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 Dislocations 93

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) 90

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

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

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

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 105

Resuscitation Administration Emergency Department Ultrasounds 105

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 98

Burns Fluid Resuscitation Resuscitation Poisoning 98

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

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

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

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. 2016 May;181(5):482-7. Cardiotoxicity: Overdose can cause prolonged QRS and QTc intervals. doi: 10.7205/MILMED-D-15-00218. PMID: 27136657.

Seizures 94

Seizures EKG/ECG Poisoning Shock 94

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

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

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 Operations Hospitals 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

PHEM Cast

APRIL 10, 2016

March 2016. One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study. 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

RebelEM

JANUARY 29, 2024

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

Stroke Outcomes Hospitals Administration 136

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

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

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. International Consensus Criteria for Pediatric Sepsis and Septic Shock. The aim of this paper was to update and evaluate the criteria for sepsis and septic shock in children. Paediatr Int Child Health.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

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

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 The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). 2016 Feb 23;315(8):801-10. 906 randomized to the Placebo cohort.

Sepsis 98

Sepsis Outcomes Administration EMS 98

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

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. Injury 2016; 47: 797– 804. But unfortunately for Ranulf, as Tarquin stood, he slipped on a blob of spilt quince jelly. Laan DV, Vu TD, Thiels CA et al.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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 96

EMS Ultrasounds Emergency Department Infectious Diseases 96

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 Shock EKG/ECG Sepsis 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. Another alternative defibrillation technique is vector-change defibrillation (VC). 2020;396(10265):1807-1816. 2005;28:3-7.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52