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

Emergency Medicine Ireland

OCTOBER 30, 2023

Well, that time has come and it’s time to run through vasopressin. Well this is where the fun beings. A somewhat underwhelming start Second is the VANISH trial by Gordon et al, JAMA 2016. Vasopressin versus norepinephrine infusion in patients with septic shock. Jama 316 , 509–518 (2016). How does it work?

Shock 52

Shock Sepsis Wellness Outcomes 52

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Pediatric Emergency Playbook

AUGUST 1, 2017

2016; 13:590-600. Eur J Pediatr Surg 2016; 26:192. 2016; 5(1):5-12. 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.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

If doing what was called "the one-man-band resurrection shuffle" [single person CPR in the back of a moving ambulance], this worked very well, as the bag would stay hanging there on the patient's face. How useful these would have been to let us know how well the patient was oxygenating and ventilating! Intraosseous Infusion.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

Pediatric Emergency Playbook

DECEMBER 1, 2015

Victims of electrical injuries present either in extremis or as the seeming well patient with insidious, developing disease. Most patients do well, and the burn heals by secondary intention. It’s a high-flow artery to the face, and if disrupted, the child may have significant bleeding and possibly hemorrhagic shock. Horeczko T.

Burns 40

Burns Emergency Department EKG/ECG Shock 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 Shock 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 Shock 52

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.) On the other hand , high-risk lesions appear to do well with aggressive treatment. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock.

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EKG/ECG Shock Wellness Ultrasounds 52

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. While it was < 15% in 1990, by 2016 it reached 40%. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. million adults!!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 2016 Dec;115(6):317-21. 2016 Aug 23;134(8):e113. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Bray C, Bell LN, Liang H, Haykal R, Kaiksow F, Mazza JJ, Yale SH. Brigden ML.

Infectious Diseases 89

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

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

Tachycardia is unusual in ACS unless there is cardiogenic shock or a second simultaneous pathology. There is an acute R V “ S train” p attern with ST depression/T wave inversion in both inferior and anterior leads ( Note dramatic ST-T wave changes in II, III and aVF — as well as V3,V4 ).

EKG/ECG 52

EKG/ECG COPD Documentation/Coding Shock 52

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

Pediatric EM Morsels

NOVEMBER 3, 2023

With concern for malaria, it is very important to identify who is non-immune and semi-immune as this can affect both the timeframe for illness after departure from the endemic country as well as severity of illness. 2016 Apr; 32(4): 227–231. vivax , P. malariae , and the less common P. knowlesi and P. simium (Forgie 2022) P.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

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 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?

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Sepsis Fluid Resuscitation Resuscitation Shock 91

RebelEM

MAY 15, 2024

The loss of these cells leads to immunosuppression as well as decreased responsiveness of the immune system as a whole Patients with neutropenia will not only get very sick very quickly, but also will have blunted immune response and may not localize signs of infection well Fever or malaise may be their only presenting symptoms.

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

APRIL 7, 2025

Careful dose adjustment and monitoring throughout childhood and adolescence ensure optimal growth, development, and well-being. Close monitoring helps prevent delays in growth and puberty, common if treatment is not well-optimised. Replace remaining deficits and maintenance fluid requirements evenly over 24 hours using 0.9%

Dehydration 72

Dehydration Pediatrics Administration Seizures 72

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

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

EMDocs

JUNE 25, 2024

Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. 2016 Aug;42(5):953-1021. Chest burns/flank/back/abdominal burns may cause issues with ventilation.

Burns 97

Burns Fluid Resuscitation Resuscitation Poisoning 97

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? Jeff : So get this -- one study showed that out-of-hospital shock index and respiratory rate were highly predictive of ICU admission.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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 Demographics, severity of illness, and comorbidities were well balanced between groups and the intervention and control groups have the same prognosis.

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Sepsis Outcomes Administration EMS 98

EMDocs

JANUARY 4, 2024

3 Bupropion blocks the reuptake of dopamine and norepinephrine, as well as antagonizes acetylcholine at nicotinic receptors. 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.

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax, 1968-2016. J Emerg Trauma Shock. Eur Respir Rev. doi:10.1001/jama.2018.14299

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 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

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. 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.

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. Mouth-to-Airway (adjunct).

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. You will be running the show today, and you want to use your preparation time well. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. Injury 2016; 47: 797– 804. The trauma call goes out. So, what are your key priorities?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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

MAY 10, 2023

A shocked friend is being ushered out of the way. And then the debrief runs through STOP : Situation – a recap of the resuscitation, including the reasoning behind decisions made Things that went well Opportunities to improve Points of action – equipment issues, or whether a case review is needed And so after the hot debrief, you pause.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

ACEP Now

JANUARY 13, 2024

While these discriminatory and brutal acts were shocking, they were not surprising to Black people. Dr. Vanessa Grubbs, founder of Black Doc Village, articulates this well: “a white-dominated physician training system that unjustly excludes, punishes, and dismisses Black medical students, trainees, and attending physicians will continue on.”

Leadership 52

Leadership Academics Emergency Department Shock 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

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. Groups were well matched at baseline. 2016 Jan 7;4(1). Do you believe the results?

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Blood Transfusions Research Outcomes Hospitals 78