ACEP Now

JULY 7, 2023

2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

Don't Forget the Bubbles

NOVEMBER 18, 2024

Research and guidelines from Australian centres, like those published by the Australian and New Zealand Neonatal Network (ANZNN), emphasize early detection and management to improve outcomes. Check electrolytes and consider the diagnosis, especially if the infant shows signs of shock or has a family history suggestive of CAH.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

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.

Sepsis 98

Sepsis Outcomes Administration EMS 98

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

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Outcomes 52

PHEM Cast

APRIL 16, 2018

The outcomes from different resuscitative interventions in a haemorrhagic shock model in porcine model: From: Watts et al. EMJ 2017; 34: 860-900. Epidemiology and aetiology of TCA in England… Resuscitation; 110 (2017): 90-94. Use of CPR in hemorrhagic shock, a dog model. 2012; 73: 102-10. Resuscitation.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

Dr. Smith's ECG Blog

JUNE 23, 2024

They shocked him twice before return of spontaneous circulation. This is a critically important determination because of the 2017 AHA/ACC/HRS Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. His daughter immediately started CPR and another family member called EMS.

EKG/ECG 108

EKG/ECG CPR EMS Hospitals 108

RebelEM

MARCH 30, 2023

Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. Article: How-Berlemont C, Lamhaut L, Diehl J, et al. Published online June 08, 2022.

Hospitals 83

Hospitals Outcomes EKG/ECG Resuscitation 83

RebelEM

MARCH 2, 2023

Essentially there was no difference, meaning we wouldn’t expect to find a difference in outcomes Although not patient oriented, why is there no breakdown of how many patients had cardiogenic shock, congestive heart failure, echocardiographic findings, or even troponin levels. Low O2 protocol: 3.1% aOR 0.96, 95% CI 0.86

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. And sepsis-3 redefined septic shock as “hypotension not responsive to fluid resuscitation” with the added requirement of vasopressors to maintain a MAP greater than or equal to 65 and with a lactate > 2. That’s where we’re at.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Mind The Bleep

AUGUST 5, 2023

Complications Short bowel syndrome (following significant resection, and more common following removal of the ileocaecal valve) Intestinal stricture Sepsis / shock DIC Intestinal perforation Mortality (1, 3) References Ginglen JG, Butki N. One-year outcomes following surgery for necrotising enterocolitis: a UK-wide cohort study.

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

The Skeptics' Guide to EM

APRIL 28, 2018

December 2017. December 2017. Background: There have been a large number of trials on steroids for a variety of conditions in the last year and we have covered some of them on the SGEM: * The ADRENAL trial on steroids in septic shock demonstrating no all-cause mortality benefit at 90 days ( SGEM#208 ). December 2017.

Hospitals 40

Hospitals Emergency Department Outcomes Shock 40

Don't Forget the Bubbles

JULY 26, 2023

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

RebelEM

SEPTEMBER 26, 2022

A meta-analysis of fifteen RCTs comparing blood product transfusion rates of cardiothoracic and surgery patients found significantly lower transfusion rates of FFP in TEG/ROTEM guided group compared to traditional tests, with no difference in survival rates (Fahrendorff 2017). Article: Kumar M et al. Significant coagulopathy: INR > 1.8

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

RebelEM

NOVEMBER 3, 2022

In 2017, a single-centered, retrospective study found a lower incidence of clinical hypotension with ketamine compared to etomidate following endotracheal intubation in septic patients. ( Van Berkel 2017) In 2020 the NEAR study reported peri-intubation hypotension rates of 18.3% in the ketamine cohort compared to 12.4%

Outcomes 52

Outcomes Emergency Department Sepsis 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. 3,950 children were recruited between September 2014 to May 2017. Outcomes Primary outcome Mortality at 28 days after randomisation. The authors chose a patient-centred, primary outcome in keeping with their pragmatic design.

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

The Skeptics' Guide to EM

DECEMBER 7, 2018

He is unsuccessfully shocked. There was also no increase in survivors with good neurological outcomes with ACLS. Clinical Question: Does the use of epinephrine in cardiac arrest improve survival rates with a favourable neurological outcome? A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

EMDocs

JULY 17, 2023

Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients. However, surgical consultation should not be delayed while waiting for imaging in a patient who is in shock, appears toxic, or has signs of peritonitis. -In

Operations 77

Operations EMS Fluid Resuscitation Resuscitation 77

EMDocs

JUNE 27, 2024

2017 Dec 1;30(4):191-201. Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. Factors associated with adverse outcome among children with sickle cell disease admitted to the pediatric intensive care unit: an observational cohort.

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

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]. doi:10.1155/2017/6014967 Light RW. J Emerg Trauma Shock. Published 2017 Sep 7. References Onuki T, Ueda S, Yamaoka M, et al. Can Respir J.

Fractures 95

Fractures COPD Hospitals Emergency Department 95

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

21, 2017 ). Smith's book : Learning points: 1) OMI can be very subtle and RV infarction may manifest poorly on the standard ECG. 2) Typical persistent chest pain with a sigificantly elevated troponin is OMI until proven otherwise, regardless of the ECG. Our THANKS to Dr. Magnus Nossen for sharing this case with us.

EKG/ECG 96

EKG/ECG COPD Wellness Shock 96

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. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Taming the SRU

AUGUST 30, 2023

A 2017 review in the American Journal of Emergency Medicine reiterates that no single inflammatory markers (including CRP, ESR, and PCT) can be used as a stand-alone test to confirm or exclude infection, but instead advocates for using the tests as adjunctive information for emergency physicians to shape their pre-test probability of infection [26].

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

Don't Forget the Bubbles

MAY 10, 2023

A shocked friend is being ushered out of the way. 2017; 55(5); 449-453. 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. You look around.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

Taming the SRU

MAY 3, 2023

During the admission, she completed a course of broad-spectrum antibiotics and as the underlying shock state improved, she was also weaned off all vasopressor support. For a complete discussion of cardiogenic shock and right ventricular failure, please see this other Air Care Series post on the subject.

Wellness 52

Wellness Hospitals Shock Outcomes 52

EMDocs

JUNE 3, 2023

For a broader overview of pelvic trauma, please review Dr. Lupez’s 2017 article here: [link]. 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. Published 2017 Jan 18.

Fractures 54

Fractures Resuscitation Operations EMS 54

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. Pediatr Allergy, Immunol Pulmonol 2017; 30: 191–201.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EB Medicine

SEPTEMBER 1, 2018

Both are at the University of Florida Jacksonville, and they reviewed a total of 120 articles from 2006-2017, in addition to reviews from both Cochrane and Dare. Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them. Those on anticoagulants and anti-platelet agents are at increased risk.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

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 Wellness Shock Ultrasounds 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

The patient went into cardiogenic shock and ultimately died of this MI. Main outcome measures Positive predictive value of an elevated cardiac troponin concentration for a diagnosis of type 1 myocardial infarction. Regional wall motion abnormality (WMA): Regional WMA: Inferobasal (this is another name for posterior), akinetic, small.

EKG/ECG 52

EKG/ECG Emergency Department Wellness Shock 52

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

RebelEM

OCTOBER 31, 2022

Marik 2017) But further randomized controlled studies have not shown the same benefit. Used an intention-to-treat analysis for the primary outcome, resembling real-world practice instead of a per-protocol analysis. Composite outcomes decrease the enrollment size required to power a study adequately.

Sepsis 52

Sepsis Outcomes Research Shock 52