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 Outcomes Fluid Resuscitation 52

EMDocs

OCTOBER 9, 2023

6 However, due to the vasoconstrictive effects, hydrocortisone may be useful in refractory shock. Corticosteroids in septic shock: a systematic review and network meta-analysis. Published 2017 Mar 28. Published 2017 Oct 12. 8 Prednisone is a prodrug and is converted in the liver to prednisolone. 2015;116(6):960-975.

Basic Life Support 81

Basic Life Support CPR Fractures Emergency Department 81

The Skeptics' Guide to EM

NOVEMBER 18, 2017

[display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Critical Care Medicine 2017. display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

AslangerE A 65-year-old gentleman presented to the emergency department after experiencing two recent ICD shocks in the preceding hours. The subsequent ECG, taken 5-10 minutes post-shock, depicted a soothing of ST deviation. This was contributed by Co-editor Emre Aslanger, an interventional cardiologist in Turkey.

EKG/ECG 96

EKG/ECG Shock Administration Emergency Department 96

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

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 107

EKG/ECG EMS CPR Hospitals 107

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. 2016; 105: 52-58.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

RebelEM

MAY 29, 2023

septic shock). Limited, small studies on its use in septic shock do not make a clear argument for use. Early Adjunctive Methylene Blue in Patients with Septic Shock: A Randomized Controlled Trial. Background: Sepsis can induce numerous physiologic derangements. Paper: Ibarra-Estrada, M et al. Crit Care 2023. 95% CI 15.4

Shock 144

Shock Fluid Resuscitation Sepsis Resuscitation 144

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. fetalneonatal-2017-313113 (2017). Necrotizing Enterocolitis. Updated 2022 Aug 8].

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

ACEP Now

JUNE 8, 2023

In 2017, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) stated, “We suggest the use of corticosteroids for 5–7 days at a daily dose <400 mg intravenous hydrocortisone or equivalent in hospitalized patients with CAP,” citing moderate-quality evidence. Intensive Care Med. Andre C.

Infectious Diseases 59

Infectious Diseases Administration Hospitals Shock 59

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

Mind The Bleep

JULY 15, 2023

If a child presents acutely unwell with nephrotic syndrome they are likely to be in hypovalaemic shock, have an infection, or both. This is typically steroid resistant and diagnosed on renal biopsy. Pathophysiology of Focal Segmental Glomerulosclerosis. Paediatric Nephrology , 350-354. Tapia C, B. 2023, July 15). Nephrotic Syndrome.

Allergic Reactions 52

Allergic Reactions Shock Hospitals Wellness 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. Neurologic and neuropsychological symptoms during the first year after an electric shock: results of a prospective multicenter study. Click to enlarge.) and five percent workplace-related deaths.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. In this study — Procainamide was superior to Amiodarone for terminating monomorphic VT, as well as having fewer adverse effects than Amiodarone ( Ortiz et al — Eur Heart J 1;38 (17): 1329-1335, 2017 ).

EKG/ECG 112

EKG/ECG Shock Hospitals Sepsis 112

Pediatric EM Morsels

JUNE 2, 2023

2017 Jun 27;10:197-207. Michelet M, Schluckebier D, Petit LM, Caubet JC. Food protein-induced enterocolitis syndrome – a review of the literature with focus on clinical management. J Asthma Allergy. doi: 10.2147/JAA.S100379. PMID: 28721077; PMCID: PMC5499953.

Dehydration 189

Dehydration Shock Pediatrics Emergency Department 189

Northwestern EM Blog

FEBRUARY 21, 2022

Emergency doctors know intuitively what trajectory patients are on, a chronically ill elderly patient presenting with shock requiring pressors have an extremely high mortality risk and we should be clear with families about that. UpToDate, www.uptodate.com/contents/discussing-goals-of-care Ganta, Niharika, et al. SGIM Forum, vol.

Dehydration 52

Dehydration Shock Hospitals Wellness 52

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. Eur Heart J 38, 1872–1882 (2017). Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. To start with there are apparently 5 types of cardiorenal syndrome. I’ll let that sink in. – Mullens, W.,

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

The Skeptics' Guide to EM

DECEMBER 7, 2018

He is unsuccessfully shocked. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation. JAMA 2009, Hagihara et al. JAMA 2012 and Cournoyer et al.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

The Skeptics' Guide to EM

AUGUST 5, 2017

[display_podcast] Date: July 13th, 2017 Guest Skeptic: Dr. Ian Stiell is Professor, Department of Emergency Medicine, University of Ottawa. display_podcast] Date: July 13th, 2017 Guest Skeptic: Dr. Ian Stiell is Professor, Department of Emergency Medicine, University of Ottawa.

Head Injuries 40

Head Injuries Research Shock Hospitals 40

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

Don't Forget the Bubbles

DECEMBER 11, 2023

This is shocking, but they discovered a staggering dose-response model when they compared these results with medical histories. A study into children in care, published in 2017 by Berridge , found that children classed as self-reliant were more successful in their schooling than those who were stressed or disengaged. Riviere, E.

Wellness 103

Wellness Research Outcomes Shock 103

EMDocs

MARCH 30, 2024

Intervertebral disks lie between vertebrae and act as shock absorbers. September 30, 2017. Answer : Thoracic and Lumbar Spine Trauma Epidemiology: Approximately half of the vertebral injuries that are seen in the emergency department are thoracic and lumbar injuries. 2 Males experience injuries to this region at an incidence of 3:1.

EMS 89

EMS Fractures Emergency Department Dislocations 89

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 64

Shock Administration Academics Hospitals 64

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8% vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

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. IV hydration for patients with severe dehydration, hypovolemic shock, septic shock, or failed oral rehydration. Hemoglobin and platelets are helpful if HUS is suspected.

Emergency Department 40

Emergency Department Dehydration Poisoning Allergic Reactions 40

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. that was barely statistically significant. Circulation 2014.

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52

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

EMDocs

JUNE 27, 2024

2017 Dec 1;30(4):191-201. 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 2024 Mar 12;14(1):5978. PMID: 38472301; PMCID: PMC10933399. Jain S, Bakshi N, Krishnamurti L.

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

Don't Forget the Bubbles

MAY 10, 2023

A shocked friend is being ushered out of the way. 2017; 55(5); 449-453. 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. Andenæs, E.,

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

EMDocs

APRIL 22, 2024

However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). A thin wall (diameter <5mm) is suggestive of an acute etiology”. A POCUS DVT exam was performed, and no DVTs were identified in the patient’s lower extremities. Dawson, Mallin, Hwang J.,

Ultrasounds 81

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 81

Taming the SRU

OCTOBER 1, 2023

doi:10.1155/2017/6014967 Light RW. J Emerg Trauma Shock. Published 2017 Sep 7. References Onuki T, Ueda S, Yamaoka M, et al. Primary and Secondary Spontaneous Pneumothorax: Prevalence, Clinical Features, and In-Hospital Mortality. Can Respir J. 2017;2017:6014967. Pleural diseases. 1992;38(5):266-331. Ann Emerg Med.

Fractures 89

Fractures COPD Hospitals Emergency Department 89

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

ACEP Now

JULY 7, 2023

However, between four and five percent of cases of VT or VF will be refractory to standard management, with nonperfusing arrhythmia persisting despite repeated shocks. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator. amiodarone or lidocaine). Resuscitation. Sakai T, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Downeast Emergency Medicine

APRIL 26, 2021

When looking at the subgroups with severe shock, there was an 18.5% When stratifying TXA administration time after injury and qualifying shock incidence, there appeared to be a lower 30 d mortality if TXA was given within 1 hour of the incident. MI or stroke). DOES TXA IMPROVE OUTCOMES IN PATIENTS WITH TBI?

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Mind The Bleep

APRIL 20, 2024

Cyanosis can be peripheral, central or both and it can be seen in cases of shock and cyanotic congenital heart disease. 2017, April 14). Peri-oral cyanosis can be observed when oxygen saturations fall < 85%. Respiratory examination guide. Retrieved from MRCPCH Clinical Revision: [link] Bonfield, A. 2018, October 8).

Shock 52

Shock Wellness 52

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

Pediatric EM Morsels

JULY 21, 2023

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! 2008 Apr;39(4):1347-8. doi: 10.1161/STROKEAHA.107.498345.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246